The Bombay High Court on Friday passed several directions while hearing a batch of PILs and petition raising various issues regarding the state of public health care amidst the pandemic of Covid-19 in the State of Maharashtra. Court asked the State to consider increasing budgetary allocation for public healthcare and advised citizens to 'serve' or perform 'seva' to others by staying indoors.
Division bench of Chief Justice Dipankar Datta ad Justice AA Sayed observed-
"It is time to rethink each individual's own lifestyle. While the pandemic has shown the fragility of human life, it is high time to rouse the greater self in all to put up a strong fight shedding fears, and the easiest way to get rid of the situation as well as the fears is to inculcate the desire and habit of helping others. By maintaining proper hygiene, proper protection and social distancing, each one of the citizens can contribute to fewer people contracting the infection."
Following are some of the important issues raised by the petitioners.
i) Failure and/or neglect to provide testing facilities for frontline/healthcare workers at non-Covid hospitals/wards
ii) Absence of Personal Protective Equipments for healthcare workers treating non-Covid patients;
iii) Reluctance of the State to introduce capping of prices/charges for pathological tests;
iv) Omission to reserve beds in private hospitals for the weaker sections in terms of the provisions of the Bombay Public Trusts Act, 1950
v) Unhealthy conditions in quarantine centres, which carry with it the risk of spread of the contagion among people kept in isolation;
vi) Despite not being registered as a drug to be administered for cure of Covid-19, Hydroxychloroquine (HCQ) is being administered to patients which contravenes the New Drugs and Clinical Trial Rules, 2019
vii) There are no helplines in cities other than Mumbai and the State may direct the relevant municipal corporations to follow the MCGM model of helpline
viii) The MCGM War Room Dashboard contains incomplete information regarding availability of beds for the weaker sections. Also, the data provided on the War Room Dashboard is not accurate and, therefore, requires to be attended to with more seriousness;
Senior Advocate Mihir Desai appeared on behalf of the NGO Jan Swasthya Abhiyan, he submitted that although the testing guidelines issued by the relevant authorities provide for testing of symptomatic workers, there is no prohibition on testing of asymptomatic health workers as well at non-Covid hospitals/wards.
Desai referred to the judgment of the Nagpur bench in (Citizen Forum for Equality Vs. State of Maharashtra & Others) where the need to test asymptomatic health workers has been emphasized by issuing necessary directions.
With Maharashtra breaching the 1 lakh mark in total positive cases and having over 49,000 active cases, Desai urged the Court to extend the benefit of testing to even asymptomatic workers.
Moreover, Desai cited Section 41 AA of the Bombay Public Trust Act and contended that it is the duty of the respondents to ensure that 10% of the beds at private/charitable hospitals are reserved for poor patients for their treatment free of charge and that an additional 10% of the beds are reserved for the weaker sections for treatment at subsidized rates. A large number of people have been deprived of the benefits of treatment by such hospitals on the specious ground of non-availability of beds, Dasi submitted.
Advocate General AA Kumbhakoni intervened and said that 20% beds in private/charitable hospitals have been directed to be kept reserved, as would be evident from the notification dated May 21, 2020.
Referring to the New Drugs and Clinical Trials Rules, 2019, Desai submitted that HCQ has not been registered for treatment of patients who have tested positive for Covid-19 and in the absence of such registration, it should not be used as a prophylactic.
AG Kumbhakoni submitted that the state guidelines do not permit administration of HCQ as a prophylactic to one and all. The National Task Force for Covid-19 recommended the use of HCQ as a prophylactic of SARS-CoV-2 infection for selected individuals, he said.
Also, with regard to making PPE kits available to all frontline workers, AG Kumbhakoni submitted that PPE in the form of a body suit includes a diaper, covered shoes, etc. which are required to be used continuously for 7 hours without there being any opening for the workers wearing it to even drink water. It is troublesome to wear a full PPE since the person wearing it sweats a lot and makes the PPE unmanageable; only those workers working in air-conditioned areas can tolerate it. It is, therefore, not pragmatic to distribute PPEs amongst all front line workers, AG Kumbhakoni told the bench.
Senior Advocate AY Sakhare appeared on behalf of the MCGM and submitted that the War Room Dashboard devised by the MCGM is updated every half an hour upon information being given by the hospitals to the Control Room.
Sakhare told the Court that there are a total of 183 institutional quarantine centres where patients are being lodged for care without any discrimination. Apart from 187 municipal dispensaries, there are 211 health posts in Mumbai. Each health post is composed of an Assistant Medical Officer, Public Health Nurses, Auxiliary Nurses, Co-ordinators and Community Health Volunteers who have been assigned duties in particular areas and they have been visiting every house to conduct surveys and to ascertain whether any inmate requires medical assistance.
More than 54 lakh houses have been visited and a population in excess of 2.18 lakh have been attended to by frequent visits. Navy Hospitals as well as Railway Hospitals will also be made available in the near future in case there is a surge in the number of positive Covid-19 cases, Sakhare said.
At the outset, the bench noted-
"The pandemic and the resultant lockdown have destabilised the Indian economy, while wrecking the 'haves' and the 'have nots' alike. It has shown how pitiable the conditions of migrant workers in India are. India, as things stand now, can hardly think of a fair and just society any time in the near future."
Chief Justice Datta held that the State may continue with following endeavours-
1) Drive for robust detection of positive cases, intensive contact tracing, aggressive testing, and extensive spread of information and awareness relating to norms to keep one safe for a better future
(2) Develop wholesome strategy for dealing with all classes of patients, and balancing health care for COVID-19 patients and patients suffering from other diseases alike
(3) Display on the website, all information relating to real time availability of facilities at Government/MCGM run hospitals/clinics as well as private hospitals for Covid-19 patients
(4) Based on statistical data as well as inputs, take an informed decision either on continuation of lockdown or revocation of relaxations to the extent necessary or regulation of human activities to keep the nation working and at the same time preventing further risk
(5) Although unavailability of beds is no excuse for admission of patients, efforts shall be made to first admit those patients who genuinely deserve treatment and care in hospitals in preference to others who out of sheer fear may seek admission but can wait;
6) Now that Covid-19 has taught a good lesson, the desirability of increasing the budgetary allocation for public health and care for setting up more modern facilities to cope up with similar such challenges may be given a serious thought.
Moreover, the bench noted that distribution of PPEs, without doubt, must be need based. State and the MCGM shall be rational in distribution of PPEs and leave no room for complaint in regard to its distribution and the other kits in keeping with the demands of the situation, Court said.
Finally, the bench quoted Pandit Jawaharlal Nehru's speech on the eve of India's independence to the constituent assembly and observed-
"In this material world, tears and suffering may not cease to exist. The work to wipe tears and suffering has to go on. If indeed tears and suffering are to be wiped from those who are ailing of Covid-19 and related matters, the nation expects service, i.e. 'seva', from each one of its citizens. It does not take much to serve."
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