I, M. Sambasiva Rao, s/o. Late Dasaiah, aged 46 yrs, Occ: Social worker, R/o. Flat No. 102, Sai Kiran Apartments, Sri Nagar Colony, Hyderabad, Andhra Pradesh do hereby solemnly affirm and state on oath as follows:
I am the petitioner herein and I am well acquainted with the facts of this case and I am filing this affidavit on behalf of another who authorized me to do so.
I submit that, from my younger days I took keen interest in the issues concerning public interest. I am a post graduate in Business Management. I have also taken various issues particularly concerning with the down trodden people before various authorities and fora. I filed a public interest litigation before the Hon?ble High Court with regard to the providing potable water to the tribals in Adilabad district and the Hon?ble High Court passed appropriate orders in the said PIL and consequently the authorities have taken effective steps in this regard.
It is further submitted that I have also filed a Public Interest Litigation before the Hon?ble High Court with regard to maintaining of standards in technical education in Andhra Pradesh and the Hon?ble High Court after examining the matter gave a direction to authorities to implement and maintain the standards as per the guidelines mentioned in the All India Council of Technical Education Act and the Hon?ble High Court appreciated my work in judgment reported in ALT 1997 Vol. 1 Page 629.
I submit that I have been keenly observing the issue of congenital heart disease in children and visited a few children suffering from heart diseases in several districts of Andhra Pradesh more particularly Guntur, Krishna, Nizamabad, Medak, Prakasam, Hyderabad and Nalgonda Districts and I have observed that in majority of the cases the treatment and surgeries are delayed due to various reasons. Therefore, I am very much concerned about the speedy medical aid to save the lives of the tender children suffering from heart diseases.
I, submit that the second petitioner herein M. Bharath Bhushan is also a public-spirited person with engagement in social work more particularly for universalisation of elementary education providing rehabilitation to child labour. He has also been associated with me in filing the public interest litigation before this Hon?ble High Court in regard to potable dinking water for adivasis of Adilabad district.
I submit that thousands of children with congenital heart problem are primarily hail from poor families. The treatment expenses estimated by corporate hospitals range from one lakh to 2 lakh rupees. Even Nizam?s Institute of Medical Sciences (NIMS), a public funded autonomous Medical Institute, is under great pressure in providing the services on time to the vulnerable children. Unable to bear the high costs of treatment, thousands of parents are struggling to get their children treated for the congenital heart diseases and some of these children even died for want of treatment.
I submit that at this juncture Madiga Dandora led by Krishna Madiga have surveyed a few hundreds of cases of children suffering from heart diseases and organised a meeting of the parents on 7 Aug. 2004 at Hyderabad. Two children died on the day of the meeting and tens of children who were critical at the camp were rushed to different corporate hospitals including NIMS. This event made the Hon?ble Chief Minister of Andhra Pradesh to respond and declare special measures to address the issue.
I submit that the Govt. after careful consideration of the matter have decided to ?provide financial aid towards surgeries to the children suffering from heart diseases to the private hospitals who provide treatment and surgery for each category at the rate of 20% less than the charges levied by NIZAMS, Hyderabad for similar cases?. The pediatric heart surgeries have been classified into nine broad categories for the purpose of costing. The child patients who were screened at Medical camps conducted by government on 14, 16, 22, 28 and 29 of August 2004 shall go to one of the nearest cardiac cells constituted in the following govt. teaching hospitals. 1) Osmania General Hospital, Afzal Gunj- Hyderabad. 2) Gandhi Hospital, Padma Rao Nagar- Hyderabad. 3) Mahatma Gandhi Memorial Hospital ? Warangal 4) Government General Hospital ? Kakinada 5) Government General Hospital ? Guntur 6) Government General Hospital ? Kurnool 7) King George Hospital ? Visakhapatnam
It is submitted that the Cardiac Cell in the teaching hospital will conduct necessary screening and render advice to the child?s patients/ attendants. The cardiac cell shall undertake treatment of Pediatric cardiac ailments at the same teaching hospital including surgeries to the extent the required facilities are available. If the facilities are not available in the teaching hospital then the Cardiac Cell of the teaching hospital refers to the nearest private hospital that can perform such surgery and has agreed to do it free of cost to the patient as per G.O Ms No 363 Dt 1.10.2004 of financial assistance to private hospitals under a special package of rates.
