IN RE : THE PROPER TREATMENT OF COVID 19 PATIENTS AND DIGNIFIED HANDLING OF DEAD BODIES IN THE HOSPITALS ETC. versus RE:
[2020] 6 S.C.R. 844, Supreme Court of India, 2020
Outcome: Directions issued
Segment: Ratio
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IN RE : THE PROPER TREATMENT OF COVID 19 PATIENTS
AND DIGNIFIED HANDLING OF DEAD BODIES IN THE
HOSPITALS ETC.
(Suo Motu Writ Petition (Civil) No. 7/2020)
JUNE 19, 2020
[ASHOK BHUSHAN, SANJAY KISHAN KAUL AND
M. R. SHAH, JJ.]
Public Health – Covid-19 pandemic – Lapses in care of Covid-
19 patients in different hospitals in National Capital Territory of
Delhi and other States – Suo motu writ petition – Held: Directions
issued for continuous supervision, monitoring of government
hospitals, Covid dedicated hospitals and other hospitals taking care
of Covid management – Directions also issued w.r.t Union of India’s
guidelines permitting one attendant of Covid-19 patient and
discharge policy – Further, Union of India may consider issuing
uniform directions to all the States and UTs w.r.t. reasonable rates
of various Covid related facilities/test for private hospitals/labs,
which may be made applicable across the country – Any variations
to be made with regard to any particular State/Union Territory be
specifically provided – Direction issued – Disaster Management
Act, 2005.
Issuing directions, the Court
HELD: 1.1 With the object of continuous supervision and
monitoring of government hospitals, Covid dedicated hospitals
and other hospitals taking care of covid management following
directions are issued -
(I) The Ministry of Health and Family Welfare, Union of
India, shall constitute Expert Committees consisting of: a) Senior
Doctors from Central Government hospitals in Delhi, b) Doctors
from GNCTD hospitals or other hospitals of Delhi Government,
c) Doctors from All India Institute of Medical Sciences, d)
Responsible officer from Ministry of Health and Family Welfare.
(II) The Expert Committee shall inspect, supervise and issue
necessary directions to all Government hospitals, Covid hospitals
and other hospitals in NCT of Delhi taking care of Covid patients;
The Expert Committees shall ensure that at least one visit in
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each hospital be done weekly. (III) The team may in addition to
normal inspection shall also conduct surprise visits to assess the
preparedness of the hospitals. The expert team after visiting may
issue necessary instructions for improvement to the hospital
concerned and also forward its report to the Government of NCT
of Delhi and the Union of India, Ministry of Health and Family
Welfare. (IV) All States shall also constitute an expert team of
Doctors and other experts for inspection, supervision and
guidance of Government hospitals and other hospitals dedicated
to Covid-19 in each State who may inspect, supervise the hospitals
in the State and issue necessary directions for the improvement
to the concerned hospital and report to the Government. [Para
12][849-F-0H; 850-A-D]
1.2 The installation of CCTV Cameras in all the wards is a
welcome step which shall not only help the hospital management
to immediately find out the requirement of proper care with regard
to patients admitted in the wards but also ensure transparency in
the patients care in the hospital. Following directions are issued-
(V) Footage from the CCTV Cameras shall be made available by
the hospitals in NCT of Delhi to the inspecting/supervising expert
team or to any other authority or body as per directions of the
Union of India, Ministry of Health and Family Welfare for
screening the footage and issuing necessary directions thereon.
