The Gujarat High Court, in its May 29 order, observed that ICMR guidelines were “being seriously criticized,” and said that it failed to understand why the approval of the chief district health officer (CDHO) or the medical officer of health (MOH) was required once the doctor prescribes the Covid-19 test as precaution before any particular treatment commences, even as the state government reiterated a “fear psychosis” creeping in if testing was allowed in all asymptomatic cases. The high court bench headed by Chief Justice Vikram Nath was hearing a public interest litigation (PIL) on Covid-19 related issues.
Denying the court’s earlier aspersions on whether the state was “artificially” controlling the data, the state replied that its decision to not permit testing in private labs until its own government labs are completely exhausted, “is in tune with the prevalent policy of ICMR and that it has no relevance or connection with the so called artificial control of data qua the number of cases in the state.”
The Gujarat government said, “The likelihood of fear psychosis being crept in, cannot be ruled out, if the Covid-19 testing is allowed in all asymptomatic cases, just for acquiring a feeling of safety and security.”
However, even as the court lifted the curbs on testing in cases of emergency procedures in its May 29 order, a health department communication on the letterhead of additional director (health) Prakash Vaghela, dated May 30, went out to the medical superintendent of the Gujarat Medical Education and Research Society (GMERS) Hospital in Sola — the nodal authority to clear testing in such cases— with instructions to process approvals within hours for those seeking testing prior to an emergency medical procedure.
When contacted, Vaghela said the communication will not hold in light of the HC direction and the department will be putting up a new circular in accordance with the HC directions “shortly”.
The court has directed that while those seeking emergency procedures and in need of a Covid-19 test, as may be prescribed by their physician, no approval from a nodal authority is required. For the rest of the patients, the court directed that though the Covid-19 test by the treating physician or surgeon would require an approval, it was directed that “such approval should be granted at the earliest and in any case, within 24 hours.”
Following debate on ICMR guidelines and who are to be tested, Advocate General Kamal Trivedi submitted that apart from following the ICMR guidelines, a report by three experts appointed in the state also opined that Covid-19 RT-PCR testing should not be done for asymptomatic individuals, asymptomatic contacts of a positive patient or asymptomatic family of those in quarantine.
The court decided to implead ICMR as a party and sought answers from them in six regards, including the ICMR’s rationale behind its testing policy.
The court has also sought a clarification on the ICMR’s guidelines with regard to testing in private laboratories and if its guidelines are statutory in nature and/or are binding upon the state government.
The court also sought information from the state government in some specific aspects, including on questions such as, how many pathological laboratories are there in Gujarat, who may not be designated for the purpose of the Covid – 19 test, but, are still well equipped to perform such tests and whether the state government can evolve a policy of its own based on the guidance issued by the ICMR contrary to the fundamental right of its citizens with regard to the pathological test or diagnosis.
On private hospitals
The HC also directed the state government to keep a “close watch” on private hospitals while also asking ICMR to be made a party so as to explain its jurisdictional powers, after it observed that it’s guidelines are being “seriously criticised”. The court also allowed private hospitals to charge pre -deposit for patients who are directly coming to private hospitals without reference from the government hospitals.
While the court had earlier said that the private hospitals were charging exorbitantly, the court pointed out “that but for the crisis, we are facing as on date, we would not have interfered with the functioning and administration of any private / corporate hospitals.”
The court also modified its earlier order wherein it had stated that no advance deposits be charged from any patients at a private hospital. The court now left it to the hospitals “to demand for a reasonable predeposit and thereafter raise the demand in phases as and when need arises.”
This amended condition would however hold for patients who come directly, minus any referral from the Civil Hospital or the SVP Hospital to any private / corporate hospital. For those with a referral from the government hospital, there will be no pre deposit.
While AHNA and the state came to a consensus of a 10 percent reduction in already capped prices, the court also added a forewarning that if a private
hospital is not adhering to the terms and conditions of the Memorandum of Understanding, “we will not hesitate to ask the State Government to institute appropriate legal proceedings against such hospitals.”
State report on resident doctors
Responding to the court’s earlier direction to improve the working conditions of resident doctors, the state in its report submitted very little with regard to the issues specifically pointed out in an anonymous letter by a 25-year-old resident doctor and instead stressed upon facilities such as hotel accommodation being provided for their quarantine period.
The state also submitted that, as was suggested by the AIIMS Director to conduct “interactive and capacity building sessions” with all the stakeholders, regular meetings held at the level of Additional Chief Secretary (COVID) and Principal Secretary (Health), issues of coordination and leadership at the level of Medicine Department have been completely addressed.
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