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TMI Blog2009 (9) TMI 1074X X X X Extracts X X X X X X X X Extracts X X X X ..... y citizens at the respondent No.2 hospital. It is contended inter alia that such inaction of both the respondents is adversely affecting the mandates of Articles 21, 39(e), 41, and 47 of Constitution of India. In course of proceedings, the Union of India and the Delhi Development Authority were also impleaded as party respondents. Before appreciating the issues under consideration in the present petition, a brief historical background is essential. THE BACKGROUND FACTS 2. In 1986, the Delhi Administration (now the Government of NCT of Delhi), in order to utilize the then incomplete Players‟ Building near IP Stadium, lying vacant with its Medical Department, initiated the decision to open a multi-disciplinary super specialty hospital on no profit no loss‟ basis, after inviting offers from private institutions. A notice was issued in this regard which has been placed on record and accordingly, building along with the land was to be made available free of cost provided the hospital is, on the whole, run on a no profit no loss‟ basis providing free medical and other facilities to at least 1/3rd of its indoor patients and 40% of its outdoor patients without ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... e facilities of medical diagnostic and other necessary care to not less than 1/3rd of the total capacity of 600 beds in the multi specialty hospital. It further provided that the hospital will also provide free of cost full medical diagnostic and other necessary facilities to 40% of the patients attending OPD of the hospital. The relevant clauses of the Joint Venture Agreement are as follows: 23. The proposed company shall soon after its registration as a public company enter into the lease/licence agreement with the Administrator in the form approved by him, for occupying the building situated next to Indira Gandhi Indoor Stadium which is in possession of Medical Department of the Delhi Administration. The proposed company shall provide to the administrator the free facilities of medical, diagnostic and other necessary care through not less than one-third of the total capacity of 600 beds in the multi-specialty hospital as contemplated in this agreement or any part thereof which may be commissioned for the time. The hospital will also provide free of cost full medical, diagnostic and other necessary facilities to 40% of patient attending the out-patient department of the hospi ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... tion of indoor and out door patients. 6. However, subsequently the Players‟ Building (where the establishment of hospital was initially planned) could not be used as the land was requisitioned by Sports Authority of India (SAI). Thus, a fresh agreement was entered into being the lease deed dated 16.03.1994 and an alternative area of 15 acres of land on Delhi-Mathura road, Jasola Village, Delhi (where the hospital at present located and functional) was leased out at a nominal rate of Re. 1 per month to the IMCL. The fresh lease deed amongst other terms and conditions, provided that a sum of Rs.14.83 crores out of Rs.15.478 crores received from SAI by way of compensation would be deposited in an interest bearing account in a Nationalized bank for the construction of the hospital building at a new site. Apart from Rs.14.83 crores plus interest, a further sum of Rs. 23.83 crores was paid by way of equity capital by the GNCTD to the joint venture. Thus, a total sum of Rs.38.66 crores (plus interest on Rs.14.83 crores) along with 15 acres of prime land on Delhi-Mathura road was leased out at the rate of Rupee 1 per month to the joint venture, IMCL. Like the earlier lease deed, t ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ons arising therefrom which could not be made subject matter of a writ petition. It described IMCL as a commercial venture jointly undertaken inter alia by the GNCTD, Apollo Group of Hospital and Schroder Capital Partners (Asia) Ltd., through another company providing Foreign Direct Investment (FDI), for establishing a modern multi-speciality hospital. It contended that the hospital was meant to be a self-generating project wherein cost of free services, if any to be rendered to the poor and needy, would have to be generated from the revenue earned commercially, keeping a balance between the two activities, to be viable. While submitting that the hospital could not be equated with facilities run by the government with the help of grants to provide free medical aid, IMCL pleaded that its obligations were well defined and clearly set out in the two basic documents namely, the Joint Venture Agreement dated 11th March, 1988 and the lease deed dated 16th March, 1994 executed by the Lt. Governor of GNCTD, neither of which required it to provide free medicines or consumables. 9. In above context it referred to Clause 7 of the Joint Venture Agreement which reads as under: Neithe ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... (emphasis supplied) 11. Disowning any responsibility to provide free medical aid to poor and needy, IMCL set out in affidavit dated 21st January, 1998, the following defences:- 1. The hospital was yet not fully commissioned , inasmuch as only 350 beds had become operational wherein average daily occupancy for the preceding six months was only 262. 2. The expression medical and diagnostic facilities as used in the lease deed does not include the cost of medicines and medical consumables, inasmuch as the qualifying word free had been consciously omitted from the stipulations in this context. 