Prabudh Manch vs State of Rajasthan and Others

Arun Mishra, C.J.—The petition as PIL has been filed by petitioner with the prayer to direct the respondent No. 1-State to provide requisite infrastructures and staff to all the Hospitals and Dispensaries of the State especially Janana Hospital, Ajmer to cure the suffering of common man of the State on the front of Medical and Health. It was submitted by the petitioner that due to lack of medical treatment and negligence on the part of senior doctors and staff of Janana Hospital, Ajmer, a woman, namely, Lata died while delivering a child. Thereafter, newly born child had also died in the Janana Hospital and upon this, the people of Ajmer made agitation. Thereafter, a Committee was constituted to enquire into the matter and the enquiry report was submitted, but no action has been taken. According to the petitioner, there is lack of staff, infrastructures, cleanliness and safety of newly born child and patients in the Janana Hospital. Apart from this, there is also mismanagement and negligence of doctors and staff attached to the said Hospital. There is also misappropriation of checking fees and no benefit of Janani Suraksha Yojna is being extended to the patients in the Janana Hospital.

The further case of the petitioner is that all the Medical Colleges and Hospitals of Rajasthan are lacking teaching and clinical staff, which may be due to non-payment of salary including DA etc.; proper infrastructure and equipment to cure the ailing patients are also not available; the respondent No. 1-State has failed to provide even the requisite number of beds to the Hospitals and the patients are lying in wards and verandahs in a pitiable, pathetic and inhuman condition. It was further submitted by the petitioner that specialized doctors possessing qualification of post-graduation are posted in the Dispensaries while simply MBBS are posted in Medical Colleges and Hospitals, which lead to non-utilization of skill and expertise of specialized doctors. Casualty wards of all the Hospitals of the State are not well equipped with the proper infrastructures, doctors and staff to attend patients which may lead to mis-happening on day or the other. The nursing staff is also not in proportion to the beds allotted in a particular Hospital which causes suffering to the patients. Hence, the present writ petition has been filed.

A reply to the writ application was filed by the respondents contending inter-alia that the Committee has enquired the matter relating to incident of death of woman and came to the conclusion that there was no negligence on the part of treating doctors and staff of Janana Hospital. It was further submitted that as per rules and directions of the Government, payment of Zanani Suraksha is being paid to the patients on the bed through cross cheque. Since the Janana Hospital is situated away from the City, wild animals enter the hospital premises and the hospital administration used to write letters in this regard from time to time to the concerned authorities to provide adequate safety to the Hospital. The doctors used to remain available in the hospital round the clock. One STD/PCO facility is available in the hospital as well as in the surrounding area of Janana Hospital and for providing more STD/PCO facility, letters have been written to the higher authorities, but the sanction is still awaited. Though there is shortage of staff, however, the work of Hospital is not being hampered adversely. Despite best efforts made by the doctors and subordinate staff, the lady patient could not be saved.

In compliance of the order of this Court dt. 10.08.2009, progress report dt. 29.08.2009 was filed by the respondents alongwith additional affidavit to show that various steps have been taken by the Hospital administration for improving the medical and health care facilities. It was submitted that there was no negligence on the part of the doctors; ladies are being provided proper medical facilities by the doctors and the staff used to remain on duty round the clock. From Jan. 2009 to July, 2009, so many patients were provided medical facilities, the details of which are given below:-

As regards plea of death of minors (Sishus) in the Janana Hospital, it was submitted that no minor or woman had died due to medical negligence of the treating doctors or staff. However, despite sincere and earnest efforts, proper care and caution and providing best medical treatment and facilities, if on any occasion, any minor could not be saved, from that it cannot reasonably be inferred or concluded that there was medical negligence on the part of the doctors or staff of hospital.

So far as the plea of non-admission of women in the Janana Hospital is concerned, it was submitted by the respondents that whenever any patients come for treatment or delivery purposes, he/she is provided proper care and treatment and he/she is admitted only in case of necessity and emergency and in case of no urgency, if any patient is not admitted, it does not mean that the Hospital Administration refused to admit the patients.

As regards shortage of staff in the Janana Hospital, it was submitted that no doubt staff is inadequate looking to the services provided by the Hospital, but matter is pending consideration with the State Government for filling up the vacancies.

