Uttarakhand High Court
Deepak Ruwali vs State And Others on 20 July, 2018
Author: Lok Pal Singh
Bench: Rajiv Sharma, Lok Pal Singh
Reserved Judgment
IN THE HIGH COURT OF UTTARAKHAND AT NAINITAL
Writ Petition (PIL) No. 12 of 2009
Deepak Ruwali ....Petitioner
Versus
State of Uttarakhand & others ....Respondents
Mr. Vipul Sharma, Advocate for the petitioner.
Mr. M.C. Pande, Addl. Advocate General with Mr. B.S. Parihar, Standing Counsel for the State.
Mr. Lalit Sharma, Standing Counsel for the Union of India.
Mr. A.V. Pundir, Advocate for the respondent nos.5 and 6.
Judgment Reserved- 14.06.2018
Date of Judgment - 20.07.2018
Coram: Hon'ble Rajiv Sharma, J.
Hon'ble Lok Pal Singh, J.
Per: Hon'ble Rajiv Sharma, J.
The present petition was filed in the year 2009, highlighting therein shortage of doctors including paramedical staff in three Government Hospitals situated at Nainital i.e. B.D. Pandey (Male) District Hospital, B.D. Pandey (Female) District Hospital and G.B. Pant Hospital previously known as Ramsay Hospital. It is also highlighting in the petition that these hospitals lack even minimum equipment. The space is also inadequate. The B.D. Pandey (Male/Female) Hospitals have 119 beds.
2. The Court took cognizance of the matter and passed the order on 09.01.2009 directing the respondents to file the reply about the sanctioned strength of doctors in different specialities in the hospitals in Nainital town and as to whether all the specialities have been taken care of or not, if not, why?
3. The compliance affidavit was filed by the Principal Secretary, Medical, Health and Family Welfare, to the State of Uttarakhand, pursuant to the order dated 09.01.2009. According to the counter affidavit, there was only one post of General Surgeon in B.D. Pandey (Male) 2 District Hospital. Dr. N.S. Bhatt was posted as General Surgeon. In addition to this, another doctor namely Dr. Parmath Joshi was posted in the B.D. Pandey Hospital. He was on long leave. No post of Surgeon was sanctioned in G.B. Pant Hospital, Nainital. One Dr. D.C. Awasthi was appointed on contractual basis. The basic facilities were being provided to the patients by its specialist doctors and in cases where further specialized treatment was required for a patient, the patients were referred to Higher Centres at Haldwani. The total strength of doctors in Uttarakhand State was 1,922 against which only 947 doctors were working as on the date of filing the affidavit i.e. on 26.03.2009.
4. The Court was not satisfied with the affidavit filed by the State. The final opportunity was given to the State to file supplementary affidavit to deal with the directions issued by the Court vide order dated 09.01.2009.
5. The supplementary counter affidavit was filed on 22.04.2009. It was averred in the supplementary counter affidavit that in Nainital town, there were three Government Hospitals namely B.D. Pandey (Male) District Hospital, B.D. Pandey (Female) District Hospital situated at Mallital, Nainital and G.B. Pant Hospital previously known as Ramsay Hospital situated at Tallital, Nainital. The specialists who were working at the time of filing the affidavit on 22.04.2013 at B.D. Pandey (Male) District Hospital were Pathologists, Radiologist, Orthopaedic Surgeon, Eye Surgeon, Physician, Cardiologist, Paediatrician, Anesthetist and Dental Surgeon and General Surgeon. The posts of specialists existing at B.D. Pandey (Male) District Hospital, which were not filled up including Skin Specialist, ENT Specialist and Medical Officer Venereal 3 Diseases. One post each of Senior Medical Officer, Pathologist and General Duty Medical Officer were vacant. Some alternative arrangements were made. In B.D. Pandey (Female) District Hospital, Gynaecologist, Paediatrician and Anesthetist were posted. In G.B. Pant Hospital, Medical Superintendent, Anesthetist and one lady Medical Officer were posted. The State Government has sent a requisition to the Public Service Commission, Uttarakhand for filling up 380 posts of specialist doctors. In the meanwhile, the State Government has decided to fill up the posts on contractual basis.
6. Misc. Application No.3560 of 2009 was filed. The application was disposed of vide order dated 08.05.2009. A Multi-Member Committee comprising of the following was constituted:-
i. Chief Secretary, Government of Uttarakhand :(Chairperson). ii. Principal Secretary, PWD, Uttarakhand: (Member). iii. Principal Secretary, Health, Government of Uttarakhand:
(Member).
iv. Chief Engineer, Level-I, PWD, Uttarakhand: (Member). v. Chief Medical Superintendent, B.D. Pandey Hospital :(Member-Ex-Officio).
7. The Chief Secretary was directed to co-opt at least one Architect, either in Government Service or in private sector, as the 6th Member. The Committee was directed to personally inspect the premises of B.D. Pandey District Hospital, Nainital and find out whether, in public interest, it was desirable and advisable to demolish and dismantle some existing, old and dilapidated structures in the premises of the hospital and, in their place, construct new multi-storeyed buildings, equipped with latest infrastructure and other facilities. The Court was, prima facie, of the view that the existing old, dilapidated structures forming part of B.D. Pandey District Hospital 4 Complex required replacement by modern, newly built multi-storeyed structures with latest infrastructure facilities so as to cater to the needs of the patients as well as provide conducive and congenial working environment to the doctors and other paramedical staff.
8. The compliance affidavit was filed on 26.06.2009. The Committee, as ordered on 08.05.2009, was constituted on 15.05.2009. The Committee has inspected the site at B.D. Pandey District Hospital, Nainital and submitted its report. The report is at Page No.65 of the paper-book. The Committee recommended that all buildings on the present site of the B.D. Pandey District Hospital be demolished and a detailed plan for the construction of a State of Art, 150 bedded district hospital be prepared in accordance with Indian Public Health Standards (IPHS) guidelines regarding both staffing and physical infrastructure in a phased manner. The detailed master plan be prepared for the entire B.D. Pandey Campus, indicating clearly which construction should taken place in which phase of activity. Thereafter, the open tenders were to be invited for the reconstruction of the hospital. Steps were be taken to vacate the encroachment on hospital land in the B.D. Pandey Hospital campus. Thereafter, the matter came up before the Court on 30.06.2009.
9. The Court took cognizance of the affidavit, earlier filed on 22.04.2010. The State Government was directed to inform the Court about the action taken or proposed to be taken by the State Govt. pursuant to the report of the Committee and the time schedule with respect thereto.
10. The affidavit was filed on 17.08.2009, in sequel to the directions issued on 30.06.2009. It was stated in the 5 affidavit that the post of Physician lying vacant in the B.D. Pandey (Male) District Hospital was filled up. Few doctors were also appointed in B.D. Pandey District Hospital vide order dated 13.08.2009. The posts were advertised by the Public Service Commission. The Chief Medical Superintendent has sent a communication to the Uttarakhand State Industrial Development Corporation Ltd. for preparing the master-plan in accordance with Indian Public Health Standards (IPHS).
11. Order was passed by this Court on 20.08.2009, whereby the Uttarakhand State Infrastructure Development Corporation Ltd., through its Managing Director, Dehradun and Project Manager, Uttarakhand State Infrastructure Development Corporation Ltd., Unit Vikas Bhawan, Bhimtal, Nainital were added as parties.
12. The counter affidavit was filed by respondent no.5 on 07.10.2009. It was averred in the counter affidavit that after receipt of the report of the Committee, the Principal Secretary, Medical, Health and Family Welfare, State of Uttarakhand held a meeting on 11.09.2009. The respondent no.5 was directed to prepare the master-plan.
13. The detailed orders were passed on 08.10.2009 and 03.11.2009. In compliance of the order dated 08.10.2009, a meeting was held under the Chairmanship of Principal Secretary, Medical, Health and Family Welfare on 21.10.2009 with the Uttarakhand State Infrastructure Development Corporation Ltd. and the Finance Department of the Government. The Corporation was nominated as the Implementing Agency and the Corporation was asked to prepare the master plan. It was decided on 21.10.2009 that B.D. Pandey (Male/Female) District Hospitals shall be reconstructed as per Indian Public Health Standards.
614. The respondent nos.5 and 6 were directed to place on record the master-plan vide order dated 11.02.2010. The master-plan was placed on record, as is evident from the order dated 26.03.2010.
15. The Committee was constituted to examine the master-plan and thereafter, to prepare the lay out plan for the proposed B.D. Pandey District Hospital, Nainital, as per order dated 01.04.2010.
16. The final plan approved by the Chairman in consultation with the Director General, Medical, Health and Family Welfare, State of Uttarakhand and the Chief Medical Superintendent B.D. Pandey District Hospital, Nainital was handed over to the Court on 09.06.2010. Thereafter, the State Government has sought time to prepare the Detailed Project Report.
17. The order was passed on 07.07.2010 to apprise the Court about the alternative arrangements made for the transitory period. Respondent nos.1 to 4 have filed the affidavits pursuant to the order dated 07.07.2010 and undertook that the patients would be treated for the transitory period at G.B. Pant Hospital, Nainital, as per order dated 22.09.2010.
18. Thereafter, the detailed order was passed on 17.07.2014. Learned Chief Standing Counsel was directed to file detailed affidavit indicating appropriate steps taken in the light of the various orders passed by the Court.
