DAVINDER BHASIN Vs. UNION OF INDIA

JUDGEMENT

(1.) IN this writ petition, which is in the nature of Public Interest Litigation (PIL), the petitioner seeks direction to the respondents for compulsory basic life support training to be given to all the personnel working in all the Hospitals in India and also to personnel of military, para military, fire fighting agencies, police etc. According to the petitioner the bitter experience he had, while is mother Mrs. Raj Kaushlaya Bhasin was getting treatment has come to fore, the necessity of such a training to each and every employee working in the hospitals. He has mentioned in the writ petition as to how the lack of training with hospital attendant who are deputed to take care of his mother led to her unfortunate death. The narration given by the petitioner in this behalf, in the writ petition is as under:- The petitioners mother aged 86 years, was admitted to Max Hospital, 1 Press Enclave Road, Saket, New Delhi for the treatment of pneumonia. She was put under the supervision of Dr. Mishra and Dr. Sanjeev Budhiraja. The doctors advised various tests for petitioners mother which were conducted on 8.1.2011 and 9.1.2011. The patient was kept under the supervision and care of the hospital and was not discharged. While in hospital, on 9.1.2011, the oxygen saturation rate of the petitioners mother had dropped and she was put on oxygen support after which her oxygen saturation rate improved to 95%.. On 9.1.2011 while the patient was in a private room in the ward, in the evening, she wanted to pass urine and called for a hospital attendant for assisting her. The hospital attendant deputed at the ward came to her assistance but instead of giving her a bed pan (which is given to patients in serious health conditions) she decided to take her to the washroom without looking at the treatment chart of the patient. The attendant took off the oxygen mask of the patient and moved her to washroom on a wheel chair. Because of removal of the oxygen mask, the oxygen saturation level of the patient dropped drastically leading to hypoxia (low oxygen) and arrhythymia arrest. When the patient could not move to get out of the wheelchair, the attendant instead of calling the doctors started calling the family members of the patient. On realizing the gravity of the situation the family members of the patient raised an alarm to call for other attendants and doctors but valuable time had been lost by them and this proved to be fatal for the patient. The petitioners mother passed away due to the negligence of an ill-trained medical attendant.

(2.) FOR this reason, the petitioner has drawn the attention of this Court towards the fact that the fate of critically ill patients lie in the hands of the staff members and medical attendants in hospital and personnel who are the "first responders" in critical situations and in the absence of such training, they are incapable of handling huge responsibility. He has thus submitted that basic life support training should not only be confined to staff nurses etc. but be given to each and every staff in the hospital so that valuable human life is not lost due to their negligence. The petitioner also provides another justification for this kind of training stating that it would increase the number of trained personnel in the society at large without even putting any substantial burden over the infrastructure both financial or otherwise. This could ensure availability of skilled and semi skilled hands which could prove to be handy in cases of natural calamities ensuring that atleast immediate first aid is given to the patient while also ensuring that the correct message reaches the correct doctor at the shortest possible time so that time is not wasted in starting the treatment of the person needing immediate medical attention. The petitioner also mentioned that in the study conducted by Association of physicians in India entitled as ,,White Paper on Academic Emergency Medicine in India: Indo-US joint working Group (JWG) published in JAPI. Vol. 56 October, 2008, it is noted that at present in India there is no dedicated emergency medical faculty accredited by the Medical Council of India. It also mentions that there are no dedicated trauma surgeons in India and also that there are a very few dedicated trauma centres in India, but unlike India, in United States of America, Accredited Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) for emergency medicine govern training thereof which is predominantly three years in length and are designed to prepare physicians for every practice of emergency medicine. Further physicians are trained under qualified faculty to develop clinical maturity, judgment, technical skills and a knowledge base in fundamentals of Emergency Medicine, however, in a country like India which is a country of over a billion people and a hub of medical tourism, is found to be lacking. The petitioner has also referred to Article 47 of the Constitution of India which declares that it shall be the duty of the State to raise the level of care and improve the standard of public health requirements in the Hospital, which would reach a higher level if all employees of hospital are trained at least in giving basic first aid treatment to a patient in urgent need of medical help. He has also invoked the provisions of Article 21 of the Constitution which protects the Right to Life, which is fundamental right of every citizen and includes right to health and medical care. The petitioner has further mentioned that at present there is no Central law in India. Only the legislature of Gujarat in 2007 passed the Gujarat Emergency Medical Services Act, 2007 (hereinafter referred to as the ,,Gujarat Act) to provide for regulation of emergency medical services. The preamble of the Gujarat Act reads as under:-

(3.) IN the counter affidavit filed on behalf of the Union of India it is stated that basic health support training is required for only those hospital employees who are involved in "direct patient care" and not all the employees of the hospital. As per the averments made in the counter affidavits, efforts have been made by the Central Government Hospitals for training on Basic Life Support for the Doctors, nurses and some paramedical staff and this is based on a curriculum developed individually by the individual hospitals. Other established organizations like Indian Red Cross Society (IRCS) and GVK Emergency Management and Research Institute (GVK EMRI, a pioneer in Emergency Management Services in India running as a non-profit-making professional organization operating in the Public Private Partnership (PPP mode) run Basic Life Support courses on payment basis. It is stated that there is a centrally sponsored Trauma Care Programme in which indentified district/state hospitals/Medical colleges in the country are being provided assistance to augment their capacity, both infrastructure and man powers, for handling trauma cases and 140 such centres are identified in the 11th five year plan and 160 more are proposed in the next five year plan. However, in the 9 th & 10th five year plan 103 District hospitals on National highways were upgraded with Emergency care facilities to treat the victims of Road Traffic Injuries and other emergencies. According to the respondent, endeavour of providing training to more number of persons in the society would require augmentation of infrastructure and finance in consultation with other departments of the Central Government like Ministry of Home Affairs, Ministry of Defence and other departments. The respondent states that Establishment of the Emergency Medical Services Authority at the national level and similar subsidiary authorities at the State and District level requires inputs from other Departments like Ministry of Home Affairs, Ministry of Defence etc. considering the following points: Whether such training already exists for the above mentioned personnel in the various departments. The expected annual workload for such a body, if established. Under which ministry, this body/authority will be established? It is beyond the mandate of the Ministry of Health to decide on an authority which will have an overall say over the basic life support training needs for the military, para-military, fire services etc. The State Governments and the concerned organisations of the military, para military may define their training needs, develop the standardized training programme and conduct the same to cater to their needs for capacity building in terms of First Aid & Basic Life Support. The State Governments, Military and para-military Organisations may utilize their existing training curriculum or develop their own referring to the curriculums of the Central Government Hospitals or that of the Indian Red Cross Society, GVK EMRI or other similar organizations. They may like to utilize the services of the organizations already doing this job as enumerated.