Reasonable Remdesivir Distribution Policy Needed, Sensitize & Educate Public To Break COVID Chain: Gujarat High Court To State Govt

COVID19 : Gujarat High Court Directs State To Submit District Wise Split-Up Of Testing Facilities, Respond To Concerns That Patients In Private Vehicles Are Denied Admission In Hospitals

Importantly, the Government Pleader assured the Court that the State would leave no stone unturned and do its best in order to serve the people of the State in these difficult times in the best possible manner.

The issue concerning procurement, supply, and distribution of Remdesivir injection

The Court flagged concerns regarding the procurement, supply and distribution of Remdesivir injection apart from the protocol of its use, application, and administration.

The State submitted before the Court that there was a shortage vis-a-vis the demand and that, despite the best efforts being made by the State, Remdesivir injection was still in short supply.

The state further submitted that the available Remdesivir injection with the State was first administered to: -

• The patients on ventilators in the hospitals of the Corporation or Government hospitals, then,
• To the patients on ventilators in the Designated Covid Hospitals, then,
• To the patients admitted on ICU in Government / Corporation hospitals and then,
• To the similar patients in the Covid Designated Hospitals and thereafter,
• To the patients on oxygen beds subject to their prognosis and,
• If there still remains further stock with the Government/Corporation, it would be distributed to the private hospitals, Nursing Homes/Home Care on doctor's prescription considering the condition of the patient.

However, the Court noted that if the Government does not have any surplus or if it is unable to cater to its own in-house demand, it cannot provide it to the private sector.

It was also the case of the Government that Remdesivir injections were available with the stockists of the manufacturers from where private hospitals and individuals could always purchase.

To this submission of the State, the Court said,

"The policy should be of the Government and should not be left at the discretion of the individual Corporation and District Collectors regarding distribution of Remdesivir injection when the same is in short supply."

Importantly, the Court said,

"There has to be a reasonable policy of the State taking into consideration the overall factors and to ensure that all patients falling in the same category should be first administered or provided with Remdesivir injection i.e. the patients on ventilators whether they are in private or Government set up / facility, then it should be provided to patients on ICUs in private or Government set up / facility and thereafter to patients on oxygen depending upon the period they have been on oxygen and thereafter other patients who are advised Remdesivir. The condition of the patient should be the criteria for providing Remdesivir injection and not whether he/she is admitted in private or Government facility."

Further, the Principal Secretary, Department of Health and Family Welfare, Government of Gujarat, were directed to convene an emergent meeting of all stake-holders and take an appropriate policy decision which should run throughout the State.

"It should be made applicable for the entire State and should not be left at the discretion of Municipal Commissioners or Collectors as the case may be", added the Court.

The Court also observed that the distribution may be at the level of the Commissioner or Collector, but the policy to be followed must be framed by the State.

Court's other observations

In view of the rising number of Covid patients, the Court noted that the availability of Covid beds in the hospitals whether Government, Corporation or Designated private, was not enough to accommodate every person who is tested positive, however the Court did observe that a large number of Covid infected persons are being treated at home.

Insofar as supply of oxygen was concerned, the Court referred to the data provided by the State in its affidavit-in-reply to note that there was no shortage of oxygen for medical use and even though there is any shortage, the same is being actively augmented to cater to the additional demands.

In addition to the above, the Court asked the State to respond to the following: -

• Registration of patients through Ambulance 108,
• The time being taken in picking up a patient from the time the call is registered,
• The system/modalities through which the registration and the picking up is carried out, as there are some complaints that seriousness of the patient is not a criteria for giving preference and it is only on the basis of first come first serve basis that under the present dispensation of 108 Ambulance, the patients are picked up.

Another issue which the Court flagged was that only through Ambulance 108, patients are admitted in the Designated hospitals and further that 108 Ambulance picks up patients only from home/residence but not from any Nursing Home or hospital if the patient is otherwise admitted and later turns into a Covid patient.

The Court noted that the Patients being brought in private cars howsoever much critical they may be, are not admitted by the designated hospitals even though beds are available.

The Court has asked the State to respond to these aforesaid issues as well.

Lastly, the HC asked the Government to seriously address and to sensitize and educate the public at large which may break the chain and ultimately result in stabilizing the increase in numbers, flattening the curve and thereafter move towards decline.

Importantly, the Court said,

"Whatever instructions the Government feels are appropriate as per the advice and protocol of the international and the national-level decisions should be widely publisized and circulated through print, social, electronic and digital media."

The matter has been directed to be listed again on 27^th April 2021 and by the evening of 26.04.2021, the State has been directed to file its further status affidavit.