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Court No. - 7

Case :- PUBLIC INTEREST LITIGATION (PIL) No. - 574

of 2020

Petitioner :- In-Re Inhuman Condition At Quarantine Centres

And For Providing Better Treatment To Corona Positive
Respondent :- State of U.P.
Counsel for Petitioner :- Gaurav Kumar Gaur,Abhinav
Gaur,Aditya Singh Parihar,Amitanshu Gour,Arvind Kumar
Goswami,Bhagwan Dutt Pandey,Ishir Sripat,Jamil Ahamad
Azmi,Jitendra Kumar,Katyayini,Pradeep Kumar Srinette,R.K.
Shahi,Rahul Sahai,Rajeev Kumar Singh,Rishu Mishra,S.P.S.
Chauhan,Sarveshwari Prasad,Satyaveer Singh,Shailendra
Garg,Siddharth Shukla,Sunita Sharma,Suo Moto,Sushil
Kumar Mishra,Swetashwa Agarwal,Uttar Kumar
Goswami,Vibhu Rai
Counsel for Respondent :- C.S.C.,Arun Kumar,Ashish
Mishra,Dhiraj Singh,Hari Nath Tripathi,Purnendu Kumar
Singh,Satyavrat Sahai,Sunil Dutt Kautilya,Suresh Chandra
Dwivedi,Tahir Husain,Vishakha Pande

Hon'ble Siddhartha Varma,J.

Hon'ble Ajit Kumar,J.

1. In online hearing of this Public Interest Litigation, we

have heard Shri Manish Goel, learned Additional Advocate

General assisted by Shri A.K. Goel, learned Additional Chief

Standing Counsel, Shri S.K. Singh, learned Additional

Solicitor General of India, Shri Amrendra Nath Singh,

President Allahabad High Court Bar Association, Shri

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Shubham Dwivedi, learned Advocate Commissioner, Shri A.P.

Paul, Shri Anuj Singh, Ms. Shushi, learned Advocates, Shri

Ashish Mishra, learned Advocate appearing for High Court,

Shri Mohit Jain and Shri Amit Saxena, learned Advocates for

Moti Lal Nehru Medical College with which the Swaroop

Rani Nehru Medical College is attached.

2. Today as the threat of the pandemic looms large and

public health system is not able to cater the need of the people

as per demand, so people have themselves put a lockdown to

their normal activities. The roads and streets have gone

deserted and commercial activities in major cities of the state

of Uttar Pradesh have nearly come to a standstill. City

population is in complete grip of Corona virus called COVID-

19 and so people are getting infected in a large number every

day forming a complete chain for every next coming day.

People are waiting in queues outside every hospital in search

of a bed for survival but only a very few lucky ones are

getting chance and even non-Covid patients and those who

have become negative and are facing acute respiratory

problem due to Covid involvement in lungs, are not getting

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beds. Thus, public health infrastructure has attained

saturation.

3. Government hospitals and even well-established private

hospitals are not able to cater the need of the people today.

Besides that, doctors, medical and paramedical staff, other

health workers have all gone completely exhausted. Even

private hospitals while have come forward to provide their

existing infrastructure to help the government in the current

crisis are extremely insufficient. Reports are coming that

health workers of these hospitals are hesitant in serving Covid

infected patients. Further the private hospitals are running out

of stock of life saving drugs like Remdesivir and they needed

oxygen and what is worst is, as we have been informed,

certain people in private hospitals and in the medicine market

are minting money out of this crisis. Further at times, as

newspapers report, the patients are being given fake

injections.

