Madhya Pradesh High Court
Smt. Kamini Singh vs The State Of Madhya Pradesh Thr on 25 April, 2019
1 W.P. No.3871/16 (PIL)
High Court of Madhya Pradesh
Bench at Gwalior
DIVISION BENCH : Hon.Shri Justice Sanjay Yadav &
Hon.Shri Justice Vivek Agarwal
W.P. No.3871/16 (PIL)
Smt. Kamini Singh ......Petitioner
Vs.
State of M.P. & Ors. .....Respondents
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Shri D.P.Singh, learned counsel for the petitioner.
Shri Ankur Mody, learned Additional Advocate General for
respondents/State.
Shri Ravindra Dixit, learned counsel for respondent No.4.
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Whether approved for Reporting :
ORDER
(Passed on this 25th day of April, 2019) Per Justice Vivek Agarwal :
This writ petition in the form of Public Interest Litigation has been filed by the petitioner being a local resident of Gwalior and a public spirited citizen highlighting the woes of the patients, local residents and other visitors on account of pollution in the hospital campus namely Kamlaraje Hospital, Gwalior, and unhygienic atmosphere in the hospital campus inviting serious diseases.
2. It is petitioner's contention that despite taking this issue with 2 W.P. No.3871/16 (PIL) the authorities in the form of representations, no response has been solicited though such representations are being made since 2014 and copies of some of them have been enclosed as Annexure P/1. The pathetic condition of the hospital campus has been tried to be highlighted through certain photographs as are contained in Annexure P/2. It is submitted that because of such unhygienic condition prevailing in hospital campus, petitioner has been forced to file this petition in the public interest seeking relief in the nature of direction to the respondents to take cognizance of the complaint made by the petitioner and maintain hygienic environment/ pollution free atmosphere in the hospital. It is also submitted that respondent No.1 be also directed to investigate the matter in view of the complaint made by the petitioner so as to take necessary steps to protect the life and health of the patients/ care takers in the interest of public at large.
3. Return has been filed on behalf of respondents No.1 to 3 and 5 & 6 i.e. the authorities of the State and the Hospital wherein it is mentioned that petitioner has highlighted the problem of leakage of sewer in the hospital premises vide her complaint addressed to the Dean and Superintendent of J.A. Hospital. As petitioner is a resident of premises adjacent to the boundary wall of the hospital, therefore, petitioner in the name of public interest litigation is trying to settle her personal scores. It is also submitted that after adverting to the complaint made by the petitioner, 3 W.P. No.3871/16 (PIL) damaged sewer line has been duly repaired and at present no such inconvenience is being faced by any of the patients in the hospital campus or the residents of nearby areas.
4. It is also submitted that as regards allegation of not maintaining sanitation and hygiene is concerned, the management of hospital and its functionaries are well aware and cautious enough to take all possible measures in order to maintain hygiene and cleanliness but the flow of patients in hospital is so high that at times it becomes difficult to maintain cleanliness. It is also mentioned in the return that maintenance of hygiene and cleanliness has been outsourced to a private company which is working in accordance with notified standards for treatment and disposal of bio-medical waste and thus the contention of the petitioner is misconceived and deserves to be rejected. A copy of agreement with one M/s. Davis Surgico of Delhi has been enclosed as Annexure R/1. It is also submitted that without the support of public, maintenance of hygiene and aseptic condition is not possible. It is also submitted that maintaining hygiene and cleanliness is a ongoing process and cannot be decided on the basis of a single day observation. This reply is supported by affidavit of one Dr. Rita Mishra, Medical Officer, Jaya Arogya Hospital (JAH).
