Day: August 6, 2018

Poorest Of Poor Cannot Go To Private Hospitals: Uttarakhand HC

Coming straight to the core issue, it has to be noted right at the outset that in a landmark judgment delivered on July 6, 2018 with far reaching consequences, the Uttarakhand High Court in Chandra Shekhar Joshi v State of Uttarakhand & others in Writ Petition (PIL) No. 71 of 2015 recently issued a slew of commendable directions for improving the functioning of Government Medical College, Haldwani and its associate hospitals. The Court was hearing a petition filed by one Chandra Shekhar Joshi who had highlighted the lack of basic facilities at the Government Medical College, Haldwani and its associate hospitals, Dr Sushila Tewari Memorial Hospital and Swami Rama Cancer Hospital and Research Centre. It is the “poorest of poor” who cannot afford to go to private hospitals who have to suffer the most which cannot be condoned under any circumstances!
                                      As it turned out, on the oral application of petitioner, the Medical Council of India is added as respondent no. 6 in the petition. Para 3 of this landmark judgment brings out that, “According to the averments made in the petition, the institution is plagued with absenteeism. The poor patients are not getting specialized treatment. Number of posts are lying vacant. Patients are not getting the medicines from the hospital. There is a tendency among the doctors to refer the patients to other hospitals.” This is most deplorable and depreciable! Why should patients be referred to other hospitals and not treated there only?
                                         To be sure, it is rightly highlighted in para 4 of this landmark judgment that the hospital does not fall under the administrative control of the Department of Medical Health & Family Welfare, Govt. of Uttarakhand. It falls under the control of the Department of Medical Education. For this reason, free medicines cannot be provided.
                                   Truth be told, para 5 points out that, “A startling revelation has been made that Swami Rama Cancer Hospital & Research Institute currently has the Department of Radiotherapy only. Here, the conventional radiotherapy is delivered and also Brachytherapy is done. Simple forms of chemotherapy are often performed but complex form of chemotherapy is not feasible due to lack of medical oncology department. There is no Surgical Oncology Department yet. The Department of General Surgery and ENT often perform cancer surgeries when possible. The Departments of Medical Oncology, Surgical Oncology are due to be brought in when the institute is upgraded to State Cancer Institute. There are no Neurology, Gastrology, Nephrology, Urology or Cardiology Departments in the hospital. There is no independent Cardiology Department.”
                                             Going forward, in para 8, it is rightly brought out that, “Government Medical College, Haldwani (formerly known as U.K. Forest Hospital Trust Medical College) is only medical college in Haldwani, Uttarakhand, India. It was established in 1997. The Government Medical College, Haldwani is the first post graduate college in Uttarakhand, recognized by the Medical Council of India and the Government of India. The Govt. Medical College Haldwani has two hospitals associated with it – Dr Sushila Tiwari Memorial Hospital and Swami Rama Cancer Hospital & Research Center. Swami Rama Cancer Hospital & Research Center was inaugurated on 22nd February, 2010. However, there is only one Department which is functional i.e. Radiotherapy. The lack of oncological disciplines of medical oncology, surgical oncology, haematological oncology, gynaecological oncology & pediatric oncology is acutely affecting the population of the state at present.”
                                  Needless to say, para 12 of this landmark judgment further brings out that, “There are no facilities like Neo-adjuvent, and Adjuvent for Cancer patients. Swami Rama Cancer Hospital & Research Institute has been established in the year 2010 but till date, the Oncology Department is not in existence. There is no Medical Oncologist, Surgical Oncologist, Gynecological Oncologist or Pediatric Oncologist in the medical college. Swami Rama Cancer Hospital & Research Institute is functional since 22.2.2010 and it is shocking that till date, no Specialists have been appointed except the opening of Department of Radiotherapy. Swami Rama Cancer Hospital & Research Center has virtually become defunct in absence of specialists.”    
                             Let me hasten to add here that in para 13, it was explicitly held that, “The time has come when the State Government should accord Swami Rama Cancer Hospital & Research Institute as the State Cancer Institute by providing it the latest state of art equipment including Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) Scan and Specialists namely medical Oncologists, Surgical Oncologists, Hematological Oncologists, Gynecological Oncologists and Pediatric Oncologists at the earliest. The facilities provided to the Cancer Hospital in a big building are confined only to the Concurrent and Palliative Chemotherapy. The posts in Clinical and Non-Clinical Branches are lying vacant. There are no details of the persons who applied and were selected pursuant to the advertisement issued by the Medical College. The posts are required to be filled up of Teaching as well as Non-Teaching Staff in all the Departments as per the Minimum Standard Requirements for the Medical College for 100 Admissions Annually Regulations, 1999. The Equipment is to be provided as per Schedule III of the Regulations at the earliest.”