4. We have carefully gone through the affidavit of

compliance filed by one Tarun Gupta, Secretary (Home),

Government of Uttar Pradesh in which it is claimed that to

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address the issue of supply of liquid medical oxygen (LMO),

the Government has undertaken massive task and the State

has got allotted about 857 metric tone of the liquid medical

oxygen. It is claimed that the amount of oxygen that is being

received through the logistics provided by State itself, it will

be able to tackle the situation caused by the shortage of

oxygen. Various steps undertaken by the Department of

Medical and Health Services of Government of U.P. in this

regard have also been enumerated in various paragraphs of the

affidavit and which includes distribution of oxygen to the

hospitals in various districts of the State as per the demand. It

is also claimed that a control room has been set up in this

regard under the leadership of Director (Medical Education),

Jawahar Bhawan, Lucknow so that the gap between demand

and supply of the oxygen is removed. The affidavit also

discloses that in the entire State of U.P. there are 23799

isolation beds and 5913 ICU/SDU beds in 185 L-2 level

hospitals, whereas, 8156 isolation beds and 3466 ICU/SDU

beds are there in L-3 category government hospitals that are

20 in number. The number of beds in private 307 hospitals in

the State have been shown to be 17614 in isolation bed

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category and 5510 in ICU/SDU bed category. It is also stated

in the affidavit that a 600 beds covid hospital which is under

construction at Lucknow with the support of DRDO is

expected to become functional by the end of April 2021. It is

also stated that on an average 80000 RTPCR tests conducted

in the State besides the true nat test and CBNAAT tests that

are available in each district. It is also stated that till date

39905293 tests have been conducted so far and the covid

vaccination to the tune of 9783416 have been carried out in

the first dose and 20464 have also been vaccinated for the

second time. It is also stated that integrated covid command

centre has started functioning since last year from 28.03.2020

and updated information is being given on a toll free number

1800-180-5145. It is also stated that a district level ICCC is

working 24x7 and complete guidance is given to a covid

patient and those who are in home isolation are being

provided with medicine kits. Regarding treatment of non

covid patients it is stated that a tele consultation platform has

been opened. As far as spread of the virus is concerned, it is

stated in the affidavit that standard operating procedure had

already been issued on 01.03.2021 by the Ministry of Home,

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Government of India and the Police Headquarter,Lucknow

has been directed to ensure strict implementation of those

guidelines. Those migrant workers who are entering Uttar

Pradesh from another States are put to covid test as a measure

to contain any possibility of spread of infection by them.

Besides above, detailed work plan and guidelines have been

issued on 07.04.2021, it is stated, in compliance of the order

of the Court dated 06.04.2021. Even it is claimed that the

Police Head Quarter had issued guidelines vide order dated

13.04.2021 during Panchayat Elections to prevent the covid

19 pandemic. It is stated that night curfew in 10 districts have

been imposed from 8 p.m. to 7.00 a.m. as a measure to

contain the spread of pandemic and directions have been

issued by the Police Head Quarter on 16.04.2021 for strict

action to be taken against those who are violating guidelines

under Section 15(3) of the U.P. Epidemic Disease Covid-19

Regulations, 2020. Regarding distribution of oxygen cylinders

in level-1, level-2 and level-3 hospitals and for wearing of

mask, specific guidelines have been issued on 20.04.2021.

It is also stated that the directions have been issued to

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check the black marketeers of life saving drugs by issuing

guidelines on 20.04.2021 in compliance of the order of the

Court. It is also stated that the corona curfew from Friday

evening to Monday morning has been declared for the entire

State, as a major step to check the spread of virus.

Besides above, various public awareness programmes, it

is stated have been launched through print media, electronic

media, social media and digital media. The Government, it is

also stated has made extensive use of public announcement

system to generate awareness amongst the people regarding

precautions to be followed to prevent the spread of covid and

also to motivate the public to be part of vaccination

programme. Cleanliness drive, spread of disinfectent and

sanitazation drive have also been undertaken with the help of

Vyapar Mandal, Welfare Associations and Mohalla Nigrani

Samitis in various areas.

5. Thus, the Government by means of this affidavit has

shown not only its concern for the recent spread of virus but

its willingness and bonafides to take every possible step in the

interest of public so that the magnitude with which the virus

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has acquired degree of infection, is reduced at the earliest.

