The Allahabad high court, on Friday, directed the state government to ensure that all government officials and employees, who receive salary or other financial gains from public exchequer, should avail medical care services only from hospitals run and maintained by the government.
The Bench comprising Justice Sudhir Agarwal and Justice Ajit Kumar also directed that such officials should not be given any special treatment at the government hospitals and that in case medical care is obtained from private hospitals, no reimbursement should be provided by the government. It, however, clarified this condition would not apply in cases where requisite treatment is not available at government hospitals.
The Court was hearing two petitions. One had been filed by a woman labourer, Snehlata Singh, who had pleaded for improvement in the miserable conditions at hospitals in the State of UP, highlighting the complications that she had to face due to incompetent maternity care provided at a government hospital.
The second petition was filed by Raj Kumar Singh, a social worker and the editor of a weekly newspaper titled Naha Sandesh. He had sought a direction to the authorities to make it mandatory for all district private hospitals and nursing homes to display qualifications and designation of all para-medical staff. He had further pointed out that hospitals and clinics were undertaking medical termination of pregnancy without being registered under the Medical Termination of Pregnancy Rules, 2003.
While examining the various schemes on the subject, the court noted that more than Rs 3400 crores had been released for the same in the financial year 2016-17. It then observed, “Despite such huge funds if schemes have not properly been carried out and objectives have not been achieved than it can be said to be a sheer wastage of huge public funds. This requires investigation, where these funds have gone and who has pocketed it or why remain unspent if could not be utilized.”
It went on to note with concern several deficiencies in the medical services provided by government hospitals and issued the following directions:
Filling of vacancies
1. Immediate steps shall be taken to fill in existing vacancies of medical, paramedical and other attending staff at various levels in all hospitals maintained by state government through Department of Medical Health and Family Welfare or Medical Education.
2. State government shall ensure the appointment of competent staff by reducing existing vacancies to 50% within four months from the date of communication of this judgement and filling up the remaining vacancies in the next three months.
Supply of necessary equipment
3. Necessary supply of medicines of quality to all medical care centres at different levels must be ensured. Similarly, availability of requisite apparatus, instruments, operation theatres and other medical requirements as per status of medical care centres should be maintained and continuous maintenance should be ensured by constant monitoring by responsible persons and they should be made accountable for any laxity or deficiency in such supply and availability.
Staffing for medical care of women
4. For medical care of women and especially pre-natal and post-natal treatment, lady doctors and supporting lady paramedical and nursing staff should be recruited and their availability be maintained.
Road map for maintaining medical services by the state
5. A roadmap/ action plan should be prepared in consultation with all stakeholders responsible for maintaining medical services by the state so that quality medical treatment is available to poor people in the same manner as it is available to resourceful high officials and rich people, and people do not suffer in the matter of medical care merely on account of poverty, illiteracy and other constraints.
Special audit by CAG within 2 months
6. A sample survey conducted by this court through advocate commissioners demonstrated a large number of apparent mismanagement in hospitals whether maintained by State Medical College at Allahabad or by cadre of provincial medical services. Special audit should be conducted through CAG without any further delay. In this regard, we direct requisite number of specialized audit team having expertise in audit of medical care centres be constituted with request to CAG, within one month from the communication of this judgment. At first instance, medical colleges and hospitals attached to them should be audited. This audit must be completed within two months. This special audit must examine funds made available, their utilization etc. in the last 10 years. If deficiencies, irregularities and illegalities are found, concerned department shall also identify erring officials and would take appropriate stern action against them, whether civil, criminal or departmental, as the case may be, without further delay.
7. After special audit of medical colleges and hospitals attached to them, next audit should be that of district level hospitals, for which also, complete exercise will be done within two months and the deadline shall be adhered to. In the third phase such special audits will take care of the lower level medical care centres i.e. CHCs and PHCs.
8. Entire audit exercise of all levels shall be completed within a year.
9. We may also mention that above special audits shall include an investigation relating to funds made available and expenditure etc. on trauma centres also wherever they have been proposed, functional or under construction.
