JUDGMENT : M. Satyanarayana Murthy, J. 1. Nallagonda Rama Gopal working as a Medical Officer filed this Public Interest Litigation under Article 226 of the Constitution of India under pro bono publico, seeking relief of writ of mandamus, declaring the inaction of the 2nd respondent in permitting the 3rd respondent to continue to provide standard services in the dialysis centre is violative of Articles 14 and 21 of the Constitution of India, and consequently cancel the contract of the 3rd respondent and blacklist the 3rd respondent from participating in any tenders or providing such similar services in the near future. 2. The petitioner is a doctor by profession and now working as Medical Officer in Government Hospital at Gudipala Village, Chittoor District. The petitioner was diagnosed with chronic kidney disease and suffering from Hypertension and diabetes and he was directed to undergo dialysis on a regular basis by the doctors at the hospital of 2nd respondent-Sri Venkateswara Institute of Medical Sciences (for short 'SVIMS') and as such, he underwent dialysis at the 2nd respondent-SVIMS for the past 18 months, under Employee Health Scheme of the State Government. There are many patients like the petitioner, who are undergoing dialysis at 2nd respondent-SVIMS and most of them are poor patients, who avail service free of cost at the 2nd respondent-SVTMS under various health schemes of the Government. 3. The 3rd respondent has been selected by way of a tender process to provide dialysis services at 2nd respondent-SVTMS. The services being provided by the 3rd respondent are complicating the problems of the patients who are availing the services, as they are violating the public health and safety standards. Thus, as an aggrieved patient, petitioner being the responsible citizen, being a doctor by profession and in order to safeguard the public interest, filed the present writ by way of Public Interest Litigation. 4. The 2nd respondent is an autonomous university established by Act of Andhra Pradesh State Legislature in 1995 recognized under Section 12(b) of University Grants Commission. The 2nd respondent has also set up a Specialty Hospital at Tirupati, Andhra Pradesh to cater the needs of lakhs of people annually with numerous bed strength of 1,000 and around 2,000 students are prosecuting their studies in various courses. 5. The 2nd respondent has also set up a Specialty Hospital at Tirupati, Andhra Pradesh to cater the needs of lakhs of people annually with numerous bed strength of 1,000 and around 2,000 students are prosecuting their studies in various courses. 5. The 2nd respondent-SVIMS has called for tenders in the year 2016 for setting up and running a haemodialysis unit consisting of 80 dialysis machines on a public-private partnership for a period of 7 years. As per the terms of the tender, the successful bidder has to procure and install the dialysis machines, provide the requisite number of doctors and qualified technicians to run the machines. The service provider has to provide services to the patients identified by the 2nd respondent-SVIMS, the payment would be made by the 2nd respondent-SVIMS itself. As most of the patients belong to the underprivileged section of society, procured medical services at free of cost in the 2nd respondent-SVIMS. The service provider has to run the necessary and prescribed tests on periodical basis for every patient. As the 3rd respondent hospital has quoted the least price for providing service, 2nd respondent-SVIMS selected 3rd respondent being the successful bidder in the tender for providing services in the dialysis unit. Though, the 3rd respondent hospital is under obligation to provide medical service in terms of the National Dialysis Program under National Health Mission, failed to provide necessary dialysis services. Some of the instances were narrated hereunder: (a) During haemodialysis, heamodialyzer, or artificial kidney is used to filer fluids and wastes from a dialysis patient's blood. A heamodialyzer once used for a patient should be for that patient for a maximum of 6-8 times or till the heamodialyzer does not fall below 80% of bundle volume. These parameters are important a blood flows properly through an efficient heamodialyzer through the dialysis equipment, which ultimately filters and purifies the blood. The 3rd respondent is using heamodialyzers well beyond their capacity, which resulting in an inefficient session for a patient, as a result of which body fluids that have to be removed by way of blood purification, are stagnating in the body and further complication the problems. The heamodialyzer should be identified with necessary markings and indications, so that it cannot