6. From the perusal of affidavit what we find is that the

Government has come out with various plans, programmes,

guidelines but the hard fact is that except, as the Government

claims in its statistics that number of total infected persons

have come down in the last 2-3 days, nothing more is seen to

give some respite to our doctors, medical and paramedical

staff and those who are involved in CT Scanning and

pathology because large number of such workers have gone

positive and the backup system seems not to be working to the

satisfaction of the people.

7. People are by and large getting disheartened and when

their near and dear ones die they go frustrated at the system of

healthcare in the state and soft targets of their ire are the

medical and paramedical staff.

8. Shri Amrendra Nath Singh, learned Advocate has cited

problems of people in reaching to Level-1 covid centre situate

in Kalindipuram. He has submitted that Level-1 covid centre

can be further opened in an area near K.P. College either

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taking ground of K.P. College to create a make shift centre or

even the hall of K.P. College can be utilised. He has also

submitted that similarly Level-1 centre should be opened in

the other areas of the city so that people are encouraged to

shift themselves to Level-1 centres and it will be then easy for

the control command centre set up in the district, to address

the issue of admission in hospitals of such covid patients, if

need be. He has further submitted that the facilities in the

Kalindipuram Level-1 covid centre are also not upto mark as

there is issue of light, non availability of mosquito repellents

and even potable water to the patients who have chosen

themselves to be shifted there for observation by the covid

teams. He has further proposed that for the Advocates a

special vaccination drive may be undertaken by assigning a

particular centre nearby High Court so that maximum number

of Advocates may be vaccinated.

9. Shri A.P. Paul has submitted that people are not being

admitted to hospitals easily and those who are admitted in the

Government hospitals and are turned Antigen negative, are

being forced to leave the hospital even though their SPO2 is

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below 90. He has also argued that those patients who though

are RTPCR negative but there is covid involvement in their

lungs, are not being admitted to private hospitals because of

problem of referral letters of Chief Medical Officer or District

Magistrate and to obtain the same is a tedious job.

10. Shri Anuj Singh, learned Advocate who has filed the

letter petition, has questioned the wisdom of the Government

in bringing the idea of referral letters for admission of patients

to the Government and private hospitals. He has submitted

that “the mechanism of “referral letter” is putting life of covid

patients at high risk. Family members are spending days and

days in order to receive letter and then they have to wait for

another few days for allocation of hospital. The CMO

helplines are not working and calls always remain

disconnected. It is almost impossible for an ordinary citizen to

get acccess to the CMO office. The struggle to first arrange

medicine followed by oxygen and then finishing the arduous

task of registration process at CMO office, for receiving a

basic human right such as medical aid, is only adding misery

to the lives of innocent residents of State”. The letter petition

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is directed to be numbered and is taken on record.

11. Ms. Shushi learned counsel has submitted that there is

scarcity of oxygen in private hospitals and since the

Government has taken up the task of giving admission to

covid patients in private hospitals also at its own cost, it must

ensure supply of liquid medical oxygen in adequate amount to

private hospitals. She has further submitted that it is because

of this scarcity that private hospitals are insisting patients to

bring their own oxygen cylinder, if they wanted admission. It

is also submitted by her that refilling of oxygen cylinders of

the individuals at the oxygen filling centres are not being

given priority. They have to remain in queue for nearly 12

hours and more to get their cylinders filled with liquid

medical oxygen and local administration is also harassing

such people. Learned counsel has submitted that the situation

is quite chaotic as far as medical health is concerned.

12. Shri Anuj Singh also submitted that in cities like

Lucknow if the cylinders are not filled in within time where

15-16 filling stations have been provided, one can imagine

how worst would be the situation in smaller districts like

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Chandauli, Bahraich, Basti, Banda, Chitrakoot etc.

13. Shri Amrendra Nath Singh and Shri A.P. Paul at this

stage have also submitted that Government is only giving a

very rosy picture but the situation on ground has gone from

bad to worst and the lockdown of all commercial activities

and the public movements except in cases of health

emergency, could be the only solution. They have submitted

that merely creating a portal and announcing helpline

numbers would not help.