5. Respondent No.4/Municipal Corporation, Gwalior, has also filed a separate reply. It is highlighted in their reply that 4 W.P. No.3871/16 (PIL) respondents No.5 and 6 i.e. the authorities of J.A. Groups of Hospitals and Kamlaraje Hospital being part of it, are having their staff/ sweepers and man power for resolving the problems of cleanliness of drainage system and sewer problem in the hospital campus. However, respondent No.4 has already cleansed most of the areas of JA Group of Hospitals by removing garbage through JCB machine. It is alleged that petitioner never approached respondent No.4 and respondent No.4 being a law abiding institution is having highest regard to the verdict of this Hon'ble Court and is duty bound to provide clean atmosphere to the public.
6. Another status report has been filed by the hospital administration alongwith authorities of the State on 27.1.2019 mentioning therein that due to over rush and flood of patients and the fact that it is the only tertiary level Medical College/ Govt. Hospital in the entire division of Chambal, Sagar and Gwalior from where medical facilities are being provided to adjoining districts of UP like Etawah, Urai, Jalon of UP and Dholpur of Rajasthan, the management and administration do face some difficulty at times to manage the affairs in respect of cleanliness and hygiene. It is also mentioned that under the PPP model (Public Private Partnership) an agreement has been executed with one HITES company (HLL Infra Tech Services Ltd.) which will be responsible to provide following services and facilities :
"*housekeeping including sanitation and waste collection;5 W.P. No.3871/16 (PIL)
*Security Services;
*Hospital support services such as Nursing orderlies, Ward Boys & other group of employees (2nd phase);
* Operation of Central Window registration; * Operation of Central sterile services department (CSSD) (2nd phase);
* Maintenance of Existing Horticulture (2 nd phase);
* Laundry Management (2nd phase);
*Food and Beverage Management (2nd phase);
* Operation & Maintenance of Electro Mechanical Installations (2nd phase);
* Operation & Maintenance of Fire detection & suppression system (2nd phase);
*Operation & Maintenance of STP/WTP/Water supply system (2nd phase);
* AMCs of utility equipment (2nd phase)."
and has enclosed such agreement as Annexure A/1.
7. It is also mentioned that staff of about 260 employees is deployed to support maintenance of cleanliness and hygiene within the premises of J.A. Group of Hospital besides taking the assistance from the Municipal Corporation and Public Works Department. It is also mentioned that for the purpose of disposal of bio-medical waste, efficient and high quality of incinerator is installed within the premises whereby bio-medical waste is being disposed of and a copy of photograph to show cleanliness in various wards and the premises in support of their claim is enclosed.
8. It is also mentioned that there is daily OPD of 1500+ patients but due to constant in flow of attendants with the patients, to maintain 100% cleanliness and hygiene is a tough task and 6 W.P. No.3871/16 (PIL) basic lack of awareness and civic sense is the major obstacle faced in the maintenance of cleanliness and hygiene.
9. Not satisfied with the reply filed by the State Government and other instrumentalies, we had requested learned Additional Advocate General, to pay a visit to the J.A. Hospital campus and satisfy himself as to the efforts being made to maintain hygienic condition in the hospital and suggest measures which may be fruitful so to improve situation in future.
10. Learned Additional Advocate General after visiting said hospital has furnished a report wherein it is mentioned that JAH Campus comprises of :
"(a) Madhav Dispensary (OPD and-32 beds
Casualty)
(b) Trauma Centre -38 beds
(c) Ophthalmology and forensics medicine -60 beds
(d) Jaya Arogya Hospital for males -368 beds (Medicine, Surgery Orthopedics, E& T)
(e) ICU unit -20 beds
(f) Burn unit -20 beds
(g) Cardiac unit (new building) -34 beds
(h) Neurosurgery and Neurology -107 beds
(i) Cancer unit -32 beds
(j) Isolation ward (TB and others) -63 beds
(k) Kamla Raje Hospital (KRH) for females -591 beds (Gynic, Pedeat., Medicine, Surgery, Ortho, E& T)
(l) Postmortem Total beds 1365 = beds"
11. It is mentioned that infrastructure is about 70 years old and was initially conceived to support a population of 2-3 lacs but it is now catering to the need of population of more than 15 lacs, and 7 W.P. No.3871/16 (PIL) therefore, the increasing pressure of incoming patients is accommodated by using corridors and other open spaces in the hospital where patients are provided with mattress to lay around in the open spaces. It is also mentioned in the report that hospital has engaged a third party agency namely HITES for the purpose of cleaning etc. so to support Nurses and Ward Boys in various jobs including housekeeping and as per the agreement such third party has engaged 86 personnel in one shift of 8 hours for the purpose of housekeeping. It is also submitted that there is shortage of Nursing staff on account of various factors like taking of Child Care Leave or EL etc. and effectively there is one Nurse on every 20 beds.
