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

New Delhi: The Supreme Court is set to take up the case concerning the guidelines to regulate the functioning of the intensive care units (ICUs) and critical care units (CCUs) across the country and its implementation today.

Back in September, the Apex Court was informed that only eight States and Union Territories (UTs) had so far implemented the Union Government's guidelines issued in September 2023. 

Taking note of the same, the top court bench comprising Justice Sudhanshu Dhulia on September 23 had issued directions to the remaining States/UTs to inform by November 4 whether they wished to continue with the Union Government's suggestions or if they wanted changes, HT has reported.

The Apex Court bench back in 2016 had directed the Central Government as well as the erstwhile Medical Council of India (MCI), now the National Medical Commission (NMC) to informed whether any guidelines were prescribed for private hospitals on providing care to patients in the ICU and CCUs.

Also Read: GOI Releases Expert Consensus Statement on ICU Admission and Discharge Criteria, Key Takeaways

Medical Dialogues had earlier reported that the Supreme Court had issued this direction while examining a medical negligence case, in a plea filed by one Asit Baran Mandal, a resident of West Bengal, who complained against a doctor for negligence due to which post-operation, he allegedly had lost his daughter-in-law. The petitioner had alleged that the treating physician should have been well-advised to ask for a Liver Function Test (LFT) soon after the patient was operated for her pregnancy. She died three days after the surgery as her bilirubin levels touched alarming proportions. 

Back in August 2016, while considering this case and also taking note of the stream of medical negligence cases being filed against medical professionals and hospitals, the Supreme Court had observed that medical negligence was writ large in the number of private hospitals and there was no check on it. It had also said that the petitioner would urge neither the Union of India, the MCI nor the State Governments prescribe guidelines for there treatment of the ICU and CCU patients. "That apart, there is no proper care at the stage of operation or post-operational stage," it had noted.

Consequently, the Union Government set up a committee last year for guidelines for admission to ICUs, CCUs, and palliative care required for non-salvageable patients if removed from the ventilator and criteria for withdrawing treatment.

Also Read: Give guidelines on admission to ICU,CCU: SC to MCI, Centre

Accordingly, the Directorate General of Health Services (DGHS) issued guidelines, compiled by altogether 24 experts, released an Expert Consensus Statement defining patients' admission and discharge criteria to the Intensive Care Unit (ICU) and other related details.

These guidelines addressed several issues including the ICU Admission Criteria and it specifically defined the critically ill patients who should not be admitted to the ICU. Apart from this, these guidelines also clarified the ICU Discharge criteria, further defining the minimum patients monitoring required while awaiting an ICU bed, the minimum stabilisation required before transferring a patient to ICU, and the minimum monitoring required for transferring a critically ill patient (inter-facility transfer to hospital/ICU).

It also specified that to be called an "Intensivist", a specialist is required to have a specific training, certification and experience in managing critically ill patients in an ICU.

As per the guidelines, the Intensivist should have a postgraduate qualification in Internal Medicine, Anaesthesia, Pulmonary Medicine, Emergency Medicine or General Surgery with either of the following:

As per the latest media report by Hindustan Times, some of the States objected to the requirement for additional qualification of work experience and some of the States/UTs pointed out that if experience had to be insisted, it should be in ICUs in India or abroad. Last month, the Amicus Curiae in the case, Advocate Karan Bharihoke, compiled the responses from the States and informed the Court last month that Himachal Pradesh, Gujarat, Nagaland, Bihar, Telangana, and Sikkim had sought changes to the Union Government's guidelines before implementing them. West Bengal had informed that it followed its operational guidelines. Meanwhile, the remaining States/UTs did not file any responses yet.

In his report to the Apex Court, the amicus curiae had said, "The fact that seven states/UTs, in their wisdom, have thought it fit to recommend changes to the proposed guidelines, in one form or another, and one state proposes to follow its own guidelines, by itself testifies to the necessity of further broad-based discussions to achieve a standard set of parameters to be applicable to all hospitals in the country."

Also Read: New Govt Guidelines Define Who is an Intensivist