Supreme Court Sets Aside HC Direction That UP Govt Officials Must Go To Only Govt Hospitals For Treatment

The Supreme Court on Tuesday (February 25) set aside the order passed by the Allahabad High Court that government officials must avail services from Government Hospitals in Uttar Pradesh. The High Court passed the direction in 2018 while issuing a slew of directives to improve the condition of hospitals in the State of Uttar Pradesh.

The bench of CJI Sanjiv Khanna and Justice Sanjay Kumar orally remarked that the directions have interfered with policy decisions and meddled with the choice of treatment a patient wishes to have. 

"How can the High Court direct the policy decisions - from where a person can get treatment or cannot get treatment? Obviously, the conditions of the Hospitals need to improve, there is no doubt about- if that was the intent, that was a noble, good intent. But beyond that. you cannot say that you must get the treatment only from A,B and C (hospitals)," CJI Khann asked.

The CJI was referring to Direction No. 11 which states : 

(xi) It shall also be ensured that all Government Officials and others who receive 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. 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 deceases if suffered by common poor people, arrangement should be made for their treatment also at Government expenses in such Private Medical Care Institutions.

The bench was informed that previously, the directions in the impugned order with respect to the Private Hospitals were stayed by the Court.

The High Court directions also pertained to clearances of roads by traffic police for ambulances and the formation of special committees involving common people to overlook the functioning of Medical Care Centres amongst other aspect. 

Notably, the bench of Justices SA Bobde and L Nageshwar Rao on May 14, 2018, had stayed Direction No.13 (d) to (h) and Direction No.14 dealing with traffic police to ensure clearance of passages and roads for efficient movement of ambulances and forming permanent Special Committees at District and Block levels having common people to monitor the functioning of Medical Care Centres of State. 

Direction No. 15 was modified to state it shall only be confined to the patients and only one attendant. The original direction required free food to patients and their attendants in all State-run Medical Care Centres.

The CJI also verbally objected to the High Court's direction on filling medical staff vacancies in Government Hospitals. He also pointed out that the direction of not allowing financial reimbursement of private hospital bills for Government Officials and encouraging the public servants to avail treatments at government hospitals may lead to public sector services being arbitrarily diverted to government employees, overlooking the needs of underprivileged patients. 

"The government servants belonging over there, they would probably get preference over the normal citizens" 

The bench therefore proceeded to confirm the interim order or May 2018 and set aside the High Court directions to that extent. The writ petitioners were given liberty to move another petition specific to data and facts before the High Court. The relevant part of the order dictated reads : 

"We are of the view that the interim order of 14.5.2018 should be confirmed and accordingly to this extent, the directions given by the High Court in the impugned judgement shall be set aside."

"It will be open to the writ petitioner to file a fresh writ petition, setting up facts and circumstances including data before the HC for appropriate steps for execution/ implementation of the decision. If any such writ petition is filed, the same shall be considered and examined." 

Before The High Court 

The Allahabad High Court was hearing a PIL under Article 226 on the issue of poor medical services in the State of U.P. Here the lead petitioner, a working woman labourer experienced high-handedness in her child delivery by the Government Hospital. She was then forced to switch multiple hospitals (public to private hospitals) due to her post-delivery complications such as continuous discharge of urine which caused her financial constraints. 

The bench issued a slew of directions, of the total 21 directions, the main ones are as follows : 

 (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 appointment of competent staff by reducing existing vacancies to 50% within first four months from the date of communication of this Judgment and remaining vacancies in the next three months.

(iii) Necessary supply of medicines of quality to all Medical Care Centre 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.

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

(v) A road map/Action Plan should be prepared in consultation with all stake holders 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 their poverty, illiteracy and other constraints.

(vi) Looking to 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 or 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 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 any further delay. 

 (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 diagnosis 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 nonpractising allowances paid to such violators.

(xi) It shall also be ensured that all Government Officials and others who receive 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. 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 deceases if suffered by common poor people, arrangement should be made for their treatment also at Government expenses in such Private Medical Care Institutions.

 (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.

(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.

Case Details : ARVIND KUMAR BHATI Versus THE STATE OF UTTAR PRADESH AND ORS. SLP(C) No. 2972/2019 and Connected Matter 

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