19. The supplementary affidavit was filed on 31.07.2014. It was stated in the supplementary affidavit that the cadre of Class IV employees was declared as dying cadre. 20 posts of Class IV employees were vacant and the District Magistrate, Nainital on 25.06.2014 informed the 7 Principal Secretary, Medical Health and Family Welfare for making/filling up the said posts. It was also stated that for internal renovation of the B.D. Pandey District Hospital, a decision was taken on 22.05.2012. A sum of Rs.37,09,685/- was spent on the renovation of B.D. Pandey (Male) District Hospital and a sum of Rs.14,41,026/- was spent on the renovation of B.D. Pandey (Female) District Hospital. Out of the total 2.76 acres of land, 3500 sq. mt. land was given to the KMVN for the ropeway. The demolition of the office and two OPD buildings and in their place, a parking at the basement and a cardiac care unit on the first floor, Geriatric Ward, Physiotherapy Unit and Chemotherapy Unit was to be constructed at the second floor. The proposal was also sent to the State Government on 14.05.2013 for the enhancement of 30 beds in female ward and for the construction of 12 private wards.
20. Learned Chief Standing Counsel was directed to file the affidavit of Chief Medical Officer (CMO), Nainital as to the progress of cardiac centre, which was already approved for Nainital including progress of the construction of the Multi-Speciality Hospital, vide order dated 06.04.2016.
21. The compliance affidavit was filed on 12.04.2016. It is stated in the compliance affidavit that on 12th December, 2015, a meeting was held under the Chairmanship of Principal Secretary, Health and in the meeting the Uttarakhand State Infrastructure Development Corporation Ltd. was nominated as Executing Agency. The Chief Medical Officer wrote a letter dated 04.01.2016 to the Project Manager, Uttarakhand State Infrastructure Development Corporation Ltd. for construction of the Cardiac Care Unit and Geriatric Ward at B.D. Pandey 8 District Hospital, Nainital. The Uttarakhand State Infrastructure Development Corporation Ltd. wrote a letter dated 06.02.2016, demanding Rs.4.09 lakhs for preparation of D.P.R. The amount was sanctioned on 24.02.2016. It was ordered on 12.03.2016 to start the work of Cardiac care unit. The Chief Medical Officer again requested the Project Director for preparing the D.P.R. The Chief Medical Officer wrote a letter to the Secretary, Nainital Lake Development Authority for no objection certificate. He also wrote a letter to District Magistrate, Nainital for demolition of structure through Public Works Department. The Executive Engineer informed the Chief Medical Officer that he has already issued the certificate for demolition. The Uttarakhand State Infrastructure Development Corporation Ltd. has invited tenders for preparation of the D.P.R. and the firm known as M/s Negi and Associates Architect Interior Designers, Ramnagar, Nainital was selected for preparation of D.P.R. The State Government has stated that as and when the D.P.R. would be prepared by the agency, the further work would be undertaken.
22. The Court had shown its displeasure on 29.09.2016 that no efforts were made to establish the Cardiac Care Unit and Geriatric Ward. The Principal Secretary, Medical Health was directed to appoint one Cardiologist, Orthopedic Surgeon, Pathologist and two E.M.Os., who were qualified to run the hospital. These doctors were permitted to be appointed by way of transfer.
23. The compliance affidavit was filed on 22.10.2016, pursuant to the order dated 29.09.2016. It was stated in the affidavit that as far as the Project Report submitted by the Uttarakhand State Infrastructure 9 Development Corporation Ltd. (USIDC) was concerned, the USIDC had given the estimate to the tune of Rs. 3649.91 lakhs for construction of building. The Finance Department, after examination, reduced it to Rs.3208.38 lakhs. However, at that time, it was found prudent that instead of constructing a new building, the existing one should be renovated as per requirements and a Govt. Order was issued to this effect.
24. The Chief Medical Superintendent B.D. Pandey District Hospital, Nainital vide its report dated 14.10.2016 had informed that for the year 2015-16, a sum of Rs.52.02 lakhs and for the year 2016-17, a sum of Rs.46.00 lakhs were spent in the renovation works. The Finance Department had only sanctioned Rs. 167.30 lakhs. The proposal was sent to Union Health Ministry to provide grant for the construction work, equipments, consumables etc. under Non-Communicable Disease head of Project Implementation Plan under National Health Mission for the current year. However, in the meanwhile, the Govt. has decided to establish a Cardiac Care Unit on PPP mode using the existing infrastructure. According to the directions issued by this Court, in B.D. Pandey Hospital, Dr. K.B. Joshi, Cardiologist, Dr. Manoj Kumar Diwedi, Orthopedic Surgeon, Dr. Mamta Pangti, Pathologist, EMO Dr. Anirudh Gangola, EMO Dr. Nitin Kumar Singh were appointed and Dr. Sadhna Sachan, MD Micro Biology was appointed as Female Medical Officer.
25. Court passed the orders on 02.06.2017 and 06.06.2017. The order dated 02.06.2017 reads as under:-
"Inspite of order dated 29.09.2016 of this Court, compliance has not been made inasmuch as no Cardiologist has been appointed in B. D. Pandey Hospital, Nainital.
On an earlier occasion, it was recommended that the present building of B.D. Pandey Hospital, Nainital be demolished and new construction be made equipped with latest infrastructure and other 10 facilities. This report was accepted by the Principal Secretary, Health Department, Government of Uttarakhand. The State Government had released a sum of Rs.25 lacs in favour of Uttarakhand State Infrastructure Development Corporation Ltd. (in short 'USIDCL') for preparing a master plan. Consequently, the USIDCL has prepared a project report for new construction of hospital. Subsequently, the Additional Secretary (Health) passed an order that the renovation work should only be done instead of new construction of B.D. Pandey Hospital, Nainital. Once a decision has been taken by a higher body, which was constituted by the Chief Secretary of the State, such a decision cannot be reviewed or altered by a lesser committee. This has been informed that the subsequent decision of the Additional Secretary has been accepted, but this Court would like to know on what principles and on what consideration, the proposal of renovation has been accepted.
We were inclined to call the Principal Secretary (Health), since we have been informed that the Principal Secretary (Health) has himself undergone a heart surgery in the recent past, we would require instead the Director General (Health) and the Additional Secretary (Health) to be present on the next of listing.
The Director General (Health) and Additional Secretary (Health), Government of Uttarakhand shall appear in person before this Court on 06.06.2017 and apprise the Court on the basis of which such a decision, i.e., change of opinion has been taken by the State Government.
List this matter on 06.06.2017 at 03:00 pm. Let a certified copy of this order be supplied to learned counsel for the parties today itself, on payment of usual charges."
26. In sequel to the directions issued by this Court on 02.06.2017, Mr. Pankaj Kumar Pandey, Additional Secretary (Health), informed the Court on 06.06.2017 that the Cardiologist Dr. K.B. Joshi had joined at B.D. Pandey District Govt. Hospital. However, it was not explained to the Court what were the compelling reasons for the Govt. to change the decision to demolish the present structure and to reconstruct the same. The Court was only informed that since the land and infrastructure was already available at Bhowali T.B. Sanatorium, the present construction which was proposed at B.D. Pandey District Govt. Hospital could be raised at Bhowali T.B. Sanatorium for a Multi-Speciality Hospital.
27. In sequel to the order dated 06.06.2019, the State Govt. convened a meeting of the following Officers under the Chairmanship of Additional Chief Secretary, Medical, Health and Family Welfare to the State of Uttarakhand on 12.05.2017:-
11i. "Mr. Pankaj Kumar Pandey, Additional Secretary, Medical, Health and Family Welfare, Government of Uttarakhand. ii. Mr. Atar Singh, Joint Secretary, Medical, Health and Family Welfare, Government of Uttarakhand.
iii. Mr. Sunil Kumar Singh, Under Secretary, Medical, Health and Family Welfare, Government of Uttarakhand.
iv. Dr. D. S. Rawat, Director General, Medical, Health and Family Welfare, Government of Uttarakhand."