14. They have submitted that though the Government had

given helpline numbers, but are not accessible because either

lines are too busy or the reply comes that number is “out of

coverage area”. They have vehemently submitted that health

care system has completely collapsed and the Government is

covering up its failure in the name of guidelines. What is

worst, as is submitted that it is showing the attitude of 'My

way or no way”.

15. Shri A.P. Paul has also brought to notice of the Court

that there is news item published in news daily “Amar Ujala”

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that around 135 persons (Teachers, Shiksha Mitras and

Investigators) who were on an election duty in the those

recent phases of Panchayat elections that have already been

held, have turned first covid positive and then died for its

severity.

16. The situation overall in the major cites of Uttar Pradesh

has gone very chaotic for the current Covid surge. Whether it

is day or night the ghost of Corona is marching on the roads

and streets of the major cities of the state and it can be

anybody’s fate. Those who are resource full will survive and

the rest as histories of past pandemics tell us may die for want

of proper healthcare.

17. As the Government in its wisdom has resolved to only

two days weekend lockdown to break the chain and has

further proceeded with some measures as a sequel to that but

mere fact that number of positive cases as have been shown to

have been reduced a little in numbers due two weekend

lockdown days, nothing remarkable seems to have been

achieved on the front of public health care to the satisfaction

of the people.
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18. From the above discussion we find two things are

required to be streamlined immediately; A) the management

of public health infrastructure; and B) raising or enhancing the

infrastructure to at least meet 1% of the city's population in

every district of the state.

19. As far as management of existing infrastructure is

concerned, what we find is that hospitals and their staff

though are working day and night i.e. 24 x 7 but the

management of system is still not up to mark. For easing out

the situation and the given paraphernalia we propose the

following steps to be taken by the Government immediately in

the cities of Lucknow, Prayagraj, Varanasi, Agra, Kanpur

Nagar, Gorakhpur and Jhansi:

(i) Major government hospitals of the above cities

of Lucknow, Prayagraj, Varanasi, Agra, Kanpur

Nagar, Gorakhpur and Jhansi should have health

bulletin system twice a day apprising people of health

updates of the patients to avoid visiting attendants to

hospitals. The hospitals may use large screens to give

details of patients and their saturation levels. This

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will definitely help in reducing the number of visitors

every day to the hospitals and chances of spread of

further infection. The government is also directed to

declare on its district portal of the above cities the

occupied and vacant positions of beds in covid wards

and ICUs of all government hospitals and covid

assigned private hospitals and government is also

directed to make wide publication of its district covid

portals and sites in news papers and also through

public announcement systems.

(ii) Mere antigen negative report should not be a

ground to throw a patient out of the hospital as such

patients can still infect others. They needed to be

shifted to non-Covid wards for at least a week and

for this government needs to gear up to set up

makeshift wards on the campus of the hospitals if

there is a space so that there may not be problem of

nursing staff and health workers. Availability of

oxygen is to be ensured in those wards also as SPO2

level still can be on a lower side.

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(iii) Every bed in level two hospitals must be

supported with a BiPAP machine and there should be

availability of High Flow Cannula Mask at the rate

of one per two beds and there should be ventilator

available in ICUs at the rate of one per three beds

available in ordinary covid wards.

(iv) Government hospital should be provided with

sufficient medicines and injections including

Remdesivir for patients to be treated, oxygen supply

to hospitals should remain uninterrupted. This

should be ensured at all cost so that no one should

die for want of oxygen. If even after seven decades of

our attaining freedom with so many heavy industries

set up, we are not able to provide oxygen to our

citizens, it’s a matter of shame. We further direct

that despite rules regulations framed for

transporting and disposal of industrial oxygen, it

should be immediately diverted to the use of people

making it Medical Oxygen and its immediate

uninterrupted supply for the said purpose be ensured

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by the Government.

(v) Health workers should be engaged on contract

basis. Also such other staff including data feeders

and computer operators should be likewise employed

as testing sample and their collections are to be

carried out on a very large scale continuously so that

a large number of the cities' population is at least

tested for Covid and it gets its result in time. It is

unfortunate that even one percent of the city's

population of each of the major districts of the State

that are hit by Covid has not been tested so far ever

since the second wave has hit the State.

