PARMANAND KATARA V.

UNION OF INDIA & ORS

[AIR 1989 SC 2039]

Court Supreme Court of India

Full name of case Pt. Parmanand Katara v. Union of India &

Ors
Petitioner Pt. Parmanand Katara

Respondent Union Of India

Decided 28/08/1989

Bench Misra Rangnath, G.L. Oza

Laws applied Art. 321 and Art. 212

1. INTRODUCTION:
The goals of medicine, as laid down in the Hippocratic Oath3, are founded on profound
moral-ethical principles, which require healthcare providers to be committed to the
mitigation of suffering, to uphold the primacy of life and to recognize their corresponding
obligations:

1
Article 32 in the Constitution of India, 1949 available at: https://indiankanoon.org/doc/981147/ (Last
visited on 5th February, 2019).
2
Article 21 in the Constitution of India, 1949 available at: https://www.lawctopus.com/academike/article-
21-of-the-constitution-of-india-right-to-life-and-personal-liberty/ (Last visited on 5th February, 2019).
3
The Hippocratic Oath, available at: https://lsnaith.wikispaces.com/file/view/Hippocratic+Oath.pdf (Last
visited on 5th February, 2019)
(1) Historically, the medical profession has grown beyond the individual doctor–patient or
researcher–subject relationship, characterized by mere care giving, into a complex
organization that exercises power and authority, influences political decisions concerning
healthcare, and functions even as a business enterprise.
(2). Codified bioethics principles evolved in close relation to medical research under varied
historical circumstances, and have had a greater influence on research ethics than on the
practice of medical care.
(3). Consequently, the process of translating the noble goals of medicine and integrating
ethical principles into public health ethics as operating principles of the healthcare system
has been slow and fraught with struggle.
(4). Globally, in the face of violations of the human right to health and the breach of ethical
principles in health and medical care, citizens have resorted to the judicial-legal system,
which has resulted in a process referred to as “judicialization of healthcare”
(5). Judicial-legal principles emerging from court judgments are referred to as public
healthcare or social rights jurisprudence and quite often have ethical-moral overtones.
Legal scholars have alluded to the influence of such jurisprudence on healthcare policies
in several countries.
(6). In India, violations of patients’ rights have worsened into a widespread systemic
phenomenon on account of the low political priority given to public health in policy and
planning.
(7). The major systemic challenges in healthcare are inadequate financial, human and
infrastructural resources.
(8). The lack of regulatory measures to oversee the private healthcare sector, and the lack
of measures aimed at protecting patients’ rights.
(9). Historically, litigations related to the denial of life-saving care, including emergency
medical care, in the 1980s set a precedent for healthcare litigations. This paved the way for
a rudimentary judicial discourse on ethical principles in the apex court of the country.
(10). The issue of emergency medical care, which often includes dealing with life and death
situations, brings into sharp focus several intersecting concerns regarding health services,
the rights of patients, and the duty of the State and medical profession. The indignity caused
by the refusal to treat patients in critical condition, resulting in the loss of life, undue
suffering, consequent morbidity and financial loss has been challenged in courts on the
ground of moral-ethical principles that form the core of the medical profession and the
raison d’être of the healthcare system in a welfare State.
The Constitution envisages the establishment of a welfare state at the federal level as well
as at the state level. In a welfare state the primary duty of the Government is to secure the
welfare of the people. Providing adequate medical facilities for the people is an essential
part of the obligations undertaken by the Government in a welfare state. The Government
discharges this obligation by running hospitals and health centres which provide medical
care to the person seeking to avail those facilities. Article 21 imposes an obligation on the
State to safeguard the right to life of every person. Preservation of human life is of
paramount importance4. The Govt. hospitals run by State and the medical officers
employed therein are duty bound to extend medical assistance for preserving human life.
Failure on the part of a Govt. hospital to provide timely medical treatment to a person in,
results in violation of his right to life.

2. FACTS OF THE CASE5:

1. A writ petition was filed in the Supreme Court of India by a public spirited person,
Pt Parmanand Katara, in response to a news report of a scooterist who was knocked
down by a car and died due to lack of medical treatment.
2. The scooterist was taken to the nearest hospital soon after the accident, but was
turned away and sent to another hospital 20km away which was authorized to
handle medico-legal cases.
3. The scooterist died while he was being taken to another hospital.
4. The petitioner sought the issuance of a specific direction to the Union of India by
Supreme Court which read as: “Every citizen brought for treatment should
instantaneously be given medical aid to preserve life and thereafter the procedural
criminal law should be allowed to operate to avoid negligent death and in the event
of breach of such direction, apart from any action that may be taken for negligence,
appropriate compensation should be admissible.”6
5. Along with the Union of India, the Medical Council of India and Indian Medical
Association were impleaded as respondents.

3. PROCEDURAL HISTORY7:
The Union of India, through its Ministry of Health And Family Welfare, referred to the
decisions of a committee chaired by Director General of Health Services, highlighting that
such decisions mandated all doctors to immediately treat patients without waiting for
completion of police formalities. But, despite government attention to this issue, no
discernable improvement could be detected; hospitals and doctors were still refusing
patients due to medico-legal issues.

