"Can't Shift Responsibility On Private Players, See General Condition Of Healthcare": Bombay HC On Recent Deaths At Govt Hospitals In Maharashtra

The division bench of Chief Justice Devendra Kumar Upadhyaya and Justice Arif Doctor was dealing with a suo motu PIL wherein two government hospitals in Nanded and Aurangabad districts of Maharashtra reported over 50 deaths within a span of four days.

“You can't escape responsibility by saying burden of patients is there. You are the State, you can't shift responsibility to private players. See the general condition of healthcare in the State,” the court said.

“The primary responsibility of healthcare lies with public health department hospitals…To ensure the vacancies are filled we direct the Principal Secretaries of Public Health Department and Medical Education and Drugs Department to furnish details of all sanctioned posts in the State and occupancy of the posts by filing an affidavit," Court ordered.

“At least 47 posts of professors etc. in medical college in Nanded are vacant and about 50 percent of the posts of senior residents are vacant,” the bench noted.

The Court was informed that the State had on May 10, 2023 enacted the Maharashtra Medical Goods procurement Act, 2023 to ensure higher transparency and timely supply of medical goods to the hospitals.

The Act under Section 3 mandates that the State shall establish a Procurement Authority consisting of very high-ranking officers including the CM as its Chairperson. The CEO is its member secretary. However, the crucial post of CEO was vacant with an additional charge given to someone else, the court noted.

“Thus, there appears to be a fervent need for appointment of a full-fledged CEO which we expect shall be done by the state govt within two weeks.”

The Court had taken suo moto cognisance of the matter on Wednesday based on mentioning and a letter by Advocate Mohit Khanna. He was appointed as amicus curiae.

Between September 30 – October 3 2023, 31 deaths were reported at Dr. Shankarrao Chavan Government Medical College in Nanded and 18 deaths were reported at the Government Medical College and Hospital (GMCH) in Aurangabad in a day.

The Advocate General Birendra Saraf was asked to inform the court about budgetary allocation for health and about the vacancies.

Court Room Exchange

On Friday, the Court told the AG it was mainly concerned with medicine procurement mechanism for the hospitals, sanitation inside and outside hospitals and vacancies of specialists. The court sought to know the causes of deaths in the two hospitals and the steps that were being taken.

Advocate General Birendra Saraf submitted that a three-member committee has visited. Smaller hospitals did not have the facilities to handle critical patients. And most patients visiting the hospitals are brought in such a condition, he said. Saraf said they were mainly referred by private hospitals. Such hospitals were not following patient referral norms. On the other hand, government hospitals try to accommodate everyone, he claimed.

He added there was no gross negligence by the hospitals and every death was unfortunate.

The court pointed out that out of 97 sanctioned posts of senior residents only 43 were available. It also pointed that budgetary allocations have gone down after 2021-2022.

“With regard to procurement, the state has been procuring medicine through Haffkine Institute, which is a state-run entity, the tender process takes a long time. Haffkine is no longer going to be the procuring body. There have been shortfalls in procurement of medicine. Since 2017, Haffkine was not able to fulfil the requirements of the state. Rs 700 Cr worth of money was lying...” Khanna submitted.

He volunteered to take the court through four orders passed by the Nagpur bench regarding Indira Gandhi Medical College.

“This order pertains to the functioning of the medical College. The scope of the current PIL is a little different. The burden of hospitals of medical colleges is increasing because of the hospitals run poorly by public authorities,” the court said.

The AG assured that a full time CEO would be appointed, the shortfall is fulfilled and a fully functioning authority is there.

ORDER

In the detailed order the court noted that “healthcare system is the primary responsibility of public health department and medical education department. While the first administers the government hospital, the latter administers the hospitals of the medical college."

Court said for a medical college, its primary responsibility is teaching, secondary is research, and tertiary is patient care. “Thus the primary responsibility of healthcare lies with public health department hospitals. Apart from all other measures, these department need to ensure that all vacancies are filled in the medical institutions under both departments.”

It noted that recruitment of doctors in hospitals of public health department is done by recruitment board and in medical college it is done by MPSC. “At least 47 posts of professors etc. in medical college in Nanded are vacant. About 50 percent of the posts of senior residents are vacant.”

Medicine Procurement

The amicus pointed out the various provisions of the Maharashtra Medical Goods Procurement Act, 2023.

Section 5 mandates the Authority shall procure medical goods for public hospitals and medical colleges of Government of Maharashtra. Section 6 provides for powers and functions including taking policy decisions, making recommendations to the state, ensuring timely availability and distribution of medical goods and to supervise over planning and execution of the procurement process. Section 7 lays down the procedure of procurement. Section 8 provides for an executive committee. Section 9 the EC has the power to appoint officers and employees of the authority, supervise the procurement process, approve or reject tenders etc. Section 11 provides for constitution of various sub committees.

Section 23 mandates the state to provide aid till the time the procurement authority becomes self-reliant.

“The state has formed the authority and vested with it adequate powers to ensure supply of medical goods. Though it was constituted in May 2023, till date a full fledged CEO has not been appointed and only an additional charge has been given to another officer. Taking into account the CEO's function, we have no hesitation to observe that giving an additional charge of the CEO doesn't meet the requirement of the Act,” Court said.

Regarding the affidavits to be filed, the court said it must disclose various demands of medicines and medical equipment made by the hospitals in the last 6 months and the supply made against such demands.

The court also directed the MPSC to file an affidavit regarding steps taken to fill existing vacancies.

The Maharashtra Medical Goods Procurement Authority was also directed to file an affidavit sworn its CEO giving details of steps to administer it's duties and the staff available with it. This affidavit must also disclose whether the staff appointments have been made for the authority or the staff has additional charge of the authority. The affidavit should also include details of the office space available for the authority's functioning, Court ordered.

(Compiled by Sharmeen Hakim)