IN THE HIGH COURT OF JUDICATURE, ANDHRA PRADESH AT HYDERABAD (Special Original Jurisdiction) THURSDAY, THE TWENTY FOURTH DAY OF APRIL TWO THOUSAND AND EIGHT PRESENT THE HON'BLE MR JUSTICE A.GOPAL REDDY and THE HON'BLE MR JUSTICE B.SESHASAYANA REDDY WRIT PETITION NO : 1332 of 2004 Between: Paper clipping of news item published in "The Hindu" Daily newspaper dated 20-1-2004 under the caption "POOR MAN'S HEART RENDING STORY " OFFICIAL APATHY", cuts infant's life short" ..... PETITIONER AND 1 The District Collector, Ranga Reddy Dist. at Hyderabad. 2 The Mandal Revenue Officer, Malkajgiri, R.R.Dist. 3 The Director (Medical)/Superintendent, Apollo Hospital, Jubilee Hills, Hyderabad. 4 The Secretary to the Govt.of A.P., Medical & Family Welfare Dept., Secretariat, Hyderabad. 5 The Appolo Hospital, Jubilee Hills, Hyderabad, rep. by its Managing Director. R5 is impleaded as per court order dated 23-1-2004 in W.P.No.1332 of 2004. .....RESPONDENTS Petition under Article 226 of the constitution of India praying that in the circumstances stated in the Affidavit filed herein the High Court will be pleased to to issue an order, direction, or a writ, more particularly one in the nature of writ of mandamus calling for the remarks and records from the Respondents herein in and connected to (1) death of a child of 20 months old, namely., Sophia Fatima, only daughter of Moin Pasha, a private electrician; and a white ration card holder, R/o.R.T.C.Colony, Moulali, Ranga Reddy District, due to the lack of medical aid in time involving Rs.1,50,000/- from 'Save a child's Heart Foundation'; (2) Official apathy and delay on the part of the Respondents herein for granting financial aid in time through a recommondation from the District Collector for the operation of the victim suffering from the disease and to pass appropriate orders directing the concerned authorities to take necessary steps so that no child should ever suffer in future for the official apathy in granting financial aid Counsel for the Petitioner: TAKEN UP Counsel for the Respondents: THE ADVOCATE GENERAL The Court made the following : ORDER: (Per The Hon’ble Sri Justice A.Gopal Reddy) A news item titled as “Poor Man’s Heart Rendering Story – ‘Official Apathy’, cuts infant’s life short”, published in the Hindu English daily newspaper on 20-01-2004, was treated as taken up Writ Petition and notice was issued to the respondents. In response to the said notice, on behalf of the fourth respondent, the Deputy Secretary to Government of A.P., Medical and Health, Family Welfare Department, filed Counter-Affidavit and an additional Counter-affidavit sworn on 24th November, 2007 and 25th March, 2008 respectively. The first respondent-District Collector also filed a counter-affidavit on behalf of respondent Nos.1 and 2. The President of the fifth respondent-Hospital filed a counter-affidavit and additional counter-affidavit on behalf of respondent Nos.3 and 5. On 19-12-2003, one Moin Pasha filed a representation before the second respondent - Mandal Revenue Officer, Malkajgiri, stating that his daughter-Sofia Fatima is suffering from Complex Congenital Heart Disease TAPVC, that Dr.K.Sambha Murthy, a Doctor of Apollo Hospital, advised that the child should undergo open heart surgery as early as possible, that he being a private electrician with meager daily wages, cannot bear the expenditure, and therefore, he requested for sanction of amount from CM Relief Fund and PM Relief Fund and that the hospital authorities called upon him to get the recommendation of the District Collector for aid under ‘Save A Child’s Heart Program’, for which necessary recommendation should be made by the Mandal Revenue Officer concerned. The second respondent vide his letter dated 24-12- 2003 recommended the case of the child to the first respondent to consider the request for financial aid/assistance and it was received by the first respondent on 27-12-2003. The first respondent endorsed on the file recommending the case subject to eligibility Certificate of the Mandal Revenue Officer concerned and the same was informed to the second respondent vide letter dated 09-01-2004, and the second respondent submitted his report though fax on 13-01-2004 stating that Moin Pasha, father of the child, migrated from Karnataka State ten years back, that he is residing at House No.43-329, RTC Colony, Moulali, and that he is working as a private electrician and getting an income of Rs.20,000/- per annum, and requested the first respondent to consider the case on humanitarian grounds as it