Holding

Denial of timely medical treatment by state hospitals breaches Article 21, making the State liable to pay compensation.

Summary

The petitioners, members of Paschim Banga Khet Mazdoor Samiti, filed a writ petition under Article 32 on behalf of Hakim Seikh, who suffered serious head injuries after falling from a train and was repeatedly denied admission in several government hospitals due to lack of beds and facilities, eventually receiving treatment in a private hospital at a cost of Rs. 17,000. The Supreme Court examined whether the denial of immediate medical assistance by state hospitals violated the fundamental right to life under Article 21 of the Constitution. Relying on precedents such as Pt. Paramanand Katara v. Union of India, the Court held that the State has a constitutional duty to provide timely medical care and that failure to do so constitutes a breach of Article 21. Consequently, the Court awarded compensation of Rs. 25,000 to the victim and directed the State to implement systemic reforms, including upgrading primary health centres, establishing a central bed‑bureau, and ensuring ambulance services. The judgment also affirmed that the State cannot evade its obligations on financial grounds and that administrative action should be taken against the errant medical officers.

Issues considered

The denial of emergency medical treatment in government hospitals violates the right to life under Article 21.
Whether compensation is payable for the breach of Article 21.
Whether the definition of "consumer" under the Consumer Protection Act, 1986 extends to patients seeking treatment in government hospitals.

Legislation cited

Constitution of Indias. Article 21, s. Article 226, s. Article 32
Consumer Protection Act, 1986s. Section 2(1)(d)(ii), s. Section 2(1)(o)

Subjects

Article 21right to lifeemergency medical caregovernment hospitalscompensationwelfare stateconstitutional obligationconsumer protectionhealth rightsmedical negligence

Judgment

PASCHIM BANGA KHET MAZDOOR SAMIT! A
v.
STATE OF WEST BENGAL

MAY 6, 1996

[S.C. AGRAWAL AND G.T. NANAVAT!, J.J.] B

Constitution of India-A1ticle 21--Medical treatment in govemment
hospita/s----Failure of govemment hospitals to provide timely medical assis-
tance to a seriously injured person, held, is violation of the right to life-Direc-
• tions issued for inune~iate prinia1y treatlnent at Prbnary Health Centres, c
upgrading the hospitals at district and sub-divisional level including facilities
for specialist treatment, setting up centralised communication system with
information as to where beds are available for the treatment required, arran-
gements for well equipped ambulance to transport the patient from one hospi-
tal to another, and to be geared to deal with higher risk of accidents on certain D
occasions or reasons-Held further, the state has to meet its constitutional
obligations to provide medical aid and make a/location of funds for medical
services-Further, administrative action to be taken against medical officers
responsible for the /apses-Welfare state-Duties of

Constitution of India-Article 21 and Articles 32 and 226-Compensa- E
lion-Person sustaining serious injuries denied inunediate medical assistance
at govemment hospitals, held, entitled to compensation-Rs. 25, 000 awarded.

HS, a member of the petitioner-organisation of agricultural
labourers, fell off a train at Mathurapur station in West Bengal At 7.45
p.m. on July 8, 1992. As a result of the fall, he suffered serious head injuries F
and brain heamorrhage. He was thereafter taken from Primary Health
Centre to one government hospital after another. He was not admitted in
any of the hospitals either because it was said that the hospital conld not
handle the emergency, or because no vacant bed was available. Ultimately,
on July 9, 1992, he was admitted into a private hospital, where he received G
treatment an indoor patient till July 22, 1992. He incurred an expenditure
of approximately Rs. 17,000.

Aggrieved by the indifferent and callons attitnde of the medical
authorities at the various state run hospitals in Calcntta, the petitioner-
organisation filed this writ petition. H
331
332 SUPRHff CO\TRT REPORTS [ l9'!6[ SUPP. 2 S.C.R.

A During the pcndency of the petition, the State {;overnment appointed
a Committee to enquire into the incident, to lix responsibility on the
persons responsible for it, to r1::con1mend action to be taken against them
and to recommend action to be taken by the State Government to rule out
recurrence of such int:idents in the future. The Committee, in its report,
found the version oftht! victin1 largely substantiated and suggested certain
B
remedial measures. The recommendations of the Committee were accepted
by the State Government and a memorandum dated Au~ust 22, 1995 was
issued wherein certain directions were given dealing \tith patients ap-
proaching health centres/OPD Emergency Departments of hospitals.

c The issue before the court "'as about the availability of t8cilities in
government hospitals for treatn1cnt ot pt:rsons sustaining serious injuries.