4
Article 21 in the Constitution of India, 1949 available at: https://www.lawctopus.com/academike/article-
21-of-the-constitution-of-india-right-to-life-and-personal-liberty/ (Last visited on 5th February, 2019).
5
Parmanand Katara v Union of India, 1989 available at: http://www.satyamevjayate.in/road-accidents-or-
murders/episode-2article.aspx?uid=s3e2-ar-a2 (last visited on 5th February, 2019).
6
Pt Parmanand Katara v. Union Of India, available at: https://uniteforreprorights.org/resources/pt-
parmanand-katara-v-union-india/#summary-of-facts ( last visited on 5th February, 2019)
7
Ibid
The Union of India further stated that nothing in the Indian Penal Code 1860, Criminal
Procedure Code 1973, Motor Vehicles Act 1988 or any other legislation prevented doctors
from assisting those injured in accidents.
The Medical Council of India referred to its Code of Medical Ethics, which states that
medical professionals need to attend injured persons immediately without wanting for a
police report or completion of other police formalities. It further submitted that it is in the
public interest for health care providers to be able to provide immediate care without
waiting for legal formalities and for doctors to be indemnified under the law in cases where
they proceed to provide immediate care with the scope of their professional duties.
The medical association submitted an affidavit recognizing that certain police rules and the
Cr.PC necessitate certain legal formalities occur before a victim receives medical aid in
order to preserve evidence and that such requirements can sometimes result in the death of
serious injured individuals.

4. LEGAL ISSUES/ QUESTIONS OF LAW:

There were three issues8 before Supreme Court:
Issue 1. Whether there are any legal impediments that hindered timely treatment in
medico-legal cases?
Issue 2. What is the nature of the duty of the government, the government hospital
and the police in medico-legal cases?
Issue 3.Whether private hospitals could refuse to treat medico-legal cases?
The Medical Council of India in its affidavit stated that though doctors are not bound to
treat every case they cannot refuse an emergency case on humanitarian grounds and the
noble tradition of the profession necessitates this. The affidavit stated that the doctors were
reluctant to undertake medico-legal cases because of unnecessary harassment by the police
during the course of investigation and trial. The MCI urged that doctors attending medico-
legal cases should be indemnified under the law from any action by the government/ police
authorities so that it is conducive for doctors to perform their duties. Criminal procedure
should be amended so that injured persons may be treated immediately without waiting for
a police report or completion of police formalities.
The Indian Evidence Act should also be amended so that the diary maintained by doctors
in the regular course of their work is admissible as evidence for the purposes of the medico-
legal cases in place of their presence during trial to prove the same. A report of the

8
Judicial intervention and the role of Hon’ble Supreme Court available at:
http://shodhganga.inflibnet.ac.in/bitstream/10603/130522/12/12_chapter%205.pdf (Last visited on 6th
February, 2019).
Committee headed by the Director General of Health Services was filed. It had taken the
following decisions:
1. Whenever any medico-legal case attends the hospital, the medical officer on duty should
inform the Duty Constable, name, age, sex of the patient and place and time of occurrence
of the incident, and should start the required treatment of the patient. It will be the duty of
the Constable on duty to inform the concerned Police Station or higher police functionaries
for further action. Full medical report should be prepared and given to the Police, as soon
as examination and treatment of the patient is over. The treatment of the patient would not
wait for the arrival of the Police or completing the legal formalities.
2. Zonalization as has been worked out for the hospitals to deal with medico-legal cases
will only apply to those cases brought by the Police. The medico-legal cases coming to
hospital of their own (even if the incident has occurred in the zone of other hospital) will
not be denied the treatment by the hospital where the case reports, nor the case will be
referred to other hospital because the incident has occurred in the area which belongs to
the zone of any other hospital. The same police formalities as given in para 1 above will
be followed in these cases.
All Government Hospitals, Medical Institutes should be asked to provide the immediate
medical aid to all the cases irrespective of the fact whether they are medico-legal cases or
otherwise. The practice of certain Government institutions to refuse even the primary
medical aid to the patient and referring them to other hospitals simply because they are
medico-legal cases is not desirable. However, after providing the primary medical aid to
the patient, patient can be referred to the hospital if the expertise facilities required for the
treatment are not available in that Institution.
The Union government filed its affidavit and denied that there was any legal impediment
in criminal procedural law to hinder treatment in emergency cases. The affidavit
mentioned, “There are no provisions in the Indian Penal Code, Criminal Procedure Code,
Motor Vehicles Act, etc. which prevent doctors from quickly attending seriously injured
persons and accident case before the arrival of the Police and their taking into cognizance
of such cases, preparation of F.I.R. and other formalities by the Police.
The Supreme Court, agreeing with this, held that- There is no legal impediment for a
medical professional when he is called upon or requested to attend to an injured person
needing his medical assistance immediately. The effort to save the person should be the
top priority not only of the medical professional but even of the police or any other citizen
who happens to be connected with the matter or who happens to notice an incident or a
situation. Preservation of human life is of paramount importance. That is so on account of
the fact that once life is lost, the status quo ante cannot be restored as resurrection is beyond
the capacity of man. The patient whether he is innocent person or liable to be punished
under the laws of the society, it is the obligation of those who are in charge of the health
of the community to preserve life so that innocent may be protected and the guilty may be
punished. Social laws do not contemplate death due to negligence to tantamount to legal
punishment. A doctor at the Government hospital positioned to meet the State obligation
is, therefore, duty bound to extend medical assistance for preserving life.9

