IN RE : THE PROPER TREATMENT OF COVID 19 PATIENTS AND DIGNIFIED HANDLING OF DEAD BODIES IN THE HOSPITALS ETC. versus RE: on 19 June 2020

O R D E R

1. This Court issued notice on 12.06.2020 in this Suo Motu writpetition with object to notice deficiencies, shortcomings and lapses inpatient care of Covid-19 in different hospitals in National Capital Territoryof Delhi and other States. The object was to take remedial action by allconcerned to redeem the plight of patients and other persons who needsmedical care.

2. In response to notice dated 12.06.2020, Union of India, DelhiGovernment and other States have filed their affidavits. Severalapplications for intervention have also been filed by different individuals,organisations highlighting one or other aspects of the issue.

3. The Union of India in its affidavit after noticing the aberration,which were highlighted by the Court in its order, have brought on therecord remedial steps taken by Union of India. The affidavit mentionsthat on 14.06.2020, a high-level meeting was held by Hon’ble HomeMinister with Lieutenant Governor of Delhi, Chief Minister of Delhi,Union Health Minister, Health Minister of Delhi, Mayors andCommissioners of Delhi’s three Municipal Corporations to strengthenthe strategy to fight the coronavirus. The affidavit enumerates certainaction points which have emerged in the deliberation. In paragraph 13 ofthe affidavit, decision taken by the Union of India have been referred to.We may notice only few of such decisions which need to be specificallynoticed. In paragraph 13(ii), following has been stated:-

“13. (ii) It has been further decided that a team of senior doctorsfrom Central Government Hospitals in Delhi, GNCTD Hospitals,Municipal Hospitals and AIIMS shall visit all hospitals in Delhi,within 2 days, to study the arrangements made for patient careand treatment and suggest improvements to be done. Theresponsibility for implementation of the said decision has beengiven to the Union Health Secretary to coordinate with ChiefSecretary, GNCTD and Director, AIIMS, who would ensureimplementation of the said decision.”

4. In paragraph 13(iv), decision regarding increase of the testingper day in NCT of Delhi has been mentioned. It has been stated that by20.06.2020, the tests shall be increased up to 18,000 per day. The decision A

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Aalso refers to the constitution of the Committee of Dr. V.K. Paul, Member,NITI Aayog, representative of the AIIMS and representative of GNCTDwho has to report regarding reasonable rates of various covid relatedfacilities/tests etc. for private hospitals, labs.

5. We have come to know that the rates of the tests to be conductedBin the private labs is substantially reduced by the Government of Indiafor which orders have also been issued. The affidavit also gives detailsof guidelines framed by the Union of India to ensure proper treatment ofCovid-19 patients and dignified handling of the dead bodies in the hospitalsas well as the guidelines framed by the Union of India pertaining toCovid-19 hospital management.C

6. In paragraph 18, it has been stated that strict observance andadherence of guidelines shall be ensured. One of the guidelines, whoseadherence was to be ensured, was that the patients are provided withthe bed and are permitted to have one attendant and the attendant canremain in the hospital premises in the area earmarked by the hospitalDand no suspected Covid-19 patients shall be turned away from the hospitaland details of indoor facilities and advisory for OPD has also been noticed.

7. The Government of NCT, Delhi has also filed affidavit of Smt.Padmini Singla, Secretary, Health and Family Welfare, Government ofNCT of Delhi. Although affidavit gives the details of the GovernmentEhospitals of Delhi, Government designated Covid hospitals, name of anIAS officer who was deployed as a nodal officer in all Covid designatedhospitals to monitor and supervise various aspects and functioning of thehospitals, providing for 24x7 Help desk at each hospital along with displayboard/LED Screen to inform the availability of beds to the general public,Fdetails of available manpower in LNJP hospital, details of public sectorlabs and private sector labs. The affidavit also noticed the decision takenin the meeting chaired by Hon’ble Home Minister on 14.06.2020 toincrease the testing facility in Delhi.

8. We, however, noticed that in the entire affidavit, apart fromGgeneral statement that all steps are being taken, the affidavit does notindicate any mechanism for proper supervision of the functioning of thehospital and steps for improvement. The affidavit tries to give animpression to the Court that everything in the Government hospital inNCT, Delhi is well and all steps are being taken by the Government ofNCT of Delhi. When the Government does not endeavour to know anyHshortcomings or lapses in its hospitals and patient care, the chances of remedial action and improvement becomes dim. Every organisation, everyindividual should be more than ready to know about shortcomings, lapsesand it is only after knowing one’s shortcomings and deficiencies, remedialactions can be taken.

