Delhi High Court - Orders
Court On Its Own Motion vs Union Of India & Ors on 24 May, 2024
Author: Manmeet Pritam Singh Arora
Bench: Manmeet Pritam Singh Arora
$~11 and 12
* IN THE HIGH COURT OF DELHI AT NEW DELHI
+ W.P.(C) 3903/2017, CM APPL. 18718/2017, CM APPL. 19134/2017 & CM
APPL. 27526/2018
COURT ON ITS OWN MOTION ..... Petitioner
Through:
versus
UNION OF INDIA & ORS ..... Respondents
Through: Mr. Kawal Digpaul and Ms. Akanksha,
Advocates for Mr. Ajay Digpaul, Advocate for
UOI
Mr. Avishkar Singhvi, ASC, GNCTD with Mr.
Naved Ahmed, Mr. Vivek Kumar Singh and
Mr. Shubham Kumar, Advocates
Mr. Ravinder Agarwal, Advocate for R-
6/UPSC
Mr. Sagar Saxena, Mr. Parmeet Singh and Mr.
Sarthak Pandey, Advocates
Mr. AjjayAroraa, Mr. Kapil Dutta, Mr. Vansh
Luthra and Ms. Simran Arora, Advocates for
MCD
12
+ W.P.(C) 8548/2017 & CM APPL. 985/2024
COURT ON ITS OWN MOTION ..... Petitioner
Through: Mr. Ashok Agarwal, Amicus Curiae with
Mr. Kumar Utkarsh, Mr. Manoj Kumar and
Ms. Ashna Khan, Advocates
versus
UNION OF INDIA AND ORS ..... Respondents
Through: Mr. Satyakam, ASC, GNCTD with Mr.
Pradyut Kashyap, Advocate
Mr. Siddharth Panda, Adv. for Expert
Committee.
Mr. Kirtiman Singh, CGSC with Mr. Waize
Ali Noor, Ms. Shreya V. Mehra, Mr. Varun
Rajawat, Advocates for UOI
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 1 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above.
The Order is downloaded from the DHC Server on 27/05/2024 at 22:09:59
Mr. Ravinder Agarwal, Mr. Lekh Raj Singh,
Advs. for UPSC.
Mrs. Avnish Ahlawat, Standing Counsel,
GNCTD (Services) with Ms. Tania Ahlawat,
Mr. Nitesh Kumar Singh, Ms. Palak Rohmetra,
Ms. Laavanya Kaushik and Ms. Aliza Alam,
Standing Counsel, GNCTD.
CORAM:
HON'BLE THE ACTING CHIEF JUSTICE
HON'BLE MS. JUSTICE MANMEET PRITAM SINGH ARORA
ORDER
% 24.05.2024
1. In pursuance to the last order, a status report dated 23rd May, 2024 has been filed on behalf of the Government of National Capital Territory of Delhi (GNCTD), wherein the following chart has been reproduced:
"5. Furthermore the current status on the recommendations of the Expert committee is as under:-
SI. Recommendation Current Status
No
1. TOR:1 To suggest ways for the optimization of existing resources in the various hospitals located in Delhi, which are either owned by the Government of NCT including Delhi Government autonomous hospitals or MCD Immediate measures i. Redistribution of consultants: (i & iii). Regarding issue of Re-distribution Institutions where non-teaching specialists / experts of consultants & Hiring/ Empanelment of are available but are not optimally utilized due to Consultants from Pvt. Sector, a committee lack of machines, infrastructure, may be asked/ under Chairpersonship of Secretary H&FW allowed to be posted or visit on designated day(s) to has been constituted comprising the Institutions where such facilities are available. following officers:-
ii.Extension of tenure/ reappointment of 1) Dr. S.K. Sareen, Director, ILBS specialists: The age for faculty positions permitted 2) JS/SS (Finance Department) by the National medical commission is up to 70 3) JS/SS(Services Department) years. The age for superannuation in the Delhi
4) Dr. Anil Aggarwal, MD, GBPH Govt. hospitals for clinical staff should be enhanced to 70 years. While such a change can be 5) Dean, MAMC W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 2 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:09:59 implemented, it would be prudent to extend the Requisite order for constituting the tenure of the serving clinical specialists and Committee as approved by the Hon'ble L.G reappoint those clinicians who have superannuated has been issued on 13.05.2024 with the to carry out the required services in the Govt. following TOR:-
hospitals.
