Coming straight to the core issue, it has to be noted right at the outset that in a landmark judgment delivered on July 6, 2018 with far reaching consequences, the Uttarakhand High Court in Chandra Shekhar Joshi v State of Uttarakhand & others in Writ Petition (PIL) No. 71 of 2015 recently issued a slew of commendable directions for improving the functioning of Government Medical College, Haldwani and its associate hospitals. The Court was hearing a petition filed by one Chandra Shekhar Joshi who had highlighted the lack of basic facilities at the Government Medical College, Haldwani and its associate hospitals, Dr Sushila Tewari Memorial Hospital and Swami Rama Cancer Hospital and Research Centre. It is the "poorest of poor" who cannot afford to go to private hospitals who have to suffer the most which cannot be condoned under any circumstances!

As it turned out, on the oral application of petitioner, the Medical Council of India is added as respondent no. 6 in the petition. Para 3 of this landmark judgment brings out that, "According to the averments made in the petition, the institution is plagued with absenteeism. The poor patients are not getting specialized treatment. Number of posts are lying vacant. Patients are not getting the medicines from the hospital. There is a tendency among the doctors to refer the patients to other hospitals." This is most deplorable and depreciable! Why should patients be referred to other hospitals and not treated there only?

To be sure, it is rightly highlighted in para 4 of this landmark judgment that the hospital does not fall under the administrative control of the Department of Medical Health & Family Welfare, Govt. of Uttarakhand. It falls under the control of the Department of Medical Education. For this reason, free medicines cannot be provided.

Truth be told, para 5 points out that, "A startling revelation has been made that Swami Rama Cancer Hospital & Research Institute currently has the Department of Radiotherapy only. Here, the conventional radiotherapy is delivered and also Brachytherapy is done. Simple forms of chemotherapy are often performed but complex form of chemotherapy is not feasible due to lack of medical oncology department. There is no Surgical oncology Department yet. The Department of General Surgery and ENT often perform cancer surgeries when possible. The Departments of Medical oncology, Surgical oncology are due to be brought in when the institute is upgraded to State Cancer Institute. There are no Neurology, Gastrology, Nephrology, Urology or Cardiology Departments in the hospital. There is no independent Cardiology Department."

Going forward, in para 8, it is rightly brought out that, "Government Medical College, Haldwani (formerly known as U.K. Forest Hospital Trust Medical College) is only medical college in Haldwani, Uttarakhand, India. It was established in 1997. The Government Medical College, Haldwani is the first post graduate college in Uttarakhand, recognized by the Medical Council of India and the Government of India. The Govt. Medical College Haldwani has two hospitals associated with it – Dr Sushila Tiwari Memorial Hospital and Swami Rama Cancer Hospital & Research Center. Swami Rama Cancer Hospital & Research Center was inaugurated on 22ndFebruary, 2010. However, there is only one Department which is functional i.e. Radiotherapy. The lack of oncological disciplines of medical oncology, surgical oncology, haematological oncology, gynaecological oncology & pediatric oncology is acutely affecting the population of the state at present."

Needless to say, para 12 of this landmark judgment further brings out that, "There are no facilities like Neo-adjuvent, and Adjuvent for Cancer patients. Swami Rama Cancer Hospital & Research Institute has been established in the year 2010 but till date, the oncology Department is not in existence. There is no Medical oncologist, Surgical oncologist, Gynecological oncologist or Pediatric oncologist in the medical college. Swami Rama Cancer Hospital & Research Institute is functional since 22.2.2010 and it is shocking that till date, no Specialists have been appointed except the opening of Department of Radiotherapy. Swami Rama Cancer Hospital & Research Center has virtually become defunct in absence of specialists."

Let me hasten to add here that in para 13, it was explicitly held that, "The time has come when the State Government should accord Swami Rama Cancer Hospital & Research Institute as the State Cancer Institute by providing it the latest state of art equipment including Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) Scan and Specialists namely medical oncologists, Surgical oncologists, Hematological oncologists, Gynecological oncologists and Pediatric oncologists at the earliest. The facilities provided to the Cancer Hospital in a big building are confined only to the Concurrent and Palliative Chemotherapy. The posts in Clinical and Non-Clinical Branches are lying vacant. There are no details of the persons who applied and were selected pursuant to the advertisement issued by the Medical College. The posts are required to be filled up of Teaching as well as Non-Teaching Staff in all the Departments as per the Minimum Standard Requirements for the Medical College for 100 Admissions Annually Regulations, 1999. The Equipment is to be provided as per Schedule III of the Regulations at the earliest."

Furthermore, it is underscored in para 14 that, "The poorest of poor patients visit the medical college. They have a fundamental right to be treated by the Specialists. It is the duty cast upon the State Government to provide free medicines/drugs to the poorest of poor." on similar lines, in para 27, the Bench of Justices Rajiv Sharma and Lok Pal Singh asserted vocally that, "Every citizen has a fundamental right to health. The State has the obligation to provide best medical services to its citizens. The poorest of poor cannot go to the private hospitals. Since the latest equipment is not available with the respondent – Medical College, the parents are referred to other hospitals including private hospitals."

While clearly and convincingly exposing the shortcomings, this landmark judgment in para 24 points out that, "A startling revelation has been made that 4 posts of Professors, 4 posts of Associate Professor/Reader, 1 post of Medical Superintendent, 1 post of Dean are lying vacant in the medical college. 29 posts of Tutor/Registrar/Sr. Resident and 68 posts of Junior Resident and 1 post of Deputy Librarian are lying vacant. In total, 129 posts in this category are lying vacant." Para 25 goes on to further point out that, "There are 310 sanctioned posts of Staff Nurse out of which 142 have been filled up on regular basis and 64 posts have been filled up through UPNL. Nursing is the backbone of any medical institute. In all, 104 posts of Staff Nurse are lying vacant." It is also conceded in para 26 that, "Now as far as the technical staff is concerned, 380 posts are lying vacant. These posts are required to be filled up on emergent basis. The hospitals cannot be left sick."