3. Unlike government hospitals and charitable institutions, IMCL, a public limited company, was answerable to the investors and the financial institutions supporting the venture through loans, the agreements in which regard carried no such obligations. Instead IMCL, providing medicare services through huge investments for establishing proper infrastructure, was required to ensure profitable and efficient working of the corporate hospitals run by it. 4. Though GNCTD is a major shareholder of IMCL, it can neither claim nor is entitled to any special rights over and above thos ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... complicated surgeries in the main hospital. He also referred to arrangements negotiated with eminent consultants to provide free professional consultancy services and decisions taken not to charge for registration and admission, bed, treatment, surgeries and investigations (excluding medicines and medical consumables), nursing, food, housekeeping services, maintenance and preservation of records etc. While insisting that medicines and medical consumables cannot be covered under the freeship, he described these expressions as follows:- Medicines : Medicines include all items of medicines, drugs and pharmaceutical items including oral drugs, intravenous and intramuscular injectibles, intravenous fluids, vaccines for immunisation, dye and other contrast media, all dermatalogicals preparations for external use, ENT drops, disposables and such other items. Medical consumables : Materials include all consumables and disposable items used in the operation theatre, cath lab, cine angro film,DSA lab, lithotripsy theatre, etc including catheters, oxygenators, customs pack, cannulae, balloons, stents, pacemakers, valves, GDC and other coils used in DSA lab; endotracheal tub ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... annot be provided free, and which should be paid for by the patients and the medicines which can be provided free of cost, or on payment of charges and possibility of subsidizing such medicines. This Court passed an interim order dated 30th April, 1998 recording these suggestions and proposed consultations and a report was to be filed by the IMCL. The proposed mutual consultations between the IMCL and the GNCTD never materialized. The IMCL, in letter written to the petitioner and the GNCTD and report submitted to this Court, reiterated its stand that medicines and medical consumables cannot be provided as it is neither provided in the agreement between the parties nor it is possible for the hospital to provide the same free of cost. 17. The Principal Secretary (Health), GNCTD had appointed a committee on 4th July, 1998 to visit the hospital to see the arrangements made regarding free treatment in terms of directions of this Court. The committee comprising of the Director, GB Pant Hospital, Medical Superintendent, LNJP Hospital and Medical Superintendent, GTB Hospital in its report dated 13th July, 1998 stated that there was a provision to examine only 50 patients per day in OPD ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... observations made during inspection carried out on 24th February, 2003. In its report dated 5th March, 2003 the Committee brought out certain glaring deficiencies in the arrangements and discriminatory treatment qua poor patients referred for free treatment, including the following: a) The space norms, specification and services for poor patients are of much lower standards when compared with paid patients. b) No procedure had been established for identifying patients entitled to freeship. c) The area made available (2935 sq.mtrs.) for poor patients out of the total built up area (38580 sq.mtrs) works out only 7.6%. d) Free patients are entitled only to general wards, each accommodating about 50 beds with common toilets, as against paid patients having provision for luxury suites, single rooms, double rooms, general wards (with 5 to 6 beds only), all with attached toilets. e) Each paid patient on an average has available to him 72.45 sq.mtrs of space as against a space of 20.67 sq.mtrs per bed for free patient. f) The areas meant for free patients are non-airconditioned whereas all areas for paid patients are fully air-conditioned. g) No records were found main ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 2.46% of the paid indoor patients, which needless to say, was much smaller than the agreed ratio of 1/3rd indoor patients entitled for free treatment. There was not much improvement in the infrastructure and facilities available for the free patients except that the air cooling system was made functional. 23. On the issue of space per bed, it was observed that floor area norms for a standard hospital bed were not complied with and beds were placed almost abutting each other without any proper circulation space. The Committee noted that there was no improvement in the hospital facilities for free indoor patients. Though the hospital was specifically asked to furnish specific details regarding various categories of patients recommended by the GNCTD, no details were provided. It was found that almost all the recommendation letters were written by the Health Minister. It was pointed out by the hospital authorities that a large number of hospitals were also entitled to refer patients for free treatment, but they were not availing all the facilities and the hospitals were not referring the patients for free treatment. The hospital authorities informed that they could not treat any pat ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... hospital in case of road accidents and emergency. The referral system should be transparent and all the state machinery involved in health sector should be authorized to refer any patient, which they deem fit for specialized treatment irrespective of the recommendations. REPORT OF JUSTICE QURESHI COMMITTEE 25. The GNCTD (Health Family Welfare Deptt.,) vide Notification No.F.13/36/99-DHS/NH/pet.File/340 dated 12th June, 2000 constituted a Committee headed by Justice A.S.Qureshi (Retd) and some official and non-official members. The terms of reference of the Committee were set out in the said order as follows: a) To review the existing free treatment facilities extended by the Charitable and other Hospitals who have been allotted land on concessional terms/rates by the Government. b) To suggest suitable policy guidelines for free treatment facilities for needy and deserving patients uniformly in the beneficiary institutions in particular to specify the diagnostic, treatment, lodging, surgery, medicines and other facilities that will be given free or partially free. c) To suggest a proper referral system for the optimum utilization of free treatment by deserving an ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... vide a truly free treatment to genuinely poor patients. The dominant profit motive of the company has made other Directors totally indifferent and callous regarding free treatment to the poor in flagrant violation of the terms and conditions of the aforesaid agreement and the lease deed. The public limited company, has described itself as purely commercial enterprise. Therefore, profit motive is inherent in its activities, which is quite understandable. But the profit motive should not be in defiant violation of the firm commitment in respect of free treatment to the poor patients. The incorporation of the IMCL and the establishment of the Indraprastha Apollo Hospital has so far been a bad bargain as an investment for the Delhi Government. The only perceivable achievement is the setting up of State-of the-Art Super Specialty Hospital in Delhi for those who can afford to pay for its services, which is beyond most citizens of Delhi. The Delhi Government is holding 26% of the equity shares amounting to about Rs.23 crores. It has given 15 acres of prime land in South Delhi purchased from the DDA at an approximate cost of Rs.4 crores and has been leased out to the Company for 30 ye ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... d the hospital to render free treatment to the poor and needy as per the agreement. 28. Mrs. Avnish Ahlawat, learned standing counsel appearing for the GNCTD submitted that in the agreement it was clearly provided that that the company shall provide to the Administrator the free facilities of medical diagnostic and other necessary care to not less than 1/3 of the total capacity of 600 beds in the multi-speciality hospital. These terms were in conformity with the notice inviting tender where it was specifically mentioned that hospital has to run on no profit no loss basis and 1/3 of the hospital services will be provided free of cost which includes full medical diagnostic and other necessary facilities apart from 40% free treatment to OPD patients. Free bed would include consultation, bed, investigation, nursing, medicines and consumables. Learned counsel submitted that the hospital somehow or the other does not want to provide free facilities as per the terms of the agreement and is raising issues of reference and eligibility criteria of the patients referred to the hospital which in any case is not its concern. If the hospital has genuine concern for the poor patients, then a ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... er treatment to the paying patients and the hospital would become out of reach and overpriced. IMCL has obligations towards the investors, banks and financial institutions who have granted loans and has to be commercially viable. Mr. Bhasin finally urged that to provide free medical care is the obligation of the State and as such court cannot direct private parties to discharge public function in PILs against them. This is only an effort to circumvent State s obligation with a view to fastening the liability on a private party. RIGHT TO HEALTH 30. By questioning the maintainability of the Writ Petition at hand, inter alia, on the grounds that IMCL is not State or State instrumentality or that it is essentially a commercial venture, the hospital has tried to trivialize the issues. The subject matter of the controversy is not as mundane as made out to be. As we shall presently demonstrate, the case presents a situation where right to health of the public at large, recognized the world over, (sufficiently delineated in India through Constitutional provisions, as interpreted by the superior courts) itself is at stake. By agreeing to be a partner with the State in the mat ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... e improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the even to sickness. 33. There are provisions relating to protection and advancement of health in several conventions formulated under the aegis of the United Nations. The right to health is recognized, inter alia, in article 5(e)(iv) of the International Convention on the Elimination of All Forms of Discrimination of 1965, in articles 11.1(f) and 12 of the Convention on the Elimination of All Forms of Discrimination against Women of 1979 and in article 24 of the Convention on the Rights of the Child of 1989. Several regional human rights instruments also recognise the right to health, such as the European Social Charter of 1961 as revised (art.11), the African Charter of Human and Peoples‟ Rights of 1981 (art.16) and the Additional Protocol to the American Convention on Human Rights in the Area of Economic , Social and Cultural Rights of 1988 (art.10). Similarly, the right to health has been proclaimed b ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... as programmes, have to be available in sufficient quantity within the State party. The precise nature of the facilities, goods and services will vary depending on numerous factors, including the State party's developmental level. They will include, however, the underlying determinants of health, such as safe and potable drinking water and adequate sanitation