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9. We impress upon Government of NCT of Delhi to be morevigilant in knowing about the deficiency and lapses in functioning of thehospitals and patients care and take immediate & remedial steps toredeem the miseries of patients, the public who needs medical care andhelp.

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10. The necessary guidelines on all aspects of patients’ care,hospital management, testing, infrastructure are in place as has beenhighlighted by Union of India in its affidavit. The main concern is thefaithful and strict implementation of the said guidelines which can beonly ensured by constant supervision, monitoring and taking remedialsteps with regard to improvement of infrastructure, staff, facilities, etc.The most important aspect is continuous supervision and monitoring ofGovernment hospital in Government of NCT of Delhi and other States.

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11. As noted above, in the meeting dated 14.06.2020 chaired byHon’ble Home Minister, one of the decisions taken was that a team ofsenior doctors from Central Government hospitals in Delhi, GNCTDhospitals, Municipal hospitals and AIIMS shall visit all hospitals in Delhi.One visit in all hospitals of Delhi is not enough. There has to be constantmonitoring, supervision and management.

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12. We with the object of continuous supervision and monitoringof government hospitals, Covid dedicated hospitals and other hospitalstaking care of covid management issue following directions Nos.(I) to(IV):- F

(I) The Ministry of Health and Family Welfare, Union of India,shall constitute Expert Committees consisting of:

a) Senior Doctors from Central Government hospitals in Delhi,

b) Doctors from GNCTD hospitals or other hospitals of DelhiGGovernment,

c) Doctors from All India Institute of Medical Sciences,

d) Responsible officer from Ministry of Health and FamilyWelfare.

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A(II) The Expert Committee shall inspect, supervise and issuenecessary directions to all Government hospitals, Covid hospitals andother hospitals in NCT of Delhi taking care of Covid patients; The ExpertCommittees shall ensure that at least one visit in each hospital be doneweekly.B(III) The above team may in addition to normal inspection shall B(III) The above team may in addition to normal inspection shallalso conduct surprise visits to assess the preparedness of the hospitals.The expert team as indicated above after visiting may issue necessaryinstructions for improvement to the hospital concerned and also forwardits report to the Government of NCT of Delhi and the Union of India,Ministry of Health and Family Welfare.C

(IV) We further direct that all States shall also constitute an expertteam of Doctors and other experts for inspection, supervision andguidance of Government hospitals and other hospitals dedicated to Covid-19 in each State who may inspect, supervise the hospitals in the Stateand issue necessary directions for the improvement to the concernedDhospital and report to the Government. Chief Secretary of each Stateshall ensure that such Committees are immediately constituted and starttheir works within a period of seven days.

13. An affidavit has also been filed by Director, LNJP hospital,Government of NCT of Delhi, where in paragraph 4, it has been statedEthat CCTV Cameras have been installed in all the wards. The installationof CCTV Cameras in all the wards is a welcome step which shall notonly help the hospital management to immediately find out the requirementof proper care with regard to patients admitted in the wards but alsoensure transparency in the patients care in the hospital. In this regard,Fwe issue following directions as direction Nos. (V) to (VII):

(V) Footage from the CCTV Cameras shall be made available bythe hospitals in NCT of Delhi to the inspecting/supervising expert teamor to any other authority or body as per directions of the Union of India,Ministry of Health and Family Welfare for screening the footage andGissuing necessary directions thereon.

(VI) In Government hospitals of GNCT, Delhi which are Coviddedicated hospitals, where CCTV cameras have not been installed, stepsshall be taken to install CCTV Cameras in the wards.

(VII) The Chief Secretaries of other States shall also take stepsHregarding installation of CCTV Cameras in Covid dedicated hospitals where Covid patients are taking treatment to facilitate the managementof such patients and for the screening of the footage by designatedauthorities or bodies so that remedial action may be suggested andensured.

14. We have noticed above that one of the guidelines by the Unionof India is to permit one attendant of covid-19 patient. In this regard, weissue following directions as direction No. (VIII) and (IX):-

(VIII) All Covid-dedicated hospitals shall permit one willingattendant of the patient in the hospital premise, who can remainin an area earmarked by the hospital.