                                      Furthermore, it is underscored in para 14 that, “The poorest of poor patients visit the medical college. They have a fundamental right to be treated by the Specialists. It is the duty cast upon the State Government to provide free medicines/drugs to the poorest of poor.” On similar lines, in para 27, the Bench of Justices Rajiv Sharma and Lok Pal Singh asserted vocally that, “Every citizen has a fundamental right to health. The State has the obligation to provide best medical services to its citizens. The poorest of poor cannot go to the private hospitals. Since the latest equipment is not available with the respondent – Medical College, the parents are referred to other hospitals including private hospitals.”
                                    While clearly and convincingly exposing the shortcomings, this landmark judgment in para 24 points out that, “A startling revelation has been made that 4 posts of Professors, 4 posts of Associate Professor/Reader, 1 post of Medical Superintendent, 1 post of Dean are lying vacant in the medical college. 29 posts of Tutor/Registrar/Sr. Resident and 68 posts of Junior Resident and 1 post of Deputy Librarian are lying vacant. In total, 129 posts in this category are lying vacant.” Para 25 goes on to further point out that, “There are 310 sanctioned posts of Staff Nurse out of which 142 have been filled up on regular basis and 64 posts have been filled up through UPNL. Nursing is the backbone of any medical institute. In all, 104 posts of Staff Nurse are lying vacant.” It is also conceded in para 26 that, “Now as far as the technical staff is concerned, 380 posts are lying vacant. These posts are required to be filled up on emergent basis. The hospitals cannot be left sick.”
                                  Bluntly put, para 28 observes astonishingly that, “It is surprising to note that the Medical College has no Department of Neurology, Gastrology, Nephrology, Urology or Cardiology. These Departments are essential for public health. The State Government is required to take immediate steps for creation of these Departments in the Govt. Medical College, Haldwani at the earliest. The surgeries of the cancer patients are required to be undertaken only by the Oncologists/Medical Surgeons from their respective branches.” As if this is not enough, it is further observed in para 29 that, “A startling revelation has been made in the daily edition of ‘The Pioneer’ dated 3rd July, 2018 that 61 Ambulances are lying idle in the compound of office of Director General (Health). The ambulances are required to be refurbished immediately to make them functional. Ambulances which have completed their maximum mileage are required to be replaced.”
                                    To top it all, para 30 further observes that, “It has also come into light that there is also acute shortage of doctors in Kumaon Division as per the daily edition of ‘Amar Ujala’ dated 3rdJuly, 2018. There is shortage of 267 doctors in Kumaon Region. The total posts sanctioned are 981 out of which only 714 doctors are working and 267 posts are lying vacant.” Worst of all, para 31 laments that, “There is no Trauma Center in the Medical College. The Trauma Center is required for the simple reason that due to the terrain and geographical conditions of the State, the fatal accidents do occur wherein the passengers receive serious injuries. They are required to be operated upon immediately by the Neurosurgeons. The Trauma Center is a must in every Medical College.”
                                         Needless to say, para 32 makes a scathing attack for not spending enough on purchasing the latest equipments. It says that, “Petitioner has also placed on record the details of the budgetary provision. A sum of Rs 23.00 crores was spent for the construction of Swami Rama Cancer Hospital & Research Center. The system cannot permit non-utilization/under utilization of building constructed at the cost of Rs 23.00 crores. The amount is contributed by the tax payers. The system is accountable for every pie spent by the government. Budgetary provisions are available for the medical college but still the latest equipment is not purchased for the reasons best known to the management of the Medical College.”
                                      Finally and most importantly, para 33 which is the concluding part of the judgment concludes by saying that, “Accordingly, the present petition is disposed of by issuing the following mandatory directions: –
A.  The respondent-State is directed to make Swami Rama Cancer Hospital & Research Institute fully functional by creating the posts of Medical Oncologists, Surgical Oncologists, Hematological Oncologists, Gynecological Oncologists and Paediatric Oncologists within three months from today by holding the walk-in interviews. The State is also directed to upgrade the status of Swami Rama Cancer Hospital & Research Institute to the State Cancer Institute within three months. The State is also directed to give incentives to the specialists to join premier institution in the State of Uttarakhand by giving them at least 15 advance increments, suitable accommodation and conveyance befitting their status.