28. The Committee recommended that the multi- speciality hospital, which was to be constructed/ established at B.D. Pandey Hospital, Nainital, should be constructed at the T.B. Sanatorium Bhowali. This decision was accepted in principle by the State Government vide order dated 13.06.2017. The letter dated 13.06.2017 reads as under:-
"{k; jksx laLFkku Hkokyh] uSuhrky dks eYVh Lisf"k;fyVh gkWLihVy ds :i esa mPphd`r@fodflr djus ds lEcU/k esa ek0 mPp U;k;ky; ds i= fnukad 06.06.2017 esa fn;s x;s funsZ"kksa ds dze esa vij eq[; lfpo] fpfdRlk LokLF; ,oa ifjokj dY;k.k foHkkx] mRrjk[k.M "kklu dh v/;{krk esa fnukad 12.06.2017 dks lk;a 04:00 cts lEiUu cSBd dk dk;Zo`Rr A cSBd esa mifLFkr vf/kdkjhx.kksa dk fooj.k %&
1. Mk0 iadt dqekj ik.Ms;] vij lfpo] fpfdRlk&LokLF; ,oa ifjokj dY;k.k] mRrjk[k.M "kkluA
2. Jh vrj flag] la;qDr lfpo] fpfdRlk&LokLF; ,oa ifjokj dY;k.k] mRrjk[k.M "kkluA
3. Jh lquhy dqekj flag] vuq lfpo] fpfdRlk&LokLF; ,oa ifjokj dY;k.k] mRrjk[k.M "kkluA
4. Mk0 Mh0,l0 jkor] egkfuns"kd, fpfdRlk&LokLF; ,oa ifjokj dY;k.k] mRrjk[k.M "kkluA cSBd esa ih0vkbZ0,y0 la[;k&12@2009] nhid :vkyh cuke] ;wfu;u vkWQ bf.M;k vkSj vU; ds lEcU/k esa ek0 mPp U;k;ky;] uSuhrky }kjk fnukad 06.06.2017 esa fn, x;s funsZ"kksa ds dze esa le;d~ fopkjksijkUr fuEu fu.kZ; fy;k x;k %& tuin&uSuhrky ds vUrxZr ch0Mh0 ik.Ms] ftyk fpfdRlky; esa izLrkfor fuekZ.k dk;ksZa dks Hkokyh lSuhVksfj;e esa miyC/k LFkku esa djk;s tkus ij lgefr cuhA bldk fuekZ.k eYVh Lisf"k;fyVh vLirky ds :i esa fd;k tk;sxkA vUr esa cSBd l/kU;okn lEiUu gqbZA ¼vkse izdk"k½ vij eq[; lfprA"
29. Court, after receipt of the letter dated 13.06.2017, constituted a Committee of following Officers to visit the Bhowali T.B. Sanatorium:-
i. Dr. D. S. Rawat, Director General, Medical, Health and Family Welfare, Government of Uttarakhand.
ii. Mr. Pankaj Kumar Pandey, Additional Secretary, Medical, Health and Family Welfare, Government of Uttarakhand. iii. Additional Secretary - Finance (dealing with the matter pertaining to Medical, Health & Family Welfare, Government of Uttarakhand).12
iv. The Country Town Planner, Government of Uttarakhand.
30. The Committee was given a liberty to co-opt specialists, not more than two, for the purpose of making assessment. The report of the Committee headed by the Additional Chief Secretary, Medical, Health and Family Welfare to the State of Uttarakhand was permitted to be placed on record along with photographs.
31. The Court ordered on 05.07.2017 to the State Govt., as suggested by the Committee, to handover the project to an empanelled Structural Engineering Consultant/Planner, and submit the report before the Court definitely within a period of three weeks from today.
The report was filed before this Court.
32. The Union of India was also permitted to be impleaded. It was also suggested during the course of hearing on 01.08.2017 that Bhowali Sanatorium be inspected. The Director, Medical Health and Family Welfare, Kumaon along with the team were directed to make inspection. Mr. M.S. Chauhan and Mr. Akram Parvej, practicing Advocates of this Court were directed to accompany the team. The Inspection Report was submitted to the Court. The additional report was also submitted about the pathetic condition of the Bhowali T.B. Sanatorium. The Director, Medical Health and Family Welfare, Kumaon, who was present in the Court on 11.08.2017 has assured the Court for taking remedial steps for improving the condition of Bhowali T.B. Sanatorium. The State Govt. had requested the Hospital Services Consultancy Corporation Ltd. to inspect Bhowali Sanatorium. The State Government had sanctioned Rs. 5.00 lakhs for topography, contour survey and soil testing of the selected place, as was requested by Hospital Services 13 Consultancy Corporation Ltd., Noida. The Director, Medical, Health and Family Welfare, Kumaon has admitted before the Court that insufficient funds were primary reason for the lack of facilities for the in-house patients at T.B. Sanatorium, Bhowali.
33. Learned counsel appearing on behalf of the State was directed to inform the Court about the existing vacancies available in three hospitals i.e. B.D. Pandey (Male) District Hospital, B.D. Pandey (Female) District Hospital and G.B. Pant Hospital at Nainital. The information has been placed on record in a tabular form on 17.07.2018 after the judgment was reserved. According to this information, one post of Chief Medical Superintendent, one post of EMO, two posts of Chief Pharmacist, two posts of Sister, one post of Chief Assistant, one post of Health Supervisor are lying vacant. Eight ward-ayas are appointed by way of outsourcing in B.D. Pandey (Female) District Hospital, Nainital.
34. Similarly, for B.D. Pandey (Male) District Hospital, one post of Cardiologist, one post of Ortho Surgeon, one post of Dental Consultant, one post of Anusewak, one post of Cook, two posts of Gardener, one post of Attendant Physiotherapist and one post of Lab Attendant are lying vacant. The condition of G.B. Pant Hospital is worse. There is no medical officer male as well as female. There is no surgeon. No X-ray technician. Two posts of staff nurses, one post of driver, one post of sister, fourteen posts of Class IV employees are lying vacant. One eye-surgeon is working on contractual basis. Two computer operators are working and one ophthalmologist is also working.
1435. What emerges from the facts, as enumerated hereinabove, is that earlier the State Govt. has taken a policy decision to demolish the existing structure and to raise the new building at Nainital. The master-plan was prepared. All the codal formalities were completed. However, the State Govt. took the U-turn and decided to have a Multi-Speciality Hospital at T.B. Sanatorium Bhowali, as per the letter dated 13.06.2017. The decision was taken on the basis of recommendation made by the High Power Committee. Thereafter, this Court has constituted another Committee to visit the spot along with the Advocates, as appointed by this Court. It was decided to handover the project to the U.P. Hospital Services Consultancy Corporation Ltd., Noida for preparation of drawings etc. The Committee was also directed to find out the infrastructure in the shape of building existing on the spot which could be repaired and put to use. The Committee has given the report.
36. The Court is of the considered view that since the infrastructure is available at Bhowali, the Multi-Speciality Hospital can be run from the existing infrastructure and wherewithal and by making minor repairs and thereafter, new building can be constructed at T.B. Sanatorium, Bhowali. There is no shortage of land at Bhowali T.B. Sanatorium.
37. The Court had directed the State Govt. to establish the Cardiac Care Unit and Geriatric Ward. Initially, it was decided that the existing building be repaired and the Cardiac Care Unit and Geriatric Ward be setup. However, the fact of the matter, is that the Cardiac Care Unit has not been established with latest equipment. Huge amount has been spent for renovation but the 15 facilities available in the hospital are inadequate. There is shortage of doctors/specialists and paramedical staff.
38. It has come in the report submitted by the Committee that the conditions prevailing in Bhowali T.B. Sanatorium are deplorable. The entire building was stinking. Many structures were hundred years old. Some buildings can be restored after renovation. The class 'C' is a double storeyed building. It required only minor repair. Red Cross block had a capacity of 16 beds. It could also be restored. The recreation hall was in a good condition. The 12th block No.1 had a capacity of 24 beds. It could be used after minor repair. The 12th block No.2 had a capacity of 12 beds and it required minor repair. Kitchen was in bad condition and it required reconstruction. The capacity of old surgical ward is 42 beds and was in a very pathetic condition and it also required reconstruction. The new surgical building was in a good condition and it did not require reconstruction. The administrative building was in a good condition. The OPD building has developed deep crack. It was in a bad condition. The PMS residence was completely dilapidated. It has more than 3000 sq. mt. area i.e. 4 bigha. The various wards which were not in use could be used for multi-speciality hospital after renovation. The Committee has also placed on record the pictures of the existing infrastructure. It was admitted by the Director, Medical, Health and Family Welfare, Kumaon before this Court that sufficient funds were not made available. The State should release sufficient funds for looking after the patients at Bhowali T.B. Sanatorium. The State Govt. has not taken any decision, till date, to start the multi- speciality hospital at Bhowali where the infrastructure and wherewithal is present as per the decision dated 13.06.2017. The buildings only require minor repairs. The 16 State Govt. should take quick decision as far as utilizing of public buildings is concerned. The delay in taking the decision results in enhancing the cost of construction.
39. In Nainital town, the permanent population is about fifty thousand and about ten thousand is floating population. The citizen of Nainital town and floating population require state of art medical facilities. They have a fundamental right to be treated by specialists. The three hospitals i.e. B.D. Pandey (Male) Govt. District Hospital, B.D. Pandey (Female) Govt. District Hospital and G.B. Pant Hospital are not functioning as per the norms. Practically, there is no doctor in G.B. Pant Hospital, Nainital. One surgeon is more than 75 years of age. One doctor has been appointed after retirement. There is only one lady doctor. It is necessary for the State Govt. to fill up all the sanctioned posts in G.B. Pant Hospital, Nainital. The G.B. Pant Hospital, Nainital is practically defunct. None of the hospitals in Nainital town is air conditioned. Nainital is severely cold in winters. All the hospitals require central heating for the comfort of patients. TMT machine at B.D. Pandey Hospital, Nainital is lying idle.
40. The B.D. Pandey Hospital is a district hospital, a secondary referral level responsible to provide medical care to the entire district of Nainital. Right to Life includes Right to Medical Care.
41. According to the Indian Public Health Standards (IPHS) guidelines for district hospitals (101 to 500 bedded), issued by Ministry of Health & Family Welfare, Govt. of India most of the district hospitals suffer from large number of constraints as under:-
"Buildings are either very old and in dilapidated conditions or are not maintained properly, because of lack of convergence with maintenance department.
The facilities at district hospitals require continued upgradation to keep pace with the advances in medical knowledge, diagnostic procedures, storage and retrieval of information. It has been observed 17 that development of hospitals is not keeping pace with the scientific development.