does not come under below poverty line i.e., the income being below Rs.11,000/- per annum as fixed for consideration of such cases. The first respondent, in turn, recommended the case on 13-01-2004 for aid, which was handed over to Moin Pasha, father of the child on 13-01-2004 itself. In the counter-affidavit filed on behalf of the third respondent- hospital authorities, it is stated that when the child-Sofia Fatima was brought by her father-Moin Pasha to the hospital of the fifth respondent on 01-10-2003 with the complaint of Congenital Cyanotic Heart Disease, after conducting the necessary examination on the child, she was diagnosed to be suffering from Complex Heart Disease (Total Anomalous Pulmonarhy Venous Connection – TAPVC) and was advised open heart surgery. Keeping in view the poor economic status of the father of the child, her cardiac valuation was done free of charge at Appollo Hospital, Jubilee Hills, Hyderabad. As the child’s condition was stable enough to undergo elective open-heart surgery, the estimation of the expenditure was given to the father of the child advising him to obtain necessary financial assistance to meet the said expenditure. He was also advised to approach the Organization viz., ‘Save A Child’s Heart foundation’ and seek necessary aid from CM Relief fund and PM Relief fund. Alternatively, the open heart surgery being elective, he was also advised to approach the Government Hospital for the surgery and with the said advise, his daughter was discharged from the fifth respondent-Hospital on 01-10-2003. Again the child was brought to the hospital on 16-01-2004 at 4.00 p.m., in a serious condition, and she was immediately taken to emergency room and appropriate resuscitative efforts were carried out in the emergency room. Despite all such efforts, she could not be revived and was declared dead at 5.45 p.m. When the Writ Petition was taken up for hearing on 28-01-2008, this Court directed the fourth respondent to furnish information with regard to the inflow of the patients, facilities available in the Government Hospitals on par with the private hospitals across the State and the steps taken by the Government to improve the three premier Government Hospitals viz., Osmania General Hospital, Gandhi Hospital, Nizam’s Institute of Medical Sciences, Autonomous and other important Government Hospitals, to provide facilities with regard to the investigations, treatment and surgeries on par with corporate hospitals, and as to why entitlement of medical reimbursement for all classes of persons of the Government/Semi-Government organizations shall not be restricted to the treatment taken only in the above kind of Government Hospitals by improving their standards. In response to the same, the Deputy Secretary, Medical, Health and Family Welfare filed a counter-affidavit on behalf of fourth respondent sworn on 24th November, 2007 stating as under: ‘ a . The Government has taken all necessary steps to improve the services of three hospitals situated at Greater Hyderabad City by allocating lion share in the allotted budget of the Health, Medical & Family Welfare department. These three hospitals rendering round the clock services to the needy patients and attending the emergency cases, super specialty cases. b. The budget allotted to the three premier Government Hospitals for the year 2007-08 is as follows: Plan Non-Plan Total i) Osmania GeneralHospital, Hyderabad --- Rs.16.03 Crores 16.03 Crores ii) Gandhi Hospital,Secunderabad --- Rs.14.72 Crores Rs.14.72 Crores iii) Nizam’s Institute of Medical Sciences(NIMS), Hyderabad(Grant-in- Aid) Rs.45.00Crores Rs.29.57 Crores Rs.74.57 Crores c) The excellent services are provided by these three hospitals are on par with the services of any corporate hospitals situated in the Country. All the super specialty divisions are headed by eminent doctors having longstanding experience in the different branches of medicine. d) All the three hospitals are equipped with latest international quality equipment to give accurate reports on investigations, maintaining American Standards in operation theatres, to conduct surgeries in hygienic condition resulting to good success rate. e) I submit that the Government spent Rs.16,94,78,505/- for the procurement of Medical Equipment in Osmania Hospital and Rs.18,47,25,339/- for procurement of medical equipment in Gandhi Hospital during the financial year 2007-08. f) With regard to point of view expressed by the Hon’ble Court “as to why the entitlement of medical reimbursement for all classes of