12. It is mentioned in the report itself that the areas of trouble are cleanliness in wards due to inadequate infrastructural facility in Trauma Center and in KRH to support increasing footfall of patients resulting in cramming of space posing challenge to maintenance of hygiene.
13. The report suggests certain remedial measures like putting of display board in every ward displaying the name of the Head of the Department and the concerned persons from the agency assigned to that ward alongwith their contact numbers with further instructions to the Head of Department to give a verification report under his signature confirming maintenance of hygiene and cleanliness in the ward on daily basis.
14. It is also pointed out that main cause of large number of 8 W.P. No.3871/16 (PIL) footfall is that every patient is usually accompanied by 4-5 attendants although as per norms, entry of attendants accompanying patients, is checked by issuance of gate pass which permits only two attendants per patients but attendants are gaining entry by managing to smuggle out gate pass to outside campus, to the waiting visitors. It is also mentioned that sewage line often gets chocked due to lack of cooperation from PWD (Public Works Department) of the State and sewage water overflows and spreads around in the toilets and even in the compound adjoining the hospital. It is also resulting in spreading of dirty water puddles which is a serious threat to epidemic. Therefore, it is suggested that Public Works Department be directed to dedicate adequate number of plumbing staff for JAH campus 24x 7 directly reporting to the Dean of the Hospital.
15. As regards bio-waste disposal, it is mentioned that the agency which has been deployed for the job of disposal of bio- waste seems to have failed to do it neatly and the area around the incinerator which is within the hospital campus is littered with bio-medical waste. It is further mentioned that area is not only utterly unhygienic but an open invitation to serious epidemics. As a remedial measures, it is suggested that either incinerator be moved out of hospital campus to a distant place and the bio-waste be lifted from the hospital and disposed of outside the hospital campus where incinerator is placed or in the alternative the agency 9 W.P. No.3871/16 (PIL) responsible for disposing of bio-waste be subjected to heavy penalty. It is pointed out that these remedial measures have been suggested after due consultations with the Dean and a doctor from E & T Department. Again this report is supported by few photographs to highlight the issues mentioned in the report requiring urgent remedial measures.
16. Learned counsel for the petitioner was also called upon to file his objections/suggestion/road map over the report submitted by learned Additional Advocate General on 15.3.2019.
17. Petitioner has filed objections and suggestions to the alternatives submitted by learned Additional Advocate General after consultation with the Dean and another Doctor and has highlighted the requirements of the hospital by enclosing copy of National Guidelines for Clean Hospitals, 2015 popularly know as 'Kayakalp', issued by the Ministry of Health and Family Welfare, Government of India.
18. Before adverting to these guidelines, two suggestions which have been mentioned by the petitioner in her affidavit (paragraph
6) needs to be highlighted, namely, providing for waiting rooms and other facilities for the attendants of the patients, specially the indoor patients and channelization of the patients in the hierarchy of District Hospital and Civil Dispensaries to reduce the load on the existing infrastructure of the Medical College and attached hospital.