A typical district hospital lacks modern diagnostics and therapeutic equipment, proper emergency services, intensive care units, essential pharmaceuticals and supplies, referral support and resources. There is a lack of trained and qualified staff for hospital management and for the management of other ancillary and supportive services viz. medical records, central sterilization department, laundry, house keeping, dietary and management of nursing services. There is lack of community participation and ownership, management and accountability of district hospitals through hospital management committees.
District Hospitals have come under constantly increasing pressure due to increased utilization as a result of rapid growth in population, increase in awareness among common consumers, biomedical advancement resulting in the use of sophisticated and advanced technology in diagnosis and therapies, and constantly rising expectation level of the use of the services. The need for evaluating the care being rendered through district hospitals has gained strength of late. There is a need to provide guidance to those concerned with quality assurance in district hospitals services to ensure efficiency and effectiveness of the services rendered.
The Bureau of Indian standards (BIS) has developed standards for hospitals services for 30 bedded and 100 bedded hospitals with primary emphasis on structural component. However, these standards are considered very resource intensive and lack the processes to ensure community involvement, accountability, the hospital management and citizens' charter etc. peculiar to the public hospitals. Of late NABH standards are in vogue, however they are mainly process based standards and lack the structural components. In this context a set of standards are being recommended for district hospitals called as Indian Public Health Standards (IPHS) for District Hospitals. This document contains the standards to bring the District Hospitals to a minimum acceptable functional grade (indicated as Essential) with scope for further improvement (indicated as Desirable) in it."
42. The objectives of the Indian Public Health Standards (IPHS) for District Hospitals are as under:-
1. To provide comprehensive secondary health care (specialist and referral services) to the community through the District Hospital.
2. To achieve and maintain an acceptable standard of quality of care.
3. To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centres from where the cases are referred to the district hospitals.
43. The Grading of District Hospitals is as under:-
"The size of a district hospital is a function of the hospital bed requirement, which in turn is a function of the size of the population it serves. In India the population size of a district varies from 35,000 to 30,00,000 (Census 2001). Based on the assumptions of the annual rate of admission as 1 per 50 populations and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be around 300 beds. However, as the population of the district varies a lot, it would be prudent to prescribe norms by grading the size of the hospitals as per the number of beds.
Grade I: District hospitals norms for 500 beds Grade II: District Hospital Norms for 400 beds 18 Grade III: District hospitals norms for 300 beds Grade IV: District hospitals norms for 200 beds Grade V: District hospitals norms for 100 beds. The disease prevalence in a district varies widely in type and complexities. It is not possible to treat all of them at district hospitals. Some may require the intervention of highly specialist services and use of sophisticated expensive medical equipment. Patients with such diseases can be transferred to tertiary and other specialized hospitals. A district hospital should however be able to serve 85-95% of the medical needs in the districts. It is expected that the hospital bed occupancy rate should be at least 80%."
44. The District Hospital is required to provide following essential services:-
General Specialties General Medicine General Surgery Obstetric & Gynaecology Services Family Planing services like Counseling, Tubectomy (Both Laparoscopic and Minilap), NSV, IUCD, OCPs, Condoms, ECPs, Follow up services Paediatrics including Neonatology and Immunization Emergency (Accident & other emergency) Critical care/Intensive Care (ICU) Anaesthesia Ophthalmology Otorhinolaryngology (ENT) Orthopaedics Radiology including Imaging Psychiatry Geriatric Services (10 bedded ward) Health promotion and Counseling Services Dental care District Public Health Unit DOT centre AYUSH Integrated Counseling and Testing Centre; STI Clinic; ART Centre Blood Bank Disability Certification Services Services under Other National Health Programmes Diagnostic and other Para clinical services regarding Laboratory services including Pathology and Microbiology Designated Microscopy centre X-Ray, Sonography ECG Endoscopy Blood Bank and Transfusion Services Physiotherapy Dental Technology (Dental Hygiene) Drugs and Pharmacy Ancillary and support services Following ancillary services shall be ensured:
Medico-legal/post mortem Ambulance services Dietary services Laundry services Security services Waste management including Biomedical Waste Ware housing/central store Maintenance and repair Electric Supply (power generation and stabilization) 19 Water supply (plumbing) Heating, ventilation and air-conditioning Transport Communication Medical Social Work Nursing Services CSSD - Sterilization and Disinfection Horticulture (Landscaping) Refrigeration Hospital Infection Control Referral Services Administrative services
(i) Finance
(ii) Medical records (Provision should be made for computerized medical records with anti-virus facilities whereas alternate records should also be maintained)
(iii) Procurement
(iv) Personnel
(v) Housekeeping and Sanitation
(vi) Education and training
(vii) Inventory Management
(viii) Hospital Information System
(ix) Grievances redressal Services Services under various National Health and Family Welfare Programmes.
Epidemic Control and Disaster Preparedness Integrated Disease surveillance, epidemic investigation and emergency response.
45. The District Hospital is required to discharge following functions:-
1. "It provides effective, affordable health care services (curative including specialist services, preventive and promotive) for a defined population, with their full participation and in co-
operation with agencies in the district that have similar concern. It covers both urban population (district head quarter town) and the rural population in the district.
2. Function as a secondary level referral centre for the public health institutions below the district level such as Sub- divisional Hospitals, Community Health Centres, Primary Health Centres and Sub-centres.
3. To provide wide ranging technical and administrative support and education and training for primary health care."
46. The physical infrastructure required for District Hospital as per the norms reads as under:-
The size of a district hospital is a function of the hospital bed requirement which in turn is a function of the size of the population it serves. In India the population size of a district varies from 50,000 to 15,00,000. For the purpose of convenience the average size of the district is taken in this document as one million population. Based on the assumptions of the annual rate of admission as 1 per 50 population and average length of stay in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be as follows:
The size of a district hospital is a function of the hospital bed requirement which in turn is a function of the size of the population it serves. In India the population size of a district varies from 50,000 to 15,00,000. For the purpose of convenience the average size of the district is taken in this document as one million population. Based on the assumptions of the annual rate of admission as 1 per 50 population and average length of stay 20 in a hospital as 5 days, the number of beds required for a district having a population of 10 lakhs will be as follows: The total number of admissions per year = 10,00,000 × 1/50 = 20,000 Bed days per year = 20,000 × 5 = 100,000 Total number of beds required when occupancy is 100% = 100000/365 = 275 beds Total number of beds required when occupancy is 80% = 100000/365 × 80/100 = 220 beds Requirement of beds in a District Hospital would also be determined by following factors:
a) Urban and Rural demographics and likely burden of diseases
b) Geographic terrain
c) Communication network
d) Location of FRUs and Sub-district Hospitals in the area
e) Nearest Tertiary care hospital and its distance & travel time
f) Facilities in Private and Not-for profit sectors
g) Health care facilities for specialised population- Defence, Railways, etc. Area and Space norms of the hospital Land Area Minimum Land area requirement are as follows:
(Desirable) Upto 100 beds = 0.25 to 0.5 hectare Upto 101 to 200 = 0.5 hectare to 1 hecta re beds 500 beds and above = 6.5 hectare (4.5 hectare for hospital and 2 hectare for residential) Size of hospital as per number of Beds a. General Hospital - 80 to 85 sqm per bed to calculate total plinth area.
(Desirable).
The area will include the service areas such as waiting space, entrance hall, registration counter etc. In addition, Hospital Service buildings like Generators, Manifold Rooms, Boilers, Laundry, Kitchen and essential staff residences are required in the Hospital premises. In case of specific requirement of a hospital, flexibility in altering the area be kept.
b. Teaching Hospital - 100 to 110 sqm per bed to calculate total plinth area.
Following facilities/area may also be considered while planning hospital. (Desirable)
(i) Operation Theatre a. One OT for every 50 general in-
patient beds b. One OT for every 25 surgical beds.
(ii) ICU beds = 5 to 10 % of total beds
(iii) Floor space for each ICU = 25 to 30 sq m (this includes support
bed services)
(iv) Floor space for Paediatric = 10 to 12 sq m per bed
ICU beds
(v) Floor space for High = 20 to 24 sq m per bed
Dependency Unit (HDU)
(vi) Floor space Hospital beds = 15 to 18 sq m per bed
(General)
(vii) Beds space = 7 sq m per bed.
(viii) Minimum distance between = 2.5 m (minimum) centres of two beds
(ix) Clearance at foot end of = 1.2 m (minimum) each bed
(x) Minimum area for apertures = 20% of the floor area (if on same wall) (windows/ Ventilators = 15% of the floor area (if on opposite opening in fresh air) walls) 21 Site selection criteria In the case of either site selection or evaluation of adaptability, the following items must be considered: Physical description of the area which should include bearings, boundaries, topography, surface area, land used in adjoining areas, drainage, soil conditions, limitation of the site that would affect planning, maps of vicinity and landmarks or centers, existing utilities, nearest city, port, airport, railway station, major bus stand, rain fall and data on weather and climate.
Factors to be considered in locating a district hospital The location may be near the residential area. Too old building may be demolished and new construction done in its place.
It should be free from dangers of flooding; it must not, therefore, be sited at the lowest point of the district.
It should be in an area free of pollution of any kind including air, noise, water and land pollution.