(IX)All Covid dedicated hospitals shall create a helpdeskaccessible physically as well as by telephone from where wellbeing of patients admitted in the hospitals can be enquired.

15. In the supplementary affidavit dated 17.06.2020 filed on behalfof the Union of India, details of Covid-19 patients discharge policy ofUnion of India has been given. Copy of the revised discharge policy forCovid-19 dated 08.05.2020 has also been brought on the record. Therevised policy dated 08.05.2020 brought on record does not indicate thatnecessary directions have been issued to all States/Union Territories tocommunicate it to the concerned dedicated Covid hospitals and otherhospitals to uniformly follow the discharge policy. We are of the viewthat discharge policy framed by the Union of India has to be followed byall States/Union Territories uniformly to ensure discharge of the Covidpatients uniformly and to achieve clarity in the minds of all concerned.We, thus, issue following direction in this regard:-

(X) The Union of India, Ministry of Home Affairs may issueappropriate directions in exercise of power under DisasterManagement Act, 2005 to all States/Union Territories touniformly follow the revised discharge policy dated 08.05.2020with regard to discharge of different categories of patients ascategorised in the revised discharge policy.

16. We, in our order dated 12.06.2020 has observed:- “We impress upon the States to ensure that there should be steepincrease in the testing both by Government hospitals and privatelabs and whosoever desires for testing should not be denied onany technical ground or any other ground…………….”

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A17. We have also noticed in this order that Union of India hasconstituted a Committee of Dr. V.K. Paul, Member, NITI Aayog,representative of the AIIMS and representative of GNCTD who has toreport regarding reasonable rates of various Covid related facilities/testsetc. Government of India on the basis of a report from the said Committeehas already taken a decision for reducing the amount of test in the NCTBDelhi. The Union of India may consider issuing uniform directions to allthe States and Union Territories with regard to reasonable rates of variousCovid related facilities/test for private hospitals/labs, which may be madeapplicable across the country. If any variations to be made with regardto any particular State/Union Territory, the same shall be specificallyCprovided for in the guidelines. We, thus, issue following direction in thisregard:-

(XI) The Union of India may issue appropriate guidelines/directionsto all the States/Union Territories with regard to prescribing reasonablerates of various Covid related facilities/test etc., which need to beDuniformly followed by all concerned. In case, with regard to any particularState/Union Territory, there is any difference, the same may bespecifically noticed and directed accordingly.

I.A Nos.55935 & 55936 of 2020

18. Learned counsel for the applicant submits that the State ofEMaharashtra has issued an order that a positive report of the patientshall not be given to the patient or the relatives of the patient.

19. Mr. Tushar Mehta, learned Solicitor General conceded thatwhen a report of the patient is positive, the same shall be given to thepatient or his relatives.F

20. We have no doubt that the States and all concerned shallsupply a copy of the report of the patient to him or his relatives and thehospital.

21. A copy of the applications may also be given to the learnedSolicitor General as well as learned counsel for the State of Maharashtra.G

22. Learned counsel for the State of Maharashtra submits thatthe State of Maharashtra has already fixed the rate of testing asRs.2200/- and Rs.2800/-, which we feel is welcome to step-up the numberof testing in the State of Maharashtra. He further submits that everyday more than 16000 tests are conducted in the State of Maharashtra.H

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Learned counsel for the State of Maharashtra submits that he shall obtaininstructions regarding non-giving of the report to the patient or hisrelatives. He shall advise the State to issue an appropriate order permittinghanding of the report to the patient or his relatives and the hospital.

23. Learned counsel for various intervenors have submitted thattheir several suggestions have been included in the interventionapplications. Learned counsel appearing for the intervenors may give acopy of the suggestions in writing to the learned Solicitor General aswell as to learned counsel for the respective States for appropriateconsideration.

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24. A question was posed to Shri Sanjay Jain, learned AdditionalCSolicitor General appearing for the Delhi Government about the statusof construction of second trauma centre at Dwarka out of Rupees SixtyCrores deposited as a fine by the Ansal Brothers (Rupees Thirty Croreseach) in Uphaar Cinema fire tragedy case – Criminal Appeal No. 597-598 of 2010 vide this Court’s order dated 22.09.2015. Shri Sanjay JainDsubmitted that he will get back on this on the next date of hearing.

25. List the matter in third week of July, 2020.

Divya Pandey

Directions issued.

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