New Delhi: For the last several weeks, the Uttar Pradesh government has been trying to file a petition in the Supreme Court, seeking an ex parte injunction on an Allahabad high court judgement prescribing a massive overhaul and audit of the state’s public health system.
While this petition has not been admitted yet, it has come up in the apex court thrice. The Wire has studied a copy of it along with other affidavits filed by the Adityanath-led UP government.
The state is contesting a remarkable March judgement of the Allahabad high court, which was notable for its wide range of directions and its attention to detail. The court had demands ranging from several audits of the state’s health expenses and provision of free food to patients and their attendants, to ensuring free passage to ambulances.
The court also directed that government employees should use public health facilities and that their expenses at private facilities should not be reimbursed by the government.
At the Supreme Court, Justice Ashok Bhushan had recused himself at the first hearing. Since then, the state of UP has not yet been granted the injunction. The state has also been seeking an ex parte injunction, which means they want the Allahabad high court judgement stayed, but without the Supreme Court summoning the litigants who had asked the high court for these healthcare reforms.
The UP government’s anxiety towards this judgement appears to stem from fact that the high court had issued a show-cause notice to the state, demanding to know why a case of criminal contempt for filing a false affidavit should not be made out against the state’s principal secretary for medical education, Rajneesh Dubey, and the principal of a government medical college in Allahabad (Moti Lal Nehru Medical College).
It is uncommon for senior civil servants to be pulled up in this manner at high courts for mismanagement of policy and funds. Apart from the hard work involved in implementing the court’s detailed order (21 directions), the matter of falsifying affidavits will leave the government in a very awkward position.
Thus, in UP government’s attempt to get a stay on this judgement, which implicates one of their senior officers, it has said the high court has “erred in issuing notice” to Dubey. They said it is “not possible” to do an audit of the last ten years’ financial transactions in the health system. They also repeatedly stated that the petitioner herself had not asked for these wide-reaching public reforms and accountability which the court has called for, and as such, the high court was not allowed to go “beyond the pleadings”.
Interestingly, the high court gave no relief to the petitioner herself but only ordered for these wider public reforms. It is also interesting to note that the high court order left its doors open for the state government but the state has chosen to not take up this offer: “wherever any authority in state government if finds expedient, may approach this court by filing an application for clarification/modification of this order…”
The case of Sneh Lata Singh’s pregnancy
The judgement in question was passed by the Allahabad high court in March 2018 on the petition of a woman named Sneh Lata Singh from a low-income family in UP. The woman had delivered her seventh child in February 2007 and for months after that, she faced a continuous discharge of urine and visited at least ten hospitals, including government ones, for treatment. She also reached out to government officials such as the district magistrate and the state’s chief medical officer.
Her family was borrowing money, even amounts as small as Rs 250, to meet her needs. Government officials allegedly behaved harshly with her through this ordeal.
In October 2007, she was finally diagnosed at the well-known King George Medical College, Lucknow (KGMU) but was told there was no bed available to admit her for a surgery. Five months later, in February 2008, KGMU finally had a bed for her. This was a whole one year after she had delivered her baby and had first experienced the discharge of continuous urine. After the surgery, it two another two months for KGMU to find the time to remove the catheters that were in her body.
Sneh Lata had approached the high court with a public interest litigation (PIL) seeking some personal relief (Rs 50,000 as reimbursement and Rs 5 lakh as compensation), but mostly seeking changes in the public health infrastructure of the state.
“Ensure that all poor women coming for treatment in respect of a maternal health condition are compressively taken care of by the state free of cost irrespective of the treatment,” was one of her eight prayers to the court. She also asked that the National Rural Health Service Guarantee be strictly implemented for antenatal, delivery and postnatal care. She asked that in all primary health centres, community health centres and district hospitals, women be provided all the records of their treatment. Lastly, she asked that a grievance redressal mechanism be set up and an audit of maternal deaths done.
Allahabad high court’s overhaul of UP’s healthcare
The 96-page order from the court was decided by a two-judge bench comprising Justices Sudhir Agarwal and Ajit Kumar.
Seven pages of the order are simply directions to the UP government, comprising 21 directions with many sub-parts.
The bulk of the 96 pages contains data covering everything from vacancies in government hospitals and medical colleges to utilisation of funds in UP’s health system.
The order directs that quality medical treatment be made “available to poor people in the same manner as it is available to resourceful high officials and rich people, and people may not suffer in the manner of medical care merely on account of their poverty, illiteracy and other constraints.”
Some of the directions ordered by the Allahabad high court include:
- Show-cause notice to be issued to the principal secretary for medical education and principal of MLN medical college for filing false affidavits in the high court.
- All government officials should avail medical treatment only at government hospitals, with “no special VIP treatment.” Their expenses in private hospitals should not be reimbursed by the government.
- Government should ensure that funds are not unutilised. Disciplinary action should be taken against those responsible for non-utilisation because if funds are not spent, “it means that requisite service to that extent has been denied.”
- Audits to be done by the Comptroller and Auditor General (CAG) of medical colleges and hospitals within two months. The audits should examine funds and utilisation of the last ten years. Civil, criminal or departmental action would be taken against erring officials.
- Audits should also be done of district hospitals, community health centres and primary health centres. All audits to be completed in one year.
- All vacancies in government hospitals must be filled within seven months of the judgement.
- Female doctors and support staff should be hired for maternal care of women.
- Government doctors who also run a private practice, as well as the trend of government doctors referring patients to private institutes for doing radiodiagnosis and pathology tests, have to be investigated.
- Medical officers need to monitor abortions. Unregistered hospitals should not be allowed to carry out abortions. Medical officers will be liable for failure and for collusion in this area.
- Quality medicines, apparatus and operation theatres must be maintained.
- Traffic management needs to be improved so that ambulances have a smooth passage. Unregulated parking and encroachment needs to be cleared. Citizens should be regulated while buying new vehicles if they have not organised parking for these vehicles at their residence.
- Patients and their attendants should be given free food.
- Lawns in medical colleges and hospitals should not be used for any functions such as marriages. There should be no loud celebration after 10 pm.
- The chief secretary of UP is to monitor this entire process and submit a report on action taken, within six months.