10 W.P. No.3871/16 (PIL)
19. In our opinion, these are very positive suggestions. If District Hospital & Civil Dispensaries are properly and adequately manned, pathology and other diagnostic tests are made available coupled with adequate supply of pharmacy, then reduction in load of patients may be achieved. For this, authorities of Public Health and Family Welfare Department of the State are directed to take appropriate steps to achieve target of such decentralization within a period of three months or say by 15 th July, 2019. In other words, the State of Madhya Pradesh and its functionaries shall not only endeavour to upgrade the infrastructure of the District Hospital and Civil Dispensaries, but also the manpower including Specialists, Doctors, Paramedical staff and the supportive staff within said period and report compliance.
20. As per the scheme Kayakalp, available to tertiary care hospitals detailed guidelines have been provided for housekeeping, maintenance of hospital infrastructure and sanitation which includes organization of sanitation department, cleaning by health care organization, besides risk categorization of hospital areas. It also provides for standard operating procedure for cleaning including prescription for use of cleaning agents, disinfectants, equipment used for cleaning, treatment of bio- medical waste, pest control so also occupational health and safety aspects. It also provides for additional considerations like cleaning of food preparation areas, construction and containment, 11 W.P. No.3871/16 (PIL) environmental cleaning following flooding and use of evolving technologies. These guidelines already exist and are to be applied in the true spirit of things.
21. After going through the record and hearing the arguments, we are of the opinion that the biggest hindrance in maintaining clean ambiance, be a hospital premises or any other public place, is public participation. There are plethora of laws, rules, regulations and procedures providing guidelines for handling of various kinds of waste like the Municipal Solid Wastes (Management and Handling) Rules, 2000, Bio-Medical Waste (Management and Handling) Rules, 1998, the Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008, the Plastics Waste (Management and Handling) Rules 2011 etc.
22. To enlist the participation of the public there exists Samitis like Rogi Kalyan Samiti (RKS) in every hospitals i.e. Patient Welfare Committee which were introduced in 2005 under the National Rural Health Mission (NRHM) as a forum to improve the functioning and service provision in public health facilities by increasing participation and enhanced accountability with the object to hold the hospital administration and management accountable for ensuring access to equitable, high quality services with minimal financial hardship to service users. The committee is not expected to run the day to day administrative functions of the 12 W.P. No.3871/16 (PIL) hospital and it is also not concerned with management of clinical services but has to play a supportive and complementary role to the hospital administration in ensuring the provision of universal, equitable and high quality services, and in ensuring support services in addition to holding the administration accountable keeping the centrality of patient welfare in mind. The objectives with which these committees are formulated are to :-
"1. Serve as a consultative body to enable active citizen participation for the improvement of patient care and welfare in health facilities.
2. Ensure that essentially no user fees or charges are levied for treatment related to care in pregnancy, delivery, family planning, postpartum period, newborn and care during infancy, or related to childhood malnutrition, national disease control programmes such as Tuberculosis, Malaria, HIV/AIDS, etc. and other government funded programmes which are provided as assurance or service guarantees to those accessing public sector health facilities.
3. Decide on the user fee structure for outpatient and inpatient treatment, which should be displayed in a public place and be set at rates which are minimal and do not become financial barrier to accessing healthcare.
4. Ensure that those patients who are Below Poverty Line, vulnerable and marginalized groups and other groups as may be decided by the state government, do not incur any financial hardship for their treatment, and create mechanisms to cover part/full costs related to transport, diet, and stay of attendant.
5. Develop mechanisms to guard against denial of care to any patient who does not have the ability to pay, especially for services that are being provided at the government's expense.
6. Ensure provision of all non-clinical services and processes such as provisioning of safe drinking water, diet, litter free premises, clean toilets, clean linen, help desks, support for navigation, comfortable, patient waiting halls, security, clear signage systems, and prominent display of Citizens' 13 W.P. No.3871/16 (PIL) Charter,
7. Ensure availability of essential drugs and diagnostics, and use of standard treatment protocols/standard operating procedures, patient safety, effective mechanisms for maintaining patient records, periodic review of medical care/deaths,
8. The RKS, as a part of the endeavour to enable assured health services to all who seek services in the government health facility will allow the hospital in charge to procure essential drugs/ diagnostics not available in the health facility out of the RKS funds. Such local purchases must be made only as a short term interim measure. The Executive Committee will review such purchases in each meeting and ensure that the rationale for the purchase is justified and that this is not undertaken repeatedly.
