Condition Of Govt. Hospitals In UP: Allahabad HC Orders Govt. Officials To Not Use Private Hospitals; Directs Special CAG Audit, Etc [Read Judgment]

The Allahabad High Court, on Friday, directed the State Government to ensure that all Government officials and employees, who receive salary or other financial gains from public exchequer, should avail medical care services only from hospitals run and maintained by the Government.

The Bench comprising Justice Sudhir Agarwal and Justice Ajit Kumar also directed that such officials should not be given any special treatment at the government hospitals and that in case medical care is obtained from private hospitals, no reimbursement should be provided by the Government. It, however, clarified this condition would not apply in cases where requisite treatment is not available at government hospitals.

The Court was hearing two Petitions. One had been filed by a woman laborer, Ms. Snehlata Singh, who had pleaded for improvement in the miserable conditions at hospitals in the State of U.P., highlighting the complications that she had to face due to incompetent maternity care provided at a government hospital.

The second petition was filed by Mr. Raj Kumar Singh, a social worker and the editor of a weekly newspaper titled "Naha Sandesh". He had sought a direction to the authorities to make it mandatory for all District Private Hospitals and Nursing Homes to display qualifications and designation of all para-medical staff. He had further pointed out that hospitals and clinics were undertaking medical termination of pregnancy without being registered under the Medical Termination of Pregnancy Rules, 2003.

While examining the various schemes on the subject, the Court noted that more than Rs. 3400 crores had been released for the same in the Financial Year 2016-17. It then observed, "Despite such huge funds if schemes have not properly been carried out and objectives have not been achieved than it can be said to be a sheer wastage of huge public funds. This requires investigation, where these funds have gone and who has pocketed it or why remain unspent if could not be utilized."

It went on to note with concern several deficiencies in the medical services provided by government hospitals and issued the following directions:

Filling of vacancies

(i) Immediate steps shall be taken to fill in existing vacancies of Medical, Para Medical and other attending staff at various levels in all Hospitals maintained by State Government through Department of Medical Health and Family Welfare or Medical Education.

(ii) State Government would ensure the appointment of competent staff by reducing existing vacancies to 50% within first four months from the date of communication of this Judge and remaining vacancies in the next three months.

Supply of necessary equipments

(iii) Necessary supply of medicines of quality to all Medical Care Centres at different levels must be ensured. Similarly, availability of requisite apparatuses, instruments, operation theatres and other medical requirements as per status of Medical Care Centres be maintained and continuous maintenance should be ensured under constant monitoring by responsible persons and they should be made accountable for any laxity or deficiency in such supply and availability.

Staffing for medical care of women

(iv) For Medical Care of women and especially pre-natal and post-natal treatment, lady Doctors and supporting lady Para Medical and Nursing Staff be recruited and their availability be maintained.

Road Map for maintaining medical services by the State

(v) A roadmap/ Action Plan should be prepared in consultation with all stakeholders responsible for maintaining medical services by State so that quality medical treatment is 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 matter of medical care merely on account of poverty, illiteracy and other constraints.

Special Audit by CAG within 2 months

(vi) Looking so fact that in sample survey got conducted by this Court through Advocate Commissioners, demonstrating a large number of apparent mismanagement in Hospitals whether maintained by State Medical College at Allahabad by cadre of Provincial Medical Services, Special Audit through CAG should be got conducted without any further delay. In this regard, we direct requisite number of Specialized Audit Team having expertise in audit of Medical care Centres be constituted with request to CAG, within one month from the communication of this Judgment. At first instance, Medical Colleges and Hospitals attached to them should be got audited. This audit must be completed within two months. This Special Audit must examine funds made available, their utilization etc. in the last 10 years. If deficiencies, irregularities and illegalities are found, concerned department shall also identify erring officials and would take appropriate stern action whether civil, criminal or departmental, as the case may be, without further delay.

(vii) After special audit of Medical Colleges and Hospitals attached to them, next Audit should be that of District level Hospitals, for which also, complete exercise would be done within two months and it shall be adhered to. In third phase such Special Audits will take care of next lower level Medical Care Centres i.e. CHCs and PHCs.

(viii) Entire Audit exercise of all levels shall be completed within a year.

(ix) We may also mention that above Special Audits shall include an investigation relating to funds made available and expenditure etc. on Trauma Centres also wherever they have been proposed or are functional and under construction.

