JUDGMENT : Rajiv Sahai Endlaw, J.:-- 1. This petition under Article 226 of the Constitution of India, filed as a Public Interest Litigation, flags the issue of lack of essential emergency facilities in Cardio Vascular Department in Satyawadi Raja Harish Chander Government Hospital and Maharishi Valmiki Hospital being the only Government hospitals in the locality of Narela stated to be having a population of over 10 lakhs, compelling the residents of the said locality even in an emergency to travel long distances in peak traffic and which often proves fatal The petition seeks a direction to the respondent Directorate of Health Services, Govt. of NCT of Delhi (GNCTD) to provide the said facilities in the said Government hospitals. 2. The petition was entertained and notice thereof issued. 3. A counter affidavit was filed on behalf of the respondent No. 3 Health and Family Department of GNCTD inter alia stating that Maharishi Valmiki Hospital, a 150 bed hospital has a 4 bed ICU and round-the-clock facility for ECG at Casualty; that the ICU is equipped with ventilator and defibrillator and is managed round-the-clock by doctors and other staff. It is further stated that the said hospital also has a facility for Troponin-T which is an important diagnostic tool for detecting heart attack and routine Thrombolysis is carried out in appropriate patients but patients needing invasive procedure on urgent basis are transferred to higher centres for treatment. With respect to Satyawadi Raja Harish Chander Hospital, the said affidavit states that the hospital provides only basic health care to patients, who if required are then referred to higher centres for treatment / management. 4. The petitioners have filed rejoinder controverting the aforesaid counter affidavit, relying on the reply dated 14th June, 2011 of the Office of the Medical Superintendant of the Satyawadi Raja Harish Chander Hospital stating that the said hospital was not having Intensive Cardiac Care Unit and the required staff though has the equipment to deal with few cardiac cases as a first aid but it is not sufficient to deal with all cases. 5. This Court vide order dated 29th May, 2013 directed the Health and Family Welfare Department of GNCTD to nominate an officer to inspect the subject hospital and submit the Report. 5. This Court vide order dated 29th May, 2013 directed the Health and Family Welfare Department of GNCTD to nominate an officer to inspect the subject hospital and submit the Report. A Committee was so constituted and which has submitted a detailed Report dated 20th June, 2013 inter alia to the effect that:- (a) The main surgery OT is not functional and surgery ward is locked due to non-availability of surgery specialist; (b) Though there are three senior residents in surgery department but are not performing emergency surgeries and OT of casualty/ emergency is converted into minor OT; (c) Though there are two transport ventilators in the casualty department but one was found under lock and key and none of the staff including Doctors knew how to operate the transport ventilator; (d) For cardiac cases, diagnostic tests like CPK (MB) are not available; (e) There are no protocols to handle the acute emergency cases; (f) Surgery and orthopaedic senior residents are available till 1600 hours only; hardly any emergency cases are being done between 1600 hours and 0900 hours; (g) No ENT specialist is posted; (h) No proper utilization of manpower and equipment to cover emergency care round-the-clock; (i) Manpower is not adequate; and, (j) There is no ICU, With respect to Maharishi Valmiki Hospital it was stated that it has a 4 bedded ICU equipped with anaesthesia machine, emergency cart, multipara monitor (including cardiac monitor),defibrillator, ABG machine, intubation set, AMBU bag, D and B type oxygen cylinders, suction machine, central supply of medical gases and suction, portable X-ray machine but was lacking in:- (i) Senior Residents for emergency services after 1600 hours; (ii) Emergency LSCS between 1600 hours and 0900 hours; (iii) ECG technicians after 1600 hours; (iv) Protocols to handle the acute emergency cases; (v) Diagnostic tests like CPK (MB) for cardiac cases; and, (vi) Manpower. 6. The report aforesaid also made the following recommendations:- “1. Recommendations given by the committee constituted by the department of health and family welfare, Govt. of NCT of Delhi for strengthening for existing ICU and central supply of medical gases and suction should also be implemented in these two hospitals. Satyawadi Raja Harish Chandra hospital is recommended to have new 6 bedded level I ICU. Maharishi Balmiki hospital ICU is recommended for upgradation to 6 bedded level I ICU. 2. of NCT of Delhi for strengthening for existing ICU and central supply of medical gases and suction should also be implemented in these two hospitals. Satyawadi Raja Harish Chandra hospital is recommended to have new 6 bedded level I ICU. Maharishi Balmiki hospital ICU is recommended for upgradation to 6 bedded level I ICU. 2. A technical committee should be constituted to recommend about the protocols / upgradation of the existing accident and emergency services including pre hospital care and transportation in Delhi, in terms of infrastructure, manpower and equipments, based on the bed strength of the hospital, location of the hospital and local needs to the all type of emergencies. 