be used on another patient. Further, a heamodialyzer should be stored in isolated environment in gels, so that, it is not contaminated. The heamodialyzer should be identified with necessary markings and indications, so that it cannot be used on another patient. Further, a heamodialyzer should be stored in isolated environment in gels, so that, it is not contaminated. The 3rd respondent is not maintaining any records of the heamodialyzers being used on the patients, and in many instances, using the same heamodialyzer across multiple patients. Further, heamodialyzer is not being stored in a proper manner. Due to this many patients are contracting serious infections and diseases and in some cases even Hepatitis and HTV. This is a serious violation of patient health and care, such swapping is resulting in chills, fevers and infections for patients. (b) The dialysis unit has to be maintained in a hygienic manner. A high degree of maintenance is required as patients undergoing dialysis have low immunity. However, the upkeep of the ward is an improper and the linen is not being changed or washed regularly. There is thus, a huge risk of infections spreading from one patient to the other. (c) The tender document prescribes that the number and experience of the Dialysis Technicians and Dialysis Nurses should be as per the Indian Society of Nephrology (ISN) Haemodialysis guidelines. The ISN guidelines recommend that a dialysis unit should have the following categories of regular staff (i) Nephrologist (ii) Dialysis Doctors (Nephrologist can also be a dialysis doctor) (iii) Dialysis Technicians/Nurses (iv) Dialysis attendants/Sanitation personnel (v) Medical Social Worker (vi) Dietician. Besides providing the requirements of the staff members as per tender, further guidelines for National Dialysis Program under National Health Mission prescribes the staffing partem in a dialysis unit per shift: (i) Qualified Nephrologist/MD Medicine with one year dialysis training from recognized centre performing every day and clinical review for all patients. (ii) Medical Officers (on duty)-One doctor (MBBS) per shift for a maximum of 10 machines. (iii) 3 Dialysis Technicians/Nurses : one Technician for every 3 machines and one dedicated for dialysis machine for patients with blood infections per shift. (iv) Dietician (Optional). (v) Sweepers 1 for every five machines per shift. (vi) Hospital attendant/Assistant 1 for every five machines per shift. Inspite of clear guidelines, the dialysis unit is always short of staff and that the patients are forced to wait for long hours, and for this reason sometimes the appointments are shifted late into the evening and night, causing trouble to the patients. (vi) Hospital attendant/Assistant 1 for every five machines per shift. Inspite of clear guidelines, the dialysis unit is always short of staff and that the patients are forced to wait for long hours, and for this reason sometimes the appointments are shifted late into the evening and night, causing trouble to the patients. The actual status of the technicians present at the dialysis wing is as follows: Particulars No. of machines Prescribed ratio No. To be present as prescribed As present at the dialysis wing Difference Technicians 80 3:1 53 35 18 Assistants 5:1 32 10 22 Duty Medical Officers 10:1 16 6 10 Total 101 51 50 (d) The ISN Guidelines prescribed around 18 microbiological and water quality assessment tests that have to be undertaken on a periodical basis to assess the patient. The tender document prescribes that such tests shall be undertaken by the 3rd respondent at its own cost. However, his personal experience and the experience of the other patients, the 3rd respondent does not undertake all the required tests, and for this reason the dialysis is getting affected. 6. The 2nd respondent-SVIMS is being run in sorry state of affairs. Any patient, who questioned the staff of 2nd and 3rd respondents, they used to threaten them and thus, in the interests of the public, direction is sought against the respondents 1 to 3 to provide necessary facilities referred as above, but no purpose was served, therefore, the petitioner approached this Court invoking pro bono publico i.e., Public Interest Litigation seeking relief of writ of mandamus as stated above. 7. The 2nd respondent filed counter denying all the material allegations in the petition inter alia contending that each year, about 1,00,000 patients are diagnosed with chronic kidney disease in India. Based on the statistical estimates, the prevalence of Chronic Kidney Disease burden for Rayalaseema area is about 12,000 patients/15 million population. In addition, Acute Kidney failures are also increasing in incidence, adding burden to Kidney Diseases. The SVIMS, Nephrology and Urology Departments are functioning as tertiary referral programmes for Rayalaseema region. The ongoing dialysis programme prior to the Public Private Partnership modes, with 25 machines catered to over 26,000 haemodialysis sessions per year (Chronic Kidney failures over 20,000 and Acute Kidney failures about 6,000). 