FIR against State Medical Officers engaging in private practice

(x) Director General, Vigilance shall constitute special teams at District level to find out Medical Officers of State Government who are engaged in private practice or running Hospitals, Nursing Homes or attending or providing treatment to patients in such private Hospitals etc. Said teams shall also investigate into cases of radio diagnoses and pathology test from private institutions and establishments, in respect of patients who are under treatment at State Medical Care Centres. Team shall find out reasons for non conduct of Radio Diagnostic or pathological services by institutions run by Government. Wherever private Radio Diagnosis and pathology tests are found got conducted from private hands, encouraged by Government Medical Staff, appropriate action including criminal and departmental shall be taken against them. We direct competent authority in such matters to proceed with such report of vigilance and take appropriate action at the earliest. Aforesaid vigilance teams, wherever finds Government Medical Officers/ officials indulging in private practice, may also register First Information Report against them. Besides, competent authority in the State Government shall take appropriate stern action without any further delay besides recovery of entire non-practicing allowances paid to such violators.

Government officials should avail medical services from Government hospitals

(xi) It shall also be ensured that all Government Officials and others who received salary or other financial gains from Government/ Public exchequer, should avail Medical Care services from Hospitals run and maintained by Government and whenever any High-level officials, political Executives or other dignitaries go for treatment, Medical Officer on duty, by roster, shall attend him and there shall be no special VIP treatment. If medical care is obtained in Private Hospital etc. The government must not reimburse the same. However, if there are some kinds of diseases or ailment, treatment/ cure whereof is not available in Government Hospitals, and for that purpose, treatment in private becomes necessary, this condition may be relaxed but in such contingency, Government must ensure that for similar ailments and diseases if suffered by common poor people, arrangement should be made for their treatment also at Government expenses in such Private Medical Care institutions.

Separate special CAG audit for irregularities found in Hospitals attached to Moti Lal Nehru Medical College

(xii) With respect to malpractices and irregularities found in sample survey of Hospitals attached to Moti Lal Nehru Medical College, Allahabad, we recommend Special Vigilance Enquiry in the matter as also a separate Special Audit of CAG, to be conducted immediately. Vigilance enquiry shall be conducted by a team constituted by Director General, Vigilance. Aforesaid special vigilance team if finds defalcation of funds etc., appropriate criminal action would be taken besides recommending disciplinary action against erring officials, whereupon, competent authority shall take appropriate disciplinary action.

Effective Traffic Management for passage of ambulances

(xiii) In the matter of appropriate treatment at Trauma Centres, State Government shall ensure transportation of patients to Trauma Centres. One of important step which needs immediate care is that unobstructed smooth passage be made available to ambulances carrying such patients. This aspect needs effective Traffic Management on roads and other requisite preparation. On this aspect we issue specifically following directions to Principal Secretary Home; Transportation as also Director General of Police, U.P.:

 (a) Immediate instructions be issued to all Traffic Police Personnel in the State to canvass and spread public awareness about regulated parking of vehicles at places meant for same, non parking of vehicles on roads and sideways, removal of encroachment of all kinds do as to make roads, sideways and service lanes clear. This awareness programme should run for a reasonable time but not so long as may frustrate the very purpose. In our view, let this programme be conducted for a period of two months.

 (b) People driving vehicles be made aware that they should not park vehicles in an indiscreet manner, obstructing free flow of traffic on road and in no case a vehicle should be parked on road side ways and service lanes.

 (c) Whenever vehicles are topped for any reason including traffic signals, people must stop the same in a single line ensuring clear passage for ambulances and fire brigades etc. Any violation should be dealt with strictly attracting heavy fined on violators.

 (d) After carrying on above Awareness Programme for two months, entire Traffic Police Force including other Police Personnel shall ensure clear passage, proper parking of vehicles, non-encroachment of roads etc. and any person violating the same should be fined heavily.

  (e) Local Traffic Police people, if any congestion is caused, should be held personally responsible and appropriate strict action be taken against them.

 (f) Any damage suffered by injured/ serious patients due to obstruction in smooth passage for ambulances etc. must be held a criminal liability, besides civil, of the person(s) creating such obstruction as also the persons responsible for management of traffic including Traffic Police Personnel.