Allowin~ the petition, this Court

Held : 1. The right under Article 21 was breached when the injured
D person was denied treatment at the various government hospitals which
were approached even though his condition was very serious at that time
and he was in need of immediate medical attention. [340-GJ

Pt. Paramana11d Katara v. U11in11 uf India, [19891 4 SCC 286, relied
on.
E
Article 21 imposes an obligation on the State to safeguard the right to
life of every person. Preservation of human lite is thus of paramount hnpor-
tance. The government hospitals run by the State and the medical ollicer
employed therein are duty bound to extend medical assistance for preserv-
ing human life. Failure on the part of a government hospital to provide
F timely medical treatn1ent to a person in need of such treatment results in
violation of his right to life guaranteed under Article 21. [340-E-F]

Consumer Unity & Tiust Society, Jaipur v. State of Rajasthan, referred
to.
G 2. The Constitution envisages the establishment of a welfare state at
the federal level as well as at the state level. Providing adequate medical
facilities for the people is an essential part of the obligations undertaken
by the government in a welfare state. The government discharges this
obligation by running hospitals and health centres which provide medical
H care to the person seeking to avail those facilities. [340-D]
PASCHIM BANGAKHETMAZDOORSAMITI v. STATE 333

3. The denial of the right guaranteed under Article 21 was by officers A
of the State in hospitals run by the State, and the State cannot avoid its
responsibility for such denial of constitutional right. The position is well
settled that adequate comp•msation can be awarded by the court under
Articles 32 and 226 for deprivation of the constitutional rights guaranteed
under Part III of the Constitution. The victim in this case should, there-
B
fore, be suitably compensated for the breach of his right guaranteed under
Article 21. Having regard to the facts and circumstances of the case, an
amount of Rs. 25,000 is fixed as compensation. (341-H, 342-A-B]

Rudul Saiz v. State ofBih01; (1983] 3 SCR 508; Nilabati Behera v. State
of 01issa, [ 1993] 2 SCC 74•6 and Consumer Education and Research Centre C
v. Union of India, [1995] 3 SCC 42, referred to.

4. In order that proper medical facilities are available for dealing
with emergency cases is n1ust be that :

(1) Adequate facilities :are available at the Primary Health Centres D
\'Vhere the patient can be given immediate pri1nary treatment so as to
stabiJize his condition. <#

(2) Hospitals at the district level and sub-division level are upgraded
so that serious cases can be treated there.
E
(3) Facilities for giving· specialist treatment are increased and are
available at the hospitals at .district level and sub-division level having
regard to the growing needs.

(4) A centralised communication system be established so that the
patient can be sent immediately to the hospital where bed is available in
F
respect of the treatment which is required. [345-E-G]

(S) Proper arrangement of ambulance is made for transport of a
patient from the Primary Health Centre to the District hospital or Sub-
division .hospital and from the District hospital or Sub-division hospital G
to the State hospital.

(6) The ambulance is provided with necessary equipment and medi-
cal personnel. '

(7) The health centres and hospitals and the medical personal are H
334 SUPREME COURT REPORTS [1996] SUPP. 2 S.C.R.

A geared to deal with larger number of patients needing emergency treatment
on account of higher risk of accidents on certain occasions and in certain ._
seasons. (345-H, 346-A-B]

A time-bound plan for providing these services should be chalked
out. (346-E]
B
5.1. In the CO••text of providing free legal aid to a poor accused it has
been held that the State cannot avoid its constitutional obligation in that
regard on account of financial constraints. (346-D]

Khat1i (II) v. State of Bihar, (1981] 1 SCC 627, referred to.
c
5.2. The observations in Khatri (II) would apply with equal, if not
greater force in the matter of the constitutional obligation of the State to
provide medical aid to preserve human life. In the matter of allocation of
funds of medical services this constitutional obligation has to be kept in ..-::
D view. (346-E]

6. The State of West Bengal alone is a party to the proceedings. Other
States should also take necessary steps in the light of the recommenda-
tions made by the Comn1ittee, the directions contained in the Memoran-
dum of the Government of West Bengal dated August 22, 1995 and the
E further directions given herein. [346-E]

7. Since it is the joint obligation of the Centre as well as the States
to provide medical services it is expected that the Union of India would
render the necessary assistance in the improvement of the medical services
in the country on these lines. [346-H]
F
8. It is expected that the State Government will take appropriate
administrative action against those medical officers who have been found
responsible for the lapse resulting in denial of immediate medical aid in
the instant case. (347-A]
G
CIVIL ORIGINAL JURISDICTION : Writ Petition (C) No. 796 of
1992.