I submit that on such reference by the Cardiac Cell, the private hospital participating in this programme shall admit the patient immediately and give required medical care and perform surgery as required to the patient without charging any fee i.e. absolutely every thing at free of cost to the patient. The private hospitals submit bills as per the above guidelines with discharge summary to the Director of Medical Education (DME). The DME will process the bills and facilitate for the payment through the special committee constituted for the scrutiny and approval and recommendation for payment. The DME will communicate separately to the government for similar financial assistance towards the cost of such surgeries performed in Government hospitals.
I submit further that an amount of Rs.8 crores has been earmarked for this purpose under the said G.O Ms 362 as first installment from the Chief Minister?s Relief Fund to the Director of Medical Education, who will keep the said amount in his P.D. account and meet the cost of expenditure for implementation of the scheme (G.O. Ms. 362 dated 1st October 2004, 1 to 4 pages).
I submit that the Government has issued (G.O. Ms. No. 363 dated 1st October 2004 wherein the management of the private hospitals have participated in the program and agreed to admit the patients on reference from Cardiac Cells and give required medical care and perform surgery at the rate of 20% less than the rates of Nizam Institute of Medical Sciences for similar surgery. In the meeting held by the Government, the management of private hospitals on 21-9-2004 have requested for early payment for the cost they incurred for surgery done to the children as per the Government instructions. The Government decided and constituted a committee with a view to facilitate more surgeries to be conducted and to scrutinize the claims and insure speedy payment to the private hospitals and NIMS.
I submit that the Government accordingly constituted a Committee for this purpose consisting of the Director of Medical Education as Chairman and the Director of Health A.P. and others as members of the said committee. The said committee shall meet frequently as necessary to insure that the bills are paid within a maximum period of 15 days from date of their submission. The committee shall also review on monthly basis the progress of the implementation of program and submit a report to the Government. The Committee may make appropriate recommendations on child cardiac surgeries to the Government, based on the experience of the cases considered by it. In respect of surgeries performed in the Government hospitals the concerned hospital should submit the reports containing the cost of surgeries with discharge summary case wise to the Director of Medical Education who shall release the amount from the funds allotted (as per (G.O Ms No 363 dated 1-10-2004 page 5 &6).
I submit that the Government issued G O. MS No. 598 Dt 15-12-2004 wherein the heart surgeries have been classified into 9 categories. The Director of Medical Education in letter dated 8-11-2004 submitted to the Government has furnished a list of private hospitals who have expressed their willingness to perform or participate in this program and accordingly the Government has approved 26 corporate hospitals besides five government hospitals mentioned in the said G.O. for utilizing their services in providing the heart surgeries to the children suffering from heart diseases, as per the rate fixed by the Government i.e., 20% less than that of the charges leveled by the Nizam?s for the same surgeries. The G.O further mentioned categorically that specified number of surgeries that can be taken up by each individual private hospital for a month i.e, Appollo - 70, Care ? 10, NIMS Hospital ?25, Medicity ? 75. (G.O.Ms No.598 dated 15th Dec 2004 pages 7-9)
It is submitted that the Director Medical Education is required to make frequent inspections of the above mentioned hospitals to ensure that the programme is successfully implemented as planned and submit monthly reports to the government so that the monthly agreed and fixed targets of each hospital are achieved and the plan of action is complied with (Annexure attached to G.O.Ms. 598 dated 15-12-2004, at Page no. 10).
I further submit that the Government issued the G.O. Ms. No. 5 dated 6-1-05 wherein the Government accorded permission to the Director of Medical Education to reimburse the cost of surgery in Government Hospitals or Institutions performing child heart surgeries at the rate of 20% less that of the Nizam?s for similar surgeries on par with the private hospitals. The superintendents of the respective Government hospitals should arrange the account for this purpose to meet the expenses towards treating and performing the surgeries. The said GO specifies that the Director of the Medical Education shall take further necessary actions in the matter accordingly (as per Annexure no 4 G.O. Ms no 5, dated 6-1-05 pages ).
