The Maharashtra government on Friday told the Bombay High Court that the state-run hospitals in Nanded and Chhatrapati Sambhajinagar which recently saw a spurt in patient deaths faced a heavy inflow of extremely critical patients from private hospitals. However, the court said the state can’t escape its responsibility.

The state government also told a division bench of Chief Justice D K Upadhyaya and Justice Arif Doctor that there does not seem to be any gross negligence on the part of the state-run hospitals.

According to officials, 31 patients, including many infants, died at the Dr Shankarrao Chavan Government Medical College and Hospital in Nanded in 48 hours since September 30, while the death of 18 patients was recorded at the Government Medical College and Hospital at Chhatrapati Sambhajinagar, earlier known as Aurangabad, between October 2 and 3.

The bench had earlier this week taken suo motu cognisance of the deaths.

Advocate General Birendra Saraf, appearing for the government, told the court on Friday that all medicines and other equipment required at the hospitals for the management of patients were available and administered as per protocol.

The patients who died had been brought in critical condition from other hospitals.

“There are issues. There is no denying that. But it does not seem like there was any gross negligence by the hospitals. Of course, it is sad what has happened. People have died. Every death is unfortunate,” Saraf said.

He said the doctors and medical staff at the hospitals were burdened.

The bench sought to know how the government plans to strengthen public healthcare.

“How to strengthen it? Everything is there on paper but if it is not trickling down then there is no point. This is not just about procurement (of medicines and equipment) but the general state of healthcare in Maharashtra,” CJ Upadhyaya said.

“You (Maharashtra government) cannot escape by saying there is a burden. You are the State. You cannot shift the responsibility to the private player,” he added.

The court also noted that the state government has issued good policies but not implemented them.

The bench sought to know the cause of deaths in the hospitals in Nanded and Chhatrapati Sambhajinagar.

“How did the situation come to this? What happened?” Justice Doctor asked.

Saraf said smaller and private hospitals refer patients to public hospitals when their condition becomes critical.

“Most of the patients (who died in Nanded and Chhatrapati Sambhajinagar state hospitals) were referred to these hospitals when their condition was severely critical. Most of them died within a day...this includes infants,” Saraf said.

He claimed that earlier too there had been 11 to 20 deaths in a day in these hospitals.

“Public hospitals cannot ask people to go away. They try to accommodate everyone. At Nanded, there were 12 cases of infant deaths. Of this, only three were born at the government hospital. The remaining were brought in extremely critical condition from other hospitals,” Saraf said.

He added the government has formed a three-member committee, which will visit all government hospitals and submit reports.

The bench noted that the government has flagged the reasons behind the deaths as heavy inflow of patients, referral from private and smaller hospitals and patients being brought in extremely critical condition.

The bench also rued the decline in budgetary allocation for public healthcare in Maharashtra in the last three years.

“As per the report submitted by the government, in 2020- 21, 4.78 per cent of the total budget was allocated to public health. In 2021-22, it was 5.09 per cent, in 2022-23 it was 4.24 per cent and now in 2023-24 it is 4.01 per cent. The decline is thus visible,” the court said.

The court further lamented the vacancies in government hospitals and said in such hospitals, patient care work is mostly done by senior and junior resident doctors and staff.

“See the vacancy for senior residents (at the Nanded government hospital). Out of 97 posts for senior residents, only 49 posts are filled. 50 per cent vacancy...is this justifiable? How do you (government) justify this,” the court said.

The senior and junior doctors have heavy responsibilities and keeping these posts vacant cannot be accepted in any situation, CJ Upadhyaya said.

Saraf said additional posts were created in January this year due to which there were substantial vacancies. He said the posts would be filled soon.

The bench directed the Principal Secretaries of the Public Health Department and the Medical Education and Drugs Department to file affidavits furnishing details of sanctioned posts in all government hospitals and the vacancies against such posts.

The affidavits shall give details of the steps taken in the last six months to ensure the vacancies are filled, the court said.

The affidavits shall also disclose demands for medicines, medical goods and equipment made by the hospitals in Nanded and Chhatrapati Sambhajinagar in the last year and supplies made against such demands.

The affidavits shall be filed by October 30 when the court will hear the matter further.

The court also pulled up the Maharashtra government for not appointing a full-fledged Chief Executive Officer (CEO) for the Maharashtra Medicines Procurement Authority set up in May this year.

“The authority was set up in May. We are in October and still it does not have a full-fledged CEO. This is the problem. You (government) come up with good policies but when it comes to implementing nothing is done,” the HC said.

The bench directed for the CEO to be appointed within two weeks.

The court in its order noted that the incident has brought to the fore certain issues with regard to the state healthcare system that needs to be addressed by the Maharashtra government.

These include crucial problems faced by the hospitals such as vacancies, procurement of medicines and medical goods and equipment.

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