8. The SVIMS, Nephrology and Urology Departments are functioning as tertiary referral programmes for Rayalaseema region. The ongoing dialysis programme prior to the Public Private Partnership modes, with 25 machines catered to over 26,000 haemodialysis sessions per year (Chronic Kidney failures over 20,000 and Acute Kidney failures about 6,000). 8. It is further contended by the 2nd respondent that prevention of kidney diseases of various types and mitigation of chronic renal failure at the community level is the most important cost effective solution in the long term. This 'preventive nephrology' program of SVIMS is taking shape through outreach efforts in camps and schools and also various programmes undertaken by the 2nd respondent. 9. While admitting calling for tenders and accepting the tender of 3rd respondent being the successful bidder, contended that 2nd respondent is taking Feed Back Analysis of patients on Real Time which shows the concern of the Institute towards patient care. The problems pointed out, if any, are resolved to the extent possible after discussing the same in the weekly/monthly meetings. 10. The Haemodialysis are reused only after a process of Reuse and the dialyzer is reused for the same patient for 6 to 10 times, provided, showing more than 80% Fiber Bundle Volume during the process of reuse as per ISN guidelines. If, Fiber Bundle Volume is less than 80% or if the dialyzer is not clear visually are discarded immediately irrespective of number of reuses done. Further, the process of reuse include the following steps: (1) Rinsing and reverse ultra-filtration (2) Cleaning : with water, bleach, Peracetic acid (3) Tests of dialyzer performance : Pressure leak test, Blood compartment volume, water permeability, clinical confirmation (4) Disinfection (5) Final Inspection (6) Labelling (7) Storage. After undertaking those steps, the Fiber Bundle Volume (efficiency of heamodialyzer is tested by the reuse machine). The particular heamodialyzer is reused only, if, the Fiber Bundle Volume is more than 80% as displayed by the reuse machine. The Fiber Bundle Volume of each heamodialyzer is documented in a record until its disposal. Therefore, there is no use of heamodialyzers well beyond their efficiency capacity, as such, there is no negligence on the part of the 2nd respondent institution. 11. It is further contended that all the Heamodialyzers are stored in boxes. (A) The boxes are Labelled with patients name, (B) Identification number, (C) Patients photographs. Therefore, there is no use of heamodialyzers well beyond their efficiency capacity, as such, there is no negligence on the part of the 2nd respondent institution. 11. It is further contended that all the Heamodialyzers are stored in boxes. (A) The boxes are Labelled with patients name, (B) Identification number, (C) Patients photographs. In view of the steps taken by the 2nd respondent for storage of Heamodialyzers, the question of using the heamodialyzer for a different patient does not arise and the record is being maintained by the 2nd respondent. 12. It is also contended that there is no Sero conversion to HIV and no conversion of HIV. Further Sero conversion to HCV has been reported in 10 patients since 2017 and most of these patients have undergone dialysis at outside centres for their convenience and finally comeback to SVIMS with access related issues after conversions to positive status. The Sero conversion to HCV has multiple factors as follows: (a) Dialysis at different centres being recruited to the centre. At times patient would be in incubation period after exposure to HCV at a different centre, but identified at the unit after recruitment (b) Blood transfusions (c) Injections (d) Transducer protector is always single use thus prevents contractions of infections to one patient to the other. However, patients are being taken to Negative Dialysis Programme with confirmatory reports of HIV, Hepatitis-B and HCV infections. However, extra precautionary measures are being taken by the 2nd respondent-SVTMS to prevent the infections as per the Indian Society of Nephrology (for short 'ISN') guidelines. 