9. Promote a culture of user-friendly behaviour amongst service providers and hospital staff for improved patient welfare, responsiveness and satisfaction through inter-alia organizing training/ orientation/ sensitisation workshops periodically.
10. Operationalize a Grievance Redressal Mechanism including a prominent display of the "Charter of Patient Rights " (Annexure I) in the Health facility and address complaints promptly thus building confidence of people in the public health facilities.
11. Create mechanisms for enabling feedback from patients, at least at the time of discharge and take timely and appropriate action on such feedback.
12. Undertake special measures to reach the unreached / disadvantaged groups e.g. Campaigns to increase awareness about services available in the facility.
13. Ensure overall facility maintenance to ensure that the facility conforms/aspires to conform to the Indian Public Health Standards (IPHS).
14. Supervise, maintain, and enable expansion of hospital building for efficient and rational use and management of hospital land and buildings.
15. Facilitate the operationalization of National and State Health programmes as appropriate for the level of the facility.
16. Proactively seek out participation from charitable and religious institutions, community organisations, corporates for cleanliness and upkeep of the facility.14 W.P. No.3871/16 (PIL)
17. Facilitate participation and contribution from the community in cash/kind (drugs/ equipment/diet), labour including free professional services.
23. Therefore, the focus is to be primarily placed on such Samitis and if they are strengthened and have proper voice in the affairs of the hospitals, then several woes can be addressed specially most of the problems either of sanitation or of clean environment or one of proper medical facilities with proper positive mind set of different stakeholders. Objectives of these RKS deal with patients' rights but if they can include their duties as well, then it will help in securing better and efficient services.
24. The first and foremost suggestion which has been given is to devise a mechanism to reduce avoidable footfall in the hospital. In this regard, though a pass system is in vogue permitting only two attendants per indoor patient but there is no mechanism to check and control number of attendants per outdoor patient. As per the estimation, there are about 2,000/- outdoor patient per day visiting a Government Hospital like Medical College. If they are accompanied by two attendants, then the footfall will be of 6,000/- visitors which causes undue stress on the available infrastructure, specially when there is a diversity in the level of education and sensitivity towards cleanliness and hygiene looking to the diversity of our culture and ethos.
25. Therefore, there should be a de-centralized computer registration system at the entry gate of the hospital which may 15 W.P. No.3871/16 (PIL) provide access to only those outdoor patients who need treatment and taking a broad view of the condition of the patient may or may not allow an attendant to accompany such patient.
26. For the indoor patient also the number of visitors and the visiting hours needs to be strictly monitored and for this there has to be a continuous general awareness campaign by various stakeholders including Rogi Kalyan Samiti and if need being, cooperation of other NGO may be enlisted working in the field of health care so that a message may be spread that it is in the interest and well being of the patient that aseptic conditions are maintained in the hospital. For that, initially some extra security may be required but once people start accepting this system of restricted entry, is for benefit of their own patient, it may lead to a voluntary compliance on a future date.
27. Aseptic condition does not restrict to maintenance of proper sanitation but also includes stopping of exchange of septic material through contact, out breath etc. There should be a provision for sanitizing chamber through which every visitor should necessarily pass as a result of which he may be disinfected to the extent possible so that contamination of micro organism reaching to the patient, hospital equipment, hospital staff and operation theater can be reduced.
28. The breaches which have occurred in the boundary wall of hospital campus needs to be checked, repaired and maintained so 16 W.P. No.3871/16 (PIL) that hospital campus can be prevented from becoming a breeding ground for unsocial elements and stray animals. Another way of reducing the load on the existing infrastructure can be managing OPD and linked medicines disbursement facility in two or three shifts for which additional staffing will be required to be done, but that will help in more efficient utilization of existing infrastructure. This will help in distributing and dispersing the load of patients over a wider spread of time and will not only help the patients with convenience of time to choose but will also reduce the pressure on the existing infrastructure.