 (g) In residential areas where people when people park their vehicles outside their residences or in commercial areas where also people park vehicle on roads etc. due to non-availability of parking space in their residences or commercial places, responsibility shall be fixed upon the residents and persons running commercial activities without providing parking space, by imposing heavy penalty etc.

 (h) Immediate requisite provisions be made prohibiting registration of Auto vehicles unless purchaser has sufficient parking place at their private places. In other words, Government should make provision restricting purchase of new vehicles and registration thereof unless person(s) purchasing vehicle have parking place at their residences.

 (i) State Government shall also take immediate steps for providing dedicated corridors for movement of vehicles of essential service as an honor of fundamental right to patients and injured people to get quickest medical services and travel on road without any obstructions and also to ensure other essential services to be carried out without obstruction. In other words, a dedicated corridor shall be prepared for movement of ambulances carrying patients which is also a part of Trauma Care Facility and even otherwise, quick movement of ambulances for timely availability of medical services is fundamental right of patients and healthy people traveling on road are also under an obligation not to create any obstruction in life saving vehicles, like ambulances and a clear passage has to be maintained at any cost.

Special Committee for monitoring of services

(xiv) Special Committees at District and Block levels be constituted on permanent basis which may have participation of common people and members of society to monitor proper functioning of Medical Care Centres of State and regular availability of requisite instruments, apparatuses, medicines etc. and also effective careful service to poor patients.

Free food to patients and attendants

(xv) Free food to patients and their attendants shall also be ensured in all State run Medical Care Centres so that for want of appropriate diet, poor people may not suffer while undergoing treatment.

No celebration on medical college lawns

(xvi) Fields, lawns etc. maintained in medical colleges, hospitals attached to medical colleges and other Government hospitals shall not be allowed to be used for any celebration or function like marriage ceremony etc. If any staff of medical establishment is residing in campus, this restrain order will not apply to him but officer in charge shall ensure that musical sound and disturbances shall not be allowed beyond the prescribed level of noise and there shall be no celebration/ disturbance after 10 pm. In no case any such activity shall be allowed to others.

Bar against unregistered hospitals and clinics undertaking abortions

(xvii) In the matter of medical termination of pregnancy, we direct all Chief Medical Officers in concerned districts to ensure observance and compliance of Medical Termination of Pregnancy Act, 1971 as amended by Termination of Pregnancy Amendment Act, 2008 and Medical Termination of Pregnancy Rules, 2003. In no case any unregistered hospital or clinic shall be allowed to function. Any laxity shall be treated personal responsibility of the concerned Chief Medical Officer and he/she will be liable for appropriate action treating failure as his collusion with erring personnel.

Action against non-utilization of funds

(xviii) State Government shall also ensure that in no case funds allocated for Medical Services remain unutilized and unspent. Where there is a violation, persons responsible for non-utilization be taken to task by taking disciplinary action against them treating it a serious misconduct for the reason that funds allocated for the welfare of Medical Services, if are not spent, it means that requisite service to that extent has been denied.

Action against Principal Secretary for filing false affidavit

[The Affidavits had been filed on the functionality of Trauma Centre at Allahabad Medical College. While the Principal Secretary, Medical Education, Govt. of U.P. had claimed that the Trauma Centre has been functional for the last 3-4 years, the same was found to be false by the Court.]

(xix) For filing false affidavit before this Court, we also issue notice to Mr. Rajneesh Dubey, Principal Secretary, Medical Education, Government of U.P., Lucknow and Dr. S.P. Singh, Principal, Medical College to show cause as to why action for filing false affidavit before this Court, under Section 340 Cr.P.C. and for Criminal Contempt under Contempt of Courts Act, 1971 be not initiated against them. Office shall issue notice and register it separately as Miscellaneous Case.

Clarifications and modification

(xx) We also make it clear wherever any authority in State Government if finds expedient, may approach this Court by filing an application for clarification/ modification of this order wherever and whenever required for effective compliance of directions given above.

Compliance reports after the expiry of 6 months

(xxi) Chief Secretary, U.P. Lucknow is directed to ensure supervision and compliance. He shall collect information from all responsible Secretaries of Departments and Heads and submit Action taken report, first phase, within one week after expiry of six months. For perusal of such report, matter shall be listed before the Court on 25.9.2018.