1. To examine the requirement of iii. Hiring/Empanelment of Consultants from specialists/ Hospital Operational staff in private sector: Engagement of the private sector is various hospitals under H&FW, GNCTD. urgently needed and specialists should be
2. Methodology for paying empaneled/ hired, where there is non-availability or shortage of regular specialists. This can be done remuneration to contractual specialists by proper advertisement, and appropriate from private sector i.e. per case remuneration. These consultants should be given basis/hourly basis/per patient respectable designation and infrastructural support basis/consolidated/any other for providing required services. A three member 3. Performance benchmark for these committee could prepare service conditions for contractual specialists for deciding their appointing consultants from private sector.
remuneration.
iv). Proper utilization of Equipment a. In institutions where equipment are lying 4. Financial implication/ Budgetary unused due to want of technical man-power, requirements for contractual engagement/ then such equipment should be put to use by Hospital Operational staff ensuring availability of technical man-power to operate such equipment or such equipment Further the 1st meeting of the Committee should be transferred to other institutions where has already taken place on 15.05.2024. The technical man-power is available. final recommendations will be submitted in 4 week.
b. The instruments requiring repair should be made operational on priority and made ii. Regarding issue of extension of functional within next 30 days with specific tenure/ re-appointment of instructions to the PWD or related agencies to specialist, the Department has complete the work subject to compliance of ECI recommended that a committee guidelines. may be formed under Chairmanship of Pr. Secretary c. All medical equipment should be made (Services) and matter may be operational and be available for patient care 24 forwarded to Services x 7. Appropriate provisions, service models Department, GNCTD with including PPP should be explored. request to submit the recommendation within 02 week time. The proposal is presently under submission. Extending tenure beyond superannuation age 65 will have difficulties in managing cadre and career progression. Better solution will be to re-appoint after retirement.
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 3 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00 iv. A large number of meetings were taken by both Special Secretary and Secretary (H&FW) also and whereby MS/MDs were requested to ensure that all the equipment which have been procured remain functional and at present except a few high end equipment which are at the end of their life cycle are working. In fact many equipment are now functional like CT Scan in GTB hospital and Linear accelerator in DSCI.
2. TOR:2 To suggest ways and means to devise a mechanism for the establishment of a control room that will enable the provision of real-time information concerning the availability of ICU / HDU beds in the various Hospitals and their timely availability for patients in need thereof.
Immediate and Short-term measure Immediate and Short-term measure Control Room Establishment: 3. In order to establish a structured referral mechanism for the critical
3. A centralized command and control patient in need, Delhi Govt Health & room (CCR) has to be established by the Family welfare department IT Department of GNCTD which should transformed already existing COVID be manned by adequate trained executives WAR ROOM into Centralized and medical professionals round the Command and Control Room (CCR).
clock. This control room should at least To start with the department has have a live screen showing the location of available emergency and ICU hospital started to monitor real time beds and medical services (like CT / MRI, information regarding ICU Bed OT facility, etc.) in the near vicinity of the occupancy & vacancy in all Delhi patient and the promptness and Govt. Hospitals. It is being manned availability of an ambulance service. by trained executive and medical There should be a screen showing region- professionals with a live screen wise Geo-mapping of all the Delhi displaying real time specialty wise hospitals with dynamic details of ICU beds availability in Delhi Govt. available facilities. Hospitals on NIC data management ii. Every hospital shall designate a referral portal. All Delhi Govt Hospitals have coordinator, who shall update the information been mapped. Login ID and on the dashboard linked to the CCR.
password have already been issued
3. At the hospital level the referral to all the hospitals for updation of coordinator will update the information data.
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 4 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00 on the on-line dashboard at least 3 times a day, which will be linked to the CCR. In this regard training of referral
3. The CCR should be established and coordinator of the Hospitals under maintained by a reliable company which GNCTD has been held on 8 & 9 can provide uninterrupted service for the May, 2024 and 42 referral citizens, on the same level as the Delhi coordinator of the hospitals of 4 Fire Service or Police Help line.
state hospitals have been trained.
v. NIC has informed the committee that they
It is mandatory to update the Portal in
already have a DASHBOARD active in Delhi
Government hospitals and is ready to above time slot even if there is no change in
upgrade it in no time. They assured that this the URL to access the portal is
facility can be initiated immediately with the cfwcst.delhi.gov.in .
installation of hardware. It is imperative that a 24x7 highly efficient call center type
2. Every Hospital has designated a referral facility/structure to conduct and monitor this coordinator to push update the information facility is in-built with setting-up of the CCR.
on the ICU Dashboard linked to CCR. All referral coordinators have been trained for updation of ICU Bed vacancy data on the portal. Currently portal is live capturing the relevant data.