29. Photographs which have been enclosed by different stakeholders in this petition also highlight the problems of maintenance of linen, food being prepared by attendants at various places leaving burnt woods/dried cow dung cakes. For this purpose, looking to the fact that India is still a developing country and there are vast difference in the socio- economic strata of people usually visiting Government Hospitals and generally they are from under privileged section, administration should provide for de- centralized kitchens at multiple locations in the hospital which may be to begin with at least in four different localities of the hospital campus looking to the area of spread of the hospital where cooking gas may be made available alongwith cooking utensils which may be provided to the attendants to carry out their cooking on payment of nominal amount if it is not feasible to 17 W.P. No.3871/16 (PIL) provide it free of cost. This caveat of providing it on a nominal cost if not feasible to provide it free of cost is because under the Indian conditions, general tendency is to opt for easy way, rather than complying with the rules and regulations.
30. If food grains from PDS can be arranged specially 4-5 items like lentils, wheat flour, Dalia, Sugar/ jaggery, salt, Poha (pounded paddy), rice, then that can be issued to the concerned beneficiary on a nominal price. This will reduce the load of unscrupulous use of polyethylene etc. in which such things are brought to the hospital campus. These kitchens can be attached to dining area that will further prevent generation of food waste at different localities.
31. The food waste collected from dining area if channelized with the help of non-governmental organization can help in creating a system of creation of bio-gas which can be utilized for running of such kitchens and this will create a sustainable inter- dependent system of food chain.
32. The experience of hospital either as a patient or attendant to the patient or staff of the hospital administration or as a general visitor is that lavatories are not cleaned at such frequency so to keep it hygienic. For this, besides understanding the requirement of human body to excrete in normal circumstances, requirements of certain departments like pediatrics, gynecology, nephrology and diabetes (endocrinology) are to be understood and special care 18 W.P. No.3871/16 (PIL) needs to be taken in designing and maintaining public lavatories in such wards. The general experience coming from public is that there is extra pressure on lavatories in such wards. Taking into consideration commonality of human response cycle, pressure on such lavatories is very high in the morning hours of the day and many of the old and infirm or helpless patients are not able to exercise continence causing septic condition. Taking this aspect into consideration, hospital administration can think of providing facilities on the pattern of Sulabh Sauchalaya at public places in the hospital campus for the outdoor patient, attendants of the patients etc. including hospital staff. They should plan for providing adequate water and plumbing facility in each of these toilets with dedicated staff under direct supervision of matron/in- charge of the ward reporting directly to the Head of the Department so to take appropriate remedial measures. If there exists or not, Public Works Department should have one dedicated sub-division in the hospital campus specially dedicated to the needs of plumbing and sanitation. In this regard, provision for urine and stool pots to the critically ill patients or the patients in Gynecology ward and pediatric ward may help in reducing creation of septic condition and they can be asked to discharge such fecal material at appropriate discharge center or may be permitted to avail services of ward sweeper on payment of a nominal cost which can be worked out on per day basis or per 19 W.P. No.3871/16 (PIL) transaction basis in the wisdom and practicability of hospital administration.
33. Conversion of existing toilets into bio-toilets with the help of Scientists of DRDO, who have developed this facility at Gwalior and have propagated its use in public sector entities like Railways, quite successfully, will also be a progressive step in reducing congestion in the sewer lines and conversion of fecal material into biodegradable mass resulting in not only reduction of volume but also freeing it from several foul and polluted elements. In fact, this can be used as an opportunity to convert waste into bio fertilizer which can be utilized for maintaining green cover of the hospital. More number of toilets may be provided in Gynecology ward of KRH hospital taking into consideration the medical requirements of such patients, rather than following a common pattern across all the departments of the hospital. Such efforts can also be supplemented by providing mobile toilets with the assistance of Municipal Corporation to reduce load on existing infrastructure.