5. OBITER DICTA:
As per G.L. Oza, J. - It is expected of the members of the legal profession which is the
other honorable the persons in the medical profession and see that they are not called to
give evidence so long as it is not necessary. It is also expected that where the facts are so
clear it is expected that unnecessary harassment of the members of the medical profession
either by way of requests for adjournments or by cross examination should be avoided so
tha the apprehension that the men in medical profession have which prevents them from
discharging their duty to a suffering person who needs their assistance utmost is removed
and a citizen needing the assistance of a man in the medical profession receives it.
Oza, J further said that “ I entirely agree with what has been observed by my learned brother
and also agree with the directions indicated in the Order made by Hon’ble Shri Justice R.N
Misra but I would like to add:
As has been quoted by my learned brother, a high power Committee by the Government
of India was appointed at a high level and this was long before and the proceedings of 29th
May, 1986 have been filed and have also been quoted. The Medical Council of India along
with their affidavit have filed Code of Medical Ethics which everyone in the medical
profession is of 1988. The Code of Medical Ethics framed by 23rd Oct. 1970. This only
reveals an unfortunate state of affairs where the decisions are taken at the higher level good
intention and for public good but unfortunately do not reach the common man and it only
remains text good to read and attractive quote.”10
As per Ranganath Misra, J. – The petitioner who claims himself to be a ‘small human right
activist and fighting for the good causes for the general public interest’ filed this application
under Art. 32 of the Constitution asking for a direction to the Union of India that every
citizen brought for treatment should instantaneously be given medical aid to preserve life
and thereafter the procedural criminal law should be allowed to operate in order to avoid
negligent death and in the event of breach of such directions, apart from any action that
may be taken for negligence, appropriate compensation should be admissible. He appended
to the writ petition report entitled ‘Law helps injured to die’ published in the Hindustan
Times.
In the said publication it was alleged that a scooterist was knocked down by a speeding car.
Seeing the profusely bleeding scooterist, a person who was on the road, picked up the
injured and took him to the nearest hospital. The doctors refused to attend on the injured
and told that he should take the patient to a named different hospital located 20km away

9
Pt Parmanand Katara v. Union of India & Ors on 28th August, 1989, available at:
https://indiankanoon.org/doc/498126/ ( Last visited on 5th February, 2019)
10
Parmanand Katara v. Union of India, AIR 1989 SC 2039.
authorized to handle medico-legal cases. The Samaritan carried the victim, lost no time to
approach the other hospital but before he could reach, the victim succumbed to his
injuries.11

6. RATION DECIDENDI/ JUDGMENT:

6.1.Summary of judgment:
Apex Court observed:
“There can be no second opinion that preservation of human life is of paramount
importance. That is so on account of the fact that once life is lost, the status quo ante cannot
be restored as resurrection is beyond the capacity of man. The patient whether he be an
innocent or be a criminal liable to punishment under the laws of society, it is the obligation
of those who are in charge of the health of the community to preserve life so that the
innocent may be protected and the guilty may be punished. Social laws do not contemplate
death by negligence to tantamount to legal punishment.
Art 21 of the Constitution casts the obligation on the State to preserve life. The provision
as explained by this Court in scores of decisions has emphasized and reiterated with
gradually increasing emphasis that position. A doctor at the Government hospital position
to meet this State obligation is, therefore, duty bound to extend his services with due
expertise for protecting life. No law or State action can intervene to avoid/delay the
discharge of the paramount obligation cast upon members of the medical profession. The
obligation being total, absolute and paramount, laws of procedure whether in statutes or
otherwise which would interfere with the discharge of this obligation cannot be sustained
and must, therefore, give away.”12
6.2.Judgment in detail13:
Supreme Court held:
The Secretary, Ministry of Health and Family Welfare of the Union of India, the Medical
Council of India and the Indian Medical Association were later imp leaded as respondents
and return to the rule has been made by each of them. On behalf of the Union of India, the
Under Secretary in the Ministry of Health and Family Welfare filed an affidavit appending
the proceedings of the meeting held on 29-5-1986 in which the Director- General of Health
Services acted as Chairman. Along with the affidavit, decisions or papers relating to the
steps taken from time to time in matters relating to matters relevant to the application but
confined to the Union Territory of Delhi were filed. A report in May, 1983, submitted by

