Healthcare in dreadful state: Supreme Court begins rollout of nationwide ICU norms

The Supreme Court on Wednesday approved a nationwide framework prescribing minimum standards for Intensive Care Units (ICUs) and critical care services [Asit Baran Mondal & Anr. v. Dr. Rita Sinha & Ors.].

A Bench of Justices Ahsanuddin Amanullah and R Mahadevan said the country was in a “dreadful position” where population growth had outpaced the availability of quality healthcare and critical care facilities.

“The court cannot overemphasise the fact that India today is at a dreadful position in as much as the population is increasing by leaps and bounds the health system is not able to match the demand, much less quality health care,” the Bench observed.

It proceeded to approve a three-tier ICU framework and called for a nationwide healthcare grid with GPS tracking, tele-ICU integration and standardised emergency care systems.

The Court further asked States to prepare mechanisms to ensure that at least minimum ICU facilities are available locally, particularly in emergencies where “time factor is the difference between life and death.”

Pertinently, the Bench also expressed concern on being informed that nursing colleges are presently allowed to function even if the affiliated hospital with ICU facilities is situated up to 30 kilometres away.

“We are surprised and shocked as to how such stipulations exist,” the Bench remarked.

The Court said nursing students dealing with ICU patients cannot be trained in institutions operating far from hospitals.

“The students/nurses who must be visiting… at the end of the day they are working with real patients. They cannot be entrusted with such a responsibility,” the Court observed.

The matter arose from proceedings pending since 2016 concerning alleged medical negligence in private hospitals and the absence of uniform ICU and critical care standards across the country.

Although the original appeal itself was closed in 2024, the Supreme Court continued monitoring the larger issue of standardising ICU infrastructure nationwide.

Over the last several months, the Court has been working with States, the Union government and medical experts to prepare a common framework governing ICU admission, staffing, hygiene, infrastructure and patient care standards.

It had also constituted an expert committee comprising Additional Solicitor General Aishwarya Bhati, Amicus Curiae Karan Bharihoke and AIIMS cardiologist Dr Nitish Naik to prepare recommendations.

Today, the Bench recorded that a consensus had now emerged between States and the Court-appointed committee regarding a three-tier ICU framework and formally approved the same.

“A basic structure detailing the minimum requirements of the ICUs has been given. As per the agreed procedure, 3 levels of ICUs have been suggested. There is consensus among the States and the committee which this Court had set up. We give our approval to the same,” the Court said.

The key directions issued by the Court include:

• States must complete a gap assessment exercise within two months;

• States must formulate implementation plans for minimum ICU standards beginning with Level-1 ICUs;

• States must explore CSR and NGO funding for ICU infrastructure;

• States must examine the feasibility of maintaining at least five fully equipped ventilator ambulances for specialised patient transfers;

• The Union government must prepare a nationwide GPS-based system mapping healthcare institutions and facilities available across the country;

• The Centre must also explore networking all such institutions to facilitate patient transfers and coordination;

• States and the Centre must examine standardised public display systems indicating ICU availability at hospitals;

• The Union government must reconsider norms permitting nursing colleges to function far away from hospitals with ICU facilities.

The Bench also endorsed tele-ICU and teleconsultation facilities and requested the Union government to create a nationwide interconnected telemedicine grid.

“We not only endorse but encourage and request all institutions to have such facilities,” the Court said.

The Court directed heads of health departments in all States to file affidavits detailing compliance and action plans before the next hearing.

On the large distance between nursing institutions and hospitals with ICU facilities, the Bench indicated that ideally, nursing institutions should either be attached to hospitals with ICU facilities or located within a one-kilometre radius.

It directed the Union government to reconsider the existing norms and place suggestions before the Court, failing which interim directions may be passed.

The Court concluded the hearing by expressing hope that the exercise would ultimately improve healthcare access for ordinary citizens.

“We hope we are able to do something for the common man,” it said.

The matter will be heard next on August 13.

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