34. It will also be a feasible idea to provide some Imprest at the disposal of the Head of the Departments of each of the departments for maintenance of cleanliness, hygiene and aseptic condition in their departments to be utilized internally through their own resources which will help in promoting better cleanliness in the hospital.
20 W.P. No.3871/16 (PIL)
35. It has come on record that the incinerator functioning in the hospital is also a source of pollution. Immediately steps be taken to make strict compliance of the provisions contained in the Bio- Medical Waste (Management and Handling) Rules, 1998. Hospital Administration will also be obliged to make strict compliance of Rule 10 & 11 of these Rules.
36. It has been submitted by learned Additional Advocate General that cleanliness of the hospital has been outsourced. It is to be ensured that cleaning is done in dividing a day in four quarters of a day as per schedule. The responsibility of monitoring this may be fixed at each department level and the outsourced agency will have to ensure compliance. This will also decentralize and make monitoring more effective and easier. There has to be e- attendance model for the employees of such outsourcing agency based on retina detection or thumb impression detection so that it is ensured that number of people contracted are actually available in the hospital campus for discharging the work for which contract has been outsourced. Similarly, with the help of Rogi Kalyan Samiti, Superintendent of the Hospital should ensure that equipment, machinery and man power is actually deployed as per the scheme of deployment for which periodic check can be arranged by a team of monitors so to ascertain that delegatees perform their delegated work with devotion and diligence.
37. The outsourcing agency be made to adopt e-attendance 21 W.P. No.3871/16 (PIL) model and it should be mandatory for the outsourcing agency to fill in necessary information as to the task assigned and task achieved by its man power for a given day. This will help in understanding the gap between the task assigned and task achieved which can be bridged through proper administrative measures.
38. The Hospital campus needs to be made more technology friendly and surveillance can be achieved through installation of CCTV cameras. This will help in achieving the object of not only maintaining cleanliness but if required to punish the delinquent as a last resort. We emphasize that punishment, be it financial or corporal, will be used as a last resort in the chain of compliance.
39. Hospital administration with the help of Rogi Kalyan Samiti shall earmark areas for plantation in the hospital campus which may be developed as green lungs of the hospital campus with the help of patients and their relatives. We suggest that once these areas are earmarked and fenced, then with the help of Forest Department under their social forestry programme a nursery can be attached to the hospital campus from where attendants or patients can obtain necessary plants and plant them in designated area so that with the participation of the people green lungs of the hospital are developed which will act as bio reservoir of the campus in future.
40. After devoting sufficient consideration to the maintenance 22 W.P. No.3871/16 (PIL) of hospital environment, it is now time to look inwards. Biggest challenge faced today by the hospitals world around is maintenance of aseptic condition in operation theater, wards and keep their equipment sterile because there is high recurrence of cross infections/trauma post surgery and said infections resulting in mortality or delayed recovery. To achieve this goal, periodic sterilization under 3rd party supervision be developed. Dates of disinfection be notified and such schedule be followed regularly.
41. The theory of deterrence that has been developed from the work of Hobbes, Beccaria and Bentham relies on three components: severity, certainty and celerity. According to deterrence theory, people are most likely to be dissuaded from committing a crime/nuisance/offence if the punishment is swift, certain & severe. In the present context-two elements viz., certainty and promptness can bring about a transformation through a higher rate of compliance.
42. When these factors and programmes are run in coordination with all stakeholders, then it will be appropriate for some periodic introspection on the part of management and take it as an opportunity for some proactive thinking. SWOT (Strength, Weakness, Opportunity, Threat Analysis) to attain a goal of hygienic and pollution free campus within a given time frame of one year can help in achieving better results.