Bluntly put, para 28 observes astonishingly that, "It is surprising to note that the Medical College has no Department of Neurology, Gastrology, Nephrology, Urology or Cardiology. These Departments are essential for public health. The State Government is required to take immediate steps for creation of these Departments in the Govt. Medical College, Haldwani at the earliest. The surgeries of the cancer patients are required to be undertaken only by the oncologists/Medical Surgeons from their respective branches." As if this is not enough, it is further observed in para 29 that, "A startling revelation has been made in the daily edition of 'The Pioneer' dated 3rdJuly, 2018 that 61 Ambulances are lying idle in the compound of office of Director General (Health). The ambulances are required to be refurbished immediately to make them functional. Ambulances which have completed their maximum mileage are required to be replaced."

To top it all, para 30 further observes that, "It has also come into light that there is also acute shortage of doctors in Kumaon Division as per the daily edition of 'Amar Ujala' dated 3rdJuly, 2018. There is shortage of 267 doctors in Kumaon Region. The total posts sanctioned are 981 out of which only 714 doctors are working and 267 posts are lying vacant." Worst of all, para 31 laments that, "There is no Trauma Center in the Medical College. The Trauma Center is required for the simple reason that due to the terrain and geographical conditions of the State, the fatal accidents do occur wherein the passengers receive serious injuries. They are required to be operated upon immediately by the Neurosurgeons. The Trauma Center is a must in every Medical College."

Needless to say, para 32 makes a scathing attack for not spending enough on purchasing the latest equipments. It says that, "Petitioner has also placed on record the details of the budgetary provision. A sum of Rs 23.00 crores was spent for the construction of Swami Rama Cancer Hospital & Research Center. The system cannot permit non-utilization/under utilization of building constructed at the cost of Rs 23.00 crores. The amount is contributed by the tax payers. The system is accountable for every pie spent by the government. Budgetary provisions are available for the medical college but still the latest equipment is not purchased for the reasons best known to the management of the Medical College."

Finally and most importantly, para 33 which is the concluding part of the judgment concludes by saying that, "Accordingly, the present petition is disposed of by issuing the following mandatory Directions:
A.The respondent-State is directed to make Swami Rama Cancer Hospital & Research Institute fully functional by creating the posts of Medical oncologists, Surgical oncologists, Hematological oncologists, Gynecological oncologists and Paediatric oncologists within three months from today by holding the walk-in interviews. The State is also directed to upgrade the status of Swami Rama Cancer Hospital & Research Institute to the State Cancer Institute within three months. The State is also directed to give incentives to the specialists to join premier institution in the State of Uttarakhand by giving them at least 15 advance increments, suitable accommodation and conveyance befitting their status.
B.Since Swami Rama Cancer Hospital & Research Institute is the constituent hospital of Medical College, the State Government is directed to provide the latest state of art equipments/machinery required under the Minimum Standard Requirements of the Medical College for 100 Admissions Annually Regulations, 1999 for training and teaching of the MBBS and MD/MS students within two months.
C.The respondent-State is directed to establish the Nephrology, Neurology, Urology and Cardiology Departments in the Medical College within three months. Thereafter, the posts shall be filled up within a further period of three months by holding the walk-in interviews.
D.The State Government is directed to establish the Trauma Center in Government Medical College, Haldwani and make it functional within three months from today as per the standard procedure.
E.The State Government is directed to fill up all the posts of teaching staff as well as non-teaching staff, lying vacant in the Medical College, within three months from today to provide quality treatment to the patients. The first preference shall be given to the teaching faculty including clinical and thereafter to non-clinical and nursing.
F.The State Government is directed to deploy 61 newly acquired ambulances after refurbishing them within one month from today.
G.The State Government is directed to fill up all the vacancies of Medical officers in Kumaon Division within four months from today.
H.The State Government is directed to install the MRI/PET, Mammography and other states of art equipment for treatment of patients and training and teaching of MBBS and MD/MS students within three months from today.

I.The State Government is directed to provide essential life-saving drugs/medicines to the patients free-of-cost.
J.The Principal of the Medical College is directed to ensure absolute hygiene in the hospital and if necessary, by outsourcing the same.
K.The State Government may consider constructing Inns/Sarays for the attendants of patients in the close vicinity of the hospital.
L.The Medical Council of India shall carry out the inspection of the Medical College immediately after six months to ensure that all the parameters laid down by it are followed in letter and spirit by the respondent- Medical College failing which it shall be open to the MCI to take action, as envisaged under law, against the Medical College for non-fulfilling the minimum standards."

All said and done, it is a landmark judgment and its mandatory and laudable directions must be implemented in letter and spirit in totality. It will go a long way in ensuring that the poorest of poor who cannot afford to go to private hospitals get proper treatment for cancer. It is India which tops in world with maximum death from cancer at 2.2 million per year.

To be sure, health spending has pushed 55 million Indians into poverty in a year as was published in 'The Times of India' on June 13, 2018. Cancer has the highest probability of resulting in 'catastrophic expenditure' for a household. But it can be checked if the landmark directives laid down in this landmark judgment are implemented in totality. It will also go a long way in ensuring that the Medical Colleges function as per the directives laid down. Not just this, it will also certainly go a long way in improving the functioning of Government Medical College and Associate Hospitals which is the crying need of the hour!

Sanjeev Sirohi, Advocate,
s/o Col BPS Sirohi, A 82, Defence Enclave,
Sardhana Road, Kankerkhera, Meerut – 250001, Uttar Pradesh