11
Parmanand Katara v. Union of India, AIR 1989 SC 2039.
12
Parmanand Katara v. Union of India, available at: https://indiankanoon.org/doc/498126/ (Last visited on
6th February, 2019).
13
Parmanand Katara v. Union of India, AIR 1989 SC 2039.
the Sub-Committee set up by the Home Department of the Delhi Administration on
Medico-Legal Centres and Medico-legal Services has also been produced.
The Secretary of the Medical Council of India in his affidavit referred to clauses 10 and 13
of the Code of Medical Ethics drawn up with the approval of the Central Government under
S. 33 of the Act by the Council, wherein it had been said : that Though a physician is not
bound to treat each and every one asking his services except in emergencies for the sake of
humanity and the noble traditions of the profession, he should not only he ever ready to
respond to the calls of the sick and the injured, but should be mindful of the high character
of-his mission and the responsibility be incurs in the discharge of his ministrations, he
should never forget that the health and the lives of those entrusted to his care depend on
his skill and attention. A physician should Endeavour to add to the comfort of the sick by
making his visits at the hour indicated to the patients.
The patient must be priority:
A physician is free to choose whom he will serve. He should, however, respond to any
request for his assistance in an emergency or whenever temperate public opinion expects
the service. Once having undertaken a case, the physician should not neglect the patient,
nor should he withdraw from the case without giving notice to the patient, his relatives or
his responsible friends sufficiently long in advance of his withdrawal to allow them to
secure another medical attendant. No provisionally or fully registered medical practitioner
shall willfully commit an act of negligence that may deprive his patient or patients from
necessary medical care."
7. There can be no second opinion that preservation of human life is of paramount
importance. That is so on account of the fact that once life is lost, the status quo ante cannot
be restored as resurrection is beyond 'the capacity of man. The patient whether he be an
innocent person or be a criminal liable to punishment under the laws of the society, it is the
obligation of those who are in charge of the health of the community to preserve ,life so
that the innocent may be protected and the guilty may be punished. Social laws do not
contemplate death by negligence to tantamount to legal punishment.
8. Article 21 of the Constitution casts the obligation on the State to preserve life. The
provision as explained by this Court in scores of decisions has emphasized and reiterated
with gradually increasing emphasis on that position. A doctor at the Government hospital
positioned to meet this State obligation is, therefore, duty-bound to extend medical
assistance for preserving life.
Every doctor whether at a Government hospital or otherwise has the professional obligation
to extend his services with due expertise for protecting life. No law or State action can
intervene to avoid/delay the discharge of the paramount obligation cast upon members of
the medical profession. The obligation being total, absolute -and paramount, laws of
procedure whether in statutes or otherwise, which would interfere with the discharge of
this obligation cannot be sustained and must therefore, give way.
On this basis, we have not issued notices to the States and Union Territories for affording
them an opportunity, of being heard before we accepted the statement made in the affidavit
of the Union of India that there is no impediment in the law.
The matter is extremely urgent and in our view, brooks no delay to remind every doctor of
his total obligation and assure him of the position that he does not contravene the law of
the land by proceeding to treat the injured victim on his appearance before him either by
himself or being carried by others.
We must make it clear that zonal regulations and classifications cannot also operate as
fetters in the process of discharge of the obligation and irrespective of the fact whether
under instructions or rules, the victim has to be sent elsewhere or how the police shall be
contacted, the guideline indicated in the 1985 decision of the Committee, as extracted
above, is to become operative. We order accordingly.
9. We are of the view that every doctor wherever he be within the territory of India should
forthwith be aware of this position and, therefore, we direct that this decision of ours shall
be published in all journals reporting decisions of this Court and adequate publicity
highlighting these aspects should be given by the national media -as also through the
Doordarshan and the All India Radio.
The Registry shall forward adequate number of copies of this judgment to every High Court
so that without delay the respective High Courts can forward them to every Sessions Judge
within their respective jurisdictions and the Sessions Judges in their turn shall give due
publicity to the same within their jurisdictions. The Medical Council of India shall forward
copies of this judgment to every medical college affiliated to it. Copies of the judgment
shall be forwarded to every State Government with a direction that wide publicity should
be given about the relevant aspects so that every practicing doctor would soon become
aware of the position.
10. In case the State Governments and the Union Territories which have not been heard
file any representation against the direction, they shall have liberty to appear before this
Court and ask for appropriate direction within three months from now. Applications filed
after that date shall not be entertained by the Registry of this Court. Until altered, this
judgment shall be followed.
11. Before we part with the case we place on record our appreciation of the services
rendered by the petitioner by inviting the attention of the Court to the problem raised in
this case. We must also place on record in our appreciation of the co-operation and
understanding exhibited by the Union of India in the relevant Ministry, the Medical
Council of India and the Indian Medical Association. It could not be forgotten that seeing
an injured man in a miserable condition the human instinct of every citizen moves him to
rush for help and do all that can be done to save the life. It could not be disputed that in
spite of development economic, political and cultural still citizens are human beings and
all the more when a man in such a miserable state hanging between life and death reaches
the medical practitioner either in a hospital (run or managed by the State) public authority
or a private person or, a medical professional doing only private practice he is always called
upon to rush to help such an injured person and to do all that within his power to save life.
So far as this duty of a medical professional is concerned its duty coupled with human
instinct, it needs no decision nor any code of ethics nor any rule or law. Still in the Code
of Medical Ethics framed by the Medical Council of India Item 13 specifically provides
for it. Item 13 reads as under:
A physician is free to choose whom he will serve. He should, however, respond to any
request for his assistance in an emergency or whenever temperate public opinion expects
the service. Once having undertaken a case, the physician should not neglect the patient,
nor should he withdraw from the case without giving notice to the patient, his relatives or
his responsible friends sufficiently long in advance of his withdrawal to allow them to
secure another medical attendant. No provisionally or fully registered medical practitioner
shall willfully commit an act of negligence that may deprive his patient or patients from
necessary medical care."
Medical profession is a very respectable profession. Doctor is looked upon by common
man as the only hope when a person is hanging between life and death but they avoid their
duty to help a person when he is facing death when they know that it is a medico-legal
case.
To know the response of the medical profession the Medical Council of India and also the
All India Medical Association were noticed and were requested to put up their cases. Some
apprehensions were expressed because of some misunderstanding about the law of
procedure and the police regulations and the priorities in such situations. On the basis of
the affidavit filed by the Union of India and considering the matter it is clear that there is
no legal impediment for a medical professional when he is called upon or requested to
attend to an injured person needing his medical assistance immediately.
There is also no doubt that the effort to save the person should be the top priority not only
of the medical professional but even of the police or any other citizen who happens to be
connected with the matter or who happens to notice such an incident or a situation.
But on behalf of the medical profession there is one more apprehension which sometimes
prevents a medical professional in spite of his desire to help the person, as he apprehends
that he will be a witness and may have to face the police interrogation which sometimes
may need going to the police station repeatedly and waiting and also to be a witness in a
court of law where also he apprehends that he may have to go on number of days and may
have to wait for a long time and may have to face sometimes long unnecessary cross
examination which sometimes may even be humiliating for a man in the medical profession
and in our opinion it is this apprehension which prevents a medical professional who is not
entrusted with the duty of handling medico-legal cases to do the needful, he always tries to
avoid and even if approached directs the person concerned to go to a State hospital and
particularly to the person who is in-charge of the medico-legal cases.
We, therefore, have no hesitation in assuring the persons in the medical profession that
these apprehensions, even if have some foundation, should not prevent them from
discharging their duty as a medical professional to save a human life and to do all that is
necessary but at the same time we hope and trust that with this expectation from the
members of the medical profession, the police, the members of the legal profession, our
law courts and everyone concerned will also keep in mind that a man in the medical
profession should not be unnecessarily harassed for purposes of interrogation or for any
other formalities and should not be dragged during investigations at the police station and
it should be avoided as far as possible.
We also hope and trust that our law courts will not summon a medical professional to give
evidence unless the evidence is necessary and even if he is summoned attempt should be
made to see that the men in this profession are not made to wait and waste time
unnecessarily and it is known that our law courts always have respect for the men in the
medical profession and they are called to give evidence when necessary and attempts are
made so that they may not have to wait for long.
We have no hesitation in saying that; it is expected of the members of the legal profession
which is the other honorable, profession to honour the persons in the medical profession
and see that they are not called to give evidence so long as it is not necessary, it is also
expected that where the facts are so clear it is expected that unnecessary harassment of the
members of the medical profession either by way of request for adjournments or by cross-
examination should be avoided so that the apprehension that the men in the medical
profession have which prevents them from discharging their duty to a suffering person who
needs their assistance utmost, is removed and a citizen needing the assistance of a man in
the medical profession receives it.
We would also like to mention that whenever on such occasions a man of the medical
profession is approached and if he finds that whatever assistance he could give is not
sufficient really to save the life of the person but some better assistance is necessary it is
also the duty of the man in the medical profession so approached to render all the help
which he could and also see that the person reaches the proper expert as early as possible.

