The Supreme Court is set to hear a case on Monday regarding the implementation of comprehensive guidelines aimed at regulating the functioning of Intensive Care Units and Critical Care Units throughout the country.
In a report from September, it was revealed that only 8 states and Union territories (UTs) have adopted the Union government’s guidelines, which were issued in September 2023. A bench led by Justice Sudhanshu Dhulia previously directed the remaining states and UTs to respond by November 4, indicating whether they would proceed with the guidelines or propose changes.
The Union government’s guidelines outline standards for the treatment of ICU and CCU patients, including minimum qualifications for specialists and criteria for patient admission and discharge. The states that have accepted these guidelines are Andhra Pradesh, Meghalaya, Chandigarh, Punjab, Rajasthan, Jammu and Kashmir, Chhattisgarh, and Haryana.
This issue is being examined within the context of a 2015 petition linked to a medical negligence case. Asit Baran Mondal filed the petition in a consumer court after his wife died in 2013 at a Kolkata hospital, allegedly due to medical negligence.
In August 2016, the Supreme Court acknowledged the petitioner’s claims, stating that medical negligence is prevalent among private hospitals and there is a lack of regulatory oversight. The Court noted the absence of guidelines from the Union of India, the Medical Council of India, or state governments concerning the treatment of patients in ICUs and CCUs, highlighting deficiencies in care during operations and post-operative stages.
In response to these concerns, the Union government established a committee last year to develop guidelines for ICU admissions, CCUs, and palliative care for non-salvageable patients who are removed from ventilators, as well as criteria for the withdrawal of treatment.
The committee recommended that intensivists—specialists managing critically ill patients—should possess postgraduate qualifications in relevant fields such as internal medicine, anesthesia, pulmonary medicine, or surgery, along with additional qualifications in intensive care and at least one year of training in a recognized ICU abroad.
However, some states have raised objections to the requirement for additional qualifications and experience. They argued that if experience is mandated, it should specifically pertain to ICUs either in India or abroad. The guidelines also detail circumstances under which critically ill patients should not be admitted to ICUs, including situations where the patient or their next of kin refuse admission.
The Union government informed the court that these recommendations were developed after consultations with state governments. Advocate Karan Bharihoke, serving as amicus curiae, compiled the states’ responses and reported that Himachal Pradesh, Gujarat, Nagaland, Uttarakhand, Bihar, Telangana, and Sikkim have sought modifications to the proposed guidelines.
West Bengal stated that it would follow its own operational guidelines, while other states and UTs have yet to respond.
In his report to the court, the amicus curiae noted that the fact that several states have proposed changes or opted for their own guidelines underscores the need for broader discussions to establish standardized parameters applicable to all hospitals in the country.
The court’s upcoming deliberations are expected to address these critical issues surrounding the quality of critical care in India.