It must be serviced by public utilities: water, sewage and storm-water disposal, electricity and telephone. In areas where such utilities are not available, substitutes must be found, such as a deep well for water, generators for electricity and radio communication for telephone.
Necessary environmental clearance will be taken. Site selection Process A rational, step-by-step process of site selection occurs only in ideal circumstances. In some cases, the availability of a site outweighs other rational reasons for its selection, and planners and architects are confronted with the job of assessing whether a piece of land is suitable for building a hospital.
In the already existing structures of a district hospital It should be examined whether they fit into the design of the recommended structure and if the existing parts can be converted into functional spaces to fit in to the recommended standards.
If the existing structures are too old to become part of the new hospital, could they be converted to a motor pool, laundry, store or workshop or for any other use of the district hospital. If they are too old and dilapidated then they must be demolished. And new construction should be put in place. Hospital Building - Planning and Lay out Hospital Management Policy should emphasize on hospital buildings with earthquake proof, flood proof and fire protection features. Infrastructure should be eco-friendly and disabled (physically and visually handicapped) friendly. Local agency Guidelines and Bylaws should strictly be followed.
(i) Appearance and upkeep
a) The hospital should have a high boundary wall with at least two exit gates.
b) Building shall be plastered and painted with uniform colour scheme.
c) There shall be no unwanted/outdated posters pasted on the walls of building and boundary of the hospital.
d) There shall be no outdated/unwanted hoardings in hospital premises.
e) There shall be provision of adequate light in the night so hospital is visible from approach road.
f) Proper landscaping and maintenance of trees, gardens etc. should be ensured.
g) There shall be no encroachment in and around the hospital.
ii) Signage
a) The building should have a prominent board displaying the name of the Centre in the local language at the gate and on the building. Signage indicating access to various facilities at strategic points in the Hospital for guidance of the public should be provided. For showing the directions, colour coding may be used.
b) Citizen charter shall be displayed at OPD and Entrance in local language including patient rights and responsibilities.
22c) Hospital lay out with location and name of the facility shall be displayed at the entrance.
d) Directional signages for Emergency, all the Departments and utilities shall be displayed appropriately, so that they can be accessed easily.
e) Florescent Fire Exit plan shall be displayed at each floor.
f) Safety, Hazard and caution signs displayed prominently at relevant places.
g) Display of important contacts like higher medical centres, blood banks, fire department, police, and ambulance services available in nearby area.
h) Display of mandatory information (under RTI Act, PNDT Act, MTP Act etc.).
iii) General Maintenance Building should be well maintained with no seepage, cracks in the walls, no broken windows and glass panes. There should be no growth of algae and mosses on walls etc. Hospital should have anti-skid and non-slippery floors.
iv) Condition of roads, pathways and drains
a) Approach road to hospital emergency shall be all weather motorable road.
b) Roads shall be illuminated in the nights.
c) There shall be dedicated parking space
d) separately for ambulances, Hospital staff and visitors.
e) There shall be no stagnation/over flow of drains.
f) There shall be no water logging/marsh in or around the hospital premises.
g) There shall be no open sewage/ditches in the hospital.
v) Environmental friendly features The Hospital should be, as far as possible, environment friendly and energy efficient. Rain-Water harvesting, solar energy use and use of energy-efficient bulbs/equipment should be encouraged. Provision should be made for horticulture services including herbal garden. A room to store garden implements, seeds etc. will be made available.
vi) Barrier free access For easy access to non-ambulant (wheel-chair, stretcher), semi-ambulant, visually disabled and elderly persons infrastructure as per "Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons" of Government of India, is to be provided. This will ensure safety and utilization of space by disabled and elderly people fully and their full integration into the society. Provisions as per 'Persons with Disability Act' should be implemented.
vii) Administrative Block Administrative block attached to main hospital along with provision of MS Office and other staff will be provided. Block should have independent access and connectivity to the main hospital building, wherever feasible.
viii) Circulation Areas Circulation areas comprise corridors, lifts, ramps, staircase and other common spaces etc. The flooring should be anti-skid and non-slippery. Corridors - Corridors shall be at least 3 m Wide to accommodate the daily traffic. Size of the corridors, ramps, and stairs shall be conducive for manoeuvrability of wheeled equipment. Corridors shall be wide enough to accommodate two passing trolley, one of which may have a drip attached to it. Ramps shall have a slope of 1:15 to 1:18. It must be checked for manoeuvrability of beds and trolleys at any turning point.
ix) Roof Height The roof height should not be less than approximately 3.6 m measured at any point from floor to roof.
x) Entrance Area Barrier free access environment for easy access to nonambulant (wheel- chair, stretcher), semi-ambulant, visually disabled and elderly persons as per "Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons" of CPWD/Min of Social Welfare, GOI. Ramp as per specification, Hand- railing, proper lightning etc. must be provided in all health facilities and retrofitted in older one which lacks the same.
23The various types of traffic shall be grouped for entry into the hospital premises according to their nature.
An important consideration is that traffic moving at extremely different paces (e.g. a patient on foot and an ambulance) shall be separated. There can be four access points to the site, in order to segregate the traffic.
1. Emergency: for patients in ambulances and other vehicles for emergency department.
2. Service: for delivering supplies and collecting waste.
3. Service: for removal of dead
4. Main: for all others
xi) Residential Quarters All the essential medical and para-medical staff will be provided with residential accommodation. If the accommodation can not be provided due to any reason, then the staff may be paid house rent allowance, but in that case they should be staying in near vicinity, so that essential staff is available 24 x 7.
Disaster Prevention Measures (For all new upcoming facilities in seismic zone 5 or other disaster prone areas) Desirable Building structure and the internal structure of Hospital should be made disaster proof especially earthquake proof, flood proof and equipped with fire protection measures.
Earthquake proof measures - structural and non-structural should be built in to withstand quake as per geographical/state Govt. guidelines. Non- structural features like fastening the shelves, almirahs, equipment etc. are even more essential than structural changes in the buildings. Since it is likely to increase the cost substantially, these measures may especially be taken on priority in known earthquake prone areas. (For more details refer to Annexure IX.) Fire fighting equipment - fire extinguishers, sand buckets, etc. should be available and maintained to be readily available when there is a problem. Every district hospital shall have a dedicated disaster management plan in line with state disaster management plan. Disaster plan clearly defines the authority and responsibility of all cadres of staff and mechanism of mobilization resources.
All health staff should be trained and well conversant with disaster prevention and management aspects. Regular mock drill should be conducted. After each drill the efficacy of disaster plan, preparedness of hospital and competence of staff shall be evaluated followed by appropriate changes to make plan more robust.
Hospital communication 24x7 working telephone shall be available for hospital. Additional telephone lines with restricted access for priority messages should be installed especially with ISD facilities. All messages should be written down in the log book in details for follow up especially in case of disaster situations. Wireless Services with police assistance and hotline with the collector can be used in emergency. Fax should be used for communication of information like quantity of drugs, specification of equipment etc so as to avoid errors. Internal communication system for connecting important areas of hospitals like Emergency, Wards, OT, Kitchen, Laundry, CSSD, administration etc. should be established. Central Information booth should be functional and competent person shall be available for answering the enquiries. The anxious excited friends and relatives want to know the welfare of their kith and kin and hospital authorities should calm them down, console them and provide them with detail information from time to time from information booth. List of patients may be displayed with their bed/ward location.
Crowds should be controlled and only the authorized attendants/relatives with passes should be allowed entry . Departmental Lay Out Clinical Services 24 I) Outdoor Patient Department (OPD) The facility shall be planned keeping in mind the maximum peak hour patient load and shall have the scope for future expansion. OPD shall have approach from main road with signage visible from a distance. a. Reception and Enquiry Enquiry/May I Help desk shall be available with competent staff fluent in local language. The service may be outsourced. Services available at the hospital displayed at the enquiry. Name and contacts of responsible persons like Medical superintendent, Hospital Manager, Causality Medical officer, Public Information Officer etc. shall be displayed. b. Waiting Spaces Waiting area with adequate seating arrangement shall be provided. Main entrance, general waiting and subsidiary waiting spaces are required adjacent to each consultation and treatment room in all the clinics. Waiting area at the scale of 1 sq ft/per average daily patient with minimum 400 sq ft of area is to be provided.
c. Layout of OPD shall follow functional flow of the patients, e.g.:
Enquiry→Registration→Waiting→Sub-waiting→ Clinic→Dressing room/Injection Room→Billing→ Diagnostics (lab/X-ray)→Pharmacy→Exit d. Patient amenities (norms given in following pages) Potable drinking water.
Functional and clean toilets with running water and flush. Fans/Coolers.
Seating arrangement as per load of patient.
e. Clinics The clinics should include general, medical, surgical, ophthalmic, ENT, dental, obsetetric and gynaecology, Post Partum Unit, paediatrics, dermatology and venereology, psychiatry, neonatology, orthopaedic and Indian Public Health Standards (IPHS): Guidelines for District Hospitals social service department. Doctor chamber should have ample space to sit for 4-5 people. Chamber size of 12.0 sq meters is adequate. The clinics for infectious and communicable diseases should be located in solation, preferably, in remote corner, provided with independent access. For National Health Programme, adequate space be made available. Immunization Clinic with waiting Room having an area of 3 m × 4 m in PP centre/Maternity centre/Pediatric Clinic should be provided. 1 Room for HIV/STI counseling is to be provided. Pharmacy shall be in close proximity of OPD. All clinics shall be provided with examination table, X-ray- View box, Screens and hand wishing facility. Adequate number of wheelchairs and stretcher shall be provided.
f. Nursing Services Various clinics under Ambulatory Care Area require nursing facilities in common which include dressing room, side laboratory, injection room, social service and treatment rooms etc. Nursing Station: Need based space required for Nursing Station in OPD for dispensing nursing services. (Based on OPD load of patient).
