Supreme Court Directs Enhanced COVID-19 Patient Care and Monitoring (19 June 2020)

Date of the Judgment: 19 June 2020
Citation: Suo Motu Writ Petition (Civil) No. 7/2020
Judges: Ashok Bhushan, Sanjay Kishan Kaul, and M.R. Shah, JJ.

Can the Supreme Court intervene to ensure proper treatment of COVID-19 patients and dignified handling of dead bodies in hospitals? The Supreme Court of India, in a Suo Motu Writ Petition, addressed this critical issue, taking cognizance of deficiencies in patient care across various hospitals. The court issued a series of directives aimed at improving hospital management, patient care, and transparency in the handling of the COVID-19 crisis. This order was delivered by a three-judge bench comprising Justices Ashok Bhushan, Sanjay Kishan Kaul, and M.R. Shah.

Case Background

The Supreme Court initiated a Suo Motu Writ Petition on June 12, 2020, due to concerns about inadequate patient care for COVID-19 patients in hospitals across Delhi and other states. The court aimed to rectify the situation and ensure proper medical care for those affected by the pandemic. The Union of India, the Delhi Government, and other states responded by filing affidavits detailing the steps they had taken to address the crisis. Several intervention applications were also filed, highlighting various aspects of the issue.

Timeline:

Course of Proceedings

The Supreme Court took suo motu cognizance of the issues surrounding the treatment of COVID-19 patients. In response to the notice issued on June 12, 2020, the Union of India, the Delhi Government, and other states submitted affidavits detailing the measures they had undertaken. The court also received intervention applications from individuals and organizations, highlighting specific concerns and suggestions. The court considered these submissions and issued directions to ensure better management of the pandemic.

Legal Framework

The judgment primarily relies on the Supreme Court’s inherent powers to ensure the protection of fundamental rights, particularly the right to health. The Disaster Management Act, 2005, was also invoked to ensure uniform implementation of the revised discharge policy across all states and union territories. The court did not specifically cite any other legal provisions, but it emphasized the need for strict adherence to guidelines issued by the Union of India.

Arguments

The arguments presented before the Supreme Court primarily revolved around the measures taken by the Union of India and the Delhi Government to manage the COVID-19 crisis. The Union of India highlighted the remedial steps taken, including high-level meetings and decisions to increase testing and improve hospital facilities. The Delhi Government provided details of the government hospitals, COVID-designated hospitals, and the deployment of nodal officers. However, the court noted a lack of specific mechanisms for supervision and improvement in the Delhi Government’s affidavit. The intervenors raised concerns about various issues, including the non-availability of test reports to patients in Maharashtra, which was later addressed.

Issues Framed by the Supreme Court

The Supreme Court did not explicitly frame specific issues in a numbered list. However, the core issues addressed by the court can be summarized as follows:

• Ensuring proper treatment of COVID-19 patients in hospitals.
• Guaranteeing dignified handling of dead bodies in hospitals.
• Establishing mechanisms for continuous supervision and monitoring of hospitals.
• Implementing uniform discharge policies across all states and union territories.
• Prescribing reasonable rates for COVID-19 related facilities and tests in private hospitals and labs.

Treatment of the Issue by the Court

The following table demonstrates how the Court addressed the issues:

Authorities

The Supreme Court did not cite specific cases or books in this order. The primary authorities relied upon were the guidelines and policies issued by the Union of India, along with the Disaster Management Act, 2005. The court emphasized the need for strict adherence to these guidelines to ensure proper management of the COVID-19 crisis.

Judgment

The Supreme Court issued a series of directions to ensure proper treatment of COVID-19 patients, dignified handling of dead bodies, and effective management of the pandemic. The court emphasized the need for continuous supervision and monitoring of hospitals, uniform implementation of discharge policies, and reasonable rates for COVID-19 tests. The court also addressed the issue of non-availability of test reports to patients in Maharashtra, directing that such reports be provided to patients or their relatives.

What weighed in the mind of the Court?

The Supreme Court’s primary concern was to ensure that COVID-19 patients receive proper medical care and that the dead are handled with dignity. The court was also keen to establish mechanisms for continuous supervision and monitoring of hospitals to ensure that guidelines are followed and that any deficiencies are promptly addressed. The court emphasized the need for transparency and uniformity in the management of the pandemic across all states and union territories. The court’s decision was driven by a combination of factual concerns about the situation on the ground and legal principles related to the right to health and the need for effective disaster management.

Logical Reasoning

The court’s reasoning was based on the need for immediate action to address the deficiencies in patient care and hospital management. The court emphasized the importance of implementing the guidelines issued by the Union of India and the need for continuous supervision and monitoring to ensure that these guidelines are followed. The court also considered the need for uniformity in the implementation of discharge policies and the need for reasonable rates for COVID-19 facilities and tests to ensure that these are accessible to all.

The court did not explicitly consider alternative interpretations but focused on the need for immediate and effective action. The final decision was reached by issuing specific directions to the Union of India, the Delhi Government, and other states to ensure that the necessary measures are taken to manage the pandemic effectively.

The court’s decision was based on the following reasons:

• To ensure proper treatment of COVID-19 patients.
• To ensure dignified handling of dead bodies.
• To establish mechanisms for continuous supervision and monitoring of hospitals.
• To implement uniform discharge policies across all states and union territories.
• To prescribe reasonable rates for COVID-19 related facilities and tests.

“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.”

“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.”

“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.”

There was no minority opinion in this case. The judgment was delivered by a three-judge bench unanimously.

Key Takeaways

• Expert committees must be constituted to inspect and supervise hospitals.
• Hospitals must permit one attendant for COVID-19 patients.
• CCTV cameras should be installed in COVID-19 wards for transparency and monitoring.
• Help desks must be established in hospitals for patient inquiries.
• Revised discharge policies must be uniformly followed across all states and union territories.
• Reasonable rates must be prescribed for COVID-19 related facilities and tests.

The judgment has significant implications for the management of the COVID-19 pandemic, ensuring better patient care, transparency, and uniformity in the implementation of policies across the country. It sets a precedent for the judiciary’s role in ensuring that fundamental rights are protected during a public health crisis.

Directions

The Supreme Court issued the following directions:

1. The Ministry of Health and Family Welfare, Union of India, shall constitute Expert Committees consisting of:
   • Senior Doctors from Central Government hospitals in Delhi.
   • Doctors from GNCTD hospitals or other hospitals of Delhi Government.
   • Doctors from All India Institute of Medical Sciences.
   • Responsible officer from Ministry of Health and Family Welfare.
2. 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.
3. The above team may, in addition to normal inspection, also conduct surprise visits to assess the preparedness of the hospitals. The expert team may issue necessary instructions for improvement and forward its report to the Government of NCT of Delhi and the Union of India, Ministry of Health and Family Welfare.
4. 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. Chief Secretary of each State shall ensure that such Committees are immediately constituted and start their works within a period of seven days.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.

Development of Law

The ratio decidendi of this case is that the Supreme Court has the power to issue directions to ensure proper treatment of COVID-19 patients and dignified handling of dead bodies. The court’s intervention was aimed at addressing deficiencies in patient care and ensuring that guidelines issued by the Union of India are strictly followed. This case reinforces the judiciary’s role in protecting fundamental rights during a public health crisis and ensures that the government is accountable for its actions.

Conclusion

The Supreme Court’s order in this Suo Motu Writ Petition was a significant intervention to address the COVID-19 crisis. The court directed the constitution of expert committees for hospital supervision, emphasized the need for uniform discharge policies, and mandated reasonable rates for COVID-19 tests. These directions aimed to improve patient care, ensure transparency, and establish mechanisms for continuous monitoring and improvement.