J.Hillson Angom vs State Of Manipur And Ors

R.S., CJ

The prayers in this PIL are as follows:-

"ii) to issue a writ in the nature of Mandamus directing the Respondents to ensure adequate supply of blood/availability of blood in all the District Hospitals by setting up Blood Banks at all the District Hospitals in the State of Manipur within a specific period of time;

(iii) to issue a writ in the nature of Mandamus directing the Respondents to set up Blood Storage units at all the Community Health Centres (CHCs), Primary Health Centres (PHCs) and Primary Health Sub-Centers (PHSCs) and ensure that all the Blood Storage units are functioning at the earliest;

(iv) in the interim to issue an appropriate order for constituting a high powered committee for investigating and preparing a report

(a) on the demand for blood or its components for clinical use at various hospitals In the State, (b) the supply of blood or Its components to the various hospitals in the State, the quantum of collection of blood by various blood banks, (c) the end use of blood/its components collected by the blood banks, (d) the prices at which blood or its components are made available by the blood banks and for all matters connected with distribution of the blood collected by blood banks;"

[2] In this PIL, notice was issued on 22.3.2018. On 12.7.2018, the following advocates were appointed as Advocate Commissioners:-

"1. Ms. Ksh. Harichhaya, Advt. Commissioner

Ms.Laisom Sillori, Advt. Commissioner

Ms. N.Savitri Devi, Advt. Commissioner,

Mr. Henba Thokchom, Advt. Commissioner

Mr. Th.Rohitkumar, Advt. Commissioner"

And the Advocate Commissioner filed a report on 29.11.2018. The said report has been taken on record and on the basis of the defects pointed out by the Advocate Commissioners, subsequent orders have been passed and the Director of Health Services filed a preliminary report dated 10.12.2018 which reads as below:-

"REPORT SUBMITTED BY THE DIRECTOR OF HEALTH SERVICES, MANIPUR IN COMPLIANCE WITH THE ORDER OF THE HON'BLE HIGH COURT PASSED ON 29- 11-2018

Upon perusal and examination of the Report submitted by the Advocate Commissioners as constituted by the Hon'ble High Court, the certain shortfalls can be seen in respect of the Blood Banks in Regional Institute of Medical Sciences (RIMS), Imphal and Jawaharlal Nehru Institute of Medical Sciences (UNIMS), Porompat.

The shortfalls in respect of RIMS are shown as below:

Phlebotom Room : Lack of cleanliness.

Component and walk in cold room : The area/place and entrance to this room is in a very pathetic and unhygienic condition which is against the guidelines.

Component separation room:2 (two) segregation machines are there, but 1 (one) is working and it has very bad smell. AC installed in the room has water dripping/flowing inside the room which is quite dangerous which may cause infections leading to contamination of blood segregation process and quite unhygienic,

Rest cum refreshment room : Particular room for rest and refreshment of the donor are not available

Wash room : The wash room was room wherein test tubes are washed for reuse is in a very worst condition. Male wash room is inside this room and slides are very dirty and kept in a very dirty place The shortfalls in respect of JNIMS are shown below:

Location& surrounding: Premises around the blood bank is not properly maintained and unhygienic and next to the gynaecology ward and also near the site for dumping bio-medical waste which is against the guidelines

Cold room : The distillation machine is installed in a very unhygienic place which is very much prone to infections.

Component room : 2 (two) Refrigerated Centrifuge machines are there, but 1 (one) is not well functional.

Taking in to consideration of the importance of blood, the Director of Health Services, Manipur/State Licensing Authority vide its Letter dated 7h December, 2018 requested the authorities of RIMS, Imphal and JNIMS, Porompat to take up necessary to make up the shortfalls within a stipulated period (Copies enclosed).

State Blood Transfusion Council, Manipur has vide its Order dated 10th October, 20108 fixed the service charges to be recovered from the patients. The amount incurred in the processing of blood and blood components including blood bags, reagents, test kits etc. is regulated by the State Blood Transfusion Council, Manipur and as such, the authority has proposed the State Blood Transfusion Council to look into the matter and decide its decision/resolution. Once the State Council has accepted the proposal, the authorities will take necessary steps in this regard. Now, the report from the State Blood Transfusion Council is awaiting.

Dated/Imphal

The 10th December, 2018

Sd/-

(Dr.K.Rajo Singh)

Director of Health Services, Manipur".

