Supreme Court orders states to prepare 'realistic' action plan to implement ICU guidelines

New Delhi: The Supreme Court of India has 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.

While hearing about healthcare services, including guidelines for the treatment of patients in the ICU or critical care unit, the apex court was informed that "Guidelines for Organisation and Delivery of Intensive Care Services", on which there is consensus and which is practical, implementable and necessary as a minimum standard for an ICU, has been prepared.

Several leading doctors and experts appeared before the Court. Those present physically included Prof. (Dr.) M. Srinivas, Director of All India Institute of Medical Sciences; Prof. (Dr.) Nitish Naik; Prof. (Dr.) Vimi Rewari and Dr Harsh Mahajan of Mahajan Imaging and Labs.

Other prominent experts joined through video conferencing, including Dr. Naresh Trehan, Chairman and Managing Director of Medanta; Dr. Shiv Sarin, Director of the Institute of Liver and Biliary Sciences; Dr. Pankaj Chaturvedi from Tata Memorial Centre (ACTREC, Navi Mumbai); Dr. Sheel Pushp Bhosale; Dr. Saumitra Rawat from Sir Ganga Ram Hospital; Dr. Nishant Kumar; Dr. Devi Prasad Shetty of Narayana Health; Dr. Sulagna Bhattacharjee; Dr. Richa Aggarwal; and Dr. Manas Roy from the Ministry of Health.

A Bench of Justices Ahsanuddin Amanullah and R Mahadevan observed that the suggestions given by the doctors were "highly practical" and deserve due consideration for inclusion in the final ICU guidelines.

"Most of the doctors have personally addressed the Court and have come up with suggestions, which we find to be highly practical and deserving of due consideration for incorporation in the final guidelines, which the Court would be required to approve for taking forward the process of establishing on-ground requirements for Intensive Care Units at various levels with varying set of standards," said the court. 

The Court noted that most doctors personally addressed the Bench and gave practical suggestions for improving ICU systems which include that timelines should be prescribed; personnel operating specialized/sophisticated equipments should be properly trained; standard operating procedures in the form of checklists should be formulated; and most importantly, a GPS-based hospital locator should be created so that, in times of need, the public may identify the nearest medical facility and the services available there, depending upon the nature of the case and the condition of the patient concerned.

Directing that copies of the guidelines should be shared with all the states and UTs, the Bench held, "We are pleased to record that the exercise, as envisaged in the present proceeding, has reached an important stage. We are informed that a foundational document, namely, Guidelines for Organization and Delivery of Intensive Care Services, on which there is consensus, and which is practical, implementable, and necessary as a minimum standard for an Intensive Care Unit, has been prepared. Copies of the same have been handed over to us and are taken on record. Let copies thereof be shared with all the States and Union Territories (UTs)."

"Moving further, as an immediate measure, let all the additional chief secretaries/secretaries ... heading the department of health and medical education in the states and the UTs, convene a meeting of all experts involved in this exercise to prepare an action plan for implementation of the guidelines. Such a plan shall be realistic and practical," the bench said in its April 20 order.

The Court asked States to first identify and prioritise five basic issues. The challenge, according to the Court, lies in determining what ought to be treated as absolutely essential and mandatory; accordingly, an initial list of five basic requirements, in terms of priority, relating to both manpower and equipment/logistics, shall be prepared. 

It said a methodology should also be formulated for implementation on the ground, and more importantly, a mechanism to ensure compliance and monitoring of the implementation.

"We expect the exercise to commence immediately and the first meeting to be held within one week from today. We direct that the meeting shall be attended personally by the concerned additional chief secretary/secretary ... heading the department of health and medical education in the states and the UTs," the bench said.

It said the report prepared pursuant to the deliberations should be forwarded by the respective states and UTs to the Secretary of the Department of Health, Government of India, who in turn would circulate it to all the states and UTs.

The bench said thereafter, a meeting of all concerned should be convened where a final common agreed draft shall be prepared and circulated.

"A final report/blueprint/recommendation shall be prepared, which shall be placed before this court on the next date," it said, adding that the entire exercise should be completed within three weeks.

"Let the Ministry of Health, Government of India, formally issue the guidelines placed before us today, to the states and UTs concerned by way of an advisory. A copy of it shall also be uploaded on the website of the Ministry of Health, Government of India," the bench said.

The Court has directed that the entire exercise be completed within three weeks. The matter will next be heard on May 18, 2026 at 2:00 PM.

During the hearing, a suggestion was made that, keeping future needs in mind, nursing staff must be properly trained to handle ICU situations, as they stay with patients round the clock unlike doctors who visit at intervals. The Court agreed with this view, calling it both practical and necessary. Accordingly, it decided to implead the Indian Nursing Council and the Para Medical Council of India as party respondents.

On the next hearing date, the bench said the newly added respondents shall come up with a plan indicating how they propose to augment the courses or curriculum and training imparted by them so that persons emerging from institutions recognised by them are capable of managing and handling situations in the ICUs.

"In the meantime, it shall also be open to all experts/doctors forming part of the team constituted by this Court, to furnish their suggestions in advance to Ms. Aishwarya Bhati, learned ASG, or to the learned Amicus Curiae, for onward transmission to all the States/UTs and the Union of India. On the next date, the Court requests that all members of the team make it convenient to attend the proceedings. However, they shall have the option of appearing either physically or through virtual mode," the court said in conclusion. 

To view the court order, click on the link below:

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