FIR against State Medical Officers engaging in private practice
10. Director General, Vigilance shall constitute special teams at district level to find out medical officers of the state government who are engaged in private practice or running hospitals, nursing homes or attending and providing treatment to patients in such private hospitals etc. Said teams shall also investigate into cases of radio diagnoses and pathology tests ordered from private institutions and establishments, in case of patients who are under treatment at state medical care centres. Team shall find out reasons for non conduct of radio diagnostic or pathological services in institutions run by the government. Wherever radio diagnosis and pathology tests are found to have been conducted by private hands, encouraged by government medical staff, appropriate action including criminal and departmental shall be taken against them. We direct the competent authority in such matters to proceed with such reports from vigilance and take appropriate action at the earliest. Aforesaid vigilance teams, on finding government medical officers/ officials indulging in private practice, may also register First Information Report against them. Besides, competent authority in the state government shall take appropriate stern action without any further delay besides the recovery of entire non-practicing allowances paid to such violators.
Government officials should avail medical services from government hospitals
11. It shall also be ensured that all government officials and others who received salary or other financial gains from government/ public exchequer, should avail medical care services from hospitals run and maintained by government and whenever any high-level officials, political executives or other dignitaries seek treatment, the medical officer on duty shall attend to him by roster only and there shall be no special VIP treatment. If medical care is obtained in private hospital etc., the government must not reimburse the same. However, if there are some kinds of diseases or ailment, the treatment/ cure whereof is not available in government hospitals, and for that purpose, treatment in private centres becomes necessary, this condition may be relaxed but in such contingency, the government must ensure that if common poor people suffer from similar ailments and diseases, arrangements are made for their treatment in such private medical care centres at government expense.
Separate special CAG audit for irregularities found in hospitals attached to Moti Lal Nehru Medical College
12. With respect to malpractices and irregularities found in sample survey of hospitals attached to Moti Lal Nehru Medical College, Allahabad, we recommend a special vigilance enquiry into the matter as well as a separate special audit of CAG be conducted immediately. Vigilance enquiry shall be conducted by a team constituted by Director General, Vigilance. If the aforesaid special vigilance team finds defalcation of funds etc., appropriate criminal action will be taken besides recommending disciplinary action against erring officials, whereupon, competent authority shall take appropriate disciplinary action.
Effective traffic management for passage of ambulances
13. In the matter of appropriate treatment at trauma centres, the state government shall ensure transportation of patients to trauma centres. One of the important steps which needs to be taken immediate care of is that unobstructed smooth passage is made available to ambulances carrying such patients. This aspect demands effective traffic management on roads and other requisite preparation. In this aspect, we issue the following directions specifically to Principal Secretary Home; Transportation and also Director General of Police, UP :
- Immediate instructions are to be issued to all traffic police personnel in the state to canvass and spread public awareness about regulated parking of vehicles at places meant for them and not parking vehicles on roads and sidewalks, removal of encroachment of all kinds so as to make roads, sidewalks and service lanes clear. This awareness programme should run for a reasonable time but not so long as to frustrate the very purpose. In our view, let this programme be conducted for a period of two months.
- People driving vehicles should be made aware that they should not park vehicles in an indiscreet manner, obstructing free flow of traffic. In no case should a vehicle be parked on the road, sidewalks or service lanes.
- Whenever vehicles are stopped for any reason including traffic signals, people must stop in a single line, ensuring clear passage for ambulances, fire brigades, etc. Any violation should be dealt with strictly by imposing heavy fines on violators.
- After carrying on the above awareness programme for two months, the entire traffic police force, including other police personnel, should ensure clear passage, proper parking of vehicles, non-encroachment of roads etc. and any person violating the same should be fined heavily.
- If any congestion is caused, local traffic police should be held personally responsible and appropriate strict action should be taken against them.
- Any damage suffered by injured/ serious patients due to obstruction in smooth passage for ambulances etc. must be held as a criminal liability, besides civil, of the person(s) creating such obstruction as well as the persons responsible for management of traffic, including traffic police personnel.