facilities, hospitals, clinics and other health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs, as defined by the WHO Action Programme on Essential Drugs. (b) Accessibility . Health facilities, goods and services have to be accessible to everyone without discrimination, within the jurisdiction of the State party. Accessibility has four overlapping dimensions: Non-discrimination : health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact, without discrimination on any of the prohibited grounds. Physical accessibility : health facilities, goods and services must be within safe physical reach for all sections of the population, especial ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... icy. Among several provisions that touch on the subject of health, reference can be made to Articles 39(e), (f), 42 and 47 of the Constitution. These Articles read as follows: 39(e) that the health and strength of works, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength; (f) that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment. 42. Provision for just and humane conditions of work and maternity relief :- The State shall make provision for securing just and humane conditions of work and for maternity relief. 47. Duty of the State to raise the level of nutrition and the standard of living and to improve public health The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consuming, except ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ntal rights are sought to be enforced. Relying on several previous judgments, the Court held that right to life would mean meaningful and real right to life. It would include right to livelihood, better standard of living in hygienic conditions at the work place and leisure. 39. In Paschim Banga Khet Mazdoor Samity v. State of West Bengal , (1996) 4 SCC 37 the case related to failure on the part of the government hospitals to provide timely emergency medical treatment to persons in serious conditions. The Court observed: It is no doubt true that financial resources are needed for providing these facilities. But at the same time it cannot be ignored that it is the Constitutional obligation of the State to provide adequate medical services to the people. Whatever is necessary for this purpose has to be done. In the context of the constitutional obligation to provide free legal aid to a poor accused, this Court has held that the State cannot avoid its constitutional obligation in that regard on account of financial constraints. (See : Khatri (II) v. State of Bihar (1981) 1 SCC 627). The said observations would apply with equal, if not greater, force in the matter of discharg ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... on of the health and strength of workers men and women, and of the tender age of children against abuse, opportunities and facilities for children to develop in a healthy manner and in conditions of freedom and dignity, educational facilities, just and humane conditions of work and maternity relief. These are the minimum requirements which must exist in order to enable a person to live with human dignity and no State neither the Central Government nor any State Government has the right to take any action which will deprive a person of the enjoyment of these basic essentials. Since the Directive Principles of State Policy contained in Clauses (e) and (f) of Article 39, Article 41 and 42 are not enforceable in a court of law, it may not be possible to compel the State through the judicial process to make provision by statutory enactment or executive fiat for ensuring these basic essentials which go to make up a life of human dignity but where legislation is already enacted by the State providing these basic requirements to the workmen and thus investing their right to live with basic human dignity, with concrete reality and content, the State can certainly be obligated to ensure obse ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... organ of the body through which the soul communicates with the outer world... by the term liberty, as used in the provision something more is meant than mere freedom from physical restraint or the bonds of a prison. The Court however came to the conclusion that the contributory scheme which was framed by the State in that case cannot be held to be illegal, unlawful or unconstitutional. ROLE OF NON-STATE ACTORS 43. Health care is an essential concomitant to quality of life. Its demand and supply cannot therefore be left to be regulated solely by the invisible hands of the market. The State must strive to move towards a system where every citizen has assured access to basic health care, irrespective of capacity to pay. In an article by Shri R.Srinivasan Health Care In India Vision 2020 Issues and Prospects the author suggested four criteria for establishing a just health care system - (i) universal access, and access to an adequate level, and access without excessive burden (ii) fair distribution of financial costs for access and fair distribution of burden in rationing care and capacity and a constant search for improvement to a more just system, (iii) training pr ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... nal corporations must come to view health and health care as non-negotiable entitlements, not as matters of governmental largesse or productivity. Judith Asher, an activist, in her book The Right to Health : A Resource Manual for NGOs says that within a human rights framework, the private sector and non-governmental bodies are expected to carry out their activities with full regard for the fundamental health rights of individuals and groups. Although not in a direct sense legally bound by the relevant obligations, they are expected to comply with the accepted health and human rights standards and norms by giving due attention to protecting, promoting, and realizing the