3. To ensure the timely up-dation of ICU Bed dashboard (minimum thrice daily) dashboard is being updated at least three times a day as per times slots:
1. 8AM - 10AM (slot 1)
2. 2PM - 4PM (slot 2)
3. 8PM - 10PM (slot 3) Terms of References have been prepared as a ready reckoner to guide referral coordinators regarding the modus operandi of this referral system.
Modus Operandi : Any patient in need of ICU Bed approaching any hospital would Intermediate Term measure be dealt by referral coordinator on duty in case of un availability of ICU bed in
(i) An App providing precise and timely particular hospital. It should be primary information about the availability of responsibility of referral coordinator of emergency health services in Delhi hospitals the hospital where patient reported first to should be made available by NIC for use of the check availability of ICU bed in other govt citizens. Hospital through portal and also confirms W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 5 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00
(ii) A robust "Ambulance service" is the availability telephonically beforehand and fundamental requirement of emergency care. facilitate transfer of the patient to that Delhi should have at least 5 Advanced hospital. In case of no vacant bed in any Cardiovascular Life Support (ACLS) hospital, patient should be put in queue in ambulances per district available 24x7. Such the hospital (where the patient can go facilities could be outsourced for the time once the bed is available) with a number being as well.
assigned (eg 9th in queue / 18th in queue).
Intermediate term measure:
(i)Under process
(ii) Already 6- 7 ambulances per district are available.
3. TOR:3 To suggest ways and means to ensure the availability of infrastructure, medicines, and adequate manpower in the Hospitals for operating / managing high-end medical equipment / critical care units in the various Hospitals.
Immediate measures: 1. The matter regarding filling up the 15% of the vacant posts in all categories to be vacant posts by recruiting GDMOs, filled within 30 days Specialists, Nursing and Para-medical
1. Manpower staff on contractual/outsourced basis i. Permitting hiring of the doctors on contract has been processed. The matter is still basis as academic faculty/ consultants by the under submission. Director/MS of the Institution. The salary and perks of contractual doctors should be at least same as of regular employees.
ii. Empanelment of private doctors as Visiting
Consultants especially in radiology,
anesthesia, and any other specialty should be done and the emoluments may be paid per patient / procedure basis. Empanelment can be for durations ranging from 2 hours, 4 hours, 8 hours, to12 hours, and for night calls every day, Sundays and holidays.
iii. For nursing staff and para-medical staff, outsource agencies to be engaged on Quality- (2) Equipment cum-Cost Based Selection (QCBS) and I. For procurement of CT scan and immediate deployment should be done. MRI Services through Public Private iv. Adequate clinical and paramedical staff Partnership model, a committee has should be made available at the primary and already been constituted under the secondary health facilities throughout Delhi orders of the Chief Secretary and Govt. institutions. Hon'ble Minister (H&FW) the copy of the order is annexed.
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 6 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00
2. Equipment Immediate and short-term measures: The following Committee is constituted with prior approval of Chief Secretary, Delhi & i. Implement Public-Private Partnership Hon'ble Minister(H&FW):-
(PPP) model for CT scan and MRI services I. MD/MS/Dean of Maulana Azad by identifying successful bidder for Medical College implementing the same. Currently, at the II. MD/MS of GB Pant Hospital Janakpuri Super-Specialty Hospital (JSSH) (GIPMER) and PGI Rohtak a PPP model is running III. MD/MS/ of Lok Nayak Hospital successfully. In all hospitals where CT/MRI IV. DGHS(whoever is senior out of scan or radiologist is not available, the the two link officers at present) aforesaid model can be adopted and V. Chief Engineer, PWD of the implemented, especially in Level 3 & 4 hospitals. concerned hospital (only for the purpose of finalisation of space ii. Provision to get equipment on lease from as well as layout plan of the concessionaires, by announcing expression location within the hospital of interest. premises, detail of which to be added in the tender document iii. Rate Contract of any Central Govt. informing that such space would Hospitals in Delhi and AIIMS Delhi should be offered to the service provider be allowed to be used by the Delhi Govt. to install the equipment) Hospitals, if the Delhi Govt has no Rate (Senior most of I II III shall chair Contract for the said equipment(s). Rate contracts should be made for longer time the committee) (say - for useable life of the equipment, subject to requirement) instead of the prevailing system of contract for one to two years.