B.  Since Swami Rama Cancer Hospital & Research Institute is the constituent hospital of Medical College, the State Government is directed to provide the latest state of art equipments/machinery required under the Minimum Standard Requirements of the Medical College for 100 Admissions Annually Regulations, 1999 for training and teaching of the MBBS and MD/MS students within two months.
C.  The respondent-State is directed to establish the Nephrology, Neurology, Urology and Cardiology Departments in the Medical College within three months. Thereafter, the posts shall be filled up within a further period of three months by holding the walk-in interviews.
D. The State Government is directed to establish the Trauma Center in Government Medical College, Haldwani and make it functional within three months from today as per the standard procedure.
E.  The State Government is directed to fill up all the posts of teaching staff as well as non-teaching staff, lying vacant in the Medical College, within three months from today to provide quality treatment to the patients. The first preference shall be given to the teaching faculty including clinical and thereafter to non-clinical and nursing.
F.   The State Government is directed to deploy 61 newly acquired ambulances after refurbishing them within one month from today.
G. The State Government is directed to fill up all the vacancies of Medical Officers in Kumaon Division within four months from today.
H. The State Government is directed to install the MRI/PET, Mammography and other states of art equipment for treatment of patients and training and teaching of MBBS and MD/MS students within three months from today.
I.     The State Government is directed to provide essential life-saving drugs/medicines to the patients free-of-cost.
J.    The Principal of the Medical College is directed to ensure absolute hygiene in the hospital and if necessary, by outsourcing the same.
K.   The State Government may consider constructing Inns/Sarays for the attendants of patients in the close vicinity of the hospital.
L.   The Medical Council of India shall carry out the inspection of the Medical College immediately after six months to ensure that all the parameters laid down by it are followed in letter and spirit by the respondent- Medical College failing which it shall be open to the MCI to take action, as envisaged under law, against the Medical College for non-fulfilling the minimum standards.”
                                    All said and done, it is a landmark judgment and its mandatory and laudable directions must be implemented in letter and spirit in totality. It will go a long way in ensuring that the poorest of poor who cannot afford to go to private hospitals get proper treatment for cancer. It is India which tops in world with maximum death from cancer at 2.2 million per year.
                                       To be sure, health spending has pushed 55 million Indians into poverty in a year as was published in ‘The Times of India’ on June 13, 2018. Cancer has the highest probability of resulting in ‘catastrophic expenditure’ for a household. But it can be checked if the landmark directives laid down in this landmark judgment are implemented in totality. It will also go a long way in ensuring that the Medical Colleges function as per the directives laid down. Not just this, it will also certainly go a long way in improving the functioning of Government Medical College and Associate Hospitals which is the crying need of the hour!
Sanjeev Sirohi, Advocate,
s/o Col BPS Sirohi,
A 82, Defence Enclave,
Sardhana Road, Kankerkhera,
Meerut – 250001, Uttar Pradesh

West UP Deserves Statehood But Has Not Even A Bench

It has to be said right at the outset that it is most disgusting, disheartening and deplorable that West UP which deserved statehood right since 1947 has not even a single bench of a high court since last more than 70 years! What bigger proof is needed than this to highlight that West UP has always received a step motherly treatment from Centre for reasons known best to it? West UP’s population at 9 crore is more than all states except Bihar, Maharashtra and UP of which it too is a part and accounts for nearly half of the population of UP!
West UP Deserves Statehood But Has Not Even A Bench

                                               Here too West UP has area of 98,933 square km which is more than even Bihar with 94,000 square km! Still it has not even bench leave alone high court! On what ground can this be ever justified?
                                       It is on record that Sampoornanand had recommended a high court bench to be created for West UP at Meerut way back in 1955 after more than 100 elected representatives met him and apprised him of the same but the then PM Jawaharlal Nehru turned down the legitimate demand even though he had allowed a bench to be created at Lucknow in 1948 on July 1 more than 70 years ago! This despite the glaring fact that Allahabad is just about 200 km away from Lucknow! Still why Lucknow with just 12 districts and area of 62,000 square km was given preference over West UP?