On the plea of non-extending of benefit of Janani Surksha Yojna in the Janana Hospital, it was submitted that the benefit of the said Yojna is being given to each lady who comes for delivery, the details of extending benefits to the patients are being given below:-

It was further submitted that in the Janana Hospital, after purchasing the medicines, as per the budget allocated by the State Government, the same are made available to the patients and under the Chief Minister BPL Yojna, medicines are being supplied free of cost to BPL card holders.

As regards plea of nuisance caused by monkey etc., it was submitted that for the last three years, there is no nuisance caused by any animal including monkey. Since Janana Hospital is situated at the distance of 8 kms. from city and there is jungle near the Hospital, therefore, sometimes wild animal comes, but it does not affect the safety of patients. However, the Hospital administration has made such arrangements that no animal could be able to enter in the hospital premises.

The petitioner has also filed additional affidavit on 24.11.2011 alleging therein that in the Janana Hospital, Ajmer there is no proper arrangements of ambulance; no STD/PCO though two STDs were sanctioned one in the first floor and other on the ground floor; lack of doctors and nursing staff; there are no residence for the doctors, nursing staff and residents in the hospital premises; only 200 beds are available though number of patients are three times more and they are lying in corridors etc.; lack of security arrangements; wild animals including monkey, cat etc. used to come in the hospital causing bother to the patients; though Sonography machine is working, but patients are given long dates thereby compelling them to go outside for Sonography purposes; there is no medicine unit; road approaching Janana Hospital is not illuminated with proper road lights causing hardships in the night; toilets are insufficient and not properly cleaned as a result of which general public at large is suffering; there should be more Ren Basera in the hospital for the general public; canteen is there, but the same is not functioning; medical shops in the hospital premises are not having all medicines forcing patients to take medicines at a higher price from medical shops situated outside Hospital; there is urgent need to establish police sub station or chowki in the hospital premises; blood bank is not working properly; hospital building is not being maintained properly as the compound is full of weeds and there are no shelter places for the attendants; there is also need for issuance of permit of public transport from main city to Janana Hospital.

A reply to the additional affidavit of petitioner was filed by the respondents on 31.01.2012.

Second additional affidavit was filed by the petitioner on 24.08.2012 reiterating lack of ambulance facility, security and staff in the Janana Hospital, there is no STD/PCO facility; there is no residence for doctors and nursing staff in hospital premises; there is insufficiency or inadequacy of beds and Sonography machines resulting in causing inconvenience and suffering to the patients. It was further submitted that since there is no medicine unit, one medicine unit be transferred from JLN Hospital so that in case of emergency, the patient would not suffer as the main hospital is far away and similarly, one unit of Janana Hospital may be shifted to JLN Hospital through rotation so that persons living in the city may not suffer; there is poor maintenance of street lights; there is insufficient toilets and improper cleaning causing inconvenience to the public at large; there is inadequate Ren Basera; there is no canteen facility; there is requirement of proper monitoring of free distribution of the medicines; no proper police personnel deputed for security purposes; blood bank is not functioning properly; since Janana Hospital is far away from city, there is a need for proper public transport; there is non-maintenance of hospital premises properly.

Thereafter, further additional affidavit was filed by the Additional Director, Medical Education Department, Jaipur on 17.09.2012 stating inter-alia that so far as ambulance service is concerned, presently, there are two Ambulance available in Government Manila Chikitsalaya, Ajmer, out of which, one is Government Ambulance and another is hired on contract basis. Besides ambulance facility, three emergency ambulance are also available for the entire Ajmer City. Apart from the above, under "Janani Sishu Suraksha Scheme", payment of Rs. 7/- per k.m. is made for every delivery case, who comes by their own vehicle to the hospital and after the delivery, vehicle facility to the concerned woman to return back to her home from the hospital is also provided under the said Scheme.

As regards public phone booth, it was stated that earlier STD/PCO was being run by the Rajasthan Medicare Relief Society in the Hospital, but the same was discontinued due to some litigation. However, though no STD/PCO is running in the hospital premises, but the Hospital Administration is providing phone services to the needy patients through its own EPBX, as and when required.