right to health, both in the work that they carry out (for example, advocacy or service delivery) and in the conduct of their internal processes and administration. MAINTAINABILITY OF WRIT PETITION 46. Article 226 of the Constitution of India states that every High Court has jurisdiction to issue appropriate writs to any person or authority for the enforcement of any fundamental right and for any other purpose. The expressions any person and for any other purpose have been explained and elucidated ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... a mandamus can issue against a person or body to carry out the duties placed on them by the Statutes even though they are not public officials or statutory body. It was observed (at 778) ; It is however not necessary that the person or the authority on whom the statutory duty is imposed need be a public official or an official body, A mandamus can issue, for instance, to an official or a society to compel him to carry out the terms of the statute under or by which the society is constituted or governed and also to companies or corporations to carry out duties placed on them by the statutes authorising their undertakings. A mandamus would also lie against a company constituted by a statute for the purpose of fulfilling public responsibilities. (See Halsbury's Laws of England (3rd Ed. Vol. II p. 52 and onwards). 21. Here again we may point out that mandamus cannot be denied on the ground that the duty to be enforced is not imposed by the statute Commenting on the development of this law, Professor De Smith states : To be enforceable by mandamus a public duty does not necessarily have to be one imposed by statute. It may be sufficient for the duty to have been imposed by ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... al Review of Administrative Action (Fifth Edn.) by de Smith, Woolf Jowell in Chapter 3 para 0.24, it is stated thus: A body is performing a public function when it seeks to achieve some collective benefit for the public or a section of the public and is accepted by the public or that section of the public as having authority to do so. Bodies therefore exercise public functions when they intervene or participate in social or economic affairs in the public interest. This may happen in a wide variety of ways. For instance, a body is performing a public function when it provides public goods or other collective services, such as health care, education and personal social services, from funds raised by taxation. A body may perform public functions in the form of adjudicatory services (such as those of the criminal and civil courts and tribunal system). They also do so if they regulate commercial and professional activities to ensure compliance with proper standards. For all these purposes, a range of legal and administrative techniques may be deployed, including: rule-making, adjudication (and other forms of dispute resolution); inspection; and licensing. Public functions n ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... surance policies, the Supreme Court observed in LIC of India v. Consumer Education Research Centre , (1995) 5 SCC 482, thus: Every action of the public authority or the person acting in public interest or its acts give rise to public element, should be guided by public interest. It is the exercise of the public power or action ' hedged with public element becomes open to challenge. If it is shown that the exercise of the power is arbitrary unjust and unfair, it should be no answer for the State its instrumentality, public authority or person whose acts have the insignia of public element to say that their actions are in the field of private law and they are free to prescribe any conditions or limitations in their actions as private citizens, simplicitor, do in the field of private law. Its actions must be based on some rational and relevant principles. It must not be guided by irrational or irrelevant considerations. Every administrative decision must be hedged by reasons. xxxx xxxx xxxx The actions of the State, its instrumentality, any public authority or person whose actions bear insignia of public law element or public character are amenable to judicial revie ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... or public body is ultimately accountable to the people in whom the sovereignty vests. As such, all powers so vested in him are meant to be exercised for public good and promoting the public interest. This is equally true of all actions even in the field of contract. Thus, every holder of a public office is a trustee whose highest duty is to the people of the country and, therefore, every act of the holder of a public office, irrespective of the label classifying that act, is in discharge of public duty meant ultimately for public good. With the diversification of State activity in a Welfare State requiring the State to discharge its wide-ranging functions even through its several instrumentalities, which requires entering into contracts also, it would be unreal and not pragmatic, apart from being unjustified to exclude contractual matters from the sphere of State actions required to be non-arbitrary and justified on the touchstone of Article 14. 