persons of the Government/Semi Government Organizations shall not be restricted to the treatment taken only in the above kind of government Hospitals by improving their standards”, I submit that if the entitlement of reimbursement is restricted to these three hospitals the situation become unmanageable and the hospital management will fail to achieve institutional task and objective. The expansion of bed capacity is not an unending process, every hospital has its own limitation in catering the needs of patients. Beyond particular capacity it is not possible to give quality service to the patients. All classes of employees working in State government and Semi government Organizations are provided completely free satisfactory treatment in these three premier hospitals. The three hospitals are already over loaded with the general public. The population is in rampant increase due to migration to city from rural areas. I submit that there are thousands of employees in the Government/Semi Government in greater City of Hyderabad. If all the employees are compelled to approach the three hospitals alone for treatment the doctors may not be in a position to take proper attention and care, resulting to failure of discharge of Professional duties. g) With regard to the point of view expressed by from lordship in the 2nd Para of the order that the practicability of payment of lumpsum sum per month or per annum, instead of reimbursement of medical bills to all kinds of persons that are entitled for reimbursement may also be examined and appropriate suggestions may be made, as that is likely to have automatic impact on the cost of treatment in Corporate Hospitals and also would avoid the malpractice and ordeal to person that would go for such kind of treatment and reimbursement and of other procedural formalities. I submit that the rate of percentage of sickness among the employees is decreasing constantly due to the general enlightenment on health care, advanced preventive medical care and modernization of working facilities (conditions). I submit that if the State Government Employees are paid lump sum every month or every year as viewed by the Hon’ble Division Bench of Hon’ble High Court there will be unbearable burden on public exchequer. Instead of involving in additional expenditure by the State the Hon’ble Court may appreciate the present policy of the Government to bear all the expenditure incurred for treatment of the needy employees in the three super specialty hospitals. With regard to malpractices in reimbursement claims is concerned there is no scope for such illegal activity as the bills are being scrutinized in DME Office by the technical Medical Officer in the Rank of Additional Director of Medical Education. The Government is taking all measures to curtail the malpractices and there is thorough check on every item of services given to the patients and the cost charged for such services. I submit that the Medical & Health, Family Welfare Department is dedicated to the cause of citizens Health, family welfare and making relentless efforts to improve the efficiency of the medical teams by providing latest infrastructure facilities to cope up with the day to day advancement in the methods of health care. The Medical Health, Family Welfare Department being the integral part of the executive one among the three instrumentalities within our play endeavour to elongate the constitutional basic structure built in the preamble, fundamental rights and directive principles viz., establishment of an egalitarian social order in which citizen receives equality of opportunity and of status, social economic justice.” Since several practical difficulties are being faced by the hospital management, to suit the needs of the patients, the above policy has been adopted by the Government. The Government is implementing the Medical reimbursement facility to the in-service and retired Government Servants and their families to enable them to have a better treatment in Corporate Hospitals. Besides the Medical reimbursement facility, the Government has also taken several steps for improving the infrastructure and manpower by installing C.T. Scan/MRI and recruiting Doctors, Nurses and Para-Medical Staff in the above said Government hospitals. In the additional affidavit filed by the Deputy Secretary, Medical, Health and Family Welfare Department, on behalf of fourth respondent, G.O.Ms.No.74 dated 15-03-2005 has been enclosed and the necessary details as regards the infrastructure available have been furnished