The committee shall undertake the following iv. Decentralization of Financial Powers - works and submit its report to the Secretary Powers of HOD (MD/MS) are limited at (H&FW) within 14 days of issue of this present. It is recommended that financial order powers up to Rs. 5 crores for purchase of I Firstly collect requirement of all equipment be considered for Heads of major equipment (like PET Scan, MRI1.5T/3T, hospitals and appropriate enhancement in CT64/128/256 slice, DRF, Digital X-Ray the powers of other category of hospitals 500/1000MA, Ultrasound, colour Doppler, should be done. Echo,, TMT, EEG, EMG, Densitometry, Digital Mammography, PFT etc) from all 38 hospitals (30 govt Hospital and 08 Society hospital) and also required for any other hospital(presently under construction)which is likely to be completed and opened for W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 7 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00 Intermediate-term measures: public by 31st Dec 2024. Install CT / MRI / PAT scan / Accelerator, etc. and other required equipment to run emergency services II Such requirement received from 38 in all hospitals on PPP Model. hospitals shall be scrutinized by the committee to make its recommendation w.r.t. number and type of equipment to be allowed to each hospital, after considering such demand of the hospital as well as average number of patients who will avail such facility, availability of space in hospital, existing number of equipment (functional/non functional ) available with the hospital along with technical staff to operate such existing equipment etc. Such recommendation of the committee will overrule the facts and figures mentioned earlier, if any.
Thereafter, the committee shall visit each hospital with concerned chief engineer PWD, of the concerned Hospital and such Chief engineer PWD (in consultation with other members of the committee) shall identify within the hospital premises the requisite constructed space(without Air-
conditioning, Furniture or any other facilities) depending upon the number of equipment the committee allow to be engaged for such hospitals on outsourcing basis. The concerned chief Engineer PWD shall also prepare layout plan of such space. Detail of such space (Size, Layout plan etc) shall be added in the tender documents informing the prospective bidder that such space would be handed over to the selected service provider on as-is-where is-basis to install the equipment to avoid any difficulty in installation of equipment after completion of tendering process. Finalize the minimum technical specification (including certifications required, if any) for each of such equipment separately, which may be identified using best equipment available, and name of equipment OEMS (at least 3-4) so that the service provider would not be W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 8 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00 able to provide equipment of lower quality/make.
The committee shall provide average useful life of each equipment so that the same may be provided in the tender documents.
The committee shall also provide the eligibility criteria for participation in this tender (such as company, partnership firm/ individual etc, experiencing, turnover, net worth, solvency, etc) as deemed fit.
II. The procurement of equipment on lease or by PPP Model is almost same and the department has decided to procure the High-end equipment on PPP Model.
III. The equipment are procured by the hospitals through GeM as per the GFR the equipment should be procured through GeM and most of the items are available on GeM. This issue, however, will be examined in details and appropriate measures will be taken.
IV. The MS/MDs of the hospitals have full power to procure medicines, consumables and equipment.
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 9 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00
3. Other diagnostic and Laboratory equipment: (3) Other diagnostic and Laboratory equipment Immediate and short-term measures: I. The procurement of equipment on PPP model or leasing models for procuring various PPP Mode as already being equipment like ultrasound machines, dialysis procured in previous paras is under machines, ventilators, lab diagnostic machines, process.
ICU and cardiac monitors, ABG machines, etc. should be done.
4. Medicines and consumables (4) Medicines and consumables I. The hospitals have already been advised Immediate measures: to maintain an inventory of about 2 i. Hospitals should maintain a minimum inventory of two months of the drugs listed in months for drugs, consumables. Regular the essential drug list (EDL) and meetings are also undertaken by the consumables, and should have ready-made concerned Special Secretary to ensure rate contacts to meet up to 50% of the annual their availability in the hospitals. demand so that the tendering process for rate Further, tender for procurement of contracts may be initiated in due time to medicines through CPA has already been ensure that there is secured supply line of floated on the website of NIC and the medicines and consumables for next six months. rate contract for most of the medicines ii. Delegation of financial powers to HoDs will be completed by 15 June, 2024. The (Medical directors or Medical EDL has also being revised by an expert Superintendents) as mentioned above to committee and the same is being maintain at least 25% of required supply and finalized in consultation with experts but inventory at any given time, subject to Rs. 5 in the mean time all the essential drugs crores per annum.