(Under Article 32 of the Constitution of India.)

H S. Muralidhar for the Petitioner.
PASCHIM BANGA KHEf MAZDOOR SAMID v. STATE [S.C. AGRAWAL, J.] 335

Rajeev Dhavan, P.H. Parekh, Shefali S. Faz\ and Anne Mathew for A
Intervenor.

S. Hegde, Dilip Sinha, Dayan Krishnan and J.R. Das Advs. for the
Sinha & Das for the State.

A.N. Jayaram, Additional Solicitor General, S.N. Sikka, Raj Singh B
Rana, D.S. Mehra and V.K. Verma for the Union of India.

The Judgment of the Court was delivered by .

S.C. AGRAWAL, J. In Pt. Paramanand Katara v. Union of India &
Ors., [1989] 4 SCC 286, this Court in the context of medico-legal cases, has
c
emphasised the need for rendering immediate medical aid to injured
persons to preserve life and the obligations of the State as well as doctors
in that regard. This petition filed under Article 32 of the Constitution raises
this issue in the context of availability of facilities in Government hospitals
for treatment of persons sustaining serious injuries. D
Hakim Seikh (petitioner No. 2) who is a member of Paschim Banga
Khet Mazdoor Samity (petitioner No. 1), an organisation of agricultural
labourers, fell off a train at Mathurapur Station in West Bengal at about
7.45 P.M. On July 8, 1992. As a result of the said fall Hakim Seikh suffered
serious head injuries and brain haemorrhage. He was taken to the Primary E
Health Centre at Mathurapur. Since necessary facilities for treatment were
not available at the Primary Health Centre, the medical officer in charge
of the Centre referred him to the Diamond Harbour Sub-Divisional Hospi-
tal or any other State hospital for better treatment. Hakim Seikh was taken
to N.R.S. Medical College Hospital near Sealdah Railway Station, Calcutta F
at about 11.45 P.M. on July 8, 1992. The Emergency Medical Officer in the
said Hospital, after examining him and after taking two X-ray prints of his
skull recommended immediate admission for further treatment. But Hakim
Seikh could not be admitted in the said hospital as .no vacant bed was
available in the Surgical Emergency ward and the regular Surgery Ward
was also full. He was thereafter taken to Calcutta Medical College Hospital G
at about 12.20 A.M. on July 9, 1992 but there also he was not admitted on
the ground that no vacant bed was available. He was then taken to
Shambhu Nath Pandit Hospital at about 1.00 A.M. on July 9, 1992. He was
not admitted in that hospital and referred to a teaching hospital in the
ENT, Neuro Surgeon Department on the ground that the hospital has no H
336 SUPREME COURT REPORTS [1996] SUPP. 2 S.C.R.

A ENT Emergency or Nrnro Emergency Department. At about 2.00 A.M.
on July 9, 1992 he Wds taken to the Calcutta National Medical College
Hospital but there also he was not admitted on account of non-availability
of bed. At about 8.IJO A.M. on July 9, 1992 he was taken to the Bangur
Institute of Neurolo,,w but on seeing the CT Scan (which was got done at
a private hospital on payment of Rs. 1310) it was found that there was
B
haemorrhage condition in the frontal region of the head and that it was
an emergency case which could not be handled in the said Institute. At
about 10.00 A.M. on July 9, 1992 he was taken to SSKM Hospital but there
also he was not admitted on the ground that the hospital has no facility of
neuro surgery. Ultimately he was admitted in Calcutta Medical Research
c Institute., a private hospital, where he received treatment as an indoor
patient from July 9, 1992 to July 22, 1992 and he had incurred an expen-
diture of approximately Rs. 17,000 in his treatment.

Feeling aggrieved by the indifferent and callous attitude on the part
D of the medical authorities at the various State run hospitab in Calcutta in
providing treatment for the serious injuries sustained by Hakim Seikh the
petitioners have filed this writ petition.