3. there is a need of regular teaching and training and sensitization of all types of staff posted in these critical areas like accident and emergency department, different type of ICUs and central supply of medical gases and suction and support services i.e. Radiology, blood bank and other laboratories (round the clock). 4. The high turnover of the staff recruited / posted should be addressed. 5. Duty roster of the existing staff should be primarily focused to take care of all types of emergencies (medical and surgical) round the clock including support services. 6. Health and family welfare department, Govt. of NCT of Delhi, can consider to have one super specialty hospital in north-west district, in view of the needs of the catchment area and the distances from one hospital to another hospital.” 7. This Court vide order dated 7th August, 2013 directed the respondents to file affidavit indicating the steps taken to rectify the capacity gaps as pointed out in the aforesaid Report. 8. Thereafter from time to time Status Reports of the steps taken have been filed. Vide order dated 22nd January, 2014 another inspection of the hospitals was ordered by the same team of Doctors who had earlier inspected the hospitals. A Report of inspection on 3rd February, 2014 has been filed which is indicative of the deficiencies in the hospitals persisting and the recommendations earlier made having not been implemented. Appalled therefrom, personal presence of the Secretary, Health & Family before this Court was requested. The said official appeared and apprised this Court of the steps being taken to remove the deficiencies and fulfill the recommendations aforesaid. Appalled therefrom, personal presence of the Secretary, Health & Family before this Court was requested. The said official appeared and apprised this Court of the steps being taken to remove the deficiencies and fulfill the recommendations aforesaid. Thereafter from time to time Status Reports have been filed with the last Status Report dated 25th June, 2014 being filed. 9. We heard the counsels for the parties on the petition on 17th September, 2014. 10. The counsel for the petitioners handed over to us a copy of the “Guidelines for District Hospitals (101 to 500 Bedded)” published by the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India as revised in the year 2011 and contended that the aforesaid two hospitals ought to be brought in consonance therewith. 11. The counsel for the respondents though not controverting that the lacunas / deficiencies persist stated that endeavours for the said hospitals to provide the essential medical services including in emergency, to the residents are being made. She also pointed out that as reported in the Status Report dated 25th June, 2014, a two bed Cardiac Care Unit has been created and operationalized in the Maharishi Valmiki Hospital. With respect to the manpower it was stated that the process of making the appointments has begun. 12. As far as the contention of the counsel for the petitioners, of the said hospitals to comply with the aforesaid Guidelines is concerned, the counsel was unable to show that the said Guidelines are mandatory. The counsel for the respondents stated that due to constraints on various fronts including financial it is not possible to make the hospital comply with all the Guidelines in a time bound manner though endeavour therefor will be made. It was also pointed out that though the national average of expenditure in the health sector is only 4.15%, the city of Delhi with a population of just over 1% of the national population has a health budget in excess of 10% of the State budget. 13. We are of the view that no purpose will be served in directing compliance with the aforesaid Guidelines in a time bound manner and in fact such a direction may not even be proper. The Supreme Court in State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117 has held that such directions cannot be made. 14. 13. We are of the view that no purpose will be served in directing compliance with the aforesaid Guidelines in a time bound manner and in fact such a direction may not even be proper. The Supreme Court in State of Punjab v. Ram Lubhaya Bagga (1998) 4 SCC 117 has held that such directions cannot be made. 14. We accordingly dispose of this petition with a direction to the respondent to within one year hereof remove all the deficiencies / lacunas pointed out by the Committee of Doctors in their Reports dated 20th June, 2013 and 3rd February, 2014 and to comply with all the recommendations made therein.