47. There is provision for accident and emergency services including operation theatre as under:-
1. 24 x 7 operational emergency with dedicated emergency room shall be available with adequate man power.
2. It should preferably have a distinct entry independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to casualities arriving in the hospital. There should be an easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients.
3. Lay out shall follow the functional flow.
4. Signage of emergency shall be displayed at the entry of the hospital with directional signage at key points.25
5. Emergency shall have dedicated triage, resuscitation and observation area. Screens shall be available for privacy.
6. Separate provision for examination of rape/sexual assault victim should be made available in the emergency as per guidelines of the Supreme Court.
7. Emergency should have mobile X-ray/ laboratory, side labs/plaster room/and minor OT facilities. Separate emergency beds may be provided. Duty rooms for Doctors/nurses/ paramedical staff and medico legal cases. Sufficient separate waiting areas and public amenities for patients and relatives and located in such a way which does not disturb functioning of emergency services.
8. Emergency block to have ECG, Pulse Oxymeter, Cardiac Monitor with Defibrillator, Multiparameter Monitor, Ventilator also.
9. Stretcher, wheelchair and trolley shall be available at the entrance of the emergency at designated area.
XI) Operation Theatre Operation theatre usually have a team of surgeons anesthetists, nurses and sometime pathologist and radiologist operate upon or care for the patients. The location of Operation theatre should be in a quite environment, free from noise and other disturbances, free from contamination and possible cross infection, maximum protection from solar radiation and convenient relationship with surgical ward, intensive care unit, radiology, pathology, blood bank and CSSD. This unit also needs constant specialized services, such as piped suction and medical gases, electric supply, heating, air- conditioning, ventilation and efficient lift service, if the theatres are located on upper floors. Zoning should be done to keep the theatres free from micro organisms. There may be four well defined zones of varying degree of cleanliness/asepsis namely, Protective Zone, Clean Zone, Aspectic or Sterile Zone and Disposal or Dirty Zone. Normally there are three types of traffic flow, namely, patients, staff and supplies. All these should be properly channelized. An Operation Theatre should also have Preparation Room, Pre-operative Room and Post Operative Resting Room. Operating room should be made dustproof and moisture proof. There should also be a Scrub-up room where operating team washes and scrub-up their hands and arms, put on their sterile gown, gloves and other covers before entering the operation theatre. The theatre should have sink/ photo sensors for water facility. Laminar flow of air be maintained in operation theatre. It should have a single leaf door with self closing device and viewing window to communicate with the operation theatre. A pair of surgeon's sinks and elbow or knee operated taps are essential. Operation Theatre should also have a Sub-Sterilizing unit attached to the operation theatre limiting its role to operating instruments on an emergency basis only. Theatre refuse, such as, dirty linen, used instruments and other disposable/non disposable items should be removed to a room after each operation. Non-disposable instruments after initial wash are given back to instrument sterilization and rest of the disposable items are disposed off and destroyed. Dirty linen is sent to laundry through a separate exit. The room should be provided with sink, slop sink, work bench and draining boards."
48. The District Hospital manpower, nurses, para- medical staff and administration has also been provided in Page No.36 of the guidelines for District Hospitals, as per Indian Public Health Standards (IPHS).
49. Following equipment is mandatory:-
i. Imaging equipment ii. X-Ray Room Accessories 26 iii. Cardiopulmonary Equipment iv. Labour ward, Neo Natal and Special Newborn Care Unit (SNCU) Equipment v. Immunization Equipment vi. Ear Nose Throat Equipment vii. Eye Equipment viii. Dental Equipment ix. Operation Theatre Equipment x. Laboratory Equipment xi. Surgical Equipment Sets xii. Physical Medicine and Rehabilitation (PMR) Equipment xiii. Endoscopy Equipment xiv. Anaesthesia Equipment xv. Furniture & Hospital Accessories xvi. Post Mortem equipment xvii. Linen xviii. Teaching Equipment xix. Administration xx. Refrigeration & AC xxi. Hospital Plants xxii. Hospital Fittings & Necessities xxiii. Transport xxiv. Radiotherapy xxv. Intensive Care Unit (ICU)
50. The above mentioned guidelines are not fulfilled by the B.D. Pandey District Hospital.
51. The Court can take judicial notice of the fact that the doctors are not available around the clock. They come to the hospital in the morning and leave in the evening. The urgent operations cannot be undertaken in the absence of either surgeon or orthopaedic surgeon. The patients cannot be permitted to wait for more than 12 hours for the arrival of doctors or surgeon.
52. It is the duty of the State to raise the level of nutrition and the standard of living and to improve public health under Article 47 of the Constitution of India.
53. The Directive Principles are the soul of the Constitution. The Directive Principles provide for guidance to interpretation of fundamental rights of citizen as also statutory rights. Their Lordships of the Hon'ble Supreme Court in AIR 2015 SC 839, in the case of "Charu Khurana vs. Union of India", have held as under:-
27"32. The purpose of referring to the same is to understand and appreciate how the directive principles of State policy and the fundamental duties enshrined under Article 51-A have been elevated by the interpretative process of this Court. The directive principles have been regarded as the soul of the Constitution as India is a welfare State. At this juncture, it is apt to notice the view expressed by a two-Judge Bench of this Court in Ashoka Smokeless Coal India (P) Ltd. v. Union of India10 wherein it has been laid down that he directive principles of State policy provide for a guidance to interpretation of fundamental rights of a citizen as also the statutory rights."
34. On a condign understanding of clause (e), it is clear as a cloudless sky that all practices derogatory to the dignity of women are to be renounced. Be it stated, dignity is the quintessential quality of a personality and a human frame always desires to live in the mansion of dignity, for it is a highly cherished value. Clause (j) has to be understood in the backdrop that India is a welfare State and, therefore, it is the duty of the State to promote justice, to provide equal opportunity to all citizens and see that they are not deprived of by reasons of economic disparity. It is also the duty of the State to frame policies so that men and women have the right to adequate means of livelihood. It is also the duty of the citizen to strive towards excellence in all spheres of individual and collective activity so that the nation constantly rises to higher levels of endeavour and achievement. In AIIMS Students' Union v. AIIMS11, a three-Judge Bench, while dealing with the reservation in All India Institute of Medical Sciences, observed:
"Pushing the protection of reservation beyond the primary level betrays the bigwigs' desire to keep the crippled crippled for ever. Rabindra Nath Tagore's vision of a free India cannot be complete unless 'knowledge is free' and 'tireless striving stretches its arms towards perfection'. Almost a quarter century after the people of India have given the Constitution unto themselves, a chapter on fundamental duties came to be incorporated in the Constitution. Fundamental duties, as defined in Article 51-A, are not made enforceable by a writ of court just as the fundamental rights are, but it cannot be lost sight of that 'duties' in Part IV-A Article 51-A are prefixed by the same word 'fundamental' which was prefixed by the Founding Fathers of the Constitution to 'rights' in Part III. Every citizen of India is fundamentally obligated to develop a scientific temper and humanism. He is fundamentally duty- bound to strive towards excellence in all spheres of individual and collective activity so that the nation constantly rises to higher levels of endeavour and achievements. State is, all the citizens placed together and hence though Article 51-A does not expressly cast any fundamental duty on the State, the fact remains that the duty of every citizen of India is the collective duty of the State."
And, thereafter opined, "Fundamental duties, though not enforceable by a writ of the court, yet provide a valuable guide and aid to interpretation of constitutional and legal issues. In case of doubt or choice, people's wish as manifested through Article 51-A, can serve as a guide not only for resolving the issue but also for constructing or moulding the relief to be given by the courts. Constitutional enactment of fundamental duties, if it has to have any meaning, must be used by courts as a tool to tab, even a taboo, on State action drifting away from constitutional values."
35. From the aforesaid enunciation of law, it is clear as day that the duty of a citizen has been extended to the collective duty of the State.
28To elaborate, it becomes the duty of the State to provide for opportunities and not to curtail the opportunities."
54. In 1987 (2) SCC 165, in the case of "Vincent Panikurlangara vs. Union of India & others", their Lordships of the Hon'ble Supreme Court have held that in a welfare State it is the obligation of the State to ensure the creation and the sustaining of conditions congenial to good health. Maintenance and improvement of public health have to rank high as these are indispensable to the very physical existence of the community and on the betterment of these depends the building of the society which the Constitution- makers envisaged. Attending to public health, therefore, is of high priority, perhaps the one at the top. Their Lordships have held as under:-
"13. The issues raised in this petition are of vital importance as they relate to maintenance of approved standards of drugs in general; the writ petition involves the claim for withdrawal of 7000 fixed dose combinations and withdrawal of licences of manufacturers engaged in manufacture of about 30 drugs which have been licensed by the Drugs Control authorities; the issues that fall for consideration are not only relating to technical and specialised matters relating to therapeutic value, justification and harmful side effect of drugs but also involve examination of the ectness (sic) of action taken by the Respondents 1 and 2 on the basis of advice; the matter also involves the interest of manufacturers and traders of drugs as also the interest of patients who require drugs for their treatment.
