Beyond noble intentions: The Supreme Court’s quest for healthcare safety

CONSTITUTION Day invites not just celebration but deep reflection— on the brilliance of the Constitution and the paradoxes it reveals in action. This remarkable document balances rights and duties to build a just society.From the debate over same-sex marriage to the delicate dance between free speech and communal harmony, the Supreme Court has arguably mediated ideals with reality, embodying the notion of a living document, as Justice Krishna Iyer noted.Yet, its handling of the tragic case of the young resident at R.G. Kar Medical College is a reminder that even noble legal interventions can stumble— at times inspiring but ultimately ineffective.The incident and the court’s responseSince the incident, a cascade of troubling developments has fuelled public suspicion about the State’s conduct. Delays in police action, the rushed cremation of the victim’s remains, and the rapid passage of the Aparajita Bill have sparked outrage, exposing more than just administrative failures..This led the Supreme Court to take suo motu cognisance of the matter, underscoring the urgent need to address both the specific incident and the broader safety concerns for medical professionals..They point to a potential breach of the State’s constitutional duty under Article 21 of the Constitution, which guarantees the right to life and personal liberty. While much has been written on these concerns, which go beyond the scope of this piece, the Calcutta High Court’s response merits attention.Acting swiftly on a writ petition by the victim’s parents, the high court transferred the investigation to the Central Bureau of Investigation (CBI) on August 13, 2024, mandated the submission of progress reports regularly before it, and began hearing the matter daily. The petition also sought systemic reforms, such as the installation of CCTV camera surveillance in hospitals and adequate rest facilities for staff.Just two days later, chaos erupted as a mob of nearly 7,000 stormed the hospital, vandalising facilities and destroying evidence. All this happened while the investigation remained under the high court’s oversight..R.G. Kar murder and rape case: SC issues slew of directions, some missing from the written Order.This led the Supreme Court to take suo motu cognisance of the matter, underscoring the urgent need to address both the specific incident and the broader safety concerns for medical professionals.The Supreme Court’s authority to intervene in pending matters, rooted in Article 142 of the Constitution, is well established, allowing it to act when extraordinary circumstances threaten fundamental rights or the dispensation of justice.However, such interventions must align with judicial restraint to avoid perceptions of encroaching upon the jurisdiction of high courts. While the Supreme Court’s efforts to protect medical professionals are commendable, Article 226 underscores the high courts’ role as co-equal custodians of constitutional justice, empowering them to issue writs and safeguard rights within their states.The NTF’s formationIn its first sitting, the Supreme Court directed the CBI to submit progress reports directly to it— effectively edging out the high court’s oversight of the investigation.While the state police were tasked with reporting on the vandalism, the Supreme Court’s vision stretched beyond the immediate case. It cast its gaze on wider patterns of violence against healthcare professionals across the country, exposing systemic vulnerabilities that defied existing safeguards..In its first sitting, the Supreme Court directed the CBI to submit progress reports directly to it— effectively edging out the high court’s oversight of the investigation..Despite protective laws in states such as Karnataka, Maharashtra, Tamil Nadu and Andhra Pradesh, the court noted that these measures barely scratch the surface, leaving deeper institutional flaws unaddressed.Thus, it constituted a National Task Force (NTF), tasked with addressing the root causes of such violence and crafting comprehensive safety protocols for healthcare professionals. Yet, as promising as this step appeared, this is where the complications start to unfold.‘Public health and sanitation; hospitals and dispensaries’ fall under the state list (Seventh Schedule, Entry 6, List II of the Indian Constitution), granting states autonomy over healthcare regulation within their territories..Supreme Court solidifies the law on medical negligence: Is it the balanced position?.This reflects the constitutional principle of federalism, integral to the basic structure doctrine affirmed in S.R. Bommai versus UOI (1994). While the Union government’s notification of the NTF to establish safety standards is a step in the right direction, the question remains: can states be mandated to adopt these recommendations without risking an overreach into their constitutionally protected powers?Article 246 delineates legislative powers between the Union and the states, ensuring a delicate balance that upholds cooperative federalism. This framework, designed to respect India’s socio-political diversity, implies that while the Union government can offer guidance, it must tread carefully so as not to unravel the threads of state autonomy.The NTF’s inherent disconnectEqually troubling is how the NTF was constituted— a process that, in hindsight, seems rushed and lacking comprehensive consultation. While the inclusion of eminent professionals was ensured, the absence of formal input from grassroots stakeholders casts a shadow over its inclusivity.A glance at the panel reveals a distinguished lineup of nine members—five from Union government institutions and four from reputable private ones, and other ex-officio members who are high-ranking officials of the Union government (with no state representation). Yet, this esteemed cohort brings with it an inherent disconnect..With NTF’s recommendations made before input from the state governments, what weight the states’ feedback will now hold is anybody’s guess, especially if their perspectives diverge from the Union government’s..Despite their impressive credentials, their lived experiences are far removed from those of young professionals at the frontline who often bear the brunt of unsafe working conditions. This gap raises the question— can a task force without voices from the trenches truly address the realities it seeks to reform?Moreover, it is notable that almost all members of the NTF come from Tier-1 city institutions. It prompts the question— are healthcare challenges outside these urban centres any less pressing, or would members from metropolitan institutions naturally understand the challenges faced by professionals in smaller towns? Either presumption would miss the mark, for, as the saying goes, ‘Only the wearer knows where the shoe pinches.’Considering that the catalyst for the court’s intervention emerged in West Bengal, one could argue that regional representation would have offered a more grounded, firsthand perspective for meaningful solutions.Consultation with stakeholders: A realisation too late?Although the Supreme Court, in a later hearing— and only after suggestions from the Bar— acknowledged that the voices of interns, residents, doctors, nurses and paramedical staff should be included in the task force’s deliberations, this realisation came belatedly..A female student’s death in Punjabi University lifts the fog on respiratory pandemic in North India.Following this, the Union government set up a web portal to facilitate the submission of suggestions. The NTF has since filed a 73-page interim report on November 7, 2024, long after the original timeframe set by the Supreme Court.This report outlines short-, medium- and long-term measures to be adopted by healthcare institutions and by states and Union territories. Under the court’s direction, a copy of this report has been sent to all states and Union territories for feedback.With NTF’s recommendations made before input from the state governments, what weight the states’ feedback will now hold is anybody’s guess, especially if their perspectives diverge from the Union government’s.While the report holds promise in its volume, it may only be the prologue to a more formidable tale, where the real work lies ahead.Looking forwardAll hope is not lost. The continued protests and calls for justice stand as a testament to the resilience of democratic and constitutional values. When the nation’s conscience is awakened, it is this collective drive that keeps the Constitution’s promises alive.Hats off to the doctors who did not let their voices be drowned out by bureaucracy. The recent stabbing of a doctor in Chennai by a patient’s attendant is a sobering reminder that the battle is far from over.As the issue of the safety of healthcare professionals remains in a policy ICU, one wonders whether the government and the judiciary will be able to perform a successful operation in time. The life of our healthcare system depends on it.The author extends sincere gratitude to Dr Adhish Basu, a distinguished plastic surgeon, for his invaluable insight.

Beyond noble intentions: The Supreme Court’s quest for healthcare safety

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