(vi) The management of the Doctors, medical and

paramedical staff needs an urgent attention. They

are all working day and night and are getting

infected as well when they remain amidst the Covid

patients day and night. Effort should be to rotate the

staff six hourly to give it the required rest.

(vii) Now since the existing medical health

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infrastructure in the major cities of Uttar Pradesh

has attained saturation, a sustained growth thereof

by way of enhancement has to be made. While

building structure is a time taking task, optimum use

of existing building should be made and setting up of

makeshift wards upon the open space on the

campuses of the hospitals should be thought of; the

Government and district administration is directed

to study viability of setting up more and more Level-

1 covid centres with all requisite facilities so that

people voluntarily approach there and stay to curb

further spread and help in admission to L2/L3 as per

need.

(viii) The number of ambulances must be increased

immediately and these ambulances that are

requisitioned or purchased must be well equipped

with life saving devices;

(ix) The Government must ensure that every death

in all covid hospitals and assigned private hospitals

and other Covid Centres in every district is reported

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to a Judicial Officer to be appointed by District

Judge at the end of the day. The Government shall

also ensure the correctness of the data forwarded to

the officer concerned each day. It is also directed that

the police station Incharge officer, in whose

territorial limit the cremation place is situate, shall

ensure that cremation in Covid death cases is strictly

followed as per the guidelines in this regard issued by

the Government. He shall also ensure that the details

of every covid death is entered in the register

maintained at the cremation area which shall also be

communicated to the concerned municipal body or

Nagar Nigam. The Government shall ensure that

every hospital where covid death has taken place, the

dead body is packed as per the protocol before it is

sent to the cremation place to be finally cremated.

The Municipal Commissioners of Nagar Nigam and

other officers of Nagar Palikas must be put to task to

ensure disposal of dead body of a covid deceased

strictly as per protocol.

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(x) Above all the administration of government

hospitals is emerging as a larger issue these days and

it should be addressed. Food, sanitation and other

budgetary aspects should not come in the way of

treatment of those admitted and patients must be

supplied with good quality food and potable water

and paper napkins at every meal which should be

served at least 4 times a day in all levels of covid

hospitals and covid centres.

(xi) Sanitization of hospitals, its corridors and

washrooms must be undertaken at least three times

to four times a day.

(xii) The hospitals that have been taken over or

assigned as Covid health centres must be ensured to

be well-equipped with all needed medical devices

including BiPAP machine High Flow Cannula Mask

and ventilators and that too all should be in sufficient

numbers and constant oxygen supply must also be

ensured to these hospitals.

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20. We, make it clear that we will not tolerate any

paperwork or public announcements to show account of the

steps taken and its sufficiency as it is now an open secret that

government had gone complacent due to weakening of virus

impact by the end of 2020 in the state and the government got

more involved in other activities including Panchayat

elections. Had it been constantly vigilant, it would have

prepared itself to face the onslaught of the pandemic in its

second wave. Posterity would never forgive us if we remain

oblivious to the real public health issues and let the people die

for want of adequate health care.

21. Though we, acknowledge the fact that government alone

can not fight with its available resources and needs people's

cooperation and active participation of various other non

government bodies, but those is power must shun the attitude

of 'My Way or no way' and should welcome suggestions

from all the quarters.

22. Now today when the Government at this late stage has

come out with detailed plans to contain the spread of the

pandemic, we can only hope and trust that new plans do work
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as public health cannot be compromised with at any cost. The

government's bonafides we don’t doubt nor do we have any

reason to doubt but plans must be translated into action with

the spirit with which they have been made.

23. We acknowledge and appreciate the duties that

administration has relentlessly performed during the last 3-4

days but they need to put in more looking to the surge of

pandemic these days.

24. Though we have examined and dismissed the plan

placed before us today to curb the pandemic but seeing

“Sursa like mouth” of this pandemic we want the

Government to come with more stringent measures by the

next date fixed.

