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SC summons senior bureaucrats of 28 states, UTs over casualness on ICU guideline
The Supreme Court has directed them to remain personally present with a response on why action not be taken against them for such a casual approach
The Supreme Court on Monday summoned senior bureaucrats of 28 states and union territories for showing casual indifference to a court order requiring them to frame guidelines for treatment of patients admitted in ICU and CCU across all hospitals by October 5.
With the deadline having expired and several states found to have either not filed any response or having belatedly submitted report, a bench of justices Ahsanuddin Amanullah and N Kotiswar Singh said, “It is now time for the court to take serious cognisance of such casualness shown by states.”
The bench issued notice to the additional chief secretary or the senior most officer handling the Health portfolio in the defaulting states and directed them to remain personally present with a response on why “action not be taken against them for such a casual approach”. The bench posted the matter on November 20 and said, “If there is non-compliance or casual compliance by the next date, the court will take a strict view against such states and its officers.”
Additional solicitor general (ASG) Aishwarya Bhati appearing for the Centre informed the court that pursuant to the last order of September 18, the states/UTs of Gujarat, Jharkhand, Madhya Pradesh, Mizoram, Arunachal Pradesh, Odisha, Rajasthan, Sikkim, Tamil Nadu, Uttarakhand, West Bengal, Delhi , Jammu & Kashmir, Ladakh, Chandigarh, Lakshadweep, Andaman and Nicobar Islands, and Dadra & Nagar Havelli and Daman and Diu have not filed any responses.
She further pointed out that most states had filed their responses beyond the cutoff date of October 5 giving a list of 28 such states and UTs which defaulted on filing a response or those which failed to submit affidavit within the October 5 deadline.
The court had directed the states to submit their responses to a three-member committee comprising ASG Bhati, advocate Karan Bharioke appearing as amicus curiae, and AIIMS doctor Nitish Naik, who were asked to compile a report based on the responses received.
On Monday, the team informed the court that the guidelines for comprehensive admission, treatment and discharge from Intensive Care Units (ICU)/Critical Care Units (CCU) in the health sector was not possible till all states submit responses.
On August 19, the top court had noted that though Model ICU/CCU guidelines have been prepared by the Centre in 2023, the same could not be implemented unless the states give their suggestions and adopt similar guidelines as health being a state subject.
The order passed by the court on August 19 required every state to identify yardsticks that are universal in application and peculiar to the needs of the hospitals catering to the requirements of the local populace or specific to the medical condition concerned. To identify these factors, the court directed the state/UT authorities to hold deliberation with all stakeholders, including private hospitals by convening state-level regional conferences.
The aim of the conference should be to formulate a minimum Standardised Procedure for operating ICUs/CCUs within the state/UT, as well as determining the grade of ICUs/CCUs required, based on the hospital’s capacity and patient volume, the court order said.
The states/UTs were further directed to lay down the basic norms relating to infrastructure/logistical support, quality of service, competence/qualification of personnel including doctors, nurses and paramedic staff, hygiene, etc. “The focus of the entire exercise should be to come up with a module which enables efficient decision-making and effective monitoring of patients in ICUs/CCUs,” the court held.
The order was passed in a 2015 petition arising out of a medical negligence case emanating from the national consumer court. The case before the consumer court was filed by Asit Baran Mondal seeking compensation for the death of his wife in a Kolkata hospital in 2013 due to alleged medical negligence.
In a detailed order passed in August 2016, the top court observed that the medical negligence is writ large in a number of private hospitals and there is neither any guidelines for treatment of the patients in the ICU/CCU, nor proper care at the stage of operation or post operational stage.
Following this order, the Centre in 2023 constituted a committee led by the director General of health services (DGHS) with specific terms of reference to “prepare guidelines for admission to ICUs, CCUs and palliative care required for non-salvageable patients if removed from the ventilator and criteria for withdrawal of treatment”. Several experts contributed to this exercise that led to the Model Guidelines taking shape in September 2023.
