ICU, CCU Guidelines: SC Slams Uttrakhand Director General of Health
New Delhi: During the case proceedings concerning guidelines for admission to the Intensive Care Unit and Critical Care Unit, the Supreme Court recently slammed Uttarakhand's Director General of Health for filing an affidavit that proposed changes to a July 23 order of the top court that directed the States to give suggestions on guidelines governing the functioning of ICUs and CCUs across the country.
While considering the matter yesterday, the Apex Court bench took note of the affidavit filed by the DG, Tara Arya, and sought details of the meeting where the decision to suggest changes to the Court order was taken, HT has reported.
Medical Dialogues had earlier reported that 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 2023. Taking note of the same, the Apex Court bench comprising Justice Sudhanshu Dhulia had issued directions to the remaining States/UTs to inform them by November 4 whether they wished to continue with the Union Government's suggestions or if they wanted changes.
As per the latest media report by Hindustan Times, the Uttarakhand Health Department convened the meeting on August 7 after the Court had directed the States and Union Territories to give their suggestions to a set of guidelines governing the ICU admissions and qualifications of specialists taking care of ICU/CCU patients to enforce a common standard for patient care in the ICUs across the country.
Since the July 23 order reproduced these guidelines, the committee of experts who met on August 7 edited the order itself as it sought to propose which portions of the guidelines in the court order should be deleted and what required to be added.
Slamming the State official, the top court bench of Justices Sudhanshu Dhulia and Ahsanuddin Amanullah observed on Monday, "You are modifying and amending our order. How can you do this? You do not deserve to be on this post."
Following this, the Director General of Health informed the bench that the modifications to the court order were only meant for internal note and were mistakenly reproduced in the affidavit. Consequently, the official filed a fresh affidavit offering apology for the mistake.
However, the court was not satisfied with this answer and questioned the State official, "That makes it worse. How dare you even take a stand even in your internal note to amend our order? Is this what you do to a Supreme Court order?"
In response, DG Tara Arya informed that the State's intention was only to present its view by citing the opinion of the expert who considered some suggestions to the Centre's guidelines to be impractical.
Thereafter, the Supreme Court bench posted the matter for further hearing after six weeks and observed, "We must record our strong displeasure at the contents of the meeting and what was contained in the minutes as prima facie we feel it amounts to contempt of court."
Meanwhile, in the interest of justice, the bench allowed the Uttarakhand Government official to put forth her view by filing an affidavit that would explain the circumstances leading to the filing of the objectionable affidavit and dispensed her personal presence on the next date of hearing.
The top court also asked the Additional Solicitor General (ASG) Aishwarya Bhati, who was present in the Court to help the officer prepare a better affidavit in two weeks stating what transpired in the meeting and under what circumstances the decision was taken that formed part of the objectionable content in the affidavit.
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 inform whether any guidelines were prescribed for private hospitals on providing care to patients in the ICU and CCUs.
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.
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.
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.
On Monday, Advocate Bharihoke informed that the committee proposing the changes did not have a copy of the original guidelines of the Centre but only the Supreme Court order before it. He also indicated that 16 States have not responded to the model guidelines yet. HT has reported that the top Court has also asked the Centre to engage with States for filing responses before the Court.
The guidelines released by the Central Government last year 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:
a) An additional qualification in Intensive Care such as DM Critical Care/Pulmonary Critical Care, DNB/FNB Critical Care (National Board of Examinations), Certificate Courses in Critical Care of the ISCCM (IDCCM and IFCCM), Post-Doctoral Fellowship inCritical Care (PDCC/Fellowship) from an NMC recognised University, or equivalent qualifications from abroad such as the American Board Certification, Australian or New Zealand Fellowship (FANZCA or FFICANZCA), UK (CCT dual recognition), or equivalent from Canada;
b) At least one year of training in a reputed ICU abroad.
Also Read: Supreme Court to Decide on Guidelines for Treating ICU, CCU Patients