and they read as under: ‘I am also to submit that the total bed strength of the 36 Teaching l& Allied Hospitals are 15097. The details are submitted below:- Sl.No.NAME OF THE INSTITUTE BED STRENGTH 1 Osmania General Hospital, Hyderabad 1168 2 Gandhi Hospital, Secunderabad 1012 3 MGM Hospital, Warangal 1000 4 Govt. General Hospital, Guntur 1177 5 Govt. General Hospital, Kakinada 1085 6 King George Hospital, Visakhapatnam 1037 7 Govt. General Hospital, Vijayawada 412 8 Govt. General Hospital, RIMS, Kadapa 750 9 Govt. General Hospital, Kurnool 1050 10 Govt. General Hospital, Ananthapur 500 11 S.V.R.R. Govt. General Hospital, Tirupathi 710 12 Govt. General Hospital, Mangalagiri 180 13 S.D.Eye Hospital, Hyderabad 577 14 Niloufer Hospital, Hyderabad 360 15 Govt. Maternity Hospital, Sultanbazar, Hyderabad 462 16 Govt. Maternity Hospital, Sultanbazar, Hyderabad 160 17 SRRIT & CD, Hyderabad 330 18 Govt. ENT Hospital, Hyderabad 125 19 Govt. General & A.P.Chest Hospital, Hyderabad 670 20 Govt. Maternity Hospital, Hyderabad 600 21 CKM Govt. Maternity Hospital, Matwada 100 22 Govt. Maternity Hospital, Hanamkonda 100 23 Regional Eye Hospital, Warangal 75 24 Govt TB and CD Hospital, Hanamkonda 100 25 Fever Hospital, Guntur 100 26 Govt. Hospital for Chest & CD, Visakhapatnam 288 27 Dr.RSPR Govt. REH, Visakhapatnam 75 28 Victoria Hospital, Visakhapatnam 147 27 Govt. ENT Hospital, Visakhapatnam 75 28 Victoria Hospital, Visakhapatnam 147 29 Govt. ENT Hospital, Visakhapatnam 100 30 Govt. Hospital for Mental Care, Visakhapatnam 300 31 RCD Hospital, Visakhapatnam 70 32 YVRCC Chinakakani, Vijayawada 30 33 Mangalagiri Hospital, Mangalagiri 20 34 Regional Eye Hospital, Kurnool 75 35 Govt. Maternity Hospital, Tirupathi 152 TOTAL BED STRENGTH 15097 I am to submit ever since the Government has started Heart Surgeries Programme, the Govt. Hospitals have taken up the responsibility of performing heart surgeries free of cost to the patients. Child Heart Surgeries are done regularly in Gandhi Hospital, Osmania General Hospital, MGM Hospital, Warangal, King George Hospital, Visakhapatnam, Government General Hospital, Kurnool & Government General Hospital, Guntur. So far 753 surgeries have been performed for children and to develop the Cardiology and Cardiothoracic departments of Government Hospitals in the last 2 years Govt. have sanctioned Rs.14.98 Crores for this purpose. The details are as follows:- Sl.No. Name of the Hospital Amount sanctioned 1 Kurnool Medical College/Govt.General Hospital, Kurnool Rs.3,33,95,371/- 2 MGM Hospital, Warangal Rs.1,71,91,838/- 3 Osmania General Hospital, Hyderabad Rs.5,23,32,574/- 4 Gandhi Hospital, Secunderabad Rs.1,58,76,725/- 5 Cathlab to King George Hospital Rs.3,10,97,137/- Total Rs.14,98,93,645/- I am to submit that the inflow of the patients and the facilities available in Andhra Pradesh Vaidya Vidhana Parishad Hospitals and activities are as follows: (a) Andhra Pradesh Vaidya Vidhana Parishad Hospitals provide the following services by the Specialty and other Doctors: Sl.No. Group Services 1 General Services Out Patients, In Patients, Emergency, Major Operations and Emergency Minor Operation 2 Clinical Services Major/Minor Operations, deliveries and Sterilizations. 3 Diagnostic Services X-Ray, Electro Cardiography, Laboratory Tests, Ultra Sonography etc. (b) The District Hospitals provide service with a bed strength that ranges from 200-350 and ten clinical specialties like Obstetrics, Gynecology, Pediatrics, General Medicine, general Surgery, Orthopedics, Ophthalmology, ENT, Dental, Anesthesia, Radiology and others. (c) The Area Hospitals provides service with 100 beds and four clinical specialties like Obstetrics & Gynecology, Pediatrics, General Medicine and General Surgery. (d) The community Health centers (CHC) with 30-60 beds and one clinical specialty. These hospitals are provided with professional Staff (Doctors, Nurses, and Paramedics) and medical equipment depending upon their service levels land bed strength. The drugs are provided to all the hospitals by the central drug stores under APHMHIDC as per the requirements specified by APVVP. (e) District Hospital, Eluru, West Godavari District have accorded revised administrative sanction for an amount of Rs.4.50 Crores for civil works and Rs.4.65 Crores for equipment for upgradation of District Hospital, Eluru to that of Super Specialty Hospital with 3 units of cardiology, Neurology and Urology Departments. I am to submit that, Trauma Care Center at District Hospital, Nellore, is functioning from 22-10-2007. The