Provide 10,000 Vials Of Remdesivir To Nagpur District By 8 PM Tonight : Bombay High Court

The division bench of Justices SB Shukre and SM Modak, hearing a Suo Motu Public Interest Litigation said, there has been a disparity in the distribution of Remdesivir amongst various districts in and around Nagpur, and the drugs ain't released in proportion to the requirement, but perhaps by considering factors which may not be relevant to the whole issue.

After it was pointed out to the bench that there may be a law and order situation owing to the non-availability of drugs, the Court directed the Commissioner of Police, Nagpur, to identify these hotspots, outside hospitals or supply centers for oxygen and drugs, and provide protection accordingly.

Regarding the shortage of Oxygen in the Nagpur district, the Bench ordered the State and the Nagpur Municipal Commissioner(NMC) to immediately grant necessary permissions to private hospitals, which are interested in setting up oxygen generation units.

Additionally, the Court has held that the supply of food to Covid patients is also an Essential Service, therefore home deliveries through food aggregators should be permitted beyond the 8 pm deadline, till the hour of the night prescribed under the Shops and Establishments Act.

The Bench was hearing a 2020 Suo Motu PIL, initiated soon after the Covid- 19 pandemic to deal with the pandemic situation in and around Nagpur. Last week the court issued several pertinent directions on Covid- 19 related issues.

Earlier during the hearing, Advocate Tushar Mandlekar, appearing on behalf of intervenor Dr. Shishir Kolhe pointed out that on April 16, the Thane Collector provided 5328 vials of Remdesivir, against 2664 Covid beds in the district, while merely 3326 vials were provided by Nagpur's Collector on the same day despite 8250 Covid- 19 beds.

"Here is a discriminatory practice by the state government," he alleged.

The Bench observed that this statistic shows some arbitrariness in the district-wise distribution of Remdesivir vials by the State and this is required to be stopped forthwith.

"The State Committee must ensure a fair and proportionate distribution of Remdesivir vials by following the principle that where the requirement is higher, the supply shall also be higher," the bench said.

It noted in its order that the "Covid scenario has turned to its worst ever and the situation is of gravest order, so much so that there are no beds available, there are no life saving drugs available in sufficient quantity, that there isn't sufficient supply of oxygen and there is also dearth of medical and paramedical staff."

It said that the spike in Nagpur at its present is of the steepest kind, not seen even during the first phase of the pandemic last year.

Following the suggestion given by the amicus curie, advocate SP Bhandarkar, the Court noted that on April 17, merely 500 vials of Remdesivir were allocated and two other dates where nothing was given. The Court was informed that denial of vials to so many patients in 117 hospitals has severely affected the management of covid patients and in some cases, the possibility of death due to non-availability of drugs could not be ruled out.

"We must point out that it is the solemn duty of State to save and preserve precious lives under Article 21 of the Constitution of India."

The bench relied on the observations of the apex court in Pt. Parmanand Katara vs Union Of India & Ors on 28 August 1989, according to which, Article 21 of the Constitution of India casts an obligation on the State to preserve life. "It noted that every doctor at the government hospital positioned is duty-bound to give medical assistance and no law can allow to avoid and delay the discharge of such duty cast upon the professional," the bench said.

The Court said it would fail in its duty if the State Government was not reminded of its solemn obligation by saving human lives by doing whatever possible. It then ordered the 10,000 vials to be supplied in Nagpur immediately.

We are also not aware of the Remdesivir requirement placed by the State to the Centre, the bench noted before directing the State to place the details before it by tomorrow.

Importantly, the Court has asked for the details regarding the regulation and production of Remdesivir drug by the seven companies and its distribution amongst various states, and parameters followed by the Union and State government.

The amicus pointed out that shortage in the supply of Remdesivir was also due to non-payment of dues.

Directions on Oxygen Supply

An issue of major concern relates to the shortage of oxygen supply. Presently it appears that production capacity itself is falling short to meet the demand, and therefore the long-term solution would lie in increasing production capacity, the bench noted.

It has directed the commissioner of Nagpur MC to grant permissions to all private Covid-19 Hospitals interested in setting up their oxygen-generation units. As for additional space required, the court said that the adjoining government land available can be allocated on payment of necessary market value without any delay.

"If Hospitals are interested in smaller plants, whatever permission be given by authorities without any delay. If they are interested in making online procurement of smaller oxygen generation units or concentrators, necessary permissions must be granted for import/delivery to these hospitals without any delay," the bench said.

Set up Covid Care Centres, facility of water outside hospitals for patients waiting to be admitted

It was also pointed out to the bench that several Covid-19 patients are standing outside the dedicated hospitals waiting to be admitted, causing their health to deteriorate.

The Bench directed the Nagpur Collector and Nagpur Municipal Commissioner to set up temporary healthcare facilities. "We had referred to setting up a day-care Centre in February. NMC commissioner suggested directions for setting up Covid Care Centres with ICMR guidelines."

The Court accepted the suggestion and said CCC can be set up in GMC, AIIMS Hospital, etc within a week. District Collector can provide funds from the district planning committee from the mines and minerals funds, with immediate effect, it added.

On a suggestion from Indian Medical Association's counsel, that three fully functional Ayurvedic hospitals could be utilized for covid patients, just by providing oxygen, the court directed the Collector to look into the matter.

"The information supplied is vital for Covid-19 management in Nagpur. Therefore we direct Collector and Commissioner to verify the readiness of these four hospitals and on being satisfied that these hospitals can be made functional, to start them as additional covid hospitals. This shall be done by today evening and the report is produced on Tuesday, April 20."

For patients waiting outside hospitals, the Bench said that pandals should be constructed to provide them drinking water facilities as a temporary relief measure.

Coercive Action Against Doctors Who Don't turn UP

Several doctors and paramedics requisitioned for Covid-19 duty are not turning up for work, which is affecting the quality of healthcare being provided by the medical fraternity in Nagpur under the supervision of Nodal authorities, the bench was told.

"We must remind such reluctant service providers that if they do not comply with orders, they would be failing in their constitutional obligation and inviting coercive action… We would also like to warn them if any such names are supplied of non-compliance and non-followers, this court would not hesitate in issuing necessary punitive orders including orders of effecting their arrest.

However, the Bench said it would be the last to resort to such coercive measures against such personnel and institutions.

Law and Order situation

It was also brought to the Court's notice that as the situation is grim and one of panic, there is a possibility of a law and order situation at hotspots, including hospitals, oxygen, and drug supply centers.

"To avoid it, we direct the Police Commissioner to provide necessary protection to all these hotspots. Of course, identification of such spots be required, and CP to undertake this process immediately and after doing so, such protection is deemed necessary to be provided."

As for the home delivery of food, there were complaints that entire families have fallen sick, making them dependent on outside food, which is difficult to procure, due to the 8 pm deadline.

The bench directed the Nagpur MC to look into the issue. "We direct NMC commissioner to sort out this issue and permit home delivery up till the hour of the night permissible under Shops and Establishments Act for the reason that supply of food to covid patients is also an essential service"

The case will now be heard on April 21 at 2.30 pm.