28. Even assuming that it is necessary to import the concept of presence of some public element in a State action to attract Article 14 and permit judicial review, we have no hesitation in saying that the ultimate impact of all actions o ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ich requires consideration of evidence which is not on record, will not normally be entertained by a court in the exercise of its jurisdiction under Article 226 of the Constitution, but there is no absolute rule that in all cases involving disputed questions of fact the parties should be relegated to a civil suit. It has even been held that in the writ petition, if the facts require, oral evidence can be taken. This clearly shows that in an appropriate case, the writ court has the jurisdiction to entertain a writ petition involving disputed questions of fact and there is no absolute bar for entertaining a writ petition even if the same arises out of a contractual obligation and/or involves some disputed questions of fact. Merely because the first respondent wants to dispute the meaning of a clause of the insurance contract it does not become a disputed fact. However, if such an objection as to disputed questions or interpretations is raised in a writ petition the courts can very well go into the same and decide that objection if facts permit. In the light of these decided cases, the objection to the maintainability of the writ petition has to be rejected. 54. In Harbanslal Sah ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... nt Venture Agreement as well as the lease deed: Joint Venture Agreement: .The proposed company shall provide to the administrator the free facilities of medical, diagnostic and other necessary care through not less than one-third of the total capacity of 600 beds in the multispecialty hospital as contemplated in this agreement or any part thereof which may be commissioned for the time. The hospital will also provide free of cost full medical, diagnostic and other necessary facilities to 40% of patient attending the out-patient department of the hospital. Lease Deed 6(i) The Lessee shall provide free diet, medical diagnostic and such other facilities to the patients aforesaid as are required by the patients for indoor treatment. (ii) That the Lessee shall also provide free medical diagnostic and other facilities for not less than 40% (Forty percent) of its out-door patients. 57. In our opinion, the words in the agreement are of wide import and cannot be read in a narrow and pedantic manner. The words free of cost full medical diagnostic and other necessary facilities would cover all the facilities including medicines and consumables. The words used in t ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ment not only without any distinction of caste, creed, race, religion or language but also,- (a) Free, on an average, to at least 40 per cent of all their outdoor patients; and (b) Free, to all indoor patients belonging to families with an income of less than rupees five hundred per month, and keeping for this purpose at least 10 per cent of all the hospital beds reserved for such patients; and (c) At reasonable charges, either on the basis of the income of the patients concerned or otherwise, to patients other than those specified in clauses (a) and (b). One of the reasons, which the respondents have while refusing the benefit of the notification cited against to the petitioner was that they were not providing free treatment to indoor patients with family income with less than Rs.500/- per month. It was pointed out that what is provided by the hospital to such patients is not treatment but only free consultation and waiver of registration and ward charges. Insofar as consumables are concerned whether the same are in the form of medicines, injectibles or otherwise the patient is asked to purchase the same from the market for use in the hospital. The hospitals, on the o ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... es and other consumable items used by the hospital in his/their treatment, it would render any such treatment in the hospital a luxury which he can ill afford. The notification has, therefore, to be interpreted rationally in order to ensure that the object underlying the same is advanced. The predominant object behind the grant of an exemption, which ran into hundreds of crores if not thousands was to ensure that the poorest in the society have an advantage of being treated free in such hospitals. The colossal amount of duty involved in the exemption could not conceivably be waived or given up by the Government only for purposes of providing free consultation to such patients. Viewed thus, the expression medical, surgical or diagnostic treatment in the exemption notification must be interpreted to mean treatment not only in the nature of providing admission and accommodation to the hospital, diagnosis and investigation, but free medicines and consumables also. 59. A disturbing feature which we noticed is as per the figures submitted by the hospital itself the expenditure on consumables and medicines is Rs.186 crores out of the total hospital revenue of Rs.391.19 crores. It was ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... e is any justification for allotting land at throw-away prices to such institutions. The allotment of land belonging to the people at practically no price is meant for serving the public interest, i.e., spread of education or other charitable purposes; it is not meant to enable the allottees to make money or profiteer with the aid of public property. DIRECTIONS 61. Despite lapse of more than 15 years there has been hardly any implementation of the conditions of the agreement providing for free treatment to indoor and outdoor patients. The Committee has submitted two reports which clearly show that the IMCL has flouted the conditions with impunity. It is in these circumstances necessary to issue the following directions in order to ensure implementation of the clauses in the agreement regarding free treatment : (i) The respondents are directed to provide 1/3 of the free beds i.e. 200 beds with adequate space and necessary facilities to the indoor patients and also to make necessary arrangement for free facilities to 40% of the outdoor patients; (ii) All government hospitals having speciality or super-speciality and even if it is general hospital shall and establish S ..... X X X X Extracts X X X X X X X X Extracts X X X X
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