In the writ petition the petitioners have also assailed the decision of
the National Consumer Disputes Redressal Commission dated December
E 15, 1989 in Consumer Unity & Trust Society, Jaipur v. State of Rajasthan &
Ors., and it has been submitted that the expression 'consumer' as defined
in section 2(1)( d)(ii) of the Consumer Protection Act, 1986 includes per-
sons getting or eligible for medical treatment in Government hospitals and
that the expression 'services' as defined in section 2(l)(o) of the Act
F includes services provided in the Government hospitals also. The said
question has been coosidered in the recent decision of this Court in Indian
Medical Association v. V.P. Shuntha, [1995] 6 SCC 651. In view of the said
decision the ouly qu,;otiun which needs to be considered is whether the
non·-availability of fc,cilities for treatment of the serious injuries .sustained
by Hakim Seikh in the various Government hospitals in Calcutta has
G resulted in denial of his fundamental right guaranteed under Article 21 of
the Constitution.

There is not much dispute on facts. In the affidavit of Ms. Lina
Chakraborti, filed on behalf of the State of West Bengal, respondent No.
H 1, it is stated that the rural areas of the State arc served by the Block Health
PASCHIMBANGAKHETMAZDOORSAMID v. STATE[S.C.AGRAWAL,J.J 337

Centres and by the Subsidiary Health Centres since re-designated as A
"Primary Health Centres" where primary and general treatment is provided
but no specialist treatment is available. Hakim Seikh was examined by the
medical officer at the Block Health Centre at Mathurapur and after giving
him first-aid the Medical Officer referred him to the Diamond Harbour
Sub-Divisional Hospital or any State hospital for tJetter treatment. It is also
admitted that Hakim Sei)<h was brought to Neel Ratan Sircar Medical B
College Hospital at 11.45 P.M. on July 8, 1992 and there he was examined
and two skull X-rays were also taken. The medical officer who attended
him at that hospital recommended immediate admission for further treat-
ment but he could not be admitted in the particular Department, i.e.,
Surgery Department having neuro-surgery facilities as at the material point
of time there was no vacant bed in Surgical Emergency Ward and the
c
regular surgery ward was also full. It is also admitted that Hakim Seikh was
thereafter taken to the Calcutta Medical College Hospital, Calcutta Na-
tional Medical College Hospital and Bangur Institute of Neurology in the
early morning of July 9, 1992 but he could not be admitted in any of these
hospital because of non-availability of bed. It was stated that Hakim Seikh D
could not be admitted in all the hospitals having facility of neuro surgery
as all such beds were fully occupied on the date/dates and that such a
patient cannot be given proper treatment if he is kept on the floor of a
hospital or a trolley because such arrangement of treatment is fraught with
grave risk of cross infection and lack of facility of proper post-operative
care. In\ the said affidavit it is also stated that total number of beds E
maintained by the State Government all over the State is 57,875, out of
which 90% are free beds for treatment of poor and indigent patients and
all the beds in the concerned wings in the Government hospitals in Calcutta
where Hakim Seikh reported for treatment were occupied on the relevant
date/dates. F
During the pendency of this writ petition in this Court the State
Government decided to make a complete and thorough investigation of the
incident and take suitable departmental action against the persons respon-
sible for the same and to take suitable remedial measures in order to
prevent recurrence of similar incidents. The State Government appointed G
an Enquiry Committee headed by Shri Justice Lilamoy Ghose, a retired
Judge of the Calcutta High Court. The terms and reference of the said
Comn1ittee were :

"A. Enquiry into the circumstances under which the said Shri H
,,.
338 SUPREME COURT REPORTS [1996] SUPP. 2 S.C.R.

A Hakim Seikh was denied admission to the Stale Government
hospitals.

B. Fixing responsibilities for dereliction of duties if any, on the part
of any Government official in this respect.

B C. Recommendations on actions against the Government "fficials
who have found wanting in the discharge of their official Juties in
this respect.

D. Recommendations on actions that should be taken by the State

c Government t.o rule out the recurrence of such in<.:ident in future
and to ensure immediate medical attention and treatment to
patient~ in real nec<l.
11

The Committee submitted its report dated March 21, 1995. In the
said report, the C.'.ornn1ittee, after examining the relevant record at the
D various hospitals, has found :

(i) The Primary Health Centre at Mathurapur was not very much
equipped to deal with such types of serious patients and the nurses
at the Centre attended on Hakim Seikh and gave some treatment.

E (ii) At the N.R.S. Medical College Hospital Hakim Seikh was
registered, Registration No. 63649, but no time W&S mentioned.
The admission register of the said hospital shows that one patient
was admitted at 12.15. A.M. on July 9, 1992 and another patient
was admitted at 4.20 A.M. on July 9, 1992. There could not have
F been any discharge during the ·odd hours i.e. between the time
when Hakim Seikh was taken to the said hospital and 4.20 A.M.
on July 9, 1992. If two other patients were admitted after Hakim
Seikh was taken and it was not understandable why Hakim Seikh
was not admitted since it is not disputed that the condition of
Hakim Seikh was grave. Even in excess of the sanctioned beds
G some piiticnt!' were kept on the trolley beds in the morning and
that even if it \Vas dangerous to keep a patient \Vith head injuries
on trolley bed he could very well be kcpl for the time being on the
l1oor and could be transferred to the cold ward, as lhe situation
demanded, temporarily. The Emergency Medical Officer con-
H cerned should have taken some measure to adtnit Hakim Seikh
PASCHIMBANGA KHETMAZDOORSAMITI '"STATE [S.C.AGRAWAL.J.] 339

and he is, therefore, responsible for his non-admission in the said A
Hospital. The Superintendent of the hospital should have taken
some measures to give guidelines to the respective medical officers
so that a patient is not refused admission although his condition
is grave and the Superintendent of the N.R.S. Medical College is
also, to son1e extent, responsible in a general way.
B
(iii) Hakim.Seikh should not have been refused admission in the
Medical College Hospital, Calcutta when the condition was so
grave. In not accommodating Hakim Seikh the Emergency Medical
Officer of the said Hospital is responsible. He should have con-
tacted the superior authority over the telephone i[ there was any c
stringency as to the beds available and admit the patient inspite of
total sanctioned beds not having been available. The Superinten-
dent should have given guidelines to the respective medical officers
for admitting serious cases under any circun1stanccs and thus in a
way the Superintendent was responsible for this general ad-
ministration. D

(iv) At the National Medical College Hospital, Calcutta the
relevant admission register was missing and in the absence of the
same the responsibility could not be fixed on the Emergency
Medical Officer concerned. The then Superintendent of the Hospi- E
ta! must be held responsible for this general state of affairs that
no provision was made for admitting any patient even if his con-
dition was serious.

(v) The hospital authorities have submitted that Hakim Seikh did
not attend the Shambhu Nath Pandit Hospital at all. From the F
out-door patient ticket it cannot be definitely said that Hakim
Seikh was taken to the said Hospital.

(vi) No responsibility could be fixed on any officer of the Bangur
Institute of NeurolO[,'Y because the said Institute does not deal with G
neuro-surgery emergency cases and it is .meant for cold cases only.

(vii) At SSKM Hospital, no record is maintained as to the condi-
tion of the patient and the steps taken with regard to his treatment.
It is necessary that such record is maintained. Even though the
patients inside the \Vard were in excess of the limit or' the sane- H
340 SUPREME COURT REPORTS [1996[ SUPP. 2 S.C.R.

A tioned beds but still some arrangements could be made and ad-
mi"ion should not have been refused when the condition was so
grave. The Emergency Medical Officer who attended Hakim Seikh
should be held responsible for not admitting the patient in the said
Hospital and that the Surgeon Superintendent is abo in a general
way responsible for this unhappy state of affairs and he should
B have given specific guidelines in that regard.

The Comn1ittee has suggested remedial n1easures to ruh:: out 1~Cur
rence of such incident~ in future and to ensure in1mediate medical attention
and treatment lo patients in real need. We will advert to it later. We will
C first examine whether the failure lo provide medical treatment to Hakim
Seikh by the Government hospitab in Cakulla has resulted in violation of
his rights and, if so, to what relief he is entil)ed.

The (:onstitution envisages the e~tablishment 1if a \Vclfare state al the
D federal level a3 well as at the state lev~l. In a \Vclfart'. state the primary duty
of the Govern1nent is to secure the welfare tu the people. Providing
adequate medical facilities for the peuplt: is an essential part of the
obligations undertaken by the Government in a welfare state. The Govern-
ment discharges this obligation by running hospitals and health centres
which provide medical care to the person seeking lo avail those facilities.
E Article 21 imposes an obligation on the State to safeguard the right to life
of every person. Preservation of human life is thus of paramount impor-
tance. The Government hospitals run by the Slate and the medical officers
employed therein are duty bound to extend medical assistance for preserv-
ing human life. Failure on the part of the Government hospital to provide
p timely medical treatment to a person in need of such treatment results in
violation of his right to life guaranteed under Article 21. In the present
case there was breach of the said right of Hakim Seikh guaranteed under
Article 21 when he \Vas denied treatment at the various Government
hospitals which were approached even though his condition was very
serious at that time and he \Vas in need of imn11:diate n1edic.:al attention.
G Since the said denial of the right of Hakim Seikh guaranteed under Article
21 was by officers of the State in hospitals run by the State the Stale cannot
avoid its responsibility for such denial of the constitutional right of Hakim
Seikh. In respect of deprivation of the constitutional righb guaranteed
under Part-lll of the Constitution the position is well settled that adequate
H compensation can be awarded by the court for such viulaliun by way of
PASCHIMBANGAKHETMAZDOORSAM!TI '· STATEfS.C.AGRAWAJ.,,J.j 341

redress in proceedings under Articles 32 and 226 of the Constitution. (See A
: Ruda/ Sail v. State of Bihm; [1983] 3 SCR 508; Ni!abati Behare v. State of
01issa, [1993] 2 SCC 746 and Consumer Education and Research Centre v.
Union of India, [1995] 3 SCC 42. Hakim Seikh should, therefore, be suitably
compensated for the breach of his right guaranteed under Article 21 of the
Constitution. Having regard to the facts and circumstances of the case, we
B
fix the amount of such compensation at Rs. 2s;ooo. A sum of Rs. 15,000
was directed to be paid to Hakim Seikh as interim compensation under the
orders of this Court dated April 22, 1994. The balance amount should be
paid by respondent No. 1 to Hakim Seikh within one month.

We may no\V con1e to the remedial measures to rule out recurrence C
of such incidents in future and to ensure immediate medical attention and
treatment to persons in real need. The Committee has made the following
recommendations in this regard :

(i) The Primary Health Centres should attend the patient and give D
proper medical aid, if cq uipped.

(ii) At the hospitals the Emergency Medical Officer, in consult-
ation- with ..the Specialist concerned on duty in the Emergency
DepartJr!!'nt, should admit a patient whose condition is
moriburld7serious. If necessary the patient concerned may be kept E
on the floor or on the trolley beds and then loan can be taken from
the cold ward. Subsequent necessary adjustment should be made
by lhe hospital authorities by way of transfer/discharge.

(iii) A Central Bed Bureau should be set up which should be F
equipped with wireless or other communication facilities to find
out where a particular emergency patient can be accommodated
when a particular hospital finds itself absolutely helpless to admit
a patient because of physical limitations. In such cases the hospital
concerned should contact immediately the Central Bed Bureau
which will communicate with the other hospitals and decide in G
which hospital an emergency moribund/serious patient is to be
admitted.

(iv) Some casualty hospitals or Traumatology Units should be set
up at some points on regional basis. H
342 SUPREME COURT REPORTS [1996] SUPP. 2 S.C.R.

A (v) The intermediate group of hospitals, viz., the district, the
sub-division and the State General Hospitals should be upgraded
so that a patient in a serious condition may get treatment locally.

The recommendations of the l.ommittee have been accepted by the
State Government and memorandum dated August 22, 1995 has been
B issued wherein the following directions have been given for dealing with
patients approaching health centrcs/OPD/Emergency Departments of
hospitals :

(1) Proper medical aid within the scope of the equipments and
c facilities available at Health Centres and Hospitals should be
provided to such patients and proper records of such aid provided
should be preserved in office. The guiding principle should be to
see that no emergency patient is denied medical care. All pos-
sibilities should be explored to accommodate emergency patients
in serious condition.
D
(2) Emergency Medical Officers will get in touch with Superinten-
dent/Deputy Superintendent/Specialist Medical Officer for taking
beds on loans from cold wards for accommodating such patients
as Extra-temporary measures.
E
(3) Superintendents of hospitals will issue regulatory guidelines for
admitting such patients on internal adjustments amongst various
wards and different kinds of beds including cold beds and \viii hold
regular \Veekly meetings for monitoring and revie\ving the situation.
A model of such guidelines is enclosed with this memorandum
F which may be suitably amended before issue according to local
arrangements prevailing in various cstablishm~nts.

(4) If feasible, such patients should be accommodated in trolley-
beds and, even, on the floor when it is absolutely necessary during
the exercise towards internal adjustments as referred lo at (3)
G above.

Having regard to the drawbacks in the system of maintenance of
admission registers of patients in the hospitals it has been directed that the
Superintendents and Medical Officers of the hospitals should take the
H follmving actions to regularise the system with a view to avoiding confusion
'
PASCHIMBANGAKHEfMAZDOORSAM!Tl v. STATE{S.C.AGRAWAL.J.] 343

in respect of Admission/Emergency Attendance Registers : A
11
(a) Clear recording of the name, age, sex, address, disease of
the patient by the attending medical officers;

(b) Clear recording of date and time of attendance/examina-
tion/admission of the patient; B
(c) Clear indication whether and where the patient has been
admitted, transferred, referred;

(d) Safe custody of the Registers:
c
(e) Periodical inspection of the arrangement by the Superin-
tendent;

(!) Fixing of responsibility of maintenance and safe custody of
the Registers.'"
D
With regard to identifying the individual medical officers attending
to the individual pa6ent approaching Out Patients' Department/Emergen-
cy Department of a hospital on the basis of consulting the hospital records,
it has been directed that the following procedure should be followed in
future :
E
"A. A copy of the Duty Roaster of Medical Officers should be
preserved in the office of the Superintendent incorporating the
modifications done for unavoidable circumstances;

B. Each Department shall maintain a register for recording the F
signature of attending medical officers denoting their arrival and
departure time;

C. The attending medical officer shall write his full name clearly
and put his signature in the treatment document;
G
D. The Superintendent of the hospital shall keep all such records
in safe custody;

E. A copy of the ticket issued to the patient should be maintained
or the relevant data in this regard should be noted in an ap-
propriate record for future guidance. H
344 St!PRFMl' COURT RFPORTS [l996J SUPP. 2 S.C.R.

A 1l is appreciated that Hospital Superintendent/Medical Of-
ficers-in charge may have difficulty in implementing these
guidelines due lo various constraints at the ground level and, as
such, feed hack is vital lo enable Government to refine and modify
the ordL:r :1s v.:ilJ ensure a volid working plan to regulate admission
on a just ha-.is. Detailed cumn1cnts and, therefore, requested with
B
con~tructlv'L· suggcstion. '
1

Shri Muralidhar, the learned counsel appearing for the petitioners,
and Shri Rajeev Ohavan, the learned senior counsel appearing for the
inti:rvenDrs, in course of their subn1issions, have, however, made certain
c further ~uggcstion!' in this regard. Shri Dhavan has submitted that in order
tu havl! proper and adequate emergency hi..:alth ~ervices and to create an
infrct .. structure for that purpose it is necessary to bear in mind the high risk
occa~iuns su...:.h as fe:--tivctls an<l high risk seasons when there is a greater
need for such ~crvic...:s. It has also been sub1nittc<l that the medical facilities
D available at the Primary Health Centres should be upgraded and the
hospitals at the district level should be suitably provided to deal with
serious case~ and that the nun1ber of beds in the hospitals &hould be
increased to meet the growing needs of the population. Shri Dhavan has
also ~U!~gcsted that a centralised ambulance service may be created for all
the hospitals and that the ambulance should have all the facilities necessary
E for giving primary medical aid and treatment to the patient. Shri Dhavan
has submitted that the emergency units at the hospital should be fully
equippeu to manage all the emergency cases and the medical officer should
be available there round the clock. Shri Ohavan has urged that the denial
of treatment to a patient should be specifically made a cognizable offence
F and further it should also he made actionable as a tort. In this context Shri
Dhavan has invited our attention to the recent developments that have
taken place in this fidd in the Cnited Stales. There it was found that
private hospitals \\'ere turning a\vay uninsured indigent persons in need of
urgent medical care and these patients were often transferred to, or
dumped on public hospitals and the resulting delay or denial of treatment
G had sometimes disastrous consequences. To meet this situation the U.S.
Congress has enacted the Consolidated Omnibus Budget Reconciliation
Act of 1986 (for short 'COBRA') to prevent this practice of dumping of
patients by private hospitals. By the said Act all hospitals that receive
medicare benefits and maintain emergency rooms are required to perform
H two tasks before they may transfer or discharge any individual; (i) the

