A. K. SIKRI ( 1 ) DR. Chander Prakash, MBBS, MS (Surgery) (hereinafter REFERRED TO to as the petitioner ) appears to be a public spirited person belonging to medical fraternity. Being a Surgeon himself, he has experienced the difficulties, obstacles and hurdies including inefficient and inadequate medical services, being faced by the victims of road accidents in the country. Due to non-availability of timely medical first aid and further treatment millions of such victims die on roads or face permanent disability leading to loss of vocation and hardships to family, this unhappy experience has disturbed the petitioner who addressed letter dated 29/06/2001 to Hon ble the Chief Justice pointing out the various defects in the system and the measures which should be taken to minimise such fatalities. ( 2 ) THIS letter was treated as writ petition in the category of Public Interest Litigation and notice was issued to the respondents. Mr. V. K. Shali appeared for the Govt. of NCT of Delhi. ( 3 ) IN this petition, the petitioner has highlighted that even after 52 years of independence our country has not been able to develop organised trauma services and disaster management medical services. The petitioner emphasises the fact that the first half hour is the crucial time 5. and if during this period proper first aid/treatment is given, many lives can be saved. He also states that the Government policies were designed and directed for the medical treatment accordingly. However, in the year 2001, 80% of health care is in private sector and 20% in government sector. So there is an urgent need to have concrete and effective trauma services giving private sector a pivotal role. He also highlights the fact that modem medical treatment is very expensive because modern diagnostic equipments, gadgets, implants and medical treatment is very costly. It will be Herculean task for anybody to think of providing these medical treatment free of cost and it is not possible by any government to provide free 4. medical treatment. He further states that it is the duty of the State, being a welfare state to dire guarantee the health of the citizen. It cannot be denied that majority of people in road accident being padestrians and cyclists are from poor economic strata. There is an urgent need of a mechanism to provide free health care to these unfortunate victims. He further states that it is the duty of the State, being a welfare state to dire guarantee the health of the citizen. It cannot be denied that majority of people in road accident being padestrians and cyclists are from poor economic strata. There is an urgent need of a mechanism to provide free health care to these unfortunate victims. Most of the time they reach hospitals as unknown persons. In view of the aforesaid dismal state of affairs the petitioner goes on to suggest certain measures which are required to be taken for providing medical treatment to the road accident victims. These suggestions are as under: 1. Certain untapped sources of revenue should be utilised for free medical treatment to people in the country, namely, (a) amount collected by the Insurance Company as a third party insurance component which is approximately Rs. 206 crores from the State of Delhi only. 25% of the above i. e. approximately 50% should be converted to corpse account every year for the treatment of road accident victims in Delhi to start and then similarly implement it in the whole country. 2. Appropriate authorities should develop the mechanism to provide free treatment to all the road accident victims and reimburse the cost to health institutions willing to provide the complete treatment from the funds so collected. 3. In case funds collected as third party insurance are not enough, an additional amount can be charged from the vehicle meant only for treatment of road accident victims, he suggests that if such persons are charged at the rate of Rs. 200. 00 per vehicle as additional amount, the sum collected would be about Rs. 70 crores in Delhi alone. 4. Mobilisation of additional sources for corpse may be considered from the following sources: (i) Some share of sale tax and excise on auto vehicles and automobile parts. (ii) Share from the sale of petrol/diesel. (iii)Some share from road tax. (iv) Share from compounding of challans of vehicles. 5. The funds so collected be put in National/state corpse account to be used for following: (i) The treatment to all road accident victims. (ii) State of Art ambulance/air ambulance services to be provided at all vulnerable places so that these can be reached at the site of accident within 5-10 minutes. (iii) Rehabilitation of disabled road accident victims. (iv) Road safety education programme for the people. (ii) State of Art ambulance/air ambulance services to be provided at all vulnerable places so that these can be reached at the site of accident within 5-10 minutes. (iii) Rehabilitation of disabled road accident victims. (iv) Road safety education programme for the people. (v) Miscellaneous services to prevent road accidents. ( 4 ) THE petitioner further suggests the following approach and prays that appropriate directions be given in this respect: A. There can be National/regional/local based Management authority consisting of doctors, Police, Politicians, Judiciary, Social Workers and all those people connected to the Trauma services. B. Standard Protocol for equipment, manpower and infrastructure to be defined by expert group. C. Hospital fully equipped with qualified speciality to be identified and trauma services organised. D. Area to be allotted to these hospitals and police to be directed to take casualties to these hospitals. E. All these hospitals should be interconnected via suitable communication system to co-ordinate the activity may be on regional basis so that the spare resources and manpower can properly be utilised. F. A group of experts should be authorised to deploy funds to upgrade the identified hospitals and organise the link services. On the basis of standard protocol decided and implemented with keeping local requirement and need in mind. G. Hastle free mechanism to reimburse the cost of treatment. ( 5 ) IT may be mentioned at this stage that it is not the first time that the problem of providing timely emergency medical treatment to the victims of road accident has come before the court. The Apex Court had the occasion to deal with such a situation twice before and detailed instructions were issued by the court at that time. The first time it happened in the case of Pt. Parmanand Katara Vs. Union of India and Ors. reported in (1989) 4 SCC 286 . The court emphasised the need for immediate medical aid to injured persons and exhorted the medical professionals to extend medical aid to injured immediately by reminding the professional obligations of all Doctors, of Government hospitals and private hospitals. The court reminded the State of its obligations on the touchstone of Article 21 of the Constitution of India observing as under: "article 21 of the Constitution casts the obligation on the State to preserve life. The court reminded the State of its obligations on the touchstone of Article 21 of the Constitution of India observing as under: "article 21 of the Constitution casts the obligation on the State to preserve life. 