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Emergency medical assistance: Pt. Parmanand Katara v. Union of India & Ors.
Citation: (1989) 4 SCC 286
Date of judgement: 08 September 1989
Introduction
Right to health forms an indispensable part of the fundamental Right to life under Article 21. The obligation of fulfilling this right passes over to medical practitioners in cases of accidents and emergencies as a victim’s life rests in the skill and treatment given to him. Nonetheless, victims of accidents are denied treatment and redirected to other hospitals due to mental apprehensions against medico-legal cases.
A Medico-legal case (MLC) involves an injury or ailment whereby affixing of liability by a law enforcement agency is necessary owing to the circumstances. [1] Such cases involve legal implications due to the nature and cause for such injury and require additional work by practitioners under the name of formalities. Victims have thus been denied treatment due to the fear of being pegged for providing evidence, being questioned by the police, presenting themselves before a Court, and getting cross-examined.
Facts:
An article was published in the Hindustan Times in 1988 which expressed that a motorist involved in an accident succumbed to his injuries on grounds of denial of treatment by the nearest hospital. The victim in that matter was denied admission on medico-legal grounds and was redirected to another.
The petitioner, a human rights activist, came across the contents of this article and thus filed a writ petition before the Hon’ble Supreme Court. The petition sought the issuance of a direction to the Union of India to ensure instantaneous medical aid to those injured. He subsequently sought a procedural criminal law to avoid deaths caused by negligence in such matters and compensations for the same. Thus, the Ministry of Health & Family Welfare, the Indian Medical Council & the Indian Medical Association were impleaded as respondents to the matter.
Submissions by the parties:
Contrary to the general trend in petitions with two opposing parties, the respondents’ contentions were on the same lines as petitioners with more input towards the legal aspect and measures incorporated by them. The hindrance in this process was contented to be caused by statutory needs to fulfill legal formalities in the presence of a police officer before administering treatment. The Medical Council, one of the respondents, raised 2 relevant clauses of the Code of Medical Ethics, 1970 that imposed a duty upon doctors to render their services.
Clause 10 stated that a physician was not bound to treat every sick person. However, in cases of emergency, it would be an obligation on a medical practitioner to be ready to respond and render service. Clause 13 of the Code expressed that the freedom to choose whom to serve would be available in cases except for emergencies. It also held that a practitioner ought not to withdraw himself from treating someone and barred willful commission of negligence.
The aforementioned clauses conveyed the duty imposed on medical practitioners to serve and treat those injured to their best without recusing themselves from performing their duty. A close reading of Clause 13 also connotes that it strictly barred willful negligence to establish the same degree of care and skill while dealing with emergencies. It was evident that the Medical Council by itself had expectations from practitioners.
Legislations such as the Indian Penal Code, CrPC, or the Motor Vehicles Act did not restrict from providing treatment before completing formalities. The life of a person is indubitably more valuable than medical formalities and to ensure the same, amendments would have to be effectuated to be able to give immediate medical care and relief. The respondents also suggested an amendment to the Indian Evidence Act to consider a doctor’s diary as evidence for accident cases to avoid the hassles of going to court.
Despite showing that these legislations did not bar practitioners from rendering aid, the ground reality of cases had cast several doubts and fears into the minds of these practitioners who wished to steer clear from litigation.
Judgement:
The learned judges recognized that the matter could not be kept at bay as it was of severe importance. The rationale behind having medical formalities for such cases was to keep the evidence intact. However, the inherent issues in the procedure resulted in delays. The Court also acknowledged that the general public was afraid of assisting those injured due to the fear of being asked to present evidence as a witness and produce themselves before courts.
In 1986, a Committee under the Chairmanship of the Director-General of Health Services even came about with directions to ensure immediate assistance. The directions imposed responsibility on the Duty Constable to report to the Police Station. The direction expressly stated that the treatment of an individual would happen immediately regardless of the completion of formalities. To conclude, all government hospitals and medical institutes were mandated to provide emergency medical aid regardless of them being medico-legal or not.
Justice Ranganath Misra held that the submissions by the parties made it evident that both the Centre and States had taken the matter seriously but were unable to clear the air of confusion around it. He upheld the view that it was the duty of a medical practitioner to treat either an innocent person or a criminal liable for punishment. Such treatment would be to preserve the life of that innocent person or to ensure that the guilty would be punished.
Protection of life was held to be a sacred duty of the State under Article 21. Nonetheless, the right had an overarching effect that would make it mandatory for each doctor, whether from a private or governmental hospital, to extend his services with expertise to preserve life. It was hence decided that this obligation was paramount and any law or procedure that hindered it would have to step away.
To ensure that the order would be complied with, the learned judge ordered the reporting of the decision in all journals reporting for the Supreme Court while also adding publicity through Doordarshan and All India Radio. A copy of the order was directed to be forwarded to every High Court and Sessions judge within the country while also forwarding it to State Governments and affiliated medical colleges to ensure that there would be no more confusion.
Justice Oza concurred with the verdict penned by Justice Misra but added on to the practical state of affairs. He held that relevant directions, Code of Ethics, and legislative clarity were in place even before the occurrence of the accident that resulted in this petition. The issue was recognized to be the failure to communicate well-intended high-level decisions to the common man.
The learned judge opined that there were no impediments caused by the legislative framework that barred a practitioner from giving treatment. He also added that this duty of saving lives rested with the public and police as well and that apprehensions about the same had to be cleared for all.
In order to alleviate the rooted fear of being called to courts, the learned judge ordered the taking of practitioners to police stations to be confined to exceptional cases. It was also added that courts had to disperse matters expeditiously and not utilize too much time of practitioners if they were summoned for cross-examination or to produce evidence. In conclusion, medical practitioners were direct to provide services to their best and if they felt that their assistance wouldn’t suffice, they were to ensure that the patient was directed to an expert as soon as possible.
Conclusion:
The Division Bench of the Hon’ble Apex Court upheld that right to life was paramount and would override medical and legal formalities in case of emergency aid. The Code of 1970 was later revised into the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations in 2002 which entails similar clauses concerning obligations of doctors. The scope of the right to health has been expanding ever since with decisions such as that in Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37 and State v. Sanjeev Nanda, (2012) 8 SCC 450 debunking the confusion surrounding emergency medical aid. Helping individuals in need of immediate medical assistance is the duty of the public as well as medical practitioners and law enforcement agencies. No law will come in the way to hinder a person’s right to receive medical assistance under Article 21 and no practitioner is to be subject to harassment in the name of formalities.
[1] Medicolegal Issues : Guidelines To Medical Officers, National Health Systems Resource Centre, http://qi.nhsrcindia.org/sites/default/files/medico_legal.pdf.
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