following 6 Trauma Care Centers are sanctioned by the Government of India and under process for establishment in the APVVP Hospitals:- 1.Dist. Hospital Srikakulam Srikakulam 2.Dist. Hospital Eluru West Godavari 3.Dist. Hospital Rajahmundry East Godavari 4.Dist. Hospital Ongole Prakasam 5.Area Hospital Tekkali Srikakulam 6.Area Hospital Tuni East Godavari I am to submit that under National Rural Health Mission (NRHM) – 80 Comprehensive Emergency Obstetric and Neonatal Care (CEMONC) Centres are established in APVVP Hospitals to provide quality service (Round the Clock) to maternal and child care. I am to submit that 17 Blood Banks and 62 Blood Storage Centers are sanctioned under RCH – II Programme, 25 Blood Banks already functioning in APVVP Hospitals. I am to submit that Govt. have sanctioned for establishment of specialty clinics of Ayurveda – 12, Homeo – 10 and Unani – 10 under 100% centrally sponsored scheme in the following hospitals: Ayurveda: 1 Community Health Center Ranasthalam Srikakulam 2 Community Health Center Bhogapuram Vizianagaram 3 Community Center Bhimavaram West Godavari 4 Area Hospital Rajahmundry East Godavari 5 Area Hospital Chirala Prakasam 6 Area Hospital Nandyala Kurnool 7 Area Hospital Kadiri Ananthapur 8 Area Hospital King Koti Hyderabad 9 Area Hospital Nirmal Adilabad 10 Area Hospital Janagaon Warangal 11 Area Hospital Bhadrachalam Khammam 12 Area Hospital Gadwal Mahabubnagar Homeo: 1 Community Health CenterRajam Srikakulam 2 Area Hospital Parvathipuram Vizianagaram 3 Area Hospital Nuziveedu Krishna 4 Area Hospital Kandukuru Prakasam 5 Area Hospital Markapuram Prakasam 6 Area Hospital Chirala Prakasam 7 Area Hospital Madanapalle Chittoor 8 Area Hospital Srikalahasti Chittoor 9 Area Hospital Vijayapuri North Nalgonda 10 Area Hospital Suryapet Nalgonda Unani: 1 Area Hospital Pulivendula Kadapa 2 Area Hospital Proddutur Kadapa 3 Area Hospital Nandyala Kurnool 4 Area Hospital Adoni Kurnool 5 Area Hospital Guntakal Ananthapur 6 Area Hospital Dharmavaram Ananthapur 7 Govt. MaternityHospital Nirmal Adilabad 8 Area Hospital Siricilla Karimnagar 9 Area Hospital Narayanpet Mahabubnagar 10 Area Hospital Siddipet Medak Necessarily, the Government employees and the other employees, who are entitled to medical reimbursement, have to undergo the treatment in the Government hospitals. In order to curb the malpractices, the Government has also taken steps to deduct 10% of the admissible medical reimbursement amount of the employees, who undergo treatment other than in the government hospitals. Para 10 of G.O.Ms.No.74, Health, Medical and Family Welfare (K1) Department dated 15-03-2005 reads as under: ‘In G.O.Ms.No.175, H.M. & F.W. (K1) Department, dated 29-05-1997, 20% cut is prescribed on the eligible amount in cases of treatment obtained under emergency condition in private hospitals recognized by Government without referral letter from Government Hospitals or Nizam’s Institute of Medical Sciences, Hyderabad, or Sri Venkateswara Institute of Medical Sciences, Tirupati. In partial modification of the orders issued in G.O.Ms.No.175, H.M.& F.W.(K1) department, dated 29-05-1997, the 20% cut prescribed therein is reduced to 10%, on the eligible amount after scrutiny of bills by the Director of Medical Education or other scrutinizing authority as per the package rates, when the treatment was obtained under emergency conditions in private hospitals recognized by Government without referral letter from any Government Hospital or Nizam’s Institute of Medical Sciences, Hyderabad, or Sri Venkateswara Institute of Medical Sciences, Tirupati.’ In view of the above said affective steps taken by the Government to improve the standards of the Government Hospitals to make available all necessary infrastructure for investigations and treatment to the patients, who are in need, no further directions are required to be issued in this Writ Petition. The Writ Petition is, accordingly, closed. No costs. _______________________ (A.Gopal Reddy, J) 24th April, 2008 __________________________ (B.Seshasayana Reddy, J) lur ..... REGISTRAR // TRUE COPY // SECTION OFFICER To 1 The District Collector, Ranga Reddy Dist. at Hyderabad. 2 The Mandal Revenue Officer, Malkajgiri, R.R.Dist. 3 The Director (Medical)/Superintendent, Apollo Hospital, Jubilee Hills, Hyderabad. 4 The Secretary to the Govt.of A.P., Medical & Family Welfare Dept., Secretariat, Hyderabad. 5 The Appolo Hospital, Jubilee Hills, Hyderabad, rep. by its Managing Director. 6 2CCs to The Advocate General (OUT) 7 2CD copies Form-NIC-OGS/WP{PPNR}