A Bench led by Chief Justice Dipankar Datta of the Bombay High Court is hearing a plea alleging the improper management of COVID-19 medical treatment in Maharashtra. .Before the hearing, Chief Justice Datta addresses the media. .CJ: I have to send a message to the media. Please do appreciate that we are passing through a critical period. .CJ: It is not the time for you to make sensational news and jack up the news. Sometimes we make comments out of anguish and despair. but to make headlines out of increase trps is not right..CJ: Some correspondents had met me for hearing matters in the court no. 1 for public interest last year. I allowed on one condition - you may not record court proceedings. .CJ: It is matter of regret, that this was not followed. We were surprised that correspondents had recorded whatever we said in court..CJ: It is possible in near future, there may be live recording of court proceedings, but till then please behave responsibly and maturely..CJ: 3-4 of our judges have tested positive, some staff has tested positive and passed away unfortunately. Please be sensitive. We are passing through a difficult time. .CJ: I am saying this in connection to a particular comment made in this case. It was made was to admonish the petitioner in this case and not to admonish a class..Hearing begins. Advocate General begins his submissions on behalf of the State..CJ: How many are the active cases? .AG: There are 22 lakhs patients in the country and 1/3 rd active patients are in Maharashtra. .CJ: And this figure, what you are saying are all symptomatic? .AG: No about 40% are. .Court asks for figures from the Centre on distribution of vaccines in the State. ASG Anil Singh submits the figures. .AG: Also milords, there is misconception that Remdesivir is a life saving drug. It is not. .ASG: Yes that misconception has to go. Patients feel everyone needs Remdesivir. That is not the case..Court: There is a general conception, that this is a drug which is required. .AG: Magic drug required as soon as you become positive. .Court: So there could be like a public notification clarifying this… .Court: This is the right time, there has to be in the print and electronic media all the clarifications. Social media has so much wrong information creating panic..Court: These are the symptoms, then you get admitted. If these are the symptoms, then you can stay at home and take care and quarantine..Court: But this has to be taken care of urgently. What people should do if they cannot go to a medical practitioner.. It is need of the hour..CJ: When I was coming today, I saw people loitering.. Mask below chin.. .AG: I realised lately that going to a vegetable market is so important.. Such a rush! .Court: What about door to door selling of vegetables. It was there right? ASG: Yes for a few months.. Can be started again...Court: If this would have been taken care of then we wouldn’t have lost so many lives...Court: So indiscriminate use of the drug to be prevented should be prevented, that has to be out in the media..Court: Can there not be a portal to know availability of drug… This seems to be a problem everywhere. This has to be a duty of the State, not the medical staff, not the patient or the relatives.. They can raise a request on the portal and then that can be sent to them..Court: not for life saving drugs, but essential drugs. Not like oxygen-requiring situation..Court: Also a helpline which the patients can call in case of extreme emergency..Advocate Simil Purohit for the petitioner makes submissions. He points out the order of the Nagpur Bench passed on Wednesday..Purohit: Data from public domain shows that there is capacity of production of 88 lakhs of drug. We have research showing that Remdesivir can aid in speedy recovery. If hospitalized, then the number of days can be reduced. .CJ: But is the manufacturing the same as the capacity? Is 88 lakhs being produced, or is it only capacity? .Court: Have you read the note of the AG? This says that the production is being ramped up..Purohit reads from the order. .Court: Yes, but this is yesterday’s order at 8 pm. AG’s note states that the government is going to take over the distribution of the drug and oxygen. .Court: People are suffering everywhere.. not just here.. There are people in Marathwada, Vidarbha, Pune, Mumbai.. Everyone is dear to us. So we have to look for now after those patients who require urgent assistance.Court: We advice everyone not to panic, do not administer Remdesivir indiscriminately till production is upped..Purohit submits that the requirement of Remdesivir is not uniform, some need more, some do not need. That has to be considered..Senior Advocate Anil Sakhare submits on behalf of BMC that Corporation procures drugs for its own hospitals. Private hospitals come under FDA. The hospitals apply to FDA and then they get as per their requirement..Court: What is this procedure of procuring? BMC has its own procedure, private different. .AG: So the demand is raised to the company, it comes to the local stockist and then that gets distributed..Court: How do you decide on