needed in the hospitals, dispensaries and iii. Such delegation of financial powers of Rs. 5 crores per annum to the MS and Directors to Aam Aadmi Mohalla Clinics are being purchase medicines and consumables procured through CPA and the tenders separate from equipment procurement be for the same have been received and is in done to meet the emergency demands shall be the process of finalization so that rate subject to following limits on daily basis, with contract for the medicines could be immediate effect:- finalized.
o For hospital more than 1000 beds Rs.10 lakhs per day (ii - iv). As already states financial powers o For hospital between 501 - 1000 beds have already been delegated to the HODs to Rs.7.5 lakhs per day procure the medicines, consumables and iv. Further delegation of financial powers of Rs. equipment. In fact on the basis of the cabinet 2.5 crores per annum to the MS and Directors decision an order dated 23.03.2022 was to purchase medicines and consumables may issued whereby in relaxation of prevision of be allowed, subject to following limits to meet rule 149 of GFR the medicines were allowed the emergency demands on daily basis, with to be procured from CPA and also from immediate effect:- other sources that is:
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 10 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00 o For hospital between 300 - 500 beds 1. On the basis of the existing Rate Rs.5 lakhs per day and Contract.
o For less than 300 beds 2. If valid rate Contract does not exist, Rs.3 lakhs per day. then procurement may be allowed to be made as per the last expired Rate v. Open Jan Aushadhi Kendras in each Contract of the CPA.
hospital so that medicines may be procured 3. Existing Rate Contract of any from such Jan Aushadi Kendra(s) in Government/Society Hospital under exigencies to avoid any shortage of GNCT of Delhi medicines in the Hospitals. 4. Existing Rate Contract of Central vi. Adequate supply of medicines and Government Hospital consumables should be ensured at primary and 5. Local Purchase Contract of the secondary level of health facilities as well. Hospital.
Short-Intermediate term:
Further, order dated 13.03.2024 was issued, whereby, the emergency i. Adequate and standard pharmacy and procurement of medicines was made easy consumable storage space and facility for the hospitals (copy enclosed).
should be made available on priority basis at all hospitals (Instructions to PWD). v. The Procurement of medicines through a. To implement a system to maintain a 2 Jan Aushadi Kendras and opening of Jan months' inventory of drugs and Aushadi Kendras in hospitals is under consumables in hospitals, with rate process.
contract for six months, to prevent shortages and ensure uninterrupted medical services. vi. The department is making all the efforts to ensure the supply of medicines and b. Adequate supply of medicines and consumables at primary and secondary consumables should be ensured at level of Health facilities also.
primary and secondary level of health facilities as well.
Long-term measures:
i. Central procurement agency (CPA) to be strengthened and made accountable for providing uninterrupted and quality medicines and consumables to all hospitals, dispensaries and other health establishments. ii. The entire system should be brought under e-
governance, through Hospital Management Information System of NIC.W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 11 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:00
4. TOR: 4 To suggest ways and means to maintain functional high-end medical equipment in various hospitals.
Maintenance of high-end equipment Maintenance of High-end equipment i. All equipment should be purchased (i) & (ii). The equipment which will be including five years of comprehensive procured in future by the hospitals will management contract (CMC) with provision be under the extended warranty with of extending CMC for further 5 years. appropriate penalty clauses. Provisions should also be there to extend the CMC till the useful life of the equipment. ii. A penalty clause should be included in the purchase contracts to compensate for the down time, in case the equipment repair is going to take long time. An in-built mechanism of provision for an immediate replacement equipment should be ensured.
5. TOR: 5 To suggest ways and means to reduce the stress on referral hospitals by strengthening the peripheral hospitals located in the various districts of Delhi.
Immediate Measures: Immediate Measures:
15% of the equipment requirements and the man The matter regarding filling up the vacant
power requirements should be met within the next posts by recruiting GDMOs, Specialists,
30 days. Nursing and Para-medical staff on
contractual/outsourced basis has been
processed. The matter is still under
submission.