With regard to sanctioned posts of senior doctors, it was submitted that there is sanctioned strength of 18 Professors, Associate Professors, Assistant Professors, Junior Specialists, Medical Officers, Deputy Superintendents, against which 12 senior doctors are working presently; there is sanctioned strength of 14 senior residents and IIIrd year residents, against which 12 are working; the sanctioned strength of nursing staff is 70, against which, 63 persons are working; sanctioned strength of Para Medical Staff is 39, against which 24 are working. The Government has already sent requisition to the Rajasthan Public Service Commission for filling up the vacant posts of doctors, nursing and para medical staff. The process of recruitment is at the final stage. Apart from the above, the Government under "Janani Sishu Suraksha Scheme" has also sanctioned new post of Assistant Professor, two posts of Senior Residents and two posts of Junior Resident in Gynaecology and Obstetrics. The institution had also organized walk-in-interview on every Tuesday in July, 2012 for post of Senior Resident and consequently, three Senior Residents have been appointed in Janana Hospital, Ajmer. The remaining posts will also be filled up shortly. In addition to the above posts of Nursing and Para-medical staff, 50 new posts of Nursing Staff and 37 posts of Para medical staff have been sanctioned and requisition for filling up the said posts has already been sent to the competent authority. In the Janana Hospital, Ajmer, the average admission/registration of patients is 55 per day, as such, after filling up all vacant posts and newly sanctioned posts, there will be adequate and sufficient staff to manage the day-to-day affairs of the Hospital.

On the point of accommodation for hospital staff, it was stated in the additional affidavit that for construction of 23 rooms for resident PG Girls, the State Government has sanctioned a budget of Rs. 70,00,000/-. The rooms will be constructed in the premises of Janana Hospital, Ajmer and for that purpose, the Public Works Department has already issued the NIT. Presently, the PG students on duty are staying in the attached duty rooms at Janana Hospital and reside in PG Girls Hostel in Jawahar Lal Nehru Hospital campus.

So far as the availability of the bed for patients is concerned, it was stated in the additional affidavit that at present, the Janana Hospital, Ajmer is having sanctioned 200 beds for Gynaecology and Obstetrics cases alongwith a nursery having 25 beds. The State Government has now sanctioned additional 60 beds for maternity ward and 30 beds for pediatric ward under the "Janani Sishu Suraksha Scheme" for the Janana Hospital, Ajmer. For the above purpose, adequate budget has also been sanctioned and Rs. 305 lacs have been approved, out of which, a provision of Rs. 200 lacs has been made for the year 2012-13.

With regard to security arrangements in the Janana Hospital, it was submitted that there are three gates in the said Hospital and in order to ensure strict security, security guards have been posted on shift basis under one supervisor. No untoward incident of theft etc. has been reported. So far as entering of animals like monkey, cat etc. is concerned, only one incident till date had occurred and the same was strictly dealt with by the help of Forest Department.

As regards Sonography Machines, it was submitted that at present four Sonography Machines are installed in the Zanana Hospital, Ajmer, which adequately fulfil the requirement of patients and as such, no patient is required to be sent outside for Sonography purposes. The hospital used to conduct 40-50 sonography tests per day and when there is rush of patients for ultra sonography test, short date is given and priority is attached to emergent cases.

So far as availability of medicine unit at the hospital is concerned, presently, the service of one Paediatrician is available on regular basis and service of other specialist as and when required is also made available on call.

As regards street lights, that matter pertains to local authorities and the hospital administration has requested the local authorities for proper maintenance of street lights on the road approaching the Hospital.

So far as maintenance of hygienic environment in the Hospital and maintenance of toilets is concerned, it was submitted that there are 65 toilets which are in use in the hospital building and the cleaning of the hospital building as well as toilets is being done by the contractors on contract basis and the cleaning operations are being done round the clock.

On the point of shelter home/waiting rooms for attendants in the Hospital, it was submitted that a permanent shelter home (Rein Basera) is available in the hospital premises having 8 rooms with adequate toilet/bath room facilities.

As regards canteen, it was submitted that canteen is functioning in Janana Hospital, which is providing facility of meals, tea, snacks etc.

With regard to medical shops, it was submitted that in Janana Hospital, essential medicines/drugs/surgical items etc. are supplied free of cost to the patients through two drug distribution centres running under "Chief Minister''s Free Medicine Distribution Yojna". Out of these two Centres, one operates round the clock. Besides this, one life line store is also running round the clock in the hospital and the same is being run by the Rajasthan Medicare Relief Society. Apart from the above facilities, free medicines are also being provided under the "Janani Sishu Suraksha Scheme" to the delivery cases.