- For residential or commercial areas where people when people park their vehicles outside on roads etc. due to non-availability of parking space in their residences or commercial complexes, responsibility shall be fixed upon the residents and persons running commercial activities without providing parking space, by imposing heavy penalty etc.
- Immediate requisite provisions should be made prohibiting registration of auto vehicles unless purchaser has sufficient parking place at their private places. In other words, government should make provisions for restricting the purchase of new vehicles and registration thereof unless person(s) purchasing vehicle have parking place at their residences.
- State government shall also take immediate steps for providing dedicated corridors for movement of vehicles of essential service to honour the fundamental right of patients and injured people to get the fastest medical services and travel on road without any obstructions and also to ensure other essential services are carried out without obstruction. In other words, a dedicated corridor shall be prepared for movement of ambulances carrying patients, which is also a part of trauma care facility. Even otherwise, quick movement of ambulances for timely availability of medical services is fundamental right of patients and healthy people travelling on the road are under an obligation to not create any obstruction for life saving vehicles, like ambulances. A clear passage has to be maintained at any cost.
Special committee for monitoring of services
14. Special committees should be constituted at district and block levels on a permanent basis which may have invite participation of common people and members of society. These committees have to monitor proper functioning of medical care centres in the state for regular availability of requisite instruments, apparatus, medicines, etc. and also effective, careful service to poor patients.
Free food to patients and attendants
15. Free food to patients and their attendants shall also be ensured in all state-run medical care centres so that poor people may not suffer for the want of appropriate diet while undergoing treatment.
No celebration on medical college lawns
16. Fields, lawns, etc., maintained in medical colleges, hospitals attached to medical colleges and other government hospitals should not be allowed to be used for any celebration or function like marriage ceremony, etc. If any staff of the medical establishment is residing on campus, this order will not apply to him but the officer-in-charge shall ensure that music, loud sound, and disturbances are not allowed beyond the prescribed level of noise and there is be no celebration/ disturbance after 10 PM. In no case should such activity be allowed to others.
Bar against unregistered hospitals and clinics undertaking abortions
17. In the matter of medical termination of pregnancy, we direct all Chief Medical Officers in concerned districts to ensure observance and compliance of the Medical Termination of Pregnancy Act, 1971 as amended by Termination of Pregnancy Amendment Act, 2008 and Medical Termination of Pregnancy Rules, 2003. In no case should any unregistered hospital or clinic be allowed to function. Any laxity shall be treated as the personal responsibility of the concerned Chief Medical Officer and he/she will be liable for appropriate action, treating his failure as collusion with erring personnel.
Action against non-utilization of funds
18. State government shall also ensure that in no case funds allocated for Medical Services remain unutilised and not spent. Where there is a violation, persons responsible for non-utilization should be taken to task by taking disciplinary action against them, treating it a serious misconduct. This is because if funds allocated for the welfare of medical services are not spent, it means that requisite service has been denied to that extent.
Action against Principal Secretary for filing false affidavit
[The affidavits had been filed on the functionality of trauma centre at Allahabad Medical College. While the Principal Secretary, Medical Education, Govt. of UP had claimed that the trauma centre has been functional for the last 3-4 years, the same was found to be false by the Court.]19. For filing false affidavit before this Court, we issue notice to Rajneesh Dubey, Principal Secretary, Medical Education, Government of UP, Lucknow, and Dr. S.P. Singh, Principal, Medical College to show cause as to why action for filing false affidavit before this Court, under Section 340 Cr.P.C., and for Criminal Contempt under Contempt of Courts Act, 1971, not be initiated against them. Office shall issue notice and register it separately as Miscellaneous Case.
Clarifications and modification
20. We also make it clear if any authority in the state government finds this order expedient, he/she may approach this Court by filing an application for clarification/ modification of this order wherever and whenever required for effective compliance of directions given above.
Compliance reports after the expiry of 6 months
21. Chief Secretary, UP, Lucknow, is directed to ensure supervision and compliance to the above orders. He shall collect information from all responsible secretaries and heads of departments and submit report of action taken, first phase, within one week of expiry of six month period. For perusal of such report, matter shall be listed before the Court on 25.9.2018.
This article was originally published on LiveLaw