Ensuring Medical Facilities in Govt Hospitals Constitutional Obligation of State, Courts can intervene if neglected: HC

Chennai: The Madras High Court bench recently observed that the State Government was constitutionally obligated to ensure the availability of medical facilities in government hospitals and make such facilities available to the underprivileged citizens of the country.

Further, the HC bench comprising Justices MS Ramesh and AD Maria Clete noted that when the State would neglect such obligations, the Court had authority under Article 226 of the Constitution of India to issue positive directions for such provisions.

"On an overall appraisal of all the decisions of the Hon'ble Supreme Court, we have no difficulty in holding that the provision of a medical facility in the Government Hospitals, so as to reach the poor, downtrodden and underprivileged citizens of the society, is a constitutional obligation of the State and when such facilities are neglected by the State Government, this Court would be well within its powers under Article 226 of the Constitution of India to issue positive directions for such provisions," observed the High Court bench.

These observations were made by the High Court bench while considering the public interest litigations regarding the absence of guidelines in respect of standards of medical and infrastructural facilities available in the Government Hospitals and for the establishment of Bone Marrow Transplantation facilities in government hospitals.

In their pleas, the petitioners informed the High Court that apart from the Rajiv Gandhi General Hospital, Chennai, the Institute of Child Health and Hospital for Children in Egmore, and the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), no other government hospitals in the State had facilities for free bone marrow transplant.

The petitioners further pointed out that the Bone Marrow Transplant procedure is used to treat rare medical conditions, and it involves a huge expenditure. They submitted that since the facilities were available only in Chennai, people from the southern districts of the State had to face hardship to avail of this facility.

Meanwhile, the Additional Advocate General relied on the status report filed by the Directorate of Medical Education which said that the total estimated cost for Civil Structure, Equipment, and Staff sanctioning would be Rs 13,52,76,000 and the Annual Expenditure for the medical and non-medical staff would be an additional sum of Rs 3,63,76,000.

Further, the AAG informed that the equipment for blood bank, oncopathology, etc. would cost Rs 4,99,00,000. It was further submitted that the medical officers were also deputed from Dindigul and Madurai for a three-month training programme.

He also added that the Medical Officers in the rank of Professor from Government Medical College, Dindigul and two Associate Professors from Madurai Medical College have been deputed to undergo the Bone Marrow Training Programme at ICHHC, Chennai. However, the AAG submitted that the estimated cost for the proposal for Civil Structure, Equipment and Human Resource for establishment of BMT at Government Rajaji Hospital, Madurai is subject to the approval of the Government.

Apart from this, the AAG also informed the Court that the State was not in a position to give a probable time limit for such establishment of the facility, since it involves the policy decision of the Government.

After taking note of the submissions, the Court noted that even though the State report began with a positive note, the rider that the proposals as well as time-limit were the policy decision of the government was not appreciable.

The HC bench noted that there was no dispute regarding the fact that apart from RGGH and ICHHC at Chennai, no other Government Hospital, within the State of Tamil Nadu, had the facility to provide free BMT procedure.

"In the status report dated 30.09.2024, the Government have set out a proposal submitted by the Dean, Government Rajaji Hospital, Madurai and have estimated the proposal for civil structure, equipments and human resource for establishment of BMT in Government Rajaji Hospital, Madurai at Rs. 13.53 crores. The facility of BMT requires to be extended to atleast one General Hospital in each district, by taking into account the unavailability of such a facility in any of the districts, except Chennai. The Government shall take into consideration all the imminent and crucial medical procedures, which have been deprived to the poor and underprivileged section of the public in the remotest districts and shall endeavour to extend the facilities at the earliest," observed the Court.

It was observed by the HC bench that the Director of Medical Education had come out with a proposal with estimation for extending the BMT facility at the Government Rajaji Hospital, Madurai. Accordingly, the bench held that "Now that the Director of Medical Education has come out with a proposal with estimation for extending the BMT facility at the Government Rajaji Hospital, Madurai, the Principal Secretary, Health and Family Welfare Department, Government of Tamil Nadu, shall consider the proposal, extracted in their status report dated 30.09.2024 and allocate the necessary funds at the earliest, in any event, within a period of three months from the date of receipt of a copy of this order."

Regarding the prayer for framing necessary guidelines in respect of the Standards of medical and infrastructural facilities in all the Government Hospitals, the Court noted that the High Court, through an interim order dated 17.06.2019, had constituted a three-member committee to conduct an inspection as to the availability of basic infrastructures and maintenance of the hospitals in a neat and tidy sanitary condition and also as to the availability of adequate manpower with the basic functions.

The Court observed that after the interim order, the committee had visited the Government Hospitals at Srivilliputhur, Ramanathapuram, and Paramakudi and through their report dated 22.07.2019, it proposed certain recommendations for improving these hospitals.

"However, several years have lapsed, since the inspection was conducted and it would not be conducive to act upon the suggestions and recommendations made by the Committee," noted the Court.

Taking note of this, the bench granted liberty to the petitioner to make a representation to the authorities for framing of guidelines, touching upon the standards of medical and infrastructural facilities in the Government Hospitals with a consequential direction to the Government to consider the same, to secure the ends of justice.

Accordingly, the bench issued the following directions:

(a) the respondents shall allocate the necessary funds for civil structure, equipments and human resource for establishment of BMT facility at Government Rajaji Hospital, Madurai, within a period of three months from the date of receipt of a copy of this order.

(b) on such allocation of funds, the respondents shall ensure that the facility of BMT is established at Government Rajaji Hospital, Madurai, within a period of six months from the date of allocation of the funds.

(c) the petitioners herein are granted liberty to make an appropriate representation to the respondents, seeking for framing of suitable guidelines, in respect of the standards of medical and infrastructural facilities in all the Government Hospitals in the State of Tamil Nadu and on receipt of the same, the Principal Secretary, Health and Family Welfare Department, Government of Tamil Nadu, shall consider it and pass suitable orders in accordance with law, within a period of three months from the date of receipt of such representation

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/gurushankar-v-the-chief-secretary-597259-284579.pdf

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