WP(C) No.140 of 2007 Pg.1 * IN THE HIGH COURT OF DELHI AT NEW DELHI 11. + W.P.(C) 140/2007 URVASHI POPLI .....Petitioner Through: Petitioner in person versus UOI & ORS. ..... Respondents Through: Mr. Sewa Ram, Mr. R.K. Bachchan, Advs. for Respondent No.1 Mr. Maninder Singh, Adv. with Mr. Kirtiman Singh, Mr. T. Singhdev, Advocates for Respondent No.2/MCI Ms. Geeta Mehrotra, Adv. for R-6 Mr. V.K. Tondon, Adv. for Govt. of Gujarat CORAM: HON'BLE THE CHIEF JUSTICE HON'BLE MR. JUSTICE NEERAJ KISHAN KAUL O R D E R % 15.04.2009 The petitioner Smt. Urvashi Popli, a practicing lawyer, has filed this petition in public interest seeking to challenge the instructions issued by Union of India through Secretary, Ministry of Health and Family Welfare vide D.O. No. M12015/22/2002-MCH dated 5.1.2006 and D.O. No. M.120115/22/ 2001-MCH dated 7.10.2005 for providing in-house / on the job training in Anesthesia to government doctors to be posted at First Referral Units (FRU) / Community Health Centres (CHC) at sub-district level in order to control the alarming high maternal deaths in the country. The petition appears to have been filed at the behest of Indian Society of Anesthesiologists (Respondent No.6 herein) who has been opposing Anesthesia Training Programme on the misplaced apprehension that the training to handle the emergency obstetric care at FRUs would be taken as an additional medical qualification in Anesthesia which is factually incorrect. The Government of India makes it very clear that this training programme, formulated in the national interest, is WP(C) No.140 of 2007 Pg.2 limited to the requirement of tackling emergency obstetric situations only and neither can be construed as an additional qualification / specialization nor entitles the person to practice anesthesiology generally except to tackle the emergency obstetric situations at FRU level while in Government service nor in any way replaces the specialist anesthetists who are working after pursuing degree/diploma in the subject. The issue of high ‘Maternal Mortality Rate (MMR)’ in the country has been a matter of grave concern to the Government of India. As per World Health Organization Report, 2005, the MMR ratio per one lakh births in India was 450 against only 44 in Thailand, 56 in China and 92 in Sri Lanka and less than 10 in the developed countries. The non-availability of Emergency Obstetric Care (EmOC) at the FRUs due to lack of qualified personnel is the primary cause of high MMR. Sri Lanka, Thailand, Malaysia and Egypt are few examples which have drastically reduced the MMR below 100 by training in midwifery and variety of integrated skills. The 10th Five Year Plan recommended for a six month training course on Anesthesia for serving government doctors. The Government of India, in association with WHO, UNICEF, UNFA, DFID, AIIMS and the States, identified 21 States and 91 medical colleges to organize programmes to train Government MBBS doctors on Life Saving Anesthetic Skills (LSAS) for emergency obstetric care. The training programme has begun in 2006 and it is reported that as on 31.12.2008, 611 doctors have been trained across 93 colleges in 24 States while 209 Master trainers are trained. A similar training programme in Emergency Gynecological Care for government doctors has been undertaken in association and active participation of the Gynecologists Association of India. The Medical WP(C) No.140 of 2007 Pg.3 Council of India has consented to the Life Saving Anesthetic Skills Training for Emergency Obstetric Care and has suggested for its review at the end of five years to judge the efficacy of the programme and the desirability of its continuing after taking into account the availability of qualified obstetricians and anesthesiologists at the FRU level. In the rejoinder that has been filed by the Respondent No.6 Society, it is alleged that the doctors who have completed four and a half months training have not been posted in FRU and are posted to the City/District hospitals to work as full-fledged anesthetists and some others, posted back to their earlier designations, are doing general medical duties, postmortem work, emergency cover duties etc. It is further alleged that most of the FRUs/CHCs are yet to be equipped with anesthesia machines, monitors and blood storage units. Further, in paragraph 5 of the rejoinder, it is suggested that the period of training should be increased to minimum of 12 months in the medical college departments and certain other suggestions are also made. In the additional affidavit filed by the Government of India, it has been demonstrated that the allegations of non posting of trained doctors are not correct. Almost all the doctors have been posted at FRUs after giving them training at the district centres. It is also seen from the affidavit that the Government of India intends to operationalise approximately 4000 FRUs with the trained doctors, of which 1652 have been made operational. That for remaining 2348 FRUs, the issues relating to availability of blood storage centre, trained/qualified doctors and the infrastructure are being handled vigorously in association with the State Governments which include the subject training programme. The Government of WP(C) No.140 of 2007 Pg.4 India intends to train a total of about 5000 doctors to meet the requirement of LSAS at FRUs considering the non-availability of some trained doctors due to their career pursuits, promotions etc. It is also seen that the doctors who undergo the training in LSAS are retained at district hospitals for a few months to gain practical experience to handle the obstetric emergency situations under the qualified specialists before being posted to the FRUs. As far as the suggestion for increasing the period of training, it is seen that it will defeat the very basic purpose of the Scheme. As far as the other suggestions are concerned, respondent No.6 society is free to forward them to the MCI for consideration. MCI may consider those suggestions while considering the issue of continuation of the scheme. With the above observations, the writ petition stands disposed of. CHIEF JUSTICE NEERAJ KISHAN KAUL, J APRIL 15, 2009 pk