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In a significant judgment, the Allahabad High Court has passed a slew of directions aimed at comprehensive reform of the healthcare delivery system in Uttar Pradesh.
Detailed orders in this regard were passed by a Bench of Justices Sudhir Agarwal and Ajit Kumar, in a batch of writ petitions filed by the Human Rights Law Network (HRLN) and a social worker, Raj Kumar Singh.
The Court also made some scathing observations about the condition of State Medical Services.
“If in one word we have to describe the State Medical Services, it is quite apt to use the word for its functioning on its destiny and fate i.e. “Ram Bharose””
The court noted that one of the reasons for the poor standards of government medical services was because only the poor people without the capacity to avail expensive services are left at the mercy of the institutions run by the State. It observed that superior bureaucrats and others holding high offices, ministers and people’s representatives avail expensive private medical services.
“Government Officials since are reimbursed medical expenses, frequently they avail better private medical services and claim reimbursement from State Exchequer. Therefore they have no reason to bother for quality of medical services run by State.”
HRLN approached the Court on behalf of a brick kiln worker, Snehalata Singh. Owing to neglect and trauma in a primary health centre after the delivery of her child, Snehalata was left with severe and chronic complications. Despite repeated to visits to state medical care centres, Snehalata was not offered any reprieve.
The second petition by Raj Kumar Singh raised allied concerns in the healthcare sector. In particular, Singh drew attention to the poor implementation of abortion laws in the state.
These petitions in turn prompted the Court to delve deep into the state of healthcare services in Uttar Pradesh. Apart from the petitioners’ averments, the Court directed that detailed reports be furnished by the State as well as Advocate Commissioners.
AAG MC Chaturvedi and other State counsel also acquiesced to refrain from treating the case as an adversarial one and to render their cooperation for the betterment of medical services.
These efforts in turn have culminated in the passage of various directions aimed at safeguarding the Right to Health under Article 21 of the Constitution. Broadly summed up, these include the following.
Remedy infrastructural/personnel deficiencies
Immediate steps are to be taken to fill vacancies in hospitals and other Medical Care Centres. When it comes to women patients, especially for pre-natal and post-natal treatment, lady doctors and supporting lady paramedical and nursing staff should be recruited and their availability be maintained.
The State government is to ensure necessary supply of quality medicines, instruments and other infrastructural facilities in Medical Care Centres at different levels.
Conduct Specialized Audits
The Comptroller and Auditor General (CAG) has been requested to constitute Specialized Audit Teams within a month to scrutinize Medical Care Centres. Audits are to be conducted on Medical Colleges and Hospitals, District level Hospitals and lower level Medical Centres (CHCs, PHCs etc.) in phases.
The Audit would look into aspects such as the availability of funds and its utilisation in the last 10 years. Audit at each phase is to be carried out within two months. The entire audit exercise is to be completed within a year.
Bridge the gap between Private and Government Medical Services
The Court noted that a major reason for the apathy of higher authorities in reforming government medical services is that they themselves are not affected. The Court remarked,
“For them, State Medical Services, in particular, rural health service programmes are meant only for poor rural class. They belong to different class. It is a class discrimination which is not allowing the system to improve in the last several decades.”
In an effort to do away with such privileges, the Court has directed that all Government Officials and others who receive salary from the Public exchequer should avail medical care services only from Government hospitals.
The Government has been directed not to reimburse government officials opting for treatment in private hospitals. However, this condition may be relaxed in certain contingencies such as when specialized treatment in private hospitals becomes necessary for the patient.
The Court also urged the Government to ensure that common poor people are also able to avail such specialized treatment, at Government expense, in Private Medical Care institutions when they require it.
The Court further directed that investigation be launched into Government Medical Officers found indulging in private practice.
Notably, in a bid to do away with VIP culture, the court also specifically ordered that no special treatment should be given to high ranking officials.
“Whenever any High level officials, political Executives or other dignitaries go for treatment, Medical Officer on duty, by roster, shall attend to him. There shall be no special VIP treatment.”
Minimize traffic obstructions to Medical Care Centres
Sensitization programmes are to be introduced to encourage citizens to refrain from obstructing traffic generally and in medical emergencies. Traffic personnel were directed to be trained to better manage such scenarios.
In case of damage suffered by patients due to obstruction of smooth passage for ambulances etc., criminal and civil liability should be cast upon both the person causing such obstruction as well as personnel responsible for traffic management.
Another direction calls for the Government to make provisions to restrict the purchase and registration of new vehicles, unless the purchaser has parking spaces at their residence.
Other notable Directions
The Chief Secretary of Uttar Pradesh has been tasked to supervise and ensure compliance with the Court’s directions. An action taken report in the first phase is to be submitted within a week and six months. The Court has listed the matter for compliance on September 25, 2018.
Read the Judgment: