U’khand official in dock over changes to SC order on ICUs

The Supreme Court on Monday expressed “strong displeasure” as it pulled up the Uttarakhand director general of health for filing an affidavit that proposed changes to a July 23 order of the top court that directed states to give suggestions on guidelines governing the functioning of ICUs and CCUs across the country.

The court took up an 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.

The meeting of the state health department was convened on August 7 following the court order that directed states and Union territories to give their suggestions to a set of guidelines governing ICU admissions and qualifications of specialists handling patients in these units. While the guidelines were introduced last year, the court sought to enforce common standards for patient care in ICUs across the country.

As the July 23 order reproduced these guidelines, the committee of experts who met on August 7 edited the order itself as it sought to proposed which portions of the guidelines in the court order should be deleted and what needs to be added.

Pulling up Arya, the bench of justices Sudhanshu Dhulia and Ahsanuddin Amanullah said, “You are modifying and amending our order. How can you do this? You do not deserve to be on this post.”

Arya told the court that the modifications to the court order were only meant for internal note and were mistakenly reproduced in the affidavit. She then filed a fresh affidavit offering apology for the mistake.

“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?” the court asked.

Arya replied that the state only wished to present its view by citing the opinion of expert who considered some suggestions in the Centre’s guidelines to be impractical.

Posting the matter after six weeks, the bench said, “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.”

In the interest of justice, to allow the officer to put forth her view, the bench gave her an opportunity to file an affidavit explaining the circumstances that led to the filing of the objectionable affidavit and dispensed her personal presence on the next date of hearing.

The bench also asked additional solicitor general (ASG) Aishwarya Bhati, who was present in court to help the officer, to help Arya 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.

Advocate Karan Bharihoke, assisting the court as amicus curiae, said that the committee proposing the changes did not have a copy of the original guidelines of the Centre but only the SC order before it.

He further indicated that 16 states are yet to respond to the model guidelines.

The bench asked the Centre to engage with states for filing responses before the court.

The guidelines framed by the Centre made two-fold recommendations on the nature of training, certification and experience of the specialists in managing critically ill patients in an ICU and the rules governing admission and discharge in ICU.

The Centre proposed that the specialists (intensivists) should have postgraduate qualification in internal medicine, anaesthesia, pulmonary medicine or surgery, combined with additional qualification in intensive care and at least one year training in a reputed ICU abroad.

The committee further proposed that some of the candidates who have been certified with a three years’ training programme in intensive care after MBBS and are recognized as intensivists must have at least two years’ experience in ICU with 50% time spent in the ICU. It said that in case, the doctors do not possess either of the qualifications or training, they should have extensive experience of at least three years after MBBS in intensive care in India.

The second recommendation of the committee was in relation to the criteria for admitting a patient to ICU and cases where critically ill patients ought not to be admitted to ICU. The criteria also prescribed the minimum monitoring required of patients while awaiting an ICU bed and transferring a critically ill patient as well as minimum stabilisation required before transferring a patient to ICU.

The guidelines also specified instances where critically ill patients should not be admitted to ICU. These included cases where the patient or the next-of-kin refuse to be admitted in ICU, anyone who has a living will or advanced directive against ICU care, any disease with a treatment limitation plan, terminally ill patients with a medical judgement of futility and low priority criteria in case of pandemic or disaster situation where there is limitation on beds, workforce or equipment.