[3] Thereafter, another order was passed on 18.3.2019 which is extracted as below:-

"R.S., CJ

In the report given by the Advocate Commissioners at page 100, general observations are given as follows:-

"Pursuant to the inspection conducted on the above mentioned Blood Banks, we have gathered from the concerned Medical Officers that even though there are only 4 Blood Banks opened in the Government Hospitals, there is no shortage of blood supply in the State whenever it is demanded. It is also informed by the Medical Officers of these Blood Banks that the ratio of unused discarded blood due to expiry is higher than the blood supplied/ used in the hospital and the same can verified from chart appended in the report of Blood Bank, JNIMS, District Hospital Thoubal. Likewise, in other Blood Banks the same remain as it is. The reason for discarding the blood stored in the Blood Banks is because of the low demands. As such, despite spending huge amount in the storage and maintenance of blood, the same cannot be used for true purposes. Therefore, instead of opening of new blood banks, proper maintenance of the already existed blood banks/ Blood Storage Centre and supply of blood whenever required by means of proper transportation would be much more beneficial and efficient. The same view is expressed by all the concerned Medical Officers of all the Blood Banks.

Apart from this, it is also come to our knowledge this Court is of the view that the equipments which are installed in these Blood Banks are mainly sponsored and initiated by NACO initially and now it had been under the control of National Health Mission. Thus, we have gathered information from the concerned staffs that expenses incurred in installing these equipments are wholly sanctioned by the NACO and NHM and not from the exchequer of the State Government.

Regarding maintenance of equipments installed in these Blood Banks, it is probably difficult to maintain by the State Government especially machines installed in the State-run Blood Banks cannot carry out routine servicing/ calibration in time because of financial constraint as expressed by the concerned Medical Officers.

We have also mainly focused on the fees charged from the patient at the time of supplying the blood and in this regard, we are informed that the present rate of fees charged from the patient is going to be dropped since there is a proposal for providing blood free of cost."

We request the State Mission Director, State Health Society, National Health Mission, Manipur, Lamphelpat, respondent No.2 and Director of Health Services, Govt. of Manipur, respondent No.6 to respond to these General Observations with material particulars and compliance report on the next hearing date.

In so far as the Jawaharlal Nehru Institute of Medical Sciences (JNIMS), at page 32 of the report of the Advocate Commissioners, details of the errors of bad management and non-maintenance has been highlighted. The Director of JNIMS Hospital, is called upon to ensure that the defects pointed out by the Advocate Commissioners are rectified and compliance also be filed on the next hearing date.

For compliance, list on 15.5.2019. A copy of this order be served to Ms. Momota Oinam, learned Addl.AG, Director, RIMS and JNIMS."

[4] This order dated 18.3.2019 was passed for directing the authorities to remove the defects pointed out by the Advocate Commissioner. In compliance to the said direction, the State Mission Director, State Health Society issued a proceeding on 9.5.2019 which reads as follows:-

"Office of the

State Health Society, NHM-Manipur

No. SBC-11/DS-C/2017 Imphal the 9th May, 2019

To,

The President

State Blood Transfusion Council, Manipur

Subject:- Processing charges of Blood and Blood Components.

Sir,

This is to bring to your notice that the State Health Society, NHM-Manipur have, vide its Sanction Order No. SBC-11/DS-C/2017 dated the 9th May, 2019 (copy enclosed), released an amount of Rs. 1,10,56,500/-(Rupees one crore ten lakhs fifty six thousand and five hundred) only to the following 4 Government licensed blood banks:-

Sl. No

Blood Bank

Amount released (Rs)

1.

RIMS(Regional Institute of Medical Sciences)

63,00,000/-

2.

JNIMS(JN Institute of Medical Sciences)

37,80,000/-

3.

DH: Churachandpur

8,19,000/-

4.

DH: Thoubal

1,57,500/-

5.

Total

1,10,56,500/-

You are therefore, requested to kindly issue the necessary directives so that no processing charges are levied while issuing blood and blood components from the above named Government licensed blood banks.

[5] The Director of Health Services, Manipur has filed another proceeding through the learned Addl.Advocate General which is dated 13th May, 2019 which reads as under:-

" GOVERNMENT OF MANIPUR

MEDICAL DIRECTORATE

No.G/HC/PIL/10-2018/DHS-2018                                                                                           Imphal the 13th May, 2019

To,

Beedyasaree M.,

Jr. Govt. Advocate to

Momota Devi Oinam,

Addl.Advocate General,Manipur.

Sub: PIL NO. 10 OF 2018

Mr. J. Hilson Angam

Vs

State of Manipur & 4 Ors.