25. The directions which we have given above as (I) to (xii)

should be carried out in letter and spirit. A blue print for

raising the existing infrastructure should be produced before

us on the next date. A compliance affidavit of an officer of the

level of a secretary to the government shall be filed on the

next date fixed.

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26. Learned Additional Advocate General is directed to

place before us also on the next date following details in

respect of cities of Prayagraj, Lucknow, Varanasi, Agra,

Kanpur Nagar, Meerut, Ghaziabad, Gautam Buddha Nagar,

Gorakhpur and Jhansi :-

1. The existing total number of beds in the

government hospitals in the level two and level

three wards and their current occupancy as on 2 nd

of May 2021. Per day demand shall also be

informed to us. Government shall also inform as

to why the various community health centres are

not being converted into level 2 hospitals. This

would lesser the burden of main hospitals;

2. Total number of beds in ICUs and its

occupancy. Total number of BiPAP machines and

high flow Cannula masks and ventilators shall

also be provided in respect of government

hospitals and covid assigned private hospitals;

3. Statistical details of the oxygen supply to the

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government hospitals where there are no oxygen

producing plants shall also be provided. Exact

need of the hospitals and the working of the

oxygen plants wherever they are there in the

hospitals shall be provided along with their

capacity;

4. The exact number of supply of life-saving

drugs including Remdesivir in government

hospitals;

5. Details of meals that are given to the

patients. The number of times, quality of meals

and vitamin and calorie value of such meals per

serving should be placed before us. The source of

the meals shall also be given;

6. Number of existing ambulances and their

status; and

7. Modalities adopted for admission to level 3

and private hospitals.

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8. Exact number of covid deaths reported

between 19th April 2021 to 2nd May 2021.

9. Viability to use LPG Cylinders for filling

Liquid Medical Oxygen to meet the demand of

cylinders.

27. All the above details must also be disclosed in respect of

the private hospitals which have been assigned as Covid

hospitals. Fee structures of these private hospitals if they have

been permitted to charge from the patients shall be placed

before us, status of oxygen supply to private hospitals and

their need shall also be placed before us on the next date

fixed.

28. We request the District Judges of Lucknow, Allahabad,

Varanasi, Kanpur Nagar, Agra, Gorakhpur, Ghaziabad,

Gautam Budh Nagar, Jhansi to nominate a judicial officer

Civil Judge (Sr. Division) or above.

29. Such nominated officer shall work as nodal officer in

their districts and shall report to the Registrar General every

weekend and the said report shall be placed before us on the

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date of hearing to ensure compliance of our directions no.

(ix).

30. Now having verified the news item dated 26.04.2021

published on the official website of Hindi news daily 'Amar

Ujala' https://www.amarujala.com wherein it has been

reported that 135 Teachers, Shiksha Mitras and Investigators,

who were assigned election duty, have died, we proceed to

take judicial notice of the same

31. It is reported that the people have leveled allegations

that during recent phases of the Panchayat elections held,

none of the covid guidelines have been followed. It appears

that neither the police nor, Election Commission did anything

to save the people on election duty from getting infected by

this deadly virus.

32. In view of the above, let notices be issued to U.P. State

Election Commission, Lucknow to explain by the next date

fixed as to why it failed in checking non compliance of covid

guidelines during various phases of the panchayat elections

held recently and why action may not be taken against it and
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its officials for the same and to prosecute those responsible for

such violations.

33. The State Election Commission is further directed to

take immediately all such measures in forthcoming phases of

panchayat elections in the State to ensure that the covid

guidelines dated 20.04.2021 of social distancing and face

masking is religiously complied with, else action is liable to

be taken against the officials involved in the election process.

34. Put up this matter again on 03.05.2021 at 11.00 a.m.

Copy of this order be placed before the Chief Secretary, State

of U.P. within 24 hours.

(Ajit Kumar,J.) (Siddhartha Varma,J.)

Order Date :- 27.4.2021/IrfanUddin