allocation? AG: This is based on the number of active cases in the district, and the company stockists in the district..Court: so today you may 5000 patients in Mumbai, but 15000 in Pune? So then can the stockist immediately transfer from Mumbai to Pune? .AG: Yes, it will be immediately transferred. .Court: We would not like if the situation depends on stockist. .AG: It is roll on basis, everyday.Sakhare: Everyday ICMR gets report on positive cases, by morning the data is analysed and we know how many are the positive cases etc. We allocate beds. So it is demand and supply..Court: how does this drug reach the private hospital? .AG: From the stockist to the hospital with collector’s order..Court: who decides the requirement in private hospital? There should be some data in public domain on the stockist data..AG: I will prepare flowchart explaining. .CJ: There has to be controlled distribution. The moment you find some loophole immediate action can be taken..ASG suggests: If there are drugs which are not required by the State then they can be opened up for use for other states..AG makes submissions on the issue of supply of oxygen in the State..AG submits that about 1500 metric tonnes is the per day requirement of the oxygen and 1200 is the supply. .AG: Remaining is imported. It is a delicate job, transporting through cryogenic tankers, by maintaining a temperature of -200 degrees. There are not many tankers..AG: Trains is found to be the safest for transport..AG: There are industries which manufacture oxygen, it is not possible to transfer the oxygen through captive technology or compress. There are less oxygen plants..AG: There should be jumbo facilities for oxygen creation. Instead of taking oxygen to patients, we are taking patients to oxygen. .AG: For transportation by train, trials have been conducted and milords is right, it is starting from Vizag and reaching Nagpur tomorrow..AG: speed will increase of transportation and secondly safety..Court: This requirement of 1500 MT is because of COVID or normally? AG: COVID times milord. Normally it is 150 MT, and it will now increase to 2000 MT. Production is 1200 MT..AG: We will try to amp up the smaller oxygen plants, use thermal and other plants for oxygen. .AG submits that Maharashtra is the only state to use 100% of the oxygen produced for medial purposes and not for any other pharmaceutical purposes..Court: This figures you have shown of acquiring oxygen from the plants, this is also on a daily basis? .AG: Yes this is roll-on roll-off..Court shows a newspaper article asking the AG and ASG to take note of this. .ASG intervenes. ASG: We just got a notification from Bar and Bench that the Supreme Court has taken cognizance of COVID management. .ASG points out that the Supreme Court said that it will examine whether to transfer these issues from High Courts to itself at a later stage..Advocate Rajesh Inamdar appearing for a proposed intervenor submits that there should be a cap on the price of injections as people from the lower strata should be able to procure it. .Inamdar: Why are private individuals being allowed to procure drugs?.Inamdar: There are reports that Government is not getting it but private individuals are..Inamdar: there is a shortage of doctors. .CJ: How do you get doctors overnight? The State cannot be directed to ensure adequate medical staff? What do they do if doctors are infected?.CJ: We agree with the issue of price which you have raised..Sakhare requests for making submissions on the issue. Court: We will hear after lunch. .Court: But AG, ASG, we need some assistance on the newspaper article we mentioned. This is about an incident in Nashik..CJ: It surprises us that despite having a shortage of oxygen in the state, there is a leakage happening. How can this happen in a civilised society. This is not what we expect from the government..Bench rises for lunch. Hearing to continue at 1.45 pm..Hearing begins. .AG: Just two topics remain. .Sakhare: May I just mention on oxygen part? All hospitals in city of Mumbai are supplied oxygen as per requirement of each hospital..Sakhare: Any hospital can demand for supply of the oxygen. So hospitals are supplied oxygen as per need of the hospital. .CJ (to AG): Covid affects lung, leading to complications. In the past year have you or ASG come across any data that COVID affected patients are smokers?.CJ: We know that people who smoke, it affects the lung. So if there is a study that if smokers are more affected by COVID, then for a temporary period there has to be a ban (on smoking). People may save they have a right to smoke, but then for the larger public interest….CJ: there should be something by the State on that. .AG: I asked my officer, so when they admit someone do they ask if the patient smoke or drink? Like past history. .CJ: Because me and my brother judge have not come across something like this since over a year..CJ: We are just putting this to your minds, to be considered. .AG: Yes and of direct connection..Purohit: There are about 7-8 industries, like pharmaceuticals, nuclear, ceramic, steel, which uses oxygen. The