13. It is further contended that during the process if any patient found positive would be segregated to the positive side of dialysis and the following steps have been taken to maintain hygiene conditions for the safety of the patients. (A) The ambience is maintained in the Air-conditioned rooms (B) The upkeep of ward is under the supervision of staff nurse (C) The linen are changed for every shift of dialysis and washed properly (D) All the services are monitored and any deviation of service provider is viewed seriously and action will be taken by the 2nd and 3rd respondents. 14. 14. It is further contended that so far as the shortage of staff is concerned that there is shortage of staff from the service provider to certain extent was addressed by the 2nd respondent several times insisting to maintain the staff as per the guidelines. Since, it is a Public Private Partnership Unit and ICU care is under the purview of the 2nd respondent, patients care is never compromised by bringing to the notice of the Service Provider. If there is any deficiency of staff at various cadres, the patient needs were always addressed to the best of their effort by deputing the necessary staff and doctors from 2nd respondent institution. 15. It is further submitted that there are 80 haemodialysis machines installed in the project and around 550 dialysis patients undergoing treatment on every alternative day. Among 80 machines, 10 machines are located at Positive Dialysis Unit, which is separately maintained for patients contracted with infection diseases. The shifts are allotted to patients and the patients undergo dialysis as per the allotted shifts. 16. The respondents are following the tests are being done periodically by the service provider as per the guidelines of Indian Society of Nephrology or DGHS guidelines and the Senior Dialysis Medical Officer and Senior Dialysis Technologist are co-coordinating to perform all the test for all the Haemodialysis machines and water treatment plants as per the guideline. The tests are being done as follows: 1. Water treatment plant in R.O. Water Purifier (a) Complete chemical and Microbiological analysis once in six months (b) Microbiological analysis for every month (c) Endotoxin analysis for R.O. water every month 2. For Haemodialysis Machines (a) Microbiological culture analysis for every machine every month (b) Bio-chemical analysis once for 6 months for every machine. Thus, all the tests are performed during Sundays, which is a non-dialysis day without causing any disturbance to patients on the labs of 2nd respondent, except the Biochemical analysis, which is done at Chennai, since not available at 2nd respondent institution. 17. The respondents denied the other allegations made in the petition while contending that the District Medical Officer of Dr. NTR Trust visited the unit on receiving the complaint by the petitioner and enquired the Senior Medical Officer about the procedure of dialysis and also interacted with the petitioner and hence, there is no truth in the statement. 18. 17. The respondents denied the other allegations made in the petition while contending that the District Medical Officer of Dr. NTR Trust visited the unit on receiving the complaint by the petitioner and enquired the Senior Medical Officer about the procedure of dialysis and also interacted with the petitioner and hence, there is no truth in the statement. 18. The 2nd respondent-SVIMS denied the other allegations made in the petition while contending that they are providing several services to the patients and requested to dismiss the petition. 19. The 3rd respondent filed a separate counter denying the material allegations while admitting about entering into the contract with the 2nd respondent. The first respondent did not file any counter, and thereby, this Court has no option to entertain the same. 20. During hearing, Sri G. Kalyan Chakravarthy, the learned Counsel for the petitioner reiterated the contentions urged in the petition. Whereas, Smt. Lalitha, the learned Standing Counsel for 2nd respondent reiterated the contentions urged in the counter and produced several documents i.e., Reuse Register maintained by the 2nd respondent-SVIMS, various letters addressed to 3rd respondent and replies received from the 3rd respondent to show the action is being taken by this petitioner. (a) Maintainability of Public Interest Litigation in contractual matters: 21. The petitioner sought writ of mandamus as stated supra and cancelled the contract by 2nd respondent with 3rd respondent and blacklisted the 3rd respondent. The learned Counsel for 2nd respondent questioned the very maintainability of Public Interest Litigation, as the 3rd respondent providing services bases on contract with 2nd respondent, being lowest tenderer. Thus, this is a concluded contract between respondent Nos. 2 and 3 to provide standard services to