7. ANALYSIS AND DISCUSSION:

In considering the plea of petitioner for immediate treatment of injured persons in medico-
legal cases, the Court through the presiding judge recognized that Article 21 of Constitution
placed an obligation on the State to preserve life and doctors at government hospitals are
therefore required to provide medical assistance in order to preserve life. The Court
recognized on immediate treatment of injured persons of the committee chaired by Director
General of Health Services and made these decisions operative. Furthermore, the Court
recognized that all doctors – whether at government hospitals or otherwise- are under a
professional obligation to provide services to protect life. The Court also recognized this
applies to all patients, even those who may have committed a crime.
The Court ordered that no law or state action can discharge medical professionals from
their paramount duty to administer life-saving care. It further ordered that the judgment be
publicize widely to ensure medical professionals across the country were aware of the
position in relation to medico-legal cases.
In a concurring opinion, Justice G.L. Oza further recognized that saving an individual’s
life should always be on the top priority of medical professionals, as well as of police and
of any citizen involved in or witnessing the incident. Justice Oza called for legal
professionals and the Courts to recognize that medical professionals should not be
harassed. Further, Justice Oza recognized that courts should not summon medical
professions unless their evidence is necessary, and in such cases, efforts should be made to
ensure that their time is not unnecessarily wasted.14