(VI) In Government hospitals of GNCT, Delhi which are
Covid
dedicated hospitals, where CCTV cameras have not been
installed, steps shall be taken to install CCTV Cameras in the
wards. (VII) The Chief Secretaries of other States shall also take
steps regarding installation of CCTV Cameras in Covid dedicated
hospitals where Covid patients are taking treatment to facilitate
the management of such patients and for the screening of the
footage by designated authorities or bodies so that remedial action
may be suggested and ensured. [Para 13][850-E-H; 851-A]
1.3 One of the guidelines by the Union of India is to permit
one attendant of Covid-19 patient. Directions- (VIII) All Covid-
dedicated hospitals shall permit one willing attendant of the
patient in the hospital premise, who can remain in an area
earmarked by the hospital. (IX) All Covid dedicated hospitals
IN RE : THE PROPER TREATMENT OF COVID 19 PATIENTS AND
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shall create a helpdesk accessible physically as well as by
telephone from where well being of patients admitted in the
hospitals can be enquired. [Para 14][851-B-C]
1.4 (X) The Union of India, Ministry of Home Affairs may
issue appropriate directions in exercise of power under Disaster
Management Act, 2005 to all States/Union Territories to uniformly
follow the revised discharge policy dated 08.05.2020 with regard
to discharge of different categories of patients as categorised in
the revised discharge policy. [Para 15][851-F-G]
1.5 (XI) The Union of India may issue appropriate
guidelines/directions to all the States/Union Territories with
regard to prescribing reasonable rates of various Covid related
facilities/test etc., which need to be uniformly followed by all
concerned.  In case, with regard to any particular State/Union
Territory, there is any difference, the same may be specifically
noticed and directed accordingly. [Para 17][852-D]
CIVIL ORIGINAL JURISDICTION: Suo Motu Writ Petition (C)
No. 7 of 2020.
By Court’s Motion.
Tushar Mehta, SG, K.M. Nataraj, ASG, Sanjay Jain, ASG, Jayanth
Muthuraj, AAG, Ms. Manisha Lavkumar, Gurukrishna Kumar, Sr. Advs.
Rajat Nair, Kanu Agrawal, Saurab Mishra, B.V. Balram Das, Gurmeet
Singh Makker, Aniruddha P. Mayee, Pukhrambam Ramesh Kumar,
Ms. Anupama Ngangom, Karun Sharma, M. Yogesh Kanna, Shivam,
Talha Abdul Rahman, Anish Kumar Gupta, Ms. Archana Preeti Gupta,
Chandra Shekhar
Suman, Avdhesh Kumar Singh, Suhaan Mukerji,
Vishaal Prasad, Amit Verma, M/S. Plr Chambers And Co., Chirag M.
Shroff, Sachin Patil, Rahul Chitnis, Abhimanyu Tewari, Ms. Eliza Bar,
Subhash Chandran K.R., Biju P Raman, and Shashank Deo Sudhi, Advs.
for the appearing parties.
Udian Sharma (Applicant-in-person)
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The following order of the Court was passed:
O R D E R
1. This Court issued notice on 12.06.2020 in this Suo Motu writ
petition with object to notice deficiencies, shortcomings and lapses in
patient care of Covid-19 in different hospitals in National Capital Territory
of Delhi and other States. The object was to take remedial action by all
concerned to redeem the plight of patients and other persons who needs
medical care.
2. In response to notice dated 12.06.2020, Union of India, Delhi
Government and other States have filed their affidavits. Several
applications for intervention have also been filed by different individuals,
organisations highlighting one or other aspects of the issue.
3. The Union of India in its affidavit after noticing the aberration,
which were highlighted by the Court in its order, have brought on the
record remedial steps taken by Union of India. The affidavit mentions
that on 14.06.2020, a high-level meeting was held by Hon’ble Home
Minister with Lieutenant Governor of Delhi, Chief Minister of Delhi,
Union Health Minister, Health Minister of Delhi, Mayors and
Commissioners of Delhi’s three Municipal Corporations to strengthen
the strategy to fight the coronavirus. The affidavit enumerates certain
action points which have emerged in the deliberation. In paragraph 13 of
the affidavit, decision taken by the Union of India have been referred to.
We may notice only few of such decisions which need to be specifically
noticed. In
paragraph 13(ii), following has been stated:-
“13. (ii) It has been further decided that a team of senior doctors
from Central Government Hospitals in Delhi, GNCTD Hospitals,
Municipal Hospitals and AIIMS shall visit all hospitals in Delhi,
within 2 days, to study the arrangements made for patient care
and treatment and suggest improvements to be done. The
responsibility for implementation of the said decision has been
given to the Union Health Secretary to coordinate with Chief
Secretary, GNCTD and Director, AIIMS, who would ensure
implementation of the said decision.”
4. In paragraph 13(iv), decision regarding increase of the testing
per day in NCT of Delhi has been mentioned. It has been stated that by
20.06.2020, the tests shall be increased up to 18,000 per day. The decision
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also refers to the constitution of the Committee of Dr. V.K. Paul, Member,
NITI Aayog, representative of the AIIMS and representative of GNCTD
who has to report regarding reasonable rates of various covid related
facilities/tests etc. for private hospitals, labs.
5. We have come to know that the rates of the tests to be conducted
in the private labs is substantially reduced by the Government of India
for which orders have also been issued. The affidavit also gives details
of guidelines framed by the Union of India to ensure proper treatment of
Covid-19 patients and dignified handling of the dead bodies in the hospitals
as well as the guidelines framed by the Union of India pertaining to
Covid-19 hospital management.
6. In paragraph 18, it has been stated that strict observance and
adherence of guidelines shall be ensured. One of the guidelines, whose
adherence was to be ensured, was that the patients are provided with
the bed and are permitted to have one attendant and the attendant can
remain in the hospital premises in the area earmarked by the hospital
and no suspected Covid-19 patients shall be turned away from the hospital
and details of indoor facilities and advisory for OPD has also been noticed.
7. The Government of NCT, Delhi has also filed affidavit of Smt.
Padmini Singla, Secretary, Health and Family Welfare, Government of
NCT of Delhi. Although affidavit gives the details of the Government
hospitals of
Delhi, Government designated Covid hospitals, name of an
IAS officer who was deployed as a nodal officer in all Covid designated
hospitals to monitor and supervise various aspects and functioning of the
hospitals, providing for 24x7 Help desk at each hospital along with display
board/LED Screen to inform the availability of beds to the general public,
details of available manpower in LNJP hospital, details of public sector
labs and private sector labs. The affidavit also noticed the decision taken
in the meeting chaired by Hon’ble Home Minister on 14.06.2020 to
increase the testing facility in Delhi.
8. We, however, noticed that in the entire affidavit, apart from
general statement that all steps are being taken, the affidavit does not
indicate any mechanism for proper supervision of the functioning of the
hospital and steps for improvement. The affidavit tries to give an
impression to the Court that everything in the Government hospital in
NCT, Delhi is well and all steps are being taken by the Government of
NCT of Delhi. When the Government does not endeavour to know any
shortcomings or lapses in its hospitals and patient care, the chances of
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remedial action and improvement becomes dim. Every organisation, every
individual should be more than ready to know about shortcomings, lapses
and it is only after knowing one’s shortcomings and deficiencies, remedial
actions can be taken.
9. We impress upon Government of NCT of Delhi to be more
vigilant in knowing about the deficiency and lapses in functioning of the
hospitals and patients care and take immediate & remedial steps to
redeem the miseries of patients, the public who needs medical care and
help.
10. The necessary guidelines on all aspects of patients’ care,
hospital management, testing, infrastructure are in place as has been
highlighted by Union of India in its affidavit. The main concern is the
faithful and strict implementation of the said guidelines which can be
only ensured by constant supervision, monitoring and taking remedial
steps with regard to improvement of infrastructure, staff, facilities, etc.
The most important aspect is continuous supervision and monitoring of
Government hospital in Government of NCT of Delhi and other States.
11. As noted above, in the meeting dated 14.06.2020 chaired by
Hon’ble Home Minister, one of the decisions taken was that a team of
senior doctors from Central Government hospitals in Delhi, GNCTD
hospitals, Municipal hospitals and AIIMS shall visit all hospitals in Delhi.
One visit in all hospitals of Delhi is not enough. There has to be constant
monitoring, supervision and management.
12. We with the
object of continuous supervision and monitoring
of government hospitals, Covid dedicated hospitals and other hospitals
taking care of covid management issue following directions Nos.(I) to
(IV):-
(I) The Ministry of Health and Family Welfare, Union of India,
shall constitute Expert Committees consisting of:
a) Senior Doctors from Central Government hospitals in Delhi,
b) Doctors from GNCTD hospitals or other hospitals of Delhi
Government,
c) Doctors from All India Institute of Medical Sciences,
d) Responsible officer from Ministry of Health and Family
Welfare.
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(II) The Expert Committee shall inspect, supervise and issue
necessary directions to all Government hospitals, Covid hospitals and
other hospitals in NCT of Delhi taking care of Covid patients; The Expert
Committees shall ensure that at least one visit in each hospital be done
weekly.
(III) The above team may in addition to normal inspection shall
also conduct surprise visits to assess the preparedness of the hospitals.
The expert team as indicated above after visiting may issue necessary
instructions for improvement to the hospital concerned and also forward
its report to the Government of NCT of Delhi and the Union of India,
Ministry of Health and Family Welfare.
(IV) We further direct that all States shall also constitute an expert
team of Doctors and other experts for inspection, supervision and
guidance of Government hospitals and other hospitals dedicated to Covid-
19 in each State who may inspect, supervise the hospitals in the State
and issue necessary directions for the improvement to the concerned
hospital and report to the Government. Chief Secretary of each State
shall ensure that such Committees are immediately constituted and start
their works within a period of seven days.
13. An affidavit has also been filed by Director, LNJP hospital,
Government of NCT of Delhi, where in paragraph 4, it has been stated
that CCTV Cameras have been installed in all the wards. The installation
of CCTV Cameras in all the
wards is a welcome step which shall not
only help the hospital management to immediately find out the requirement
of proper care with regard to patients admitted in the wards but also
ensure transparency in the patients care in the hospital. In this regard,
we issue following directions as direction Nos. (V) to (VII):
(V) Footage from the CCTV Cameras shall be made available by
the hospitals in NCT of Delhi to the inspecting/supervising expert team
or to any other authority or body as per directions of the Union of India,
Ministry of Health and Family Welfare for screening the footage and
issuing necessary directions thereon.
(VI) In Government hospitals of GNCT, Delhi which are Covid
dedicated hospitals, where CCTV cameras have not been installed, steps
shall be taken to install CCTV Cameras in the wards.
(VII) The Chief Secretaries of other States shall also take steps
regarding installation of CCTV Cameras in Covid dedicated hospitals
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where Covid patients are taking treatment to facilitate the management
of such patients and for the screening of the footage by designated
authorities or bodies so that remedial action may be suggested and
ensured.
14. We have noticed above that one of the guidelines by the Union
of India is to permit one attendant of covid-19 patient. In this regard, we
issue following directions as direction No. (VIII) and (IX):-
(VIII) All Covid-dedicated hospitals shall permit one willing
attendant of the patient in the hospital premise, who can remain
in an area earmarked by the hospital.
(IX)
All Covid dedicated hospitals shall create a helpdesk
accessible physically as well as by telephone from where well
being of patients admitted in the hospitals can be enquired.
15. In the supplementary affidavit dated 17.06.2020 filed on behalf
of the Union of India, details of Covid-19 patients discharge policy of
Union of India has been given.  Copy of the revised discharge policy for
Covid-19 dated 08.05.2020 has also been brought on the record. The
revised policy dated 08.05.2020 brought on record does not indicate that
necessary directions have been issued to all States/Union Territories to
communicate it to the concerned dedicated Covid hospitals and other
hospitals to uniformly follow the discharge policy.  We are of the view
that discharge policy framed by the Union of India has to be followed by
all States/Union Territories uniformly to ensure discharge of the Covid
patients uniformly and to achieve clarity in the minds of all concerned.
We, thus, issue following direction in this regard:-
(X) The Union of India, Ministry of Home Affairs may issue
appropriate directions in exercise of power under Disaster
Management Act, 2005 to all States/Union Territories to
uniformly follow the revised discharge policy dated 08.05.2020
with regard to discharge of different categories of patients as
categorised in the revised discharge policy.
16. We, in our order dated 12.06.2020 has observed:-
“We impress upon the States to ensure that there should be steep
increase in the testing both by Government hospitals and private
labs and whosoever desires for testing should not be denied on
any technical ground or any other ground…………….”
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17. We have also noticed in this order that Union of India has
constituted a Committee of Dr. V.K. Paul, Member, NITI Aayog,
representative of the AIIMS and representative of GNCTD who has to
report regarding reasonable rates of various Covid related facilities/tests
etc. Government of India on the basis of a report from the said Committee
has already taken a decision for reducing the amount of test in the NCT
Delhi.  The Union of India may consider issuing uniform directions to all
the States and Union Territories with regard to reasonable rates of various
Covid related facilities/test for private hospitals/labs, which may be made
applicable across the country. If any variations to be made with regard
to any particular State/Union Territory, the same shall be specifically
provided for in the guidelines. We, thus, issue following direction in this
regard:-
(XI) The Union of India may issue appropriate guidelines/directions
to all the States/Union Territories with regard to prescribing reasonable
rates of various Covid related facilities/test etc., which need to be
uniformly followed by all concerned.  In case, with regard to any particular
State/Union Territory, there is any difference, the same may be
specifically noticed and directed accordingly.
I.A Nos.55935 & 55936 of 2020
18. Learned counsel for the applicant submits that the State of
Maharashtra has issued an order that a positive report of the patient
shall
not be given to the patient or the relatives of the patient.
19. Mr. Tushar Mehta, learned Solicitor General conceded that
when a report of the patient is positive, the same shall be given to the
patient or his relatives.
20. We have no doubt that the States and all concerned shall
supply a copy of the report of the patient to him or his relatives and the
hospital.
21. A copy of the applications may also be given to the learned
Solicitor General as well as learned counsel for the State of Maharashtra.
22. Learned counsel for the State of Maharashtra submits that
the State of Maharashtra has already fixed the rate of testing as
Rs.2200/- and Rs.2800/-, which we feel is welcome to step-up the number
of testing in the State of Maharashtra. He further submits that every
day more than 16000 tests are conducted in the State of Maharashtra.
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Learned counsel for the State of Maharashtra submits that he shall obtain
instructions regarding non-giving of the report to the patient or his
relatives. He shall advise the State to issue an appropriate order permitting
handing of the report to the patient or his relatives and the hospital.
23. Learned counsel for various intervenors have submitted that
their several suggestions have been included in the intervention
applications. Learned counsel appearing for the intervenors may give a
copy of the suggestions in writing to the learned Solicitor General as
well as to learned counsel for the respective States for appropriate
consideration.
24. A question was posed to Shri Sanjay Jain, learned Additional
Solicitor General appearing for the Delhi Government about the status
of construction of second trauma centre at Dwarka out of Rupees Sixty
Crores deposited as a fine by the Ansal Brothers (Rupees Thirty Crores
each) in Uphaar Cinema fire tragedy case – Criminal Appeal No. 597-
598 of 2010 vide this Court’s order dated 22.09.2015.  Shri Sanjay Jain
submitted that he will get back on this on the next date of hearing.
25. List the matter in third week of July, 2020.
Divya Pandey
Directions issued.
IN RE : THE PROPER TREATMENT OF COVID 19 PATIENTS AND
DIGNIFIED HANDLING OF DEAD BODIES IN THE HOSPITALS