dialysis patients as per tender conditions and ISN/DGHS specifications. If the 3rd respondent committed breach of contract, the remedy available to the 2nd respondent is elsewhere. Thus, this is a concluded contract between respondent Nos. 2 and 3 to provide standard services to dialysis patients as per tender conditions and ISN/DGHS specifications. If the 3rd respondent committed breach of contract, the remedy available to the 2nd respondent is elsewhere. The petitioner who is availing services as dialysis patient is incompetent to seek relief in contractual matter by invoking Public Interest Litigation, in view of the law declared by the Supreme Court in The Silppi Constructions Contractors v. The Union of India and others, 2019 (11) SCALE 592 , wherein, the Apex Court reiterated the same principle with regard to maintainability of writ petition in tender of contractual matters, relying on the catena of judgments of Supreme Court, more particularly, Tata Cellular v. Union of India, (1994) 6 SCC 651 , wherein the Apex Court laid down six guidelines which are as follows: (1) The modern trend points to judicial restraint in administrative action. (2) The Court does not sit as a Court of appeal but merely reviews the manner in which the decision was made. (3) The Court does not have the expertise to correct the administrative decision. If a review of the administrative decision is permitted it will be substituting its own decision, without the necessary expertise which itself may be fallible. (4) The terms of the invitation to tender cannot be open to judicial scrutiny because the invitation to tender is in the realm of contract. Normally speaking, the decision to accept the tender or award the contract is reached by process of negotiations through several tiers. More often than not, such decisions are made quantitatively by experts. (5) The Government must have freedom of contract. In other words, a fair play in the joints is a necessary concomitant for an administrative body functioning in an administrative sphere or quasi-administrative sphere. However, the decision must not only be tested by the application of Wednesbury principle of reasonableness (including its other facts pointed out above) but must be free arbitrariness not affected by bias or actuated by mala fides. (6) Quashing decisions may impose heavy administrative burden on the administration and lead to increased and unbudgeted expenditure. However, the decision must not only be tested by the application of Wednesbury principle of reasonableness (including its other facts pointed out above) but must be free arbitrariness not affected by bias or actuated by mala fides. (6) Quashing decisions may impose heavy administrative burden on the administration and lead to increased and unbudgeted expenditure. The Apex Court also referred in various earlier judgments in Raunaq International Ltd. v. I.V.R. Construction Ltd., (1999) 1 SCC 492 ; Air India Limited v. Cochin International Airport Ltd., (2000) 2 SCC 617 ; Karnataka SIIDC Ltd. v. Cavalet India Ltd., (2005) 4 SCC 456 ; Master Marine Services (P) Ltd. v. Metcalfe & Hodgkinson (P) Ltd., (2005) 6 SCC 138 ; B.S.N. Joshi & Sons Ltd. v. Nair Coal Services Ltd., (2006) 11 SCC 548 ; Jagdish Mandal v. State of Orissa, (2007) 14 SCC 517 and Michigan Rubber (India) Ltd. v. State of Karnataka and others, (2012) 8 SCC 216 and finally concluded that the power of the Court to interfere with contractual matter of tender is limited. In view of the Law referred in the judgments of Apex Court and various other High Courts cited supra, Public Interest Litigation is not maintainable. (b) Violation of fundamental right of Citizen guaranteed of Article 21 of the Constitution of India: 22. The main grievance of the petitioner before this Court is that the petitioner is undertaking treatment in 2nd respondent-SVIMS and whereas, 3rd respondent is only service provider on contract basis. The 2nd respondent though entrusted services to the 3rd respondent being successful bidder in the tender process, 3rd respondent is not providing standard services to the patients as prescribed ISN and the guidelines in ISN are highlighted in the petition itself. 