8. MILE STONE CASES IN MEDICO-LEGAL CASES IN EMERGENCY

CASES:
8.1.Obligation to Provide Emergency Health Care: In Paschim Banga Khet
Mazdoor Samiti vs. State of W.B. (1996)4 SCC 3715, the issue before the
Supreme Court was the legal obligation of the Government to provide facilities in
government hospitals for treatment of persons who had sustained serious injuries
and required immediate medical attention.
The petitioner who had suffered brain hemorrhage in a fall from the train was
denied treatment at various government hospitals because of non-availability of
beds. The patient was given first aid in a PHC and referred to a specialized state
hospital for better treatment. 4 Tortuous liability arises from the breach of a duty
primarily fixed by law.
In the case of doctors it is negligence in treatment at the specialized hospital, the
patient was examined and X-rays of his skull were taken which showed his
condition to be serious. Immediate admission for further treatment was
recommended. However, he was not admitted in that hospital as there were no
vacant beds, and was referred to another specialized hospital.
There too, he was refused admission as there were no vacant beds. After doing the
rounds of three more State run specialized hospitals, the patient was admitted to a
private hospital and the final bill came to much more than he could afford. He had
to spend Rs. 17,000 for his treatment.
The West Bengal government justified its action on the ground that the petitioner
could not have been kept on the floor of a hospital or trolley because such an
arrangement of treatment was fraught with grave risks of cross-infection, and
moreover there was a lack of facility for proper care after the operation. The

14
Right to immediate medical aid, available at: http://www.satyamevjayate.in/road-accidents-or-
murders/episode-2article.aspx?uid=s3e2-ar-a2 (Last visited on 6th February, 2019).
15
Pachim Banga Khet Mazdoor Samity v. State of West Bengal& Anr on 6th May, 1996 SCC (4) 37 available
at: https://indiankanoon.org/doc/1743022/ ( Last visited on 7th February, 2019).
 government of West Bengal further stated that state hospitals catered to the need of
poor and indigent patients, and 90 per cent of the beds maintained by the state
government all over the state, were designated as free beds for treatment of such
patients. During the hearing of the case, the state government appointed an enquiry
committee to investigate the matter.
It concluded: Even in excess of the sanctioned beds some patients are kept on the
trolley-beds in the morning and that even if it is dangerous to keep a patient with
head injuries on a trolley-bed he could very well be kept for the time being on the
floor and could be transferred to the cold ward, as the situation demanded,
temporarily.
In the instant case, the Emergency Medical Officer (EMO) concerned should have
taken some measure to admit the petitioner and he is, therefore, responsible for non-
admission in the said hospital. In a situation of this kind, the Superintendent of the
hospital should take some measures to give guidelines to the respective medical
officers so that a patient is not refused admission when his condition is grave… The
EMO should have contacted the superior authority over the telephone if there was
any stringency as to the beds available and admit the patient in spite of the total
sanctioned beds not having been available.
The Superintendent should have given guidelines to respective medical Officers for
admitting serious cases under any circumstances and thus in a way the
Superintendent was responsible for this general administration. Various
recommendations made by the Enquiry Committee were adopted by the state
government and the following directions were issued by the West Bengal State
Government to health centres/OPD/ Emergency Departments of hospitals in
dealing with patients:
1. Proper medical aid within the scope of the equipments and facilities available at the
Health Centres and hospitals should be provided to such patients and proper records of the
treatment given should be maintained and preserved. The guiding principle should be to
ensure that no emergency case is denied medical care. All possibilities should be explored
to accommodate emergency patients in serious condition. To avoid confusion
Admission/Emergency Attendance.
Registers shall contain a clear recording of the following information:
a) name, age, sex, address, disease of the patient by the attending MO;
b) date and time of attendance/examination/admission of the patient; and
c) whether and where the patient has been admitted, transferred, referred; Further, there
should be periodical inspection of the arrangement by the Superintendent and responsibility
fixed for maintenance and safe custody of the registers.
2. Emergency Medical Officers will get in touch with Superintendent/Deputy
Superintendent/ Specialist Medical Officer for taking beds on loan from cold wards for
accommodating such patients as extra-temporary measures.
3. Superintendents of hospitals will issue regulatory guidelines for admitting such patients
on internal adjustments amongst various wards and different kinds of beds including cold
beds and will hold regular weekly meetings for monitoring and reviewing the situation.
4. If feasible, such patients should be accommodated in trolley-beds and, even, on the floor
when it is absolutely necessary during the exercise towards internal adjustments as referred
to above. The Enquiry Committee made certain other suggestions which were also accepted
by the state government:
 A central Bed Bureau should be set up which should be equipped with wireless or
other communication facilities to find out where a particular emergency patient can
be accommodated when a particular hospital finds itself absolutely helpless to
admit a patient because of physical limitations. In such cases the hospital concerned
should contact immediately the Central Bed Bureau which will communicate with
other hospitals and decide in which hospital an emergency serious patient is to be
admitted.
 Some casualty hospitals or trauma units should be set up at some points on regional
basis.
 The intermediate group of hospitals, viz., the district, sub-division and the State
general hospitals should be upgraded so that a patient in a serious condition may
get treatment locally. Apart from directions of the government of West Bengal and
the recommendations of the Enquiry Committee, the Supreme Court made some
additional recommendations:
a) Adequate facilities should be available at the PHCs where the patient can be given basic
treatment and his condition stabilized.
b) Hospitals at the district and sub-divisional level should be upgraded so that serious cases
can be treated there.
c) Facilities for giving specialist treatment are to be increased and having regard to the
growing need, it must be made available at the district and sub-divisional level hospitals.
d) In order to ensure availability of bed in an emergency at state level hospitals, there
should be a centralized communication system so that the patient can be sent immediately
to the hospital where bed is available in respect of the treatment which is required.
e) Proper arrangement of ambulance should be made for transport of a patient from the
primary health centre to the district hospital or subdivisional hospital to the state hospital.
f) Ambulance should be adequately provided with the necessary equipment and medical
personnel. The Supreme Court observed that while financial resources would be required
for the implementation of the above directions, the constitutional obligation of State to
provide adequate medical services to the people cannot be ignored.
The Court also observed: “In the context of the constitutional obligation to provide free
legal aid to a poor accused this Court has held that the State cannot avoid its constitutional
obligation in that regard on account of financial constraints. (Khatri II vs. State Of Bihar).
These observations will apply with equal, if not greater, force in the matter of discharge of
constitutional obligation of the State to provide medical aid to preserve human life. In the
matter of allocation of funds for medical services the said constitutional obligation of the
State has to be kept in view.”
The Court held that it was necessary that a time bound plan for providing these services
should be chalked out keeping in view the recommendations of the Committee as well as
the requirements for ensuring availability of proper medical services in this regard as
indicated by us and steps should be taken to implement the same.
The Court also observed: Providing adequate medical facilities is an essential part of the
obligation undertaken by the State in a welfare state. The Government discharges this
obligation by running hospitals and health centres. Article 21 imposes an obligation on the
State to safeguard right to life of every person. Preservation of human life is thus of
paramount importance.
Government hospitals run by the state and the medical officers employed therein are duty
bound to extend medical assistance for preserving human life. Failure on the part of a
government hospital to provide timely medical treatment to a person in need of such
treatment results in violation of his right to life guaranteed under Article 21’ (para 9)
This case arose out of an incident in West Bengal. Other states were not parties to the case.
Also, the Committee was concerned with West Bengal and the directions were also given
by the West Bengal Government.
However, the Supreme Court observed that other states, though not parties, should also
take necessary steps in the light of the recommendations made by the Committee, the
directions contained in the Memorandum of the Government of West Bengal dated August
22, 1995 and the further directions given in the Judgment. Thus all the directions referred
to above, would be equally applicable to other states in the country. Besides, the Union of
India was a party to these proceedings.
The Court observed that since it was the joint obligation of the Centre as well as the States
to provide medical services it is expected that the Union of India would render the
necessary assistance in the improvement of the medical services in the country on these
lines. The Court also ordered that the Petitioner be paid Rs. 25,000 as compensation.
8.2. Labonya Moyee Chandra vs. State of West Bengal case16 reflected the lack of
seriousness of the State in executing its duties and the implementation of the
directions and recommendations in Paschim Banga Khet Mazdoor Samiti case. The
patient was an old woman residing in a village near the city of Burdwan who was
denied admission in SSKM, a state hospital on account of nonavailability of bed
even though her condition was recorded as critical. This hospital was also involved

