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"His main problems are alcoholic liver cirrhosis and portal hypertension complicated by esophageal varices. He has had two life threatening hemorrhages from the varices (Ist episode on 8/8/92) in the last three years which were managed by I/v somatostain and Endoscopic Sclerotherapy. These episodes were complicated by liver failure.
Presently he is on a chronic sclerotherapy program which includes three monthly endoscopic reviews with variceal sclerotherapy and continuous maintenance therapy on Tab Propanolol 40 mg. bd. He will need to have lifelong maintenance treatment to avoid another bleeding episode. The only other alternative is Surgery.
43. There is no doubt that in jail some of the inmates feign illness in order to get some special treatment or be sent to an outside hospital but a competent doctor should be able to find out the actual ailment especially when he is being informed. Dr. Venkatsubbaiah was a medical officer posted in the Central Jail. He got his M.B.B.S. degree from Andhra Pradesh in the year 1982 and had an experience of about 12/13 years in the medical field. As such he is expected to know the seriousness of the problem with which Mr. Rajan Pillai was suffering.

66. The various High Courts in the country have also dealt with cases of negligence of prison authorities and reiterated the need to safeguard the rights of jail inmates. The decisions include Lawyer's Forum for Human Rights v. State of West Bengal 1997 CriLJ 1762, Rasikbhai Ramsing Rana v. State of Gujarat 1998 CriLJ 1347, Akshay Pratap Singh alias Gopal Ji v. State of Uttar Pradesh (2003) 3 ACR 2925 and P Bharathi v. Union Territory of Pondicherry 2007 CriLJ 1413. This High Court in Court on its own motion v. State [Crl. Ref. No. 1/2007 and Crl. M.A. No. 7030/2007, order dated 22nd August 2007] took note of the problem of overcrowding and the resultant violation of rights of the inmates, including the inadequacy of medical care available, and passed detailed directions to address the problem. In Court on its own motion v. State of NCT of Delhi [W.P. (Crl) 201 of 2009, order dated 27th October 2010] a Division Bench of this Court took up the case of 16 terminally ill patients lodged in the Tihar Jail. The Court directed that terminally ill patients may be exempted from personal appearance under Section 317(1) Code of Criminal Procedure, 1973 (CrPC), a separate trial may be held for them in terms of Section 317(2) CrPC or prosecution may be withdrawn all together for a terminally ill undertrial in terms of Section 321 CrPC. In Charanjit Singh and National Human Rights Commission v. State [decision dated 4th March 2005 in CrlW Nos. 729/2002 and 1278/2004], this Court empahsised the need to sensitively deal with mentally ill prisoners and address their need for special psychiatric care.

72. With Tihar Jail itself being the focus of cases in the Supreme Court and this Court, some of which have been discussed earlier, there can be no excuse for not having the best possible medical treatment available in the jail complex. Every decision of the Court concerning the conditions of the jail should have been seen as an opportunity to improve the conditions. However, the LSCI found that there was much to be desired as regards the availability of minimum standard of care and treatment in Tihar Jail. The LSCI also highlighted the serious problem of under-staffing of medical personnel and orderlies. This problem persists even today. "The Annual Review of Delhi Prisons" of the Tihar Jail („AR‟) 2011 published by the GNCTD claims a low mortality rate with only 15 (out of a total prison population of 10,856) deaths recorded in 2010. In 2009, 15 (out of 11,246) deaths have been recorded. While the figure is 13 (out of 11,553) for 2008. The AR 2011 claims that "(l)ow mortality rate is achieved by special health care shown to the sick and old prisoners and better medical attention to the inmates." The need for better medical facilities also comes from the fact that, as the AR 2011 itself notes, "(m)ost of the prisoners come from the low economic strata of society and are already suffering from various kinds of diseases." The AR notes that the problem of overcrowding persists. Even the last year (2010) in the nine central jails at Tihar and the District Jail, Rohini, the occupancy was 174%. Approximately 77% of the prison population on 31st December 2010 comprised of undertrial inmates.