14. Respondent 5 has made references to the recommendations of the Drugs Consultative Committee and the ultimate consideration of DTAB to plead against the prayer of banning of preparations. As already stated the remaining respondents are manufacturers of specific preparations and have supported in their respective counter-affidavits their claim that drugs manufactured or handled by them should not be banned.
15. Having regard to the magnitude, complexity and technical nature of the enquiry involved in the matter and keeping in view the far-reaching implications of the total ban of certain medicines for which the petitioner has prayed, we must at the outset clearly indicate that a judicial proceeding of the nature initiated is not an appropriate one for determination of such matters. There is perhaps force in the contention of the petitioner that the Hathi Committee too was not one which could be considered as an authoritative body competent to reach definite conclusions. No adverse opinion can, therefore, be framed against the Central Government for not acting upon its recommendations.
16. A healthy body is the very foundation for all human activities. That is why the adage "Sariramadyam Khaludharma Sadhanam". In a welfare State, therefore, it is the obligation of the State to ensure the creation and the sustaining of conditions congenial to good health. This Court in Bandhua Mukti Morcha v. Union of India2 aptly observed: (SCC p. 183. para 10) "It is the fundamental right of everyone in this country, assured under the interpretation given to Article 21 by this Court in Francis Mullin case3 to live with human dignity, free from exploitation. This right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and particularly clauses (e) and (f) of Article 39 and Articles 41 and 42 and at the least, therefore, it must include protection of the health and strength of the workers, men and women, and of the tender age 29 of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work and maternity relief. These are the minimum requirements which must exist in order to enable a person to live with human dignity and no State -- neither the Central Government nor any State Government -- has the right to take any action which will deprive a person of the enjoyment of these basic essentials."
While endorsing what has been said above, we would refer to Article 47 in Part IV of the Constitution. That article provides:
"The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health."
This article has laid stress on improvement of public health and prohibition of drugs injurious to health as one of the primary duties of the State. In Akhil Bharatiya Soshit Karamchari Sangh v. Union of India4 this Court has pointed out that: (SCC pp. 308-09, para 123) "The fundamental rights are intended to foster the ideal of a political democracy and to prevent the establishment of authoritarian rule but they are of no value unless they can be enforced by resort to courts. So they are made justiciable. But, it is also evident that notwithstanding their great importance, the Directive Principles cannot in the very nature of things be enforced in a court of law.... It does not mean that directive principles are less important than fundamental rights or that they are not binding on the various organs of the State."
In a series of pronouncements during the recent years this Court has culled out from the provisions of Part IV of the Constitution these several obligations of the State and called upon it to effectuate them in order that the resultant pictured by the Constitution Fathers may become a reality. As pointed out by us, maintenance and improvement of public health have to rank high as these are indispensable to the very physical existence of the community and on the betterment of these depends the building of the society of which the Constitution makers envisaged. Attending to public health, in our opinion, therefore, is of high priority -- perhaps the one at the top."
55. In 1989 (4) SCC 286, in the case of "Pt.
Parmanand Katara vs. Union of India & other", their Lordships of the Hon'ble Supreme Court have held that it is the State's obligation to preserve life. It is the professional obligation of all doctors, of government hospitals or private, to extend medical aid to the injured immediately. Statutory procedural requirements of observance of police formalities or zoning of hospitals or formalities of evidence of doctor cannot delay/avoid rendering of immediate medical relief. Their Lordships have held as under:-
"3. The Committee under the Chairmanship of the Director General of Health Services referred to above had taken the following decisions:
"1. Whenever any medico-legal case attends the hospital, the medical officer on duty should inform the Duty Constable, name, age, sex of the patient and place and time of occurrence of the incident, and should start the required treatment of the patient. It will be the duty of the Constable on duty to inform the police station concerned or higher police functionaries for further action.30
Full medical report should be prepared and given to the police, as soon as examination and treatment of the patient is over. The treatment of the patient would not wait for the arrival of the police or completing the legal formalities.
2. Zonalisation as has been worked out for the hospitals to deal with medico-legal cases will only apply to those cases brought by the police. The medico-legal cases coming to hospital of their own (even if the incident has occurred in the zone of other hospital) will not be denied the treatment by the hospital where the case reports, nor the case will be referred to other hospital because the incident has occurred in the area which belongs to the zone of any other hospital. The same police formalities as given in para 1 above will be followed in these cases.
All government hospitals, medical institutes should be asked to provide the immediate medical aid to all the cases irrespective of the fact whether they are medico-legal cases or otherwise. The practice of certain government institutions to refuse even the primary medical aid to the patient and referring them to other hospitals simply because they are medico-legal cases is not desirable. However, after providing the primary medical aid to the patient, patient can be referred to the hospital if the expertise facilities required for the treatment are not available in that institution."
(emphasis added) To the said affidavit of the Union of India also, the minutes of the 10th Meeting of the Standing Committee on Forensic Medicine (a Committee set up by the Ministry of Home Affairs of the Government of India) held on 27- 4-1985 have been appended. These minutes show that the Committee was a high-powered one consisting of the Director General, the Joint Secretary of the Ministry of Health of the Government of India, a Professor from the All India Institute of Medical Sciences, the Professor of Forensic Medicine from Maulana Azad Medical College, New Delhi, the Director and Professor of Forensic Medicine, Bhopal, the Deputy Director, Central Forensic Science Laboratory, Calcutta and certain officers of the Ministry. The proceedings indicate that the Director Generals of Police, Tamil Nadu and Uttar Pradesh were also members of the Committee. From the proceedings it appears that the question of providing medico-legal facilities at the upgraded primary health centres throughout the country was under consideration but the Committee was of the opinion that time was not ripe to think of providing such facilities at the upgraded primary health centres. One of the documents which forms part of the Union of India's affidavit is the copy of a letter dated 9-5-1978 which indicates that a report on some aspects of Medico-Legal Practice in India had been prepared and a copy of such report was furnished to the Health Secretaries of all the States and Union territories more than eleven years back.
7. There can be no second opinion that preservation of human life is of paramount importance. That is so on account of the fact that once life is lost, the status quo ante cannot be restored as resurrection is beyond the capacity of man. The patient whether he be an innocent person or be a criminal liable to punishment under the laws of the society, it is the obligation of those who are in charge of the health of the community to preserve life so that the innocent may be protected and the guilty may be punished. Social laws do not contemplate death by negligence to tantamount to legal punishment.
8. Article 21 of the Constitution casts the obligation on the State to preserve life. The provision as explained by this Court in scores of decisions has emphasised and reiterated with gradually increasing emphasis that position. A doctor at the government hospital positioned to meet this State obligation is, therefore, duty bound to extend medical assistance for preserving life. Every doctor whether at a government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. No law or State action can intervene to avoid/delay the discharge of the paramount obligation cast upon members of the medical profession. The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way. On this basis, we have not issued notices to the States and Union territories for affording them an opportunity of being heard before we accepted the statement made in the affidavit of the Union of India that there is no impediment in the law. The matter is extremely urgent and in our 31 view, brooks no delay to remind every doctor of his total obligation and assure him of the position that he does not contravene the law of the land by proceeding to treat the injured victim on his appearance before him either by himself or being carried by others. We must make it clear that zonal regulations and classifications cannot also operate as fetters in the process of discharge of the obligation and irrespective of the fact whether under instructions or rules the victim has to be sent elsewhere or how the police shall be contacted, the guideline indicated in the 1985 decision of the Committee, as extracted above††, is to become operative. We order accordingly.
14. It could not be forgotten that seeing an injured man in a miserable condition the human instinct of every citizen moves him to rush for help and do all that can be done to save the life. It could not be disputed that in spite of development economical, political and cultural still citizens are human beings and all the more when a man in such a miserable state hanging between life and death reaches the medical practitioner either in a hospital (run or managed by the State) public authority or a private person or a medical professional doing only private practice he is always called upon to rush to help such an injured person and to do all that is within his power to save life. So far as this duty of a medical professional is concerned its duty coupled with human instinct, it needs no decision nor any code of ethics nor any rule or law. Still in the Code of Medical Ethics framed by the Medical Council of India Item 13 specifically provides for it. Item 13 reads as under:
"13. The patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency or whenever temperate public opinion expects the service. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving notice to the patient, his relatives or his responsible friends sufficiently long in advance of his withdrawal to allow them to secure another medical attendant. No provisionally or fully registered medical practitioner shall wilfully commit an act of negligence that may deprive his patient or patients from necessary medical care."
17. We would also like to mention that whenever on such occasions a man of the medical profession is approached and if he finds that whatever assistance he could give is not sufficient really to save the life of the person but some better assistance is necessary it is also the duty of the man in the medical profession so approached to render all the help which he could and also see that the person reaches the proper expert as early as possible."