Short and intermediate term measures:
i. The small hospitals (100 bedded) and
district hospitals are being strengthened
in terms of manpower, equipment, and
Short and intermediate term measures: diagnostic services to provide round the
i. The small hospitals (100 bedded) and district clock emergency services, ICU services
hospitals need to be strengthened in terms of and operation theatre services and
manpower, equipment, and diagnostic maternal & child services.
services to provide round the clock
emergency services, ICU services and ii.
operation theatre services and maternal & a. The matter regarding creation of
child services. Resident Recruitment Cell for
ii. Availability of medicines and consumables smooth recruitment of JR-SRs for
should be ensured at all these hospitals, hospitals under GNCT, Delhi has
including delegating financial powers to the been processed wherein it has been
respective HoDs (MD / MS). proposed to create a centralized
Inter Departmental selection
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 12 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01 a. The Senior Residents from hospitals committee under Dean, MAMC having medical college, may be rotated consisting of representative of to district hospitals for meeting the Services Department also which will immediate need. For this purpose, the conduct centralized interview etc. for Senior Residents posts of smaller selection of JR/SR as per standard hospitals should be pooled with posts of procedure on bi-monthly basis and larger hospitals attached with the deploy the selected candidate to medical colleges for centralized various hospitals as per requisition. engagement. There should be provision Regarding providing in-house lab for selecting non-academic Senior diagnostics services and to Residents through hospital-based strengthen hospitals regarding selection committees to hire residents provision of lab testing a proposal through regular weekly walk-in has been put up with detailed interviews. The Senior Residents should planning regarding development of be rotated to peripheral and district in-house lab testing services within 6 hospitals through a proper roster in a to 7 months. district or zone wise manner. A b. Facilities have already been committee consisting of MD/MS of 3 provided in primary health centers & major hospitals of Delhi, should finalize AAMC. The hospitals have either the process of selection and rotation of these facilities or the service are SRs within the next 2 weeks and report available under DAK. to this Committee.
b. Facilities for blood testing and other standard laboratory and radiological diagnostic facilities should be made available at the primary and secondary health facilities as well. If needed, these services could be outsourced to maintain efficient and uninterrupted service.
6. TOR: 6 To suggest an end-to-end mechanism for ensuring uninterrupted supply of medicines, injections, and consumables in government hospitals. Immediate measures:
i. The CPA has to be strengthened and made i. The strengthening of the CPA has been fully functional immediately to ensure the un- suggested under long term measures by the interrupted supply of medicines and committee under TOR-3. And the same will consumables. (Action pertains to H&FW, be strengthened in the next 3 months. GNCTD) ii. Enhanced delegated financial powers to the ii. As already stated full financial powers MD / MS of the hospitals as explained above, have been delegated to the MS/MDs.
to maintain at least supply of medicines for two months at any given time (Action pertains to GNCTD).
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 13 of 18This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01 iii. Adequate storage space to be made available iii It has suggested that a long term measure on priority basis at all hospitals (action and the same will be implemented pertains to PWD). accordingly.
iv. Open Jan Aushadhi Kendra in each hospital iv. It is a policy decision and the same is so that medicines may be procured from such under process. Jan Aushadi Kendra(s) in exigencies to avoid any shortage of medicines in the Hospitals
7. TOR: 7 To suggest mechanisms to immediately fill the vacant posts of specialists (teaching/ non-
teaching), medical officers and paramedics on contract basis, till regular incumbents join through UPSC/ DSSSB.
Immediate measures:
15% of the vacant posts should be filled The matter regarding filling up the vacant immediately using the following methodologies: posts by recruiting GDMOs, Specialists, i. Existing vacancies of teaching & non- Nursing and Para-medical staff on teaching specialists should be filled up on contractual/outsourced basis has been contract basis or by hiring consultants from processed. The matter is still under the private sector. submission.
ii. The MS and Director of the respective
institutions to be empowered to chair and Regarding issue of Re-distribution of
form a committee for this purpose. The consultants & Hiring/ Empanelment of
committee should be empowered to advertise Consultants from Pvt. Sector, a committee
the vacant posts and conduct interviews for under Chairpersonship of Secretary H&FW
selection of vacant posts. The tenure of the has been constituted comprising the
clinical specialists to be extended till the age following officers:-
of 70 years.
iii. The salary and perks of the contractual staff 1. Dr. S.K. Sareen, Director, ILBS recruited in this manner should be at par with 2. JS/SS (Finance Department) the regular employees. The hospitals can have teaching and non-teaching specialists. 3. JS/SS(Services Department) v. Empanelment of private doctors as part 4. Dr. Anil Aggarwal, MD, GBPH time or full time Visiting Consultants 5. Dean, MAMC especially in radiology, anesthesia, neurosurgery, orthopedics, or any other specialty should be done and the The meeting of the committee was held on emoluments be paid on per patient / 15.05.2024 recommendation will be made in procedure basis. The payments should 3 weeks. be made not lower than the CGHS rates.