state is saying that they have diverted all the oxygen from all non-essential industries. Would state be tapping from all these industries?.Purohit: No doubt that the State is taking all measures. .CJ: Mr Purohit, we have heard the Centre’s submission, that the Centre will look after distribution of oxygen. Maharashtra has been allowed 146 MT more than its requirement. Let us wait and monitor and then take a call..Purohit: If on a temporary basis, Government lands can be utilised for setting up plants. .CJ: DO you have data on the logistics? .Purohit: My knowledge is 15-25 days. Based on public domain data..Purohit: My anxiety is after 15 days if the situation worsens we shouldn’t start from the 15th day. .CJ (to AG): He is saying that the State should tap all options.. .AG: I have submitted in my note. There are issues with liquid oxygen and bottling..AG: But we plan to set up jumbo plants for oxygen. .Purohit: And there is also another suggestion of oxygen concentration machinery. .AG: I have added that in my note..Purohit: There are Indian manufacturers who make these concentration machines. .AG: We have ordered more than 10000 such machines. But at the moment they are not available so we have ordered from a Singapore based company. .AG now submits on the shortage of beds. .AG: We have small hospitals which have say 10 beds. So we borrow their man power in jumbo hospitals. So one nurse can attend 20 rather than 10. So we are asking the small hospitals to send their man power and our infrastructure..AG: So as far as COVID test is concerned. There are two types of tests carried out. Rapid Antigen and RT PCR. Total more than 2 lakh tests are conducted which is the most in the country. The average time for getting result is 24 hours, but due to low man power, there is delay..AG: There are about 500 labs conducting this test. Their capacity is 1.35 lakh, but it is stretched to 1.5 lakh .AG: Time is taken for procurement of trained manpower for carrying out tests. Mobile testing vehicles are brought in from other states. .TATA has come up with tests which are being tested..CJ: IN all the hospitals and private nursing homes, over which principal seat exercises jurisdiction, how many beds are available? Public and private?.CJ: Because Vidarbha is taken by Nagpur Bench. So we do not want to encroach..AG submits a data sheet of April 19, 2021. .CJ: According to this chart, for every particular nature of bed, the supply is more than the demand..AG: Higher middle and higher class are highly affected and they want beds in private hospitals, and beds of their choice. They want beds near their homes, etc. That is being projected as shortage of beds in the media. .CJ: So according to this, there is no cause of alarm!? AG: No it is not. CJ: But then what we want to give petitioners a chance to respond..AG: And this is a vicious circle. The citizens do not get a bed, so they prefer waiting at home, quarantined, then they get more severe.. this circle will continue..AG: So we want to tell people, it is important to get treated fast, when and where they get..CJ: Last year there was some order where the earmarking of hospitals is done ... Rates are fixed… that was set aside by a co-ordinate bench. .AG: That was set aside for non-COVID sections, but not for COVID..AG: My argument was that non-COVID is related to COVID. Co-morbidity leads to complications in COVID..Court asks BMC figures on beds. Sakhare reads out the data..Sakare: As per corporation area, there is availability of beds and management of bed allocation..Sakhare: Public and private have vacancy. There are stray cases, but that is due to panic amongst patients. .Sakhare: This system in place helps us assess if the patient needs bed or not and accordingly we proceed..Sakhare: We have a software, to show data from ICMR at ward level which will show the positive cases based on reports. The medical staff then call the patients and then they suggest whether they need to admitted or they can be home quarantined..Sakare: We have observed that we manage to contact all patients by 12.30 to 1 pm. And we also assist them on the medications. .Sakhare: As regards testing, we have been upgrading our capacity and other infrastructure. War-room dashboard gives the details. .Court: Why is it taking so much time for test results? Sakhare: It is 24 hours. CJ: My personal experience is it take 2 days..Sakhare: throughout Maharashtra it takes 24 hours. .CJ: Please check with your commissioner once..CJ: My driver tested positive. Justice Kulkarni was in the same car that day. It was around 1 pm. We got tested and got our report the next day at 11 pm. My spouse’s report took 2 days to come..Court: We have come across that test results are taking time. Those 2-3 days are the most crucial. That was more dis-service than service if labs are taking more tests than they can..Purohit: Only 20 labs in the city are allowed to test. All labs should be allowed. The government testing are not accredited by ICMR. A disease like HIV can be tested by small labs, but not COVID because they do not have accreditation..Purohit: There are two three kinds of tests based on their time. There is a machine in which you insert the swab taken. Every lab can have this. If labs are given the liberty to set up, then it takes 4 days to set up the machine..Purohit: RTPCR is of 65 tubes, costs Rs. 300. Government has set up a price range of Rs. 500. Second kit of 4 tests at a time is German. The kit giving result within 15 mins, then that is higher..Purohit: But those kits can be purchased, that is a one time investment. Let there be price differential based on preferences. People who can pay for the test, can do it..Purohit: AG mentioned that there needs to be training for swab testing. But before 2020, there were no COVID test. They learnt on the job. Testing ought to be liberalised. Every clinic which meets the criteria, can be allowed by BMC..Purohit: If based on their accreditation, if the machines can be purchased, the labs can purchase and BMC can give a price band..Purohit: For instance if there is a building which is made a micro-containment zone, if one person is deputed with a rapid RT PCR test, then that person can test and within 15 minutes each member can find out what is the result..Purohit: Any laboratory expert who can afford the machine should be allowed to purchase. Any effort to break the chain should be considered..The petitioner Sneha Marjadi’s husband informed the Court that he was asked to bring a doctor’s prescription for Antigen test. .Court (to AG): Is prescription mandatory for antigen test? How do we disbelief a member of the Bar expressing his personal experience?.AG points out something from his note. .Court: But this is your submission, the ground reality seems to be something else..AG: Please appreciate, we are conducting more than 1 lakh rapid antigen test daily. .Court: We will record your submission, but we want to pass a direction to that effect. That any person wanting to conduct antigen tests do not need prescription..AG: Please do milords Please! .Purohit: There is load on 20 labs. And then that entire load is on ICMR. Why not decentralise it?.Court: The sending of lab reports from BMC to ICMR was so effective that even before the patient comes to know that he is positive, the BMC officials would reach his house. I don’t think it was effective anywhere else..Sakhare: Milords may record this statement that factually there is nothing that requires certification or prescription for antigen tests or RT PCR tests. .Purohit: But will you consider giving directions to the state to decentralise the lab testing. .Court: We will be giving directions to the State to consider giving permissions to labs. .Court: We do not want labs sprouting.. .AG: Please also appreciate this, that this disease was spread because there was a sample leaked from a lab. We do not want such a situation from private labs .CJ: Yes, we have heard you all enough on this plea now..CJ: What about the new GR? Which says attendance is only 15%. This will affect the number of courts sitting wouldn’t it? .AG: This court have been exempted from this. .CJ: It says govt establishment... .AG: Yes but there is exemption..CJ reads out the Govt resolution. Asks AG which category does court fall under?.AG reads out an order of the government of November 2020 which granted liberty to the administrative committee to the high court to decide on the attendance for themselves and courts. .CJ: But that was modified by the April 13 order? .AG: But if you see para 7, judiciary is exempted. Season tickets are also allowed to lawyers..Purohit: Milords may I be permitted to make small submission. The hospitals which are non-COVID should be allowed to admit COVID patients..CJ: But the BMC data states that there are vacancies. Then why do we bring in non-COVID hospitals, and then where do the non-COVID patients go for being admitted? .CJ: You can show us the data on record. But then we will have non-COVID hospitals coming to us like last year, will say that they have to reject the non-COVID patients and they are facing losses. .Purohit: Can a direction also be passed that stockists ought not hoard drugs. Because one vial is being sold for Rs. 25000 in the market now. .Court: We are expanding the scope of this PIL, and not limit it to the prayers, but those we want to deal first..Purohit: Milords may only direct to them to not hoard, nothing else. .Court (to ASG): This has to be considered. How will you tackle this situation. .Advocate Dhruti Kapadia, petitioner in door to door vaccination, mentions an article which deals with effect of cigarette smoke on immune system..AG submits on the Nashik incident. He shares the report of the Nashik Commissioner on the incident..AG apprised the court that due to leakage in the main oxygen storage tank of a hospital in Nashik, about 24 people died at the hospital. After the tank was repaired, oxygen was restored. .CJ: but 24 people died.. .AG: Yes indeed. I will submit this all on an affidavit. .Court states that the detailed order will be uploaded by tonight. Posts the matter for hearing on May 4, 2021. Directs all respondents to file affidavit.