43. This scheme requires sustained endeavour and effort on the 23 W.P. No.3871/16 (PIL) part of all the stakeholders. Therefore, statistical and management tools like path evaluation and review technique (PERT) can also be used so that persons responsible for implementation of the programme can check for themselves as to at which place more efforts are required to push the resources to achieve ultimate object.
44. At the cost of repetition, it is once again reiterated that peoples participation and an endeavour to gain such participation leads to better results than punishment, and therefore, instead of applying the principle of 'polluter must pay' a modified version can be implemented i.e. polluter must clean in the first instance, that may help in achieving better goals.
45. Accordingly, this petition is disposed of with following directions:-
(i) The State and its functionaries shall take all steps to equip all their hospital campus in such a manner that there will be regulated entry in terms of the discussion and details provided above.
(ii) The State of Madhya Pradesh and its functionaries shall make all endeavour to upgrade the infrastructure of the District Hospital and Civil Dispensaries and shall also provide adequate manpower including Specialists, Doctors, Paramedical staff and the supportive staff by 15th July, 2019.
(iii) Necessary steps will be taken by the State and its functionaries to strengthen Rogi Kalyan Samitis.24 W.P. No.3871/16 (PIL)
(iv) The Hospital administration shall take necessary steps to reduce avoidable footfalls in the hospital in terms of paragraph 25 and 26 of the order.
(v) Necessary provision for sanitizing chambers be made by the hospital administration before permitting any person in the ICUs or areas attached to the operation theater.
(vi) The breaches in the boundary wall of the hospital campus be checked, repaired and maintained.
(vii) Necessary steps be taken to manage OPD and linked pharmacy disbursement facility in two or three shifts in such a manner to reduce load on the hospital infrastructure.
(viii)Necessary steps be taken to provide decentralized kitchens in the hospital as per paragraph 29 of the order, so also food grains from PDS on nominal payment so to avoid pollution in the campus.
(ix) Necessary steps be also taken to use the food waste for creation of bio-gas & it be utilized for the purposes of cooking etc.
(x) Proper arrangements for cleaning of lavatories be made by the hospital administration and cleaning of lavatories be done in such a schedule that in every two hours they are cleaned by dedicated staff for such purpose and necessary steps for conversion of existing toilets into bio-toilets with the help of Scientists of DRDO be also taken. Needless to say that there should be adequate arrangements for water in the lavatories.
(xi) Hospital administration to provide facilities on the pattern of Sulabh Sauchalay at public places in the hospital and to consider to make a provision for additional lavatories taking into account specific needs 25 W.P. No.3871/16 (PIL) of certain departments of the hospital like pediatrics, gynecology, nephrology and diabetes (endocrinology).
(xii) Public Works Department shall make available a sub-
division in the hospital campus, specially dedicated to the needs of plumbing and sanitation.
(xiii) The State of Madhya Pradesh and its functionaries shall take necessary steps to provide some Imprest at the disposal of the Head of the Department of each of the departments for maintenance of cleanliness in their departments to be carried out in addition to general cleaning through their own resources of manpower.
(xiv) Hospital administration shall make strict compliance of Rule 10 & 11 of Bio-Medical Waste (Management and Handling) Rules, 1998.
(xv) The outsourcing agency be made to adopt e-attendance model and it should be made mandatory for the outsourcing agency to fill in necessary information as to the task assigned and task achieved by its man power for a given day and display it at prominent places in the hospital campus.
(xvi) CCTV cameras be installed in the hospital campus. (xvii)Hospital administration with the help of Rogi Kalyan Samiti shall earmark areas for plantation in the hospital campus which may be developed as green lungs of the hospital campus with the help of patients and their relatives.
In above terms, petition is disposed of. However, a quarterly compliance report be furnished by the respondents and for reporting such first compliance, list this matter on 1st August, 2019.
(Sanjay Yadav) (Vivek Agarwal)
Judge Judge
ms/-
MADHU SOODAN PRASAD
2019.04.25 18:41:24 -07'00'