Requisite order for constituting the Committee as approved by the Hon'ble L.G has been issued on 13.05.2024 with the following TOR:-W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 14 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01 Short-term and intermediate measures: 1. To examine the requirement of specialists/ Hospital Operational staff in i. The due process of regular selection through various hospitals under H&FW,GNCTD.
UPSC, etc. should be streamlined and 2. Methodology for paying remuneration to expedited. contractual specialists from private ii. Pharmacists and data entry operators: The sector i.e. per case basis/hourly basis/per distribution of medicines in the OPD is patient basis/consolidated/any other severely affected due to shortage of 3. Performance benchmark for these pharmacists and non-computerization of OPD contractual specialists for deciding their registration counters is resulting in long remuneration. queues and discomfort to the patients. Hence, 4. Financial implication/ Budgetary urgent recruitment or outsourcing of data requirements for contractual entry operators is recommended with engagement/ Hospital Operational staff implementation of Hospital Management Information System of NIC. Further the 1st meeting of the Committee has already taken place on 15.05.2024.
iii. Following additional cadres of manpower should be created:
Regarding issue of extension of tenure/ re-
a. Hospital Operations staff - qualified appointment of specialist, the Department hospital administrators, managers, are has recommended that recommended that a essential for hospital operations and committee may be formed under administrative matters, such as Chairmanship of Pr. Secretary(Services) pertaining to the procurement of and matter may be forwarded to Services medicines, equipment, maintenance and Department, GNCTD with request to submit construction of buildings for expansion the recommendation within 02 week time. in the hospital, outsourcing of The proposal is presently under submission.
specialized manpower, coordination
with other authorities, etc. These Regarding issue of extension of tenure/ re-
activities are currently looked after by appointment of specialist, the Department
the senior doctors in the hospital. This has recommended that a committee may be
adversely affects the patient care. formed under Chairmanship of Pr. Secretary
(Services) and matter may be forwarded to
In view of above it is proposed to create Services Department, GNCTD with request
a dedicated post of one to two managers to submit the recommendation within 02
in level 2 & 3 hospitals, and two week time. The proposal is presently under
additional posts of deputy managers in submission.
Level 4 hospitals. Their engagement is
recommended on emergent basis.
b. Resident medical officers (RMOs):
M.B.B.S. with 3 years of experience to
man emergencies, ICUs and other
essential services as RMOs will help
ease the pressure on academic senior
W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 15 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01 residents The RMOs should be paid a salary as per years of service undertaken.
c. Junior Residents: Post MBBS, residents,
can be permitted to work upto 3 years,
to provide continuous service and also
be eligible to become RMOs.
d. Intensivists, phlebotomist,
physiotherapists, etc.
8. TOR: 8 To make any other recommendation that the Committee thinks is fit and proper for the purpose of improving the medical services provided by the hospitals in Delhi to the public at large.
Immediate and Short-term measures: Immediate and Short-term measures:
i. Introduction of Emergency services in the i. Already OM has been issued and private Delhi ArogyaKosh (DAK). A mechanism of hospitals can do the treatment for life on-line approvals for availing DAK facility threatening issues (copy enclosed). within 4 hours of application should be ensured.
ii. Residents of Delhi should be allowed to use ii. The fixation of rate for every services in their Aadhar card in all private hospitals private hospital is a policy matter and it and get cashless facilities at the CGHS rates seems in one of the case Hon'ble SCI has in an emergency situation in any nearby directed GOI to do the same. We may facility. The private hospitals should be await the outcome of the same. asked to give such an undertaking while operating in Delhi.
iii. Dedicated full time MS / Director for all iii.The same is under process. hospitals.
iv. Teaching faculty to provide tele medicine iv. Presently, 22 hospitals have been trained services to the district hospitals. and registered for providing Tele-Medicine services in Delhi through e-Sanjeevani. To review the status and further progress of e-
sanjeevani, a meeting was held under the chairmanship of Spl Secretary (H&FW), GNCTD on 01.05.2024.