Madam,

In inviting a reference to the Secretariat : Health Department, Government of Manipur letter No. 18/8/2018-M(C) dated 9th April, 2019 on the above subject and in compliance with directions of the Hon'ble High Court in the above referred case, I am to submit herewith the report as regards the observations made in the order dated 18-3-2019 as per report of the Advocate Commissioners are as follows :

(a) Regional Institute of Medical Sciences (RIMS) being the tertiary health centre, demand of blood is always more than the supply. In the financial year 2018-2019, the total blood collection was 12,036 units and the total supply was 19,539 units after separation of components. There are many valid reasons for discard viz. blood clots, undertap, TTI positive cases, expiry, etc. The discard of unused blood units is minimum in RIMS. The discard happens particularly in blood group "AB" when the units are in excess and the demand is less because "AB" blood (PRBC) cannot be given to any other group except "AB"/ However, components (FFP and Platelet) prepared from "AB" blood group are used. Only PRBC is discarded. The record of discard from April, 2018 to March, 2019 (Copy enclosed as R/ 1) in respect of RIMS is as follows :

(i) Blood clots/undertap 45 nos.

(ii) TTI positive cases 228 nos.

(iii) Expiry 25 nos.

b) Any blood group cannot be transfused to anybody while there is shortage of some specific group, there may be surplus in some other groups. Blood stored in Blood Bank has got limited self-life of 35 days only under strict storage conditions. Usages rate is quite low in the periphery where invasive and operative procedures are hardly done.

c) Number of patients who required blood transfusion in District Hospital, Thoubal in spite of having specialized facilities where blood is used in cases of General Surgery, Obstetric and Gynae, General Medicine, Trauma Centre, Orthopaedic, etc. is low. Managing blood is a challenging task. Blood is perishable and with perishable product. It has become deteriorated/expired and discarded in due course of time as stated above. Besides, 24X7 uninterrupted power supply is required for which Manipur State Power Distribution Corporation Limited made by made a party respondent in the case for directing it to make avail uninterrupted power supply.

d) The service charges levied from the patients/relatives at the time of issuing of blood units for transfusion has been in existence since 2008 by an order of the State Blood Transfusion Council, Manipur. Very fortunately, the Government has issued a Sanction Order dated 9th May, 2019 for processing charges of Blood and Blood Components for supporting the 4 (four) Government Blood Banks i.e. RIMS, JNIMS, District Hospital, Churachandpur and District Hospital, Thoubal (Copy enclosed as R/2). Thus, it is likely to issue necessary notification by the Manipur State Blood Transfusion Council not to recover service charges from the patients while issuing blood units for transfusion.

Encl: As stated above.

Yours faithfully,

Sd/-

(Dr. K. Rajo Singh) .

Director of Health Services, Manlpur."

[6] In that, Annexure- R/1 is relating to the manner in which blood is being collected and they have given details of blood goes wasted to non-used.

In the report, they have also enclosed the sanction order dated 9th May, 2019,

R/2 which is extracted as under.

"OFFICE OF THE

STATE HEALTH SOCIETY: MANIPUR

SANCTION ORDER

Imphal, the 9th May, 2019

No. SBC-11/DS-C/2017: Sanction to an amount not exceeding Rs. 1,10,56,500/- Rupees (One crore ten lakhs fifty-six thousand and five hundred) only is hereby accorded for release of Fund to RIMS (Rs.63,00,000/-), JNIMS (Rs. 37,80,000/-), DHS-CCP (Rs. 8,19,000/-) and DHS-TBL (Rs.1,57,500/-) for processing charges of Blood and Blood Component.

The expenditure may be met from 6.2.7.1 (Drugs & Supplies Components).

IFD Concurrence No.: NHM/SBC-Blood Component/2019/5471.

PPA No.C051904542426 Dated: 8th May, 2019 (Rs. 1,00,80,000/-).

CO419116883OO Dated: 8"" May, 2019 (Rs.9,76,500/-).

S/d

(Vumlunmang Vualnam, IAS)

Principal Secretary (HFW)/Chairman

EC, State Health Society, NHM,

Manipur"

to the four blood banks in the Government hospitals with the direction not to collect processing fees from the beneficiaries. A reading of the report dated 13.5.2019 makes it clear that in so far as the State of Manipur is concerned, maintenance of blood bank would be more appropriate at the four main hospital as they have adequate facilities to ensure that the blood is not wasted due to improper maintenance. Sufficient funds have been released by the State Government. However, keeping that in mind, we are inclined to direct that the blood bank facilities should be provided to district hospitals and rural hospitals at the time of need by providing special vehicles so that blood is transported in the case of accident, emergency in hospital, etc. For this, Director of Health Services will provide a road map and scheme to ensure that the blood distribution from the four recognised blood banks will be available to the farthest reaches in Manipur, more particularly, hill districts and through specialized vehicles fitted with ability to carry the blood without getting spoiled.

If that endeavour is taken up in effective manner, the needs of the people of Manipur for providing emergency blood will be addressed.

[7] With this observation and recording the statements of the Director, Health Services, we disposed of the PIL.

[8] The four Advocate Commissioners will be entitled to further final remuneration of Rs. 5000/- each to be paid by the Director of Health Services.