,
PASCHIMBANGAKHETMAZDOORSAMITJ v. STATE[S.C.AGRAWAL,J.] 345

hospital must pcrforn1 a medical screening examination of all prospective A
patients, regardless of their ability to pay; (ii) if the hospital determines
that a patient suffers from an emergency condition, the la\\' requires the
hospital to stabilize that condition and the hospital cannot transfer or
discharge an unstabilized patient unless the transfer or discharge is ap-
propriate as defined by the statute. Provision is made for imposing penal-
B
ties against hospitals or physicians that negligently violate CO BRA. In
addition the individual who suffers personal harm as a direct result of a
participating hospital's violation can bring a civil suit for damages against
that hospital. According to Shri Dhavan the standard of care in emergency
cases implies three obligations, viz., (i) screening the patient; (ii) stabilizing
the patient's condition; and (iii) transfer or discharge of the patient for c
better treatment. The submission of Shri Dhavan is that emergency health
services 111 our country must be provided keeping in vie\V these three
requirements.

We have considered the aforesaid submissions urged by Shri Dhavan.
Apart from the recommendations made by the Committee in that regard
D
and the action taken by the State Government in the memorandum dated
August 22, 1995 on the basis of the recommendations of the Committee,
we are of the view that in order that proper medical facilities arc available
for dealing with emergency cases it must be that :
E
1. Adequate f~cilities are available at the Primary Health Centres
where the patient can be given immediate primary treatment so as to
stabilize his condition;

2. Hospitals at the district level and Sub-Division level are upgraded
so that serious cases can be treated there; F
3. Facilities for giving specialist treatment are increased and are
available at the hospitals at District level and Sub-Division level having
regard to the growing needs.
G
4. In order to ensure availability of bed in an emergency at State level
hospitals there is a centralised communication system so that the patient
can be sent immediately to the hospital where bed is available in respect
of the treatment which is required.

5. Proper arrangement of ambulance 1s made for transport of a H
346 SUPREME COURT REPORTS (1996] SUPP. 2 S.C.R.

A patient from the Primary Health Centre to the District hospital or Sub-
Division hospital am! from the District hospital or Sub- Division hospital
to the State hospital.

6. The ambulance is adequately provided with necessary equipment
and medical personnel.
B
7. The Health Centres and the hospitals and the medical personnel
attached to these Centres and hospitals are geared to deal with larger
number of patients needing emergency treatment on account of higher risk
of accidents on certain occasions and in certain seasons.
c
It is no doubt true that financial resources are needed for providing
these facilities. But at the same time it cannot ignored that it is the
Constitutional obligation of the State to provide adequate medical services
to the people. Whatever is necessary for this purpose has to be done. In

D the context of the constitutional obligation to provide free legal aid to a
pour accused this Court has held that the State cannot avoid its constitu-
tional obligation in that regard on account of financial constraints. (See :
Klzalli (II) v. State of Bihm; (1981 J 1 SCC 627 at p. 631. The said observa-
tions would apply with equal, if not greater, force in the matter of discharge
of constitutional obligation of the State to provide medical aid to preserve
E human life. In the matter of allocation of funds for medical services the
said constitutional obligation of the State has to be kept in view. It is
necessary that a time-bound plan for providing these services should be
chalked out keeping in view the recommendations of the Committee as well
as the requirements for ensuring availability of proper medical services in
F this regard as indicated by us and steps should be taken to implement the
same. The State of West Bengal alone is a party to these proceedings.
Other States, though not parties, should also take necessary steps in the
light of the recommendations made by the Committee, the directions
contained in the Memorandum of the Government of West Bengal dated
August 22, 1995 and the further directions given herein.
G
The Union of India is a party to these proceedings. Since it is the
.1omt obligation of the Centre as well as the States to provide medical
services it is expected that the Union of India would render the necessary
assistance in the improvement of the medical services in the country on
H these lines.
PASCHIMBANGAKHErMAWOORSAMill v. STATE[S.C.AGRAWAL,J.] 347

As regards the medical officers who have been found to be respon- A
sible for the lapse resulting in denial of immediate medical aid to Hakim
Seikh it is expected that the State Government will take appropriate
administrative action against those officers.

A copy of this judgment be sent for taking necessary action to the
Secretary, Medical and Health Department, of the States. B
The writ petition is disposed of with these directions. No order as to
costs.

U.R. Petition disposed of.

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