23. The respondents denied the specific allegation that they failed to provide necessary services to the petitioner as per the guidelines, but admitted in Paragraph No. 14 of the counter that the 3rd respondent is not maintaining staff members as per the guidelines of ISN. The petitioner did not file any reply to the counter-affidavit filed by the 2nd respondent. Therefore, the main grievance of the petitioner is that 2nd respondent failed to maintain reuse register of haemodialysis and also failed to maintain haemodialysis is controverted by the 2nd respondent in counter, but not denied by the petitioner. The petitioner did not file any reply to the counter-affidavit filed by the 2nd respondent. Therefore, the main grievance of the petitioner is that 2nd respondent failed to maintain reuse register of haemodialysis and also failed to maintain haemodialysis is controverted by the 2nd respondent in counter, but not denied by the petitioner. The learned Standing Counsel for the 2nd respondent produced the haemodialysis Reuse register for the perusal of this Court and on perusal, no such deficiency is found by this Court. Therefore, the alleged violation of maintenance of haemodialysis and failure to maintain reuse register is not based on any material. Hence, we find that the 2nd and 3rd respondents are maintaining haemodialysis, as per the guidelines of ISN and also maintaining the reuse register. 24. The other contention of the petitioner is that the respondent is not maintaining cleanliness. But this fact is denied while disclosing the steps taken in maintaining the centres with good ambience in the air conditioned rooms and maintaining the Wards under the supervision of staff nurses and linen is being changed for every shift of dialysis and washed properly and providing cleanliness in the dialysis centres. This fact is pleaded in the counter filed by the 2nd respondent. The petitioner did not file and reply to the counter-affidavit filed by the 2nd respondent and in the absence of any denial, this Court has to accept that steps that are being taken by the 2nd and 3rd respondents in maintaining the heamodialyzer and maintenance of dialysis centres properly. 25. The main grievance of the petitioner is that sufficient number of staff is not being provided by the 3rd respondent in terms of the guidelines issued by ISN. This fact is admitted by 2nd respondent to certain extent, while contending that the 2nd respondent is taking steps to clear the deficiency of staff members and produced bunch of letters consisting of 7 in number to show that 2nd respondent is always trying to take steps to clear the deficiency in providing staff with the help of 3rd respondent by way of tender and as per the guidelines of ISN. In support of the same, Medical Superintendent, SVIMS addressed a letter dated 18.9.2017 to the Executive Officer, Nephroplus clearly stating that 2nd respondent is always insisting the 3rd respondent to provide better services as per the guidelines of Indian Society of Nephrology/Directorate General of Health Services (for short 'ISN/DGHS') and tender conditions for better functioning of the giant Public Private Partnership Project by raising some issues. Thereafter, 3rd respondent sent a reply dated 7.10.2017 by giving response for the issues raised by 2nd respondent which are as follows: Sl. No. Issues raised by 2nd respondent Response given by 3rd respondent 1. Staff issues: There is a deficiency in provision of services of Clinical staff namely Doctors, dialysis technicians and nurses. Presently, there are only 3 doctors 26 dialysis Technicians and 10 staff nurse, thus their strength is far below the requirement as per standard norms expected as per DGHS/ISN guidelines. As per ISN guidelines, the staff ratio should be 3:1 (Number of machines : Number of Technicians / staff nurses) which comes to approximately 40 clinical staff. Presently, we have 35 clinical staff and we have already issued offer letters for another 8 members, who are expected to join in next 15 days. 2. Because of this deficiency the patient satisfaction and safety is getting affected and this needs immediate remedial measures to be taken. Operations and clinical teams are closely working with centre team to avoid any adverse events and strive for immediate closure of issues, if any. Patient satisfaction scores are usually the highest in the industry. Additionally we are pushing for immediate joining of the new staff too which help further improve the satisfaction levels. 3. Keeping in mind SVIMS as an unique model, please focus and concentrate on providing the requirements in this centre for best and quality patient care. SVIMS is an extremely prestigious project. Regretting wishes to VIMS Management for lending their full support and co-operation in executing this project. Nephroplus is determined to make this unique model a success and provide superlative patient care. 4. There are certain other issues also need to be addressed such as compensating SVIMS for supporting the services of their HD Technicians to support your Nephroplus team due to lack of sufficient clinical staff in Neprhoplus. It is appropriate to atleast compensate 50% of their salaries to SVIMS with retrospective effect. 