The Supreme Court on Wednesday ordered a nationwide review of intensive care unit (ICU) facilities and gave states and union territories two months to assess infrastructure and manpower gaps and ascertain necessary equipment to bring critical care facilities at par with model guidelines by a court-appointed expert committee.
The court simultaneously ordered a nationwide review of nursing colleges and asked the Indian Nursing Council (INC) to submit a report on practical training facilities available to students across its 800 colleges.
“The states/union territories shall ensure that the gap assessment exercise is undertaken by them and completed within two months. At the same time, they will work out modalities for establishing/implementing the minimum standards required for the presence of an ICU in any institution, starting from the first level of ICU,” the bench of Justices Ehsanuddin Amanullah and R Mahadevan directed.
The directions were passed in the proceedings in which the court is considering the formulation of the Intermediate Guidelines (ICU), to which the states and union territories were ordered to respond on April 20 to a draft document prepared by a 17-member expert committee consisting mostly of doctors from various fields.
The draft guidelines specify what a hospital ICU should provide based on staffing standards (qualifications of doctors, nurses and paramedical staff), infrastructure (ventilator, oxygen ports, equipment) and treatment protocol that stipulates three levels of ICU – basic level (level 1), followed by level 2 and level 3, depending on the specialized care required by patients.
Additional Solicitor General (ASG) Aishwarya Bhatti and court-appointed advocate amicus curiae Karan Bhariuk, both of whom were part of the expert panel, informed the court that the states and union territories had requested a period of six to nine months to conduct a “gap analysis”, which the bench shortened to two months.
Acknowledging that treatment costs are commensurate with patients suffering from life-threatening conditions barely getting the necessary treatment, the court noted that “India is passing through a critical phase where the population is growing by leaps and bounds with healthcare facilities unable to meet this demand.”
The court expressed shock at the NTC’s submission that under prevailing rules, a nursing college can be established within a 30 km radius of an attached hospital facility, and directed the Center to reconsider this requirement.
It ordered INC to submit a report by July 31 on all nursing colleges, facilities provided for practical training and the distance of the hospital attached to the college.
Joining the proceedings virtually, renowned cardiologist Devi Shetty said a large number of colleges were producing nurses who did not touch a single patient. “Ideally, the institution that owns the ICU should be the place where the nursing faculty should be attached, and if not, such facility should be within a one-kilometre radius of the hospital,” the court order noted.
Renowned hepatologist Shiv Sareen, who was also consulted by the court on developing the guidelines, recommended nationwide GPS mapping of hospitals to ensure that patients in need are easily informed of the nearest hospital and the specialties and ICU levels available.
The bench took the proposal further. “The system must include a way to connect institutions into a network so that there can be communication between institutions to transfer patients rather than leaving it to the patient’s companion to coordinate,” she said.
The court also asked the states and union territories to explore the possibility of having a standard unit of ambulance facilities with people trained to operate it. “At present, states/union territories may consider the possibility of providing 5 ambulances (per district) with ventilation facility to be ready to transport persons in need of special care to centers where such service is available,” he said, adding that an arrangement could be arrived at through non-government sources via CSR funds, NGOs or voluntary contributions, provided they are kept under a separate account.
The court asked the states/union territories, the NCI and the National Commission for Allied and Healthcare Professionals to submit their responses to the directions by July 31. The committee was given two weeks to examine it and make any changes. The matter is listed for hearing on August 13.
The petition relates to a medical negligence case brought by the National Consumer Protection Court. The case was brought before the consumer court by Asit Baran Mondal, who sought compensation for the death of his wife in a Kolkata hospital in 2013. In the course of the proceedings, the Center informed the court about the model guidelines for ICU/ICU prepared by the Union Health Ministry in 2023.
