'Nothing short of fraud': SC pulls up Indian Nursing Council rule allowing nursing colleges 30km away from ICU hospitals

New Delhi: Expressing shock over a reported Indian Nursing Council (INC) norm allowing nursing colleges to be located up to 30 kilometres away from hospitals having Intensive Care Unit (ICU) facilities, the Supreme Court recently questioned how nursing students could be expected to receive meaningful hands-on training under such an arrangement.

Taking note of the fact that the nursing curriculum requires students to undertake daily ICU visits as part of the practical training, the Apex Court bench comprising Justice Ahsanuddin Amanullah and Justice R. Mahadevan found it shocking that nursing institutes could get permission to operate despite being located so far away from hospitals equipped with functioning ICUs.

Expressing its shock, the top court bench noted that nursing students must work on real patients as part of their training and cannot be entrusted with responsibility without actual clinical exposure.

When the existing guidelines were brought to the Court's notice, the bench observed that such an arrangement of allowing affiliated hospitals to be located within a 30-kilometre radius was wholly impractical.

During the hearing, Justice Amaullah orally remarked that requiring students to travel such distances on a daily basis was "atrocious" and "shocking to the conscience of this Court."

Also Read: Supreme Court to Decide on Guidelines for Treating ICU, CCU Patients

Live Law has reported that while considering the issue, Justice Amanullah asked, "Every day the student would have to travel 40-50 km to a hospital? How is this guideline there? Nothing short of fraud on the system. 30 Kms every day a student will go for the course to hospital? This is atrocious and shocking to the conscience of this Court. How did you allow the provision to be there?"

In response, Additional Solicitor General Aishwarya Bhati submitted that she would seek instructions on whether such a provision indeed existed and whether the competent authority could revisit it. 

At this outset, the bench clarified that ideally, nursing colleges should be attached to ICU hospitals and if not, such hospitals should be within a one-kilometre radius.

The bench has also issued directions to the Indian Nursing Council for submitted a report on around 800 such colleges, specifically mentioning their distances from hospitals with ICU facilities.

"The Indian Nursing Council, on query, submitted that the basic course incorporates a daily visit to an ICU as per the course curriculum for hands-on training. At this juncture, the Court expressed its surprise as to how such institutions are approved or given permission to start the institute, where clearly the said institution is miles apart from the hospital having a proper and regular ICU. The Court was informed that, as per guidelines, the said hospital can be at a distance of 30 kms. The Court is shocked, and clearly it can't be believed that students of nursing can be visiting every day, which is also imperative for the reason that at the end of the course, they have to practically work on a real patient. Without real experience, they can't be entrusted with responsibility. ASG submitted that she would take instructions as to whether such a provision is there and if it's there, the authority may have a relook," the Apex Court ordered.

The top court made these observations during the hearing of a long-pending matter that concerned healthcare standards. After considering the recommendations prepared by a panel appointed by the Court and taking note of the suggestions from healthcare experts, the Apex Court issued a series of nationwide directions for strengthening the critical care infrastructure and standardising ICU facilities across India.

Apex Court's Directions on Improving ICU Standards: 

During the hearing, the bench approved the framework titled "Guidelines for Organisation and Delivery of Intensive Care Services". Under this framework, ICUs have been classified into Level I, Level II and Level III categories.

The Court endorsed the classification of the ICUs into Level I, Level II, and Level III categories, observing that the proposed standards were well considered and required strict enforcement.

Further, it also emphasised the urgency of strengthening critical care infrastructure, noting that the healthcare system in the country is facing immense pressure due to the growing population of the country. This, according to the bench, is resulting in a shortage of quality emergency care facilities.

The Apex Court observed that the healthcare infrastructure of the country was struggling to keep pace with the rising demand and emphasised that access to critical care directly implicates the fundamental right to life.

Underlining that the State is obligated to ensure access to such care to protect the citizens' right to life, the bench observed, "When it comes to a person in a critical health condition, there is a real dearth and shortage of facilities to ensure that the least patient is made stable so as to give him or her further corrective measures."

The bench has directed the States and Union Territories to complete a gap assessment exercise within two months. Further, the States have also been asked to begin work on implementing minimum standards for Level I ICUs in healthcare institutions, focusing on ensuring that critically ill patients receive stabilising care in time-sensitive emergencies.

Taking note of the financial constraints in expanding the healthcare infrastructure, the Supreme Court bench recommended the States to explore funding through Corporate Social Responsibility (CSR) initiatives, NGO support and public donations. It also cautioned that such funds must be ring-fenced and used only for ICU-related infrastructure.

Further, the States have been directed by the top court bench to assess the feasibility of maintaining at least five fully-equipped ambulances, including ventilator support and trained personnel, through donated funding for the transportation of the critically ill patients within districts.

Apart from these, in another major direction, the Supreme Court has asked the Centre to formulate a nationwide GPS-based system that would map the hospitals and indicate the availability of ICU along with capacity, enable faster referrals and coordinated transfers between institutions. The top court bench has also endorsed tele-ICU and tele-consultation systems and called for a digital communication grid linking hospitals.

The matter has been listed for further hearing in August, when the court-appointed committee is expected to place its final recommendations.

Medical Dialogues had previously reported that earlier this year, the Supreme Court of India had directed all the States and Union Territories to prepare a 'realistic and practical' action plan to strengthen Intensive Care Unit (ICU) facilities and implement the guidelines necessary as a minimum standard, while asking the Centre to circulate standardised ICU guidelines as an advisory.