4. There are certain other issues also need to be addressed such as compensating SVIMS for supporting the services of their HD Technicians to support your Nephroplus team due to lack of sufficient clinical staff in Neprhoplus. It is appropriate to atleast compensate 50% of their salaries to SVIMS with retrospective effect. Promised to take necessary steps to envisage the requirement of SVIMS HD Technicians and they will not repeat the same. 5. As per tender condition No.21, it is the responsibility of service provider to take up the investigations as per DGHS/ISN guidelines, hence the tests done so far from SVIMS needs to be reimbursed. They are working on this and the same can be discussed in their upcoming review meeting. 6. Due to above predicaments, the IInd phase of the Mission of introducing 20 more HD machines (at present 60 HD machines installed) is getting delayed. Further, the targeted HDs of 6000 p.a., cannot be reached in the present scenario and this target can only be reckoned starting from the time of all issues are resolved and the mission started functioning with all the specified guidelines. They appreciate the concerns raised by SVIMS and believe they should work towards increasing dialysis sessions per month. Given the paucity of trained clinical manpower, they plan to start 4th cycle of dialysis sessions to cater to the existing demand. Addition to new machines can be explored as soon as the exiting capacity is adequately utilized. 26. Again, the Assistant Director of Public Private Partnership Project addressed several letters to 3rd respondent pointing certain deficiencies, in turn, 3rd respondent gave responses to them. 27. On perusal of the correspondence between 2nd and 3rd respondents, it is evident that 3rd respondent is not providing sufficient staff in terms of ISN/DGHS Guidelines and the conditions of the tender document on account of the deficiency of staff members. If the guidelines of ISN are not strictly adhered, there is every possibility of failure to attend the patient, who is undergoing dialysis. If one doctor is overloaded or burdened with more number of patients, beyond the permissible capacity of the individual, then there will certainly be reduction in the quality of treatment. On account of such negligence, there is every likelihood to cause loss of life or damage to certain parts in the body, which wound eventually cause serious consequence, resulting in death. On account of such negligence, there is every likelihood to cause loss of life or damage to certain parts in the body, which wound eventually cause serious consequence, resulting in death. In these circumstances, it is the responsibility of the 2nd respondent to adhere to each and every guidelines of ISN/DGHS and failure to provide necessary service amounts to violation of fundamental right guaranteed under Article 21 of the Constitution of India, since, Right to life includes Right to good health. 28. In view of the specific contention, it is appropriate to examine this issue in human rights and constitutional perspective. Article 12 of the International Covenant on Economic, Social and Cultural Rights makes it obligatory on the "State to fulfill everyone's right to the highest attainable standard of health". The Supreme Court of India interpreting Article 21 of the Indian Constitution in the light of the Article 12 of the Covenant held that the right to health inhered in the fundamental right to life under Article 21. (vide Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37 ) 29. Article 12 of the International Covenant on Economic, Social and Cultural Rights states that right to health is not to be understood as a right to be healthy. The right to health contains both freedoms and entitlements. The freedom include the right to control one's health and body, including sexual reproductive freedom, and the right to be free from interference, such as the right to be free from torture, nonconsensual medical treatment and experimentation. By contrast, the entitlements include the right to a system of health, protection which provides equality of opportunity for people to enjoy the highest attainable level of health. It further state 'Non-discrimination and equal treatment by virtue of Article 2.2 and Article 3, the Covenant prescribes any discrimination in access to health care and underlying determinants of health, as well as to means and entitlements for their procurement, on the ground of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, physical or mental disability, health status (including HIV/AIDS) sexual orientation and civil, political, social or other status, which has the intention or effect of nullifying or impairing the equal enjoyment or exercise of the right to health. The committee stresses that many measures, such as most strategies and programmes designed to eliminate health-related discrimination, can be pursued with minimum resource implications through the adoption, modification or abrogation of legislation or the dissemination of information. (Vide Naz Foundation v. Government of NCT of Delhi, 2010 Crl. LJ 94) 30. Therefore, as per Article 21 of I the Constitution of India, right to health is the part of right to life. It is the duty of the State to provide health to the citizens without any discrimination and it is also recognized as a human right by the International Covenant to which India is a party. Therefore, it is the duty of the 1st respondent to monitor the services provided by the 2nd respondent and it is the duty of the 2nd respondent to provide treatment to the patients strictly adhering to the guidelines issued by ISN/DGHS and failure to provide such standard treatment to the patients amounts to violation of fundamental right to life guaranteed under Article 21 of the Constitution of India, which is recommended by Article 12 of International Covenant. So, the admissions made in the counter by the 2nd respondent and the correspondence between the 2nd and 3rd respondents clearly established that 3rd respondent has violated the terms and conditions of tender notification, so also, the guidelines issued by ISN. Providing health services to patients is though a human act, the patients are being survived only on account of the treatment being given by the doctors in the institution, but failure to provide standard treatment prescribed by the Government will result in serious consequences to loss of life. Therefore, 2nd and 3rd respondents have to make every endeavour to provide better treatment as per the standard guidelines issued by ISN/DGHS and in terms of tender document. Therefore, taking into consideration of the facts and circumstances of the case, 1st respondent is hereby directed to monitor the functioning of 2nd respondent-SVTMS and the services being provided by the 3rd respondent and verify whether the treatment being provided by 2nd respondent with the aid of the services being provided by the 3rd respondent are in accordance with the standards of ISN/DGHS, if not, take immediate steps for providing necessary standard services to the patients, who are undergoing dialysis in the centre of the 2nd respondent. For any reasons, the 3rd respondent is unable to provide standard services to the dialysis patients in terms of tender document, so also in terms of the guidelines issue by ISN/DGHS, 2nd respondent is directed to take steps and provide necessary services to the dialysis patients upto maximum standard prescribed by ISN/DGHS. 31. On overall consideration of entire material on record, it is clear that respondents 2 and 3 are not maintaining sufficient staff members and despite direction issued by this Court to produce staff pattern being provided by 3rd respondent as per the contract, 2nd respondent did not produce any material before this Court, but the admission made by the 2nd respondent in the counter-affidavit and the correspondence between 2nd and 3rd respondents is sufficient to accept the contentions of the petitioner that 2nd and 3rd respondents are not providing standard services and also staff members as per the guidelines of ISN/DGHS. 32. The Public Interest Litigation is not maintainable as held above. Keeping in view of the difficulties of various patients who are undergoing dialysis treatment and taking into consideration of the facts and circumstances of the case, 1st respondent-Government of Andhra Pradesh, Represented by Principal Secretary, Health, Medical & Family Welfare Department is directed to inspect the dialysis unit in the hospital of 2nd respondent-SVEVIS, where services are provided by 3rd respondent-Nephrocare Health Services Pvt. Ltd., within a month and find out whether services are being provided in the dialysis centre strictly in terms of guidelines issued by ISN/DGHS and also as per the terms and conditions of the tender. If the 1st respondent concludes that the services being provided by the 3rd respondent to the dialysis patients in the 2nd respondent-SVIMS with regard to providing dialysis is not in accordance with the guidelines referred supra, 1st respondent shall take immediate steps by directing the 2nd respondent to steps, if deficiency is not rectified within a month from the date of receipt of copy of this order. 33. With the above direction, this writ petition (PDL) is disposed of. 34. Consequently, if any miscellaneous applications are pending, shall stand closed.