It was decided that to improve the status of implementation of e-Sanjeevani (already under implementation through CDAC). A pool of trained MBBS & Specialists doctors W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 16 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01 and their daily roster may be made by Hospital administration so that timely availability of doctors for online tele-
consultation us may be ensured subject to the availability of man power Training and of identified Medical Officers and Specialists for Tele-consultation through CDAC may be facilitated by Delhi State Health Mission.
Mass awareness through IEC in Hospitals
and public health facilities of Delhi by
concerned hospitals for maximum
participation.
Intermediate- Long term measures: Intermediate- Long term measures:
ii. Presently, 22 hospitals have been trained i. NABH accreditation of all Delhi hospitals and registered for providing Tele-Medicine by Dec. 2024. services in Delhi through e-Sanjeevani. To ii. Start Tele- Medicine services. review the status and further progress of e-
sanjeevani, a meeting was held under the iii. Starting of teaching programs (Doctors, chairmanship of Spl Secretary (H&FW), Nurses, Paramedics) at society-based GNCTD on 01.05.2024.
hospitals and district hospitals.
iv. Dedicated Chief Engineer(s) of PWD for It was decided that to improve the status of Delhi hospitals. implementation of e-Sanjeevani (already v. Non-medical HR professionals for running under implementation through CDAC). A ministerial and ancillary services. pool of trained MBBS & Specialists doctors and their daily roster may be made by vi. Yearly enhancement of Delhi Health budget Hospital administration so that timely to meet the growing needs of quality health availability of doctors for online tele- care for Delhi citizens. Opening up of at consultation us may be ensured subject to least one Medical college in every district the availability of man power of Delhi, by converting hospitals with 300 Training and of identified Medical Officers bed capacity to teaching hospitals. and Specialists for Tele-consultation vii. Facilitating the private sector to open through CDAC may be facilitated by Delhi medical college cum specialty hospitals in State Health Mission. Delhi. Mass awareness through IEC in Hospitals and public health facilities of Delhi by viii. Providing at least 5 ACLS ambulances concerned hospitals for maximum round the clock in each district to help the participation. citizens to avail of emergency care. These ambulances should be linked to CCR.
Point i, iii, iv, v, vi, vii and viii is under process.W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 17 of 18
This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01
6. ICU Strengthening: A committee under Dr Deepak Tempe has been constituted to identify the hospitals as per their suitability for different levels of ICU. Further, this would require expansion of existing staff strength and adding new equipment.
Therefore, the process of strengthening will need a detail roadmap which can be acted upon according to a schedule, the same is being devised.
7. It is submitted that Department of Health and Family Welfare has already sent the requisition for 234 posts of GDMOs and 279 posts of Non-teaching Specialist to UPSC on 24.04.2023 and 19.10.2023 respectively. Further Department has also sent the requisition for 1621 Nursing cadre posts and 895 paramedical posts to DSSSB on 12.01.2024. Appointment of Teaching Specialist is made by Govt. of India, Department is filling up these posts on contractual basis for time being. Copy of letter dated 24.04.2023 and 19.10.2023 is annexed herewith and marked as ANNEXURE - D."
2. The Union Public Service Commission (UPSC) and Delhi Subordinate Services Selection Board ('DSSSB') are directed to file their responses to the aforesaid status report within four weeks.
3. Let a copy of the aforesaid status report be placed for consideration and comments before Dr. S.K. Sarin Committee of Doctors constituted by this Court.
4. The counsel for Dr. S.K. Sarin Committee of Doctors states that an additional report shall be furnished by the said Committee to this Court within four weeks.
5. Let the additional report along with the comments of Dr. S.K. Sarin Committee of Doctors to the present status report be filed within four weeks.
6. The GNCTD is directed to file an updated status report before the next date of hearing.
7. List on 29th July, 2024.
ACTING CHIEF JUSTICE MANMEET PRITAM SINGH ARORA, J MAY 24, 2024/msh W.P.(C) 3903/2017 & W.P.(C) 8548/2017 Page 18 of 18 This is a digitally signed order.
The authenticity of the order can be re-verified from Delhi High Court Order Portal by scanning the QR code shown above. The Order is downloaded from the DHC Server on 27/05/2024 at 22:10:01