16
Smt. Labonya Moyee Chandra v. State of West Bengal & Ors on 31 st July 1998, available at: https:
https://indiankanoon.org/doc/68349/ (Last visited on 7th February, 2019).
 in the earlier case of Paschim Banga Khet Mazdoor Samiti. The patient suffered
severe chest pain and difficulty in breathing.
The local doctor examined her, diagnosed a heart block and recommended
immediate hospitalization. She was taken to Burdwan where she was shown to
Burdwan Medical College hospital (BMCH) who referred her to cardiology
department of Seth Sukhlal Karnanl Medical College (SSKM) in Calcutta or any
other State hospital having cardiology department as they didn’t have the said
facility. At SSKM, RMO referred her to the cardiology department who informed
her that there were no vacant beds and referred her back to the RMO.
She instead got admitted to a private hospital where she underwent an operation
and a permanent pacemaker was implanted. There were two issues before the
Supreme Court:
 First, whether the patient was brought to SSKM hospital in a critical state,
and;
 Second, whether she was refused admission and ‘turned out at night’. The
Supreme Court considered the following evidence to conclude that the
patient indeed was in a critical state, based on the case notes and
prescription of the local doctor, the discharge certificate of the BMCH and
the endorsement of the cardiology RMO on the outdoor emergency
department ticket of the SSKM hospital:
a) The prescription of the local doctor recorded that patient was unconscious, suffering
from convulsion and frothing at the mouth. He diagnosed a complete heart block condition
known as Stokes-Adams. It is a medical term to designate occasional transient cessation of
the pulse and loss of consciousness, especially caused by heart block. ‘The condition of
such patient must be critical.’ Accordingly the local doctor advised urgent hospitalization,
and prescribed oxygen inhalation and medication.
b) Discharge certificate of BMCH described her condition as a ‘complete heart block’ and
referred her to a State hospital with a cardiology department.
c) The endorsement of the cardiology RMO on the outdoor emergency department ticket
of SSKM hospital also described her as suffering from a ‘complete heart block’ with S.A.
Attack. This clearly showed that Appellant’s condition was not stable as alleged by the
State.
As regards the second issue, the Supreme Court held that though the SSKM hospital did
not turn her out, she could not possibly have been expected to bear with the jostling
between the two departments when she was in a critical state. It was the responsibility of
the doctor in charge of the cardiology department who examined her, to ensure that a bed
was made available in any of the department so that she could be accommodated in SC
decided on 31/7/1998 7 the cardiology department as and when a vacancy arose.
The Supreme Court observed that despite the directions issued by it and the State
government in Paschim Banga Khet Mazdoor Samiti case there had been no compliance
of the same. The Appellant was denied treatment in BMCH on grounds of lack of proper
facility. This was despite the specific direction in Mazdoor Samiti case to upgrade facilities
and to set up specialist treatment in the district-level hospitals. “Clearly State Government
has not taken any follow up action to ensure that recommendations are implemented.”
There was no ‘centralized communication system’ set up with the help of which BMCH
could have referred the Appellant to a hospital that had vacant beds before setting her off
on a long journey in a critical state.
The ‘admission register’ maintained by SSKM hospital was not as per the guidelines set
out in the Mazdoor Samiti case. The entries were haphazardly and irresponsibly made.
They did not describe the medical condition of the Appellant although such a column had
been provided. The inquiry report submitted by SSKM hospital to the Court did not show
that a bed could not be arranged for the Appellant.
It was silent about the occupancy of beds in other departments. In the light of above
circumstances and lapses on the part of State and the government hospital to implement
the recommendations in Paschim Banga Khet Mazdoor Samiti17 case the Supreme Court
held the state liable to compensate the Appellant for the cost of the pacemaker assessed at
Rs.25, 000. Further, the State government was directed to take follow up action on the
implementation of the recommendations under the earlier case.

