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TMI Blog1996 (5) TMI 446X X X X Extracts X X X X X X X X Extracts X X X X ..... treatment were not available at the Primary Health center, the medical officer in charge of the center referred him to the Diamond Harbour Sub-Divisional Hospital or any other State hospital for better treatment. Hakim Seikh was taken to N.R.S. Medical College Hospital near Sealdah Railway Station, Calcutta at about 11.45 P.M. on July 8, 1992. The Emergency Medical Officer in the said Hospital, after examining him and after taking two X-ray prints of his skull recommended immediate admission for further treatment. But Hakim Seikh could not be admitted in the said hospital as no vacant bed was available in the Surgical Emergency ward and the regular Surgery Ward was also full. He was thereafter taken to Calcutta Medical College Hospital at about 12.20 A.M. on July 9, 1992 but there also he was not admitted on the ground that no vacant bed was available. He was then taken to Shambhu Nath Pandit Hospital at about 1.00 A.M. on July 9, 1992. He was not admitted in that hospital and referred to a teaching hospital in the ENT, Neuro Surgeon Department on the ground that the hospital has no ENT Emergency or Neuro Emergency Department. At about 2.00 A.M. on July 9, 1992 he was taken to the ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... served by the Block Health centers and by the Subsidiary Health centers since re-designated as "Primary Health centers" where primary and general treatment is provided but no specialist treatment is available. Hakim Seikh was examined by the medical officer at the Block Health center at Mathurapur and after giving him first-aid the Medical Officer referred him to the Diamond Harbour Sub-Divisional Hospital or any State hospital for better treatment. It is also admitted that Hakim Seikh was brought to Neel Ratan Sircar Medical College Hospital at 11.45 P.M. on July 8, 1992 and there he was examined and two skull X-rays were also taken. The medical officer who attended him at that hospital recommended immediate admission for further treatment but he could not be admitted in the particular Department, i.e., Surgery Department having neurosurgery facilities as at the material point of time there was no vacant bed in Surgical Emergency Ward and the regular surgery ward was also full. It is also admitted that Hakim Seikh was thereafter taken to the Calcutta Medical College Hospital, Calcutta National Medical College Hospital and Bangur Institute of Neurology in the early mornin ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... al College Hospital Hakim Seikh was registered, Registration No. 63649, but no time was mentioned. The admission register of the said hospital shows that one patient was admitted at 12.15. A.M. on July 9, 1992 and another patient was admitted at 4.20 A.M. on July 9, 1992. There could not have been any discharge during the odd hours i.e. between the time when Hakim Seikh was taken to the said hospital and 4.20 A.M. on July 9, 1992. If two other patients were admitted after Hakim Seikh was taken and it was not understandable why Hakim Seikh was not admitted since it is not disputed that the condition of Hakim Seikh was grave. Even in excess of the sanctioned beds some patients were kept on the trolley beds in the morning and that even if it was dangerous to keep a patient with head injuries on trolley bed he could very well be kept for the time being on the floor and could be transferred to the cold ward, as the situation demanded, temporarily. The Emergency Medical Officer concerned should have taken some measure to admit Hakim Seikh and he is, therefore, responsible for his non-admission in the said Hospital. The Superintendent of the hospital should have taken some measures to giv ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... n that regard. 8. The Committee has suggested remedial measures to rule out recurrence of such incidents in future and to ensure immediate medical attention and treatment to patients in real need. We will advert to it later. We will first examine whether the failure to provide medical treatment to Hakim Seikh by the Government hospitals in Calcutta has resulted in violation of his rights and, if so, to what relief he is entitled. 9. The Constitution envisages the establishment of a welfare state at the federal level as well as at the state level. In a welfare state the primary duty of the Government is to secure the welfare to the people. Providing adequate medical facilities for the people is an essential part of the obligations undertaken by the Government in a welfare state. The Government discharges this obligation by running hospitals and health centers which provide medical care to the person seeking to avail those facilities. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The Government hospitals run by the State and the medical officers employed therein are duty boun ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ecessary adjustment should be made by the hospital authorities by way of transfer/discharge. (iii) A Central Bed Bureau should be set up which should be equipped with wireless or other communication facilities to find out where a particular emergency patient can be accommodated when a particular hospital finds itself absolutely helpless to admit a patient because of physical limitations. In such cases the hospital concerned should contact immediately the Central Bed Bureau which will communicate with the other hospitals and decide in which hospital an emergency moribund/serious patient is to be admitted. (iv) Some casualty hospitals or Traumatology Units should be set up at some points on regional basis. (v) The intermediate group of hospitals, viz., the district, the sub-division and the State General Hospitals should be upgraded so that a patient in a serious condition may get treatment locally. 11. The recommendations of the Committee have been accepted by the State Government and memorandum dated August 22, 1995 has been issued wherein the following directions have been given for dealing with patients approaching health centers/OPD/Emergency Departments of hospitals: ( ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ollowed in future : A. A copy of the Duty Roaster of Medical Officers should be preserved in the office of the Superintendent incorporating the modifications done for unavoidable circumstances; B. Each Department shall maintain a register for recording the signature of attending medical officers denoting their arrival and departure time; C. The attending medical officer shall write his full name clearly and put his signature in the treatment document; D. The Superintendent of the hospital shall keep all such records in safe custody; E. A copy of the ticket issued to the patient should be maintained or the relevant data in this regard should be noted in an appropriate record for future guidance. It is appreciated that Hospital Superintendent/Medical Officers-in-charge may have difficulty in implementing these guidelines due to various constraints at the ground level and, as such, feed back is vital to enable Government to refine and modify the order as will ensure a valid working plan to regulate admission on a just basis. Detailed comments and, therefore, requested with constructive suggestion. 14. Shri Muralidhar, the learned Counsel appearing for the petitioners, and ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... requires the hospital to stabilize that condition and the hospital cannot transfer or discharge an unstabilized patient unless the transfer or discharge is appropriate as defined by the statute. Provision is made for imposing penalties against hospitals or physicians that negligently violate COBRA. In addition the individual who suffers personal harm as a direct result of a participating hospital's violation can bring a civil suit for damages against that hospital. According to Shri Dhavan the standard of care in emergency cases implies three obligations, viz., (i) screening the patient; (ii) stabilizing the patient's condition; and (iii) transfer or discharge of the patient for better treatment. The submission of Shri Dhavan is that emergency health services in our country must be provided keeping in view these three requirements. 15. We have considered the aforesaid submissions urged by Shri Dhavan. Apart from the recommendations made by the Committee in that regard and the action taken by the State Government in the memorandum dated August 22, 1995 on the basis of the recommendations of the Committee, we are of the view that in order that proper medical facilities are ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... the requirements for ensuring availability of proper medical services in this regard as indicated by us and steps should be taken to implement the same. The State of West Bengal alone is a party to these proceedings. Other States, though not parties, should also take necessary steps in the light of the recommendations made by the Committee, the directions contained in the Memorandum of the Government of West Bengal dated August 22, 1995 and the further directions given herein. 17. The Union of India is a party to these proceedings. Since it is the joint obligation of the center as well as the States to provide medical services it is expected that the Union of India would render the necessary assistance in the improvement of the medical services in the country on these lines. 18. As regards the medical officers who have been found to be responsible for the lapse resulting in denial of immediate medical aid to Hakim Seikh it is expected that the State Government will take appropriate administrative action against those officers. 19. A copy of this judgment be sent for taking necessary action to the Secretary, Medical and Health Department, of the States. 20. The writ petition is ..... X X X X Extracts X X X X X X X X Extracts X X X X
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