                                          Needless to say, at that point of time even Uttarakhand formed part of UP and together with West UP accounted for 40 districts still why not a single bench was created? Why the people especially litigants of hilly areas now forming a separate state called Uttarakhand along with West UP were compelled to travel thousands of kilometers all the way to Allahabad to get justice? Why did Jawaharlal Nehru not accede to the commendable recommendation by the then UP CM Sampoornanand to create a high court bench in Meerut in 1955 which would have considerably reduced the distance as compared to Allahabad not just from 26 districts of West UP but also from the hilly areas district numbering 13 which now form part of Uttarakhand but which till 2000 formed part of UP and had to travel so far all the way to Allahabad?
                                          What is even more reprehensible is that when Centre led by the then PM late Mrs Indira Gandhi herself appointed Justice Jaswant Singh Commission headed by former Supreme Court Judge Justice Jaswant Singh in late 1970s to look into where all high court benches are needed had explicitly recommended that UP must have 3 more benches at Agra, Dehradun and Nainital apart from the one at Lucknow but not even one bench was created by Centre which is totally incomprehensible even though Centre took no time in creating a high court bench for Maharashtra at Aurangabad which already had bench at Nagpur and Panaji, for Tamil Nadu at Madurai and for West Bengal in Jalpaiguri which already had a bench at Port Blair for just 3 lakh people of Andaman and Nicobar islands! It was so baffling to see that Centre could not come up with any cogent and convincing argument to justify denying even a single bench to UP!
                                            It is not hidden from anyone that UP has maximum pending cases in the country both in the high court at more than 10 lakh whereas other big states have just about 1 lakh and some have just few thousands and some like Sikkim have just 100 still have high court and same is the case also in the lower courts with more than 60 lakh pending cases which is highest in India yet has just one bench only! Not just this, UP is among the largest states, is the most populated state with more than 19 lakh population as per the 2011 census, maximum MPs in Lok Sabha at 80, maximum MPs in Rajya Sabha at 31, maximum MLAs in Vidhan Sabha at 404 and in Vidhan Parishad at 104, maximum PM including the present PM Narendra Modi who represents Varanasi, maximum villages more than one lakh whereas no other state has more than 5000 villages, maximum districts at 75, maximum Judges in high court at 160, maximum Judges in lower courts at nearly 2500, maximum poverty, maximum cases of dacoity, robbery, riots, murders etc and here too West UP owes for more than half of them and still it has neither high court nor bench!
                                             It is not hidden from anyone that Allahabad high court is the oldest high court in India along with Calcutta and Madras High Court which completed its 150 years in 2016 and is also among the biggest in Asia yet has just one bench at Lucknow which is so close to Allahabad! This is what is most condemnable! If Lucknow is capital then so are Bhubaneshwar which is capital of Odisha, Bhopal which is capital of Madhya Pradesh, Thiruvananthapuram which is capital of Kerala and Dehradun which is capital of Uttarakhand but they have neither high court nor bench then why Lucknow was accorded VVIP treatment at the cost of West UP? Why Centre did not take into account that the high court and benches of 8 states including Delhi, Gwalior bench of Madhya Pradesh high court, Jaipur bench of Rajasthan high court among others and above all even Lahore high court in Pakistan are nearer to West UP as compared to Allahabad?
                                            Why West UP with more than 26 districts and more than 9 crore population are punished since independence to travel all the way to Allahabad in which a whole night is spent and many times without reservation also since 1947 till 2018 to attend court hearings? Why 2 benches were approved straightaway for Dharwad and Gulbarga by Centre for just 4 and 8 districts in Karnataka in 2008 which already had bench at Hubli even though Karnataka has just less than 2 lakh pending cases whereas UP has more than 10 lakh pending cases and West UP alone has more than 5 lakh pending cases which is more than whole of Karnataka put together and populationwise also Karnataka has just 6 crore population and West UP has 9 crore population still it has not even a bench? Why Centre didn’t approve former UP CM Mayawati’s laudable recommendation to create West UP as a separate state in 1995 when she was CM?
                                         Why Centre approved statehood for just 88 lakh people of Uttarakhand with 13 districts in 2000 but not even a bench for more than 9 crore population and 26 districts of West UP leave alone statehood as recommended by former UP CM Mayawati? Why even after so many UP CM like ND Tiwari, Rajnath Singh among others recommended a high court bench for West UP was it not accepted by Centre? Why Centre has repeatedly succumbed to those opposing a bench in West UP?