9. CONCLUSION:
Ethics-compliant healthcare in India can be revitalized on the basis of the core of ethics,
encapsulated in the Code of Medical Ethics and reinforced through ethics jurisprudence.
Several policy measures, including a comprehensive law to institutionalize ethical
principles for upholding the right to healthcare, would be required for streamlining ethics
in the public and private healthcare systems. Most importantly, medical professionals
themselves would have to show resoluteness in resurrecting and restoring the profession to
its noble ethical goals of patient care and mitigation of suffering. Ethically sensitive,
equitable and justice-oriented healthcare for the disadvantaged requires not only
determination on the part of the medical profession, but also a strong political will.

17
Pachim Banga Khet Mazdoor Samity v. State of West Bengal& Anr on 6 th May, 1996 SCC (4) 37
available at: https://indiankanoon.org/doc/1743022/ ( Last visited on 7th February, 2019).
10. BIBLIOGRAPHY:
 Article 32 in the Constitution of India, 1949 available at:
https://indiankanoon.org/doc/981147/ (Last visited on 5th February, 2019).
 Article 21 in the Constitution of India, 1949 available at:
https://www.lawctopus.com/academike/article-21-of-the-constitution-of-india-
right-to-life-and-personal-liberty/ (Last visited on 5th February, 2019).
 Pt Parmanand Katara v. Union of India & Ors on 28th August, 1989, available at:
https://indiankanoon.org/doc/498126/ (Last visited on 5th February, 2019).
 Parmanand Katara v. Union of India, AIR 1989 SC 2039.
 Parmanand Katara v Union of India, 1989 available at:
http://www.satyamevjayate.in/road-accidents-or-murders/episode-
2article.aspx?uid=s3e2-ar-a2 (last visited on 5th February, 2019).
 Pt Parmanand Katara v. Union of India, available at:
https://uniteforreprorights.org/resources/pt-parmanand-katara-v-union-
india/#summary-of-facts (Last visited on 5th February, 2019).
 Judicial intervention and the role of Hon’ble Supreme Court available at:
http://shodhganga.inflibnet.ac.in/bitstream/10603/130522/12/12_chapter%205.pdf
(Last visited on 6th February, 2019).
 Right to immediate medical aid, available at: http://www.satyamevjayate.in/road-
accidents-or-murders/episode-2article.aspx?uid=s3e2-ar-a2 (Last visited on 6th
February, 2019).
 Pachim Banga Khet Mazdoor Samity v. State of West Bengal& Anr on 6th May,
1996 SCC (4) 37 available at: https://indiankanoon.org/doc/1743022/ ( Last visited
on 7th February, 2019).
 Smt. Labonya Moyee Chandra v. State of West Bengal & Ors on 31st July 1998,
available at: https: https://indiankanoon.org/doc/68349/ (Last visited on 7th
February, 2019).
 Law Commission of India, 201st report on emergency medical care to victims of
accidents and during emergency medical condition and women under labour,
available at: http://lawcommissionofindia.nic.in/reports/rep201.pdf (Last visited
on 7th February, 2019).
 The Hippocratic Oath, available at:
https://lsnaith.wikispaces.com/file/view/Hippocratic+Oath.pdf (Last visited on 7th
February, 2019)