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. Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. The obligation beingtotal, 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. The matter is extremely urgent and 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. " ( 6 ) THE second time it happened in the case of Paschim Banga Khet Mazdoor Samity and Ors. Vs. State of West Bengal and Anr. reported in AIR 1996 SC 2426 . The court emphasised in this case as under: "that 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 thus of paramount importance. The Government hospitals run by the State and the medical officers employed therein are duty bound to extend medical assistance for preserving human life. Article 21 imposes an obligation on the State to safeguard the right to life of every person. Preservation of human life is thus of paramount importance. The 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. In the instant case there was breach of the said right of a person injured in accident when he was denied treatment at the various Government hospitals which were approached even though his condition was very serious at that time and he was in need of immediately medical attention. Since the said denial of the right of injured person guaranteed under Article 21 was by officers of the State in hospitals run by the State the State cannot avoid its responsibility for such denial of the constitutional right. In respect of deprivation of the constitutional rights guaranteed under Part III of the Constitution the position is well settled that adequate compensation can be awarded by the court for such violation by way of redress in proceedings under Articles 32 and 226 of the Constitution. " ( 7 ) THEREAFTER, the Apex Court issued the following directions to ensure that proper medical facilities are available for dealing with emergency cases: I. Adequate facilities are available at the Primary Health Centres where the patient can be given immediately primary treatment so as to stabilize his condition; II. Hospitals at the district level and Sub-Division level are upgraded so that serious cases can be treated there; III. FACILITIES for giving specialist treatment are increased and are available at the hospitals at District level and Sub-Division level having regard to the growing needs; IV. In order to ensure availability of bed in an emergency at State level hospitals there is centralised 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. V. Proper arrangement of ambulance is made for transport of a patient from the primary Health Centre to the District Hospital or Sub-Division hospital and from the district Hospital or Sub-Division hospital to the State hospital. VI. V. Proper arrangement of ambulance is made for transport of a patient from the primary Health Centre to the District Hospital or Sub-Division hospital and from the district Hospital or Sub-Division hospital to the State hospital. VI. The ambulance is adequately provided with necessary equipment and medical personnel. VII. The Health Centres and the hospitals and the medical personnel attached to these Centres and hospitals are geared to deal with larger number of patients needing emergency treatment on account of higher risk of accidents on certain occasions and in certain seasons. ( 8 ) THE court was also conscious of the fact that financial resources are needed for proving the aforesaid facilities. However it observed that: ". . . . . AT the same time it cannot be ignored that it is the constitutional obligation of the State to provide adequate medical services to the people. Whatever is necessary for this purpose has to be done. 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. " ( 9 ) IN view of the detailed guide-lines laid down and directions given in the aforesaid judgments, it is not necessary to issue any further directions to the respondents. It is trite that the law laid down in the aforesaid two judgments is the law of the land and every court and authority is bound to comply with the same having regard to the provisions of Article 141 of the Constitution of India. We were informed by learned counsel for the respondents that in view of the authoritative pronouncement of Apex Court in the aforesaid two judgments, this court had disposed of CWP No. 5409/97 filed on earlier occasion without issuing any directions. ( 10 ) HOWEVER, one cannot lose sight of the fact that inspite of directions contained in the aforesaid two judgments of the Apex Court, there is not much improvement in the situation and the casualties due to road accidents, because of not providing adequate medical treatment in time, are of alarming magnitude. However, we may mention that some of the suggestions given by the petitioner are worthy of appropriate consideration. However, we may mention that some of the suggestions given by the petitioner are worthy of appropriate consideration. While we do not comment upon the suggestions regarding tapping the sources of revenue for free medical treatment as that may require appropriate legislative action, the feasibility of the approach suggested by the petitioner and recorded in paras A to G needs to be examined. ( 11 ) THEREFORE, this writ petition is disposed of with the following directions: 1. The copies of the two judgments of the Apex Court be circulated to all concerned government and private hospitals, dispensaries and medical units etc. once again and it may be ensured that they comply with the directions contained in the aforesaid judgments. 2. The functionaries 6f the respondents at a very high/appropriate level may examine the feasibility and desirability of adopting the suggestions given by the petitioner in this writ petition and recorded in paras A to G above and proper policy decision be taken in this respect preferably within a period of four months from today.