I submit that the Government issued G.O. Ms. 19, dated 19-1-2005 wherein the Government accorded a permission to the Director of Medical Education to reimburse the cost of open surgery in each individual case on the actual costs incurred by the respective hospitals for procuring the disposables and costly medicines involved in treatment of particular child as submitted by the respective hospital.(G.O. Ms. 5 dated 19-1-2005 pages ).
I submit further that corporate hospitals have a social responsibility. The Government has provided certain concessions to some hospitals so that they provide free Medicare to poor and needy patients. As per the G.O. Ms No. 517 dated 26th March, 1981 the Government alienated lands to an extent of 30 Acres in Banjara Hills in favour of Deccan Medical Center for setting up a Modern Medical Hospitals i.e. Apollo Hospitals situated at Banjara Hills, on the condition that such hospital shall reserve/ allot at least 15% of the beds free of cost for the poor. (G.O. Ms 517 dated 26-3-1981 page )
I submit that more than 60 private hospitals were given exemption by the Government from payment of customs duty in recognition of their services to the poor patients i.e, is 40% outpatients at free of cost and 10% of beds reserved for free treatment as per custom notification Nos., 64/88 dated 1-3-1988. The Apollo Hospitals have been given exemption of customs duty of a value of Rs 50.51 lakh according to the Report of the House Committee on Corporate Hospitals Report dated 28/9/1996. Similarly the CDR Hospitals have been granted exemption of Rs 73 lakh and Medicity an amount of Rs 2.95 Crore of exemption among several other private hospitals. (pages )
I submit that the respondents are not honouring the Government Orders and have failed in discharging their duties as per the said Government orders which has resulted in untold suffering to the children and their poor parents who flock to the hospitals from different corners of the state. The delay and neglect of the management of the said hospitals, who are under obligation, has also been responsible for the loss of lives in some cases that could have been saved by timely assistance. It is a matter of grave concern that lives of children suffering from heart ailments are put to great suffering despite the government?s willingness to provide all financial assistance to save the lives on a war footing.
I further submit that thousands of children are still suffering for want of timely treatment. In this connection I would like to submit that the Hon?ble Chief Minister of Andhra Pradesh gave a direction to conduct 400 child surgeries per month in review meeting held on 1st March 2004. Sadly very few operations were conducted even after the said review by the Hon?ble Chief Minister. If the process of treatment and operations goes like this it would take 4 to 5 years to get all the children operated who are in the queue and by which time many lives would be lost owing to the neglect and indifference of the hospitals and other respondents in the face of a humane government that has come forward to provide financial assistance. It is submitted that this neglect of the respondents is violation of the right to life guaranteed by the Constitution of India.
It is submitted that main grievance of the petitioners is that despite the government orders the management of the private corporate hospitals (i.e., Respondents 4 to 7) are charging fee for providing diagnosis and also demanding additional amount far and above the amount permissible by the government and those who are not able to pay such amounts are denied of the medical care that is obligatory and the very purpose of the Government Scheme is defeated. Some children admitted in Gandhi Hospitals have been kept waiting for more than four months without surgeries for want of adequate infrastructure. These children are deprived of schooling and also the surgery. Some of the parents submitted representations on 1st , 5th and 6th August, 2005 stating that the private hospitals are demanding to bear the extra amount ranging from Rs 40,000 to Rs 1,00,000 as the amount given by Government is very less compare to the actual costs incurred by them for giving treatment and conducting surgery.
I submit that some private hospital authorities like Apollo are also charging fees for consultation and diagnosis/ medical examinations. The Apollo Hospitals is claiming that the fee fixed by the Government is not adequate and thereby demanding extra amounts from the patients and this fact has been brought to the notice of the authorities by the parents of the patients and also by the petitioner. The private hospitals are simply demanding more money for something or the other and simply giving the date and delaying the surgery and treatment on one pretext or the other. In this process the poor families who have come from different parts of the state to the hospitals have incurred unreasonable expenditure. The Government hospitals are also delaying the treatment and surgeries and are forcing these vulnerable children to wait for months affecting their health, schooling, and also the earning of the parents besides putting them to additional costs of travel and stay in locations near the hospitals.