56. In 1996 (4) SCC 37, in the case of "Paschim Banga Khet Mazdoor Samity vs. State of W.B. & another", their Lordships of the Hon'ble Supreme Court have held that Constitution envisages the establishment of a welfare State at the federal level as well as the State level. In the welfare State the primary duty of the Government is to secure the welfare of the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Govt. in a welfare State. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. Failure on the part of the part of a government hospital to provide timely medical 32 treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21. Their Lordships have held as under:-
"9. The Constitution envisages the establishment of a welfare State at the federal level as well as at the State level. In a welfare State the primary duty of the Government is to secure the welfare of the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Government in a welfare State. The Government discharges this obligation by running hospitals and health centres which provide medical care to the person seeking to avail of those facilities. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The government hospitals run by the State and the medical officers employed therein are duty-bound to extend medical assistance for preserving human life. Failure on the part of a government hospital to provide timely medical treatment to a person in need of such treatment results in violation of his right to life guaranteed under Article 21. In the present case there was breach of the said right of Hakim Seikh guaranteed under Article 21 when he was denied treatment at the various government hospitals which were approached even though his condition was very serious at that time and he was in need of immediate medical attention. Since the said denial of the right of Hakim Seikh guaranteed under Article 21 was by officers of the State, in hospitals run by the State, the State cannot avoid its responsibility for such denial of the constitutional right of Hakim Seikh. In respect of deprivation of the constitutional rights guaranteed under Part III of the Constitution the position is well settled that adequate compensation can be awarded by the court for such violation by way of redress in proceedings under Articles 32 and 226 of the Constitution. Hakim Seikh should, therefore, be suitably compensated for the breach of his right guaranteed under Article 21 of the Constitution. Having regard to the facts and circumstances of the case, we fix the amount of such compensation at Rs 25,000. A sum of Rs 15,000 was directed to be paid to Hakim Seikh as interim compensation under the orders of this Court dated 22-4-1994. The balance amount should be paid by Respondent 1 to Hakim Seikh within one month.
16. It is no doubt true that financial resources are needed for providing these facilities. But at the same time it cannot be ignored that it is the constitutional obligation of the State to provide adequate medical services to the people. Whatever is necessary for this purpose has to be done. In the context of the constitutional obligation to provide free legal aid to a poor accused this Court has held that the State cannot avoid its constitutional obligation in that regard on account of financial constraints. The said observations would apply with equal, if not greater, force in the matter of discharge of constitutional obligation of the State to provide medical aid to preserve human life. In the matter of allocation of funds for medical services the said constitutional obligation of the State has to be kept in view. It is necessary that a time-bound plan for providing these services should be chalked out keeping in view the recommendations of the Committee as well as the requirements for ensuring availability of proper medical services in this regard as indicated by us and steps should be taken to implement the same. The State of West Bengal alone is a party to these proceedings. Other States, though not parties, should also take necessary steps in the light of the recommendations made by the Committee, the directions contained in the memorandum of the Government of West Bengal dated 22-8-1995 and the further directions given herein."
57. In 1996 (2) SCC 682, in the case of "Kirloskar Brothers Ltd. vs. Employees' State Insurance Corpn.", their Lordships of the Hon'ble Supreme Court have held that Right to health is a fundamental right of the workmen. Their Lordships have held as under:-
33"10. In expanding economic activity in liberalised economy Part IV of the Constitution enjoins not only the State and its instrumentalities but even private industries to ensure safety to the workman and to provide facilities and opportunities for health and vigour of the workman assured in relevant provisions in Part IV which are integral part of right to equality under Article 14 and right to invigorated life under Article 21 which are fundamental rights to the workman. Interpretation of the provisions of the Act, therefore, must be read in the light of not only the objects of the Act but also the constitutional and fundamental and human rights referred to hereinbefore."
58. The Court can take judicial notice of the fact that the government hospitals, private hospitals do not render medical assistance immediately to the victims of accident cases and emergency cases and unnecessarily insist upon registration of FIR. It is the duty of all the sub-district/sub- divisional hospitals, Special Centres, Primary Health Centres (PHCs'), Community Health Centres, District Hospitals and Tertiary Hospitals including Army Hospitals and Private Hospitals to treat the accident victims immediately without insisting for registration of FIR.
59. The State of Uttarakhand is a hilly State. Roads are narrow. The accident claims number of lives and renders number of people disabled. The victims of accident and other emergency cases are required to be treated immediately and for that purpose, we must have trauma centres in each district hospital. The trauma centres should be equipped, as per the Indian Public Health Standards guidelines.
60. The State of Uttarakhand is a sensitive State since it shares international borders with China and Nepal. The infrastructure raised can be utilized in case of any emergency. We see god in every doctor being saviour of life, may be employed in Govt. hospital, private hospital or serving in Army hospital, Navy hospital and Air force hospital.
61. We are not oblivious of the financial crunch faced by the State of Uttarakhand. It is the duty of the 34 Central Govt. to provide special health package to all the hilly states to maintain and improve public health. We would like to mention at this stage that all the schemes announced, launched must be completed in a time bound manner to save public money. The Union of India was added as party at the subsequent stage, since the State Govt. has stated in its one of the affidavits that it has sent the proposal to the Central Govt. to release the sufficient funds.
62. Accordingly, the writ petition is disposed of by issuing the following mandatory directions:-
A. The State Govt. is directed to start Multi-Speciality Hospital at Bhowali T.B. Sanatorium within a period of six months from today, as per the norms of Medical Council of India and Indian Public Health Standards issued from time to time, as per decision dated 13.06.2017.
B. The State Govt. is directed to construct the new buildings for Multi-Speciality Hospital as per the norms of Indian Public Health Standards by initiating the tender process after completing all the codal formalities i.e. DPR, building plans etc., within a period three months from today.
C. The State Govt. is also directed to release sufficient funds for the treatment of patients admitted in T.B. Sanatorium, Bhowali, within a period of seven days' from today.
D. The State Govt. is also directed to undertake minor repairs of buildings at Bhowali T.B. Sanatorium on urgent basis and to make it functional for 35 establishment of Multi-Speciality Hospital within a period of two weeks from today.
E. The State Govt. is also directed to setup/establish Cardiac Care Unit and Geriatric Ward at B.D. Pandey District Hospital, within a period of three months from today. Cardiologist and Gynecologist be appointed within two weeks from today.
F. All the vacant posts of doctors, paramedical staff and ministerial staff in B.D. Pandey (Male) District Hospital, B.D. Pandey (Female) District Hospital and G.B. Pant Hospital be filled up within a period of three months from today, if necessary by holding walk-in- interview on urgent basis.
G. The State Govt. is also directed to make provision for Central heating in all the three hospitals i.e. B.D. Pandey (Male) District Hospital, B.D. Pandey (Female) District Hospital and G.B. Pant Hospital, Nainital before the onset of winter season.
H. The State Govt. is further directed to install generators in every district hospital to provide uninterrupted power supply.
I. The State Govt. is also directed to ensure that all the doctors posted at a particular place/station remain available around the clock, failing which, disciplinary proceedings be initiated against them.
J. The State Govt. is directed to appoint doctors, nurses, para-medical staff, administrators etc. and to provide equipment as per Indian Public Health Standards within a period of six months from today at the secondary level/tertiary level hospitals.
36K. The State Govt. is also directed to appoint doctors, nurses, para-medical staff, administrators etc. in all the sub-district/sub-divisional hospitals, Special Centres, Primary Health Centres (PHCs'), Community Health Centres as per the norms of Indian Public Health Standards and Medical Council of India, within a period of six months from today.
L. The State Govt. is also directed to comply with all the norms of Indian Public Health Standards issued from time-to-time in the Multi-Speciality Hospital to be opened/ established in T.B. Sanatorium, Bhowali including doctors, nurses, para-medical staff, administrators and equipment.
M. The State Govt. is directed to establish trauma centres with following essential equipments in every district hospital, within three months from today, as per the norms prescribed by the Indian Public Health Standards:-
A. 24 x 7 operational emergency with dedicated emergency room shall be available with adequate man power.
B. It should preferably have a distinct entry independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to casualities arriving in the hospital. There should be an easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients. C. Lay out shall follow the functional flow.
D. Signage of emergency shall be displayed at the entry of the hospital with directional signage at key points. E. Emergency shall have dedicated triage, resuscitation and observation area. Screens shall be available for privacy. F. Separate provision for examination of rape/sexual assault victim should be made available in the emergency as per guidelines of the Supreme Court.
G. Emergency should have mobile X-ray/ laboratory, side labs/plaster room/and minor OT facilities. Separate emergency beds may be provided. Duty rooms for Doctors/nurses/ paramedical staff and medico legal cases. Sufficient separate waiting areas and public amenities for patients and relatives and located in such a way which does not disturb functioning of emergency services.
H. Emergency block to have ECG, Pulse Oxymeter, Cardiac Monitor with Defibrillator, Multiparameter Monitor, Ventilator also. I. Stretcher, wheelchair and trolley shall be available at the entrance of the emergency at designated area.37
N. There shall be a direction to all the sub-district/sub- divisional hospitals, Special Centres, Primary Health Centres (PHCs'), Community Health Centres, District Hospital, tertiary hospitals to treat the accident victims and other emergency cases without insisting for registration of FIR. We also direct that Army Hospitals and Private Hospitals, Private Clinics shall also render medical assistance to the accident victims /emergency cases as per their Constitutional duty.
O. We request the Ministry of Health & Family Welfare, Govt. of India to release the special health package to the hill states to maintain and improve the public health in a phased manner.
63. Pending application, if any, also stands disposed of.
(Lok Pal Singh, J.) (Rajiv Sharma, J.) NISHANT