As regards availability of police protection in the Hospital, it was submitted that under the orders of Superintendent of Police, Ajmer, three constables and one head constable of Police Station Christianganj, Ajmer have been posted on permanent basis at Janana Hospital, Ajmer for round the clock security.

On blood bank, it was submitted that Janana Hospital Ajmer has well established blood bank under the zonal blood bank centre situated at Jawahar Lal Nehru hospital, Ajmer, which is sufficient to cater the day-to-day needs of the Hospital.

As regards public/private transportation facility, it was submitted that the said facility is available for the Janana Hospital between interval of 5 to 10 minutes.

As regards maintenance of hospital premises, it was submitted that weeds and bushes in the hospital premises are uprooted and premises are being cleaned on regular basis by the contractors. The maintenance of hospital is done by PWD and for that, annual budget is provided by the State Government and for the year 2011-12, a budget of Rs. 50 lacs was allocated for repair and renovation work at Janana Hospital and a budget of Rs. 25 lacs was allocated for electrical works. The repair and renovation work is going on and will be completed by 31.03.2013. The adequate plantation in the hospital premises will also be done within a period of one month.

In order to corroborate and substantiate the aforesaid submissions made in the additional affidavit, some documents have been placed on record as Annex. AF/1 to Annex. AF/13.

After hearing the learned counsel for the parties and going through the material and documents available on record, we deem it appropriate to issue the following directions:-

(1) That it is apparent that no STD/PCO facility is available in the Janana Hospital, it is absolutely necessary. Let it be provided within one month.

(2) That the concerned authorities are directed to ensure that street lights on the road approaching the Janana Hospital are repaired and kept in working order within a period of 15 days. The Collector, Ajmer to ensure the compliance of the directions.

(3) That respondents to find out whether there is any additional requirement for Rein Basera and if it is so, let it be proposed and provided within six months.

(4) That as against the sanctioned strength of 18 Professors, Associate Professors, Assistant Professors, Junior Specialists, Medical Officers, Deputy Superintendents, 12 senior doctors are working and thus, 6 posts are lying vacant; as against sanctioned strength of 14 senior residents and IIIrd year residents, 12 are working and thus, 2 posts are lying vacant; as against sanctioned strength of nursing staff of 70, 63 persons are working and thus, 7 posts are lying vacant; against the sanctioned strength of Para Medical Staff of 39, 24 are working and thus, 15 posts are lying vacant;

Apart from the above, the Government under "Janani Sishu Suraksha Scheme" has also sanctioned new post of Assistant Professor, two posts of Senior Residents and two posts of Junior Resident in Gynaecology and Obstetrics. Three Senior Residents have been appointed in Janana Hospital, Ajmer. However, the remaining posts are to be filled up.

In addition to the above, 50 new posts of Nursing Staff and 37 posts of Para Medical Staff have also been sanctioned and the same are to be filled up. Let all the vacant posts and newly sanctioned posts mentioned above be filled up as early as possible preferably within three months.

(5) That for construction of 23 rooms for resident PG Girls, the State Government has sanctioned a budget of Rs. 70,00,000/-. Let rooms be constructed within six months.

(6) That additional 60 beds for maternity ward and 30 beds for pediatric ward under the "Janani Sishu Suraksha Scheme" for the Janana Hospital, Ajmer has been sanctioned and for that purpose, adequate budget has also been sanctioned and Rs. 305 lacs have been approved, out of which, a provision of Rs. 200 lacs has been made for the year 2012-13. Let the work of providing 90 beds be done within 8 months by 30.05.2013.

(7) That the respondents-authorities are further directed to ensure cleanliness and proper maintenance of hospital building including toilet etc.

(8) That the respondents-authorities shall ensure that all essential medicines/drugs/surgical items etc. are supplied free of cost to the patients under "Chief Minister''s Free Medicine Distribution Yojna". They shall further ensure that free medicines are also being provided under the "Janani Sishu Suraksha Scheme" to the delivery cases.

(9) That a budget of Rs. 50 lacs was allocated for repair and renovation work at Janana Hospital and a budget of Rs. 25 lacs was allocated for electrical works. As assured, let the repair and renovation work including electrical etc. be completed by 31.03.2013.

(10) That as assured, let the adequate plantation in the hospital premises be also done within a period of one month.

(11) That requisite number of permits be issued so that public/private transportation facility is easily made available to the public for approaching the Janana Hospital.

With the aforesaid directions and observations, the writ petition is disposed off.