I submit that I made a representation to the first respondent on June 18, 2005 requesting to speed up the process of treatment and I also took a few patients to Dr. Ravindra Babu, Convener of Cardiac Cell at the DME office (the 2nd respondent) and he requested the authorities of CARE and Apollo Hospitals to take immediate action in this regard which has been ignored by the authorities of said hospitals.(page no )
I would like to submit that a few cases of such neglect by the Respondents and the suffering of the children with heart ailments. These cases reveal amply the violation of the Government Orders and gross failure by the respondents in discharging their duties as per the above said G.Os.
26.1) Master Hussain Khan, aged 6 months, s/o Rasheed Khan r/o H. No 18-11-159/1 Barkas, Hyderabad was referred to Apollo by the Cardiac Cell ? OGH on 18-6-2005. The child was treated at private a nursing home (Princess Durru Shehvar Children?s & General Hospital, Purani Haveli) on payment basis from 7 to 10 June 2005. As the treatment was expensive and surgery was recommended at the above hospital, the parents took the child to the Cardiac Cell- Osmania General from where he was referred to Apollo Hospitals. The child was examined at the Apollo Hospitals on 28th June 2005 and was charged Rs 200 for the consultations. (vide Cash Bill Dated 28-Jul-2005 # COCS3826 Identity Card UHID: APJ1. 0000531365 of Baby HUSSAIN KHAN). The child with complex problem of heart ailment is still waiting without surgery since June 2005 for reasons of inability to pay the extra amounts demanded by the Apollo Hospitals. A representation of the problem is given to the DME and the Principal Secretary on 6 August 2005. (enclosed copy of representation at para no.23)
26.2) Baby Sharanya d/o K Sudarshan, (born on 31 May 2002 and died on 2nd July 2005), r/o Pedda Kamela, Tirumalgherry, Hyderabad was seen by a cardiologist at Mahaveer Hospital. The cardiologist after a study had suggested for surgery and advised them to go to Sri Satya Sai Institute of Higher Medical Sciences, Puttaparthy. The baby was given medication at this institute and was asked to get back upon intimation after about a year for surgical correction. No intimation came from Sri Satya Sai Institute of Higher Medical Sciences, Puttaparthy. The baby was diagnosed at Apollo Hospital in the month of August 2003 for complex CHD, SCD, DORV, VSD, SEVPAH, (mild PS). The hospital authorities estimated the cost of surgery as Rs 150,000 and wrote a letter to District Collector and CM?s Office. The Govt sanctioned Rs.25000/- vide letter No.5328/DA2/2004 dated 21-2-2004. The District Collector recommended the case, on request from the Hospital, to Save A Child Heart Foundation (SACH), which provides financial aid for treatment and surgery to children with heart diseases. The District Collector accordingly recommended on 8-4-2004 the case to Apollo Hospital ? for surgery that has been tentatively posted on 12th April 2004 under SACH. Financial Assistance of Rs 25,000/- from Chief Minister?s Relief Fund was released (vide cheque no. 505267 dt 24 September 2004) to meet the medical expenses in connection with treatment of the baby. Though the recommended surgery was required immediately and a grant of Rs 25,000 under the CMRF was sanctioned, the Apollo Hospitals did not perform the much-needed surgery, for under one pretext or the other despite of the Collector?s recommendation. As there was no intimation from Appollo Hospital authorities The parents took Baby Sharanya for help at CARE hospital on 10th August 2004 and consulted Dr.Gopi Chand, and he advised for a surgery and said that the Hospital would send intimation for the surgery. Baby Sharanya developed some health problem and was admitted at Appollo Hospital on 7th Sep 2004, and she was treated in the hospital for a week. The financial assistance of Rs.25,000/- which was sanctioned for surgery in Feb 2004 was utilized for the treatment of the baby from 7th to 14th Sep 2004. Further the Cardiac Cell -Gandhