SC to hear case on regulating functioning of ICUs, CCUs 

The Supreme Court will on Monday take up the case on implementing comprehensive guidelines for regulating the functioning of intensive care units (ICUs) and critical care units (CCUs) across the country. It was informed in September that only eight states and Union territories (UTs) have so far implemented the Union government’s guidelines issued in September 2023 in this regard. A Justice Sudhanshu Dhulia-led bench on September 23 directed the remaining states and UTs to inform by November 4 whether they wish to continue with these suggestions or seek changes.

The Union government’s guidelines prescribed standards for the treatment of ICU and CCU patients, minimum qualifications for specialists, and criteria for admission and discharge of patients in need of critical care. Andhra Pradesh, Meghalaya, Chandigarh, Punjab, Rajasthan, Jammu and Kashmir, Chhattisgarh, and Haryana accepted them.

The court is examining the issue in a 2015 petition linked to a medical negligence case. One Asit Baran Mondal filed the case in a consumer court seeking compensation for the death of his wife at a Kolkata hospital in 2013 over alleged medical negligence.

In August 2016, the Supreme Court noted the submissions of the petitioner and said medical negligence is writ large in the number of private hospitals and there is no check on it. It said the petitioner would urge that neither the Union of India, the Medical Council of India nor the state governments prescribe guidelines for the treatment of the patients in ICUs or CCUs. “That apart, there is no proper care at the stage of operation or post-operational stage.”

The Union government subsequently constituted a committee last year for guidelines for admission to ICUs, CCUs, and palliative care required for non-salvageable patients if removed from the ventilator and criteria for withdrawal of treatment.

The committee proposed the nature of training, certification, and experience of the specialists in managing critically ill patients. It suggested the specialists (intensivists) should have postgraduate qualifications in internal medicine, anesthesia, pulmonary medicine, or surgery combined with additional qualifications in intensive care and at least one year of training in a reputed ICU abroad.

Some of the states objected to the requirement for additional qualification of work experience. Others said if experience is insisted, it should be in ICUs in India or abroad.

The guidelines also specified instances where critically ill patients should not be admitted to ICUs. These included cases where the patient or the next-of-kin refused to be admitted to the ICU.

The Union government informed the court that recommendations were framed after receiving inputs from state governments.

Advocate Karan Bharihoke, assisting the court as amicus curiae, compiled the responses from states and informed the court last month that Himachal Pradesh, Gujarat, Nagaland, Uttarakhand, Bihar, Telangana, and Sikkim have sought changes to the Union government’s guidelines before implementing them. West Bengal said it followed its operational guidelines. The remaining states and UTs were yet to file their responses.

“The fact that seven states/UTs, in their wisdom, have thought it fit to recommend changes to the proposed guidelines, in one form or another, and one state proposes to follow its own guidelines, by itself testifies to the necessity of further broad-based discussions to achieve a standard set of parameters to be applicable to all hospitals in the country,” said amicus curiae in his report to the court. Hindustan Times