                                 With what face Centre approves one more bench for Maharashtra in 2018 which already had 3 benches at Kolhapur for just 6 districts but stubbornly refuses even a single bench for West UP for 26 districts even though Justice Jaswant Commission had recommended 3 benches for UP? With what face Centre repeatedly assures lawyers of West UP to end their 6 month strike as was done in 2001, 3 to 4 month strike as was done in 2014-15 and one to 2 month strike as normally happens year after year since last many decades apart from the strike of Saturday continuously from May 1981 till August 2018 as also many times on Wednesdays and now also from 6th to 8th August the lawyers of West UP of more than 20 districts will be on strike and this can intensify further if Centre fails to address this vexed issue once and for all yet takes no action in this regard? With what face can Centre cite the lameless excuse of not getting recommendation from the State Chief Minister or State Chief Justice for creating a bench which is just not required as per Section 51 of the States Reorganisation Act of 1956 which postulates that Centre can create a high court bench for UP, Bihar and Jammu and Kashmir by directly bringing it up in Parliament? None other than former Attorney General while he was in office as Attorney General in 2001 had categorically said that, “Centre is empowered to create a high court bench anywhere in UP without any recommendation from the Chief Justice or Chief Minister or anyone else in this regard”!
                                            With what face can Centre ignore what its own top leader and former PM Atal Bihari Vajpayee himself demanded – the creation of a bench in West UP and that too right inside Parliament in 1986? With what face can Centre ignore what Satyapal Singh who is Union Minister and BJP MP from Baghpat had demanded in Parliament a long time back that UP need 5 benches at Meerut, Agra, Jhansi, Gorakhpur and Varanasi? With what face can Centre not listen even to its own other senior Union Cabinet Ministers like Home Minister Rajnath Singh, Dr Mahesh Sharma, Gen VK Singh among others who have all demanded bench in West UP at some point of time or the other?
                                          With what face can Centre not listen event o its own former Union Ministers like Sanjeev Baliyan who just recently forcefully raised the demand for a bench in West UP on several grounds and rightly asserted that for just 10,000 lawyers of Allahabad, the neck of more than 8 crore people of West UP cannot be strangulated? With what face can Centre not listen to so many of its other BJP MPs like Rajinder Agarwal from Meerut, BJP MP Vijaypal Singh Tomar who too recently raised it in Parliament among others and not relent even though its own national BJP President Amit Shah too had assured the lawyers that a high court bench would be created here as the demand is totally justified?
                                           Why Centre even disregarded what former Chairman of Supreme Court Bar Association BN Krishnamani said so eloquently that, “Only by the creation of a high court bench in any of the districts in West UP will the people living there get real justice”? If UP can’t be given more benches and West UP can’t have even one bench which actually deserves statehood in the real sense then all benches in India must be disbanded right now because it is the people of West UP who are suffering the most because of no bench here and have to travel the most!
                                  What a pity that  Assam with just about 2 crore population had 7 high court benches before Manipur, Meghalaya and Tripura were given high court itself for just 27, 29 and 36 lakh population, Sikkim with just 6 lakh population and less than 100 pending cases has high court and above all even Port Blair with just 3 lakh population has bench but West UP with more than 9 crore population and more than half of the total pending cases of UP has not even a single bench of high court! Why Centre is clinging with the recommendation made by the Law Commission in 1956 in its fourth report that more benches should not be created while not caring for the 230th report of Law Commission made in 2009 which recommended creation of more benches and here too why just UP is being singled out?Why can’t one bench at least be approved straightaway for West UP at any of the 26 districts?
                                           Why should the more than 9 crore people of West UP be denied “speedy Justice”, “justice at doorsteps” and “affordable cheap justice”? Why should the people be made to travel so far even after more than 70 years of independence? It is a national tragedy that West UP which deserves statehood since independence has not even a bench more than 70 years later in 2018! No PM till date has dared to show the political will to address it till now even though there have been repeated agitations, repeated strikes, repeated shutdown of West UP many times and what not over it! Why the constitutional right of more than 9 crore people of West UP of having access to “speedy and cheap justice” is being denied even after more than 70 years of independence? Can Centre answer?
Rajendra Singh Jani, Advocate,
President, Meerut Bar Association,
Chairman of Central Action Committee for Establishment of High Court Bench in West UP,
Chamber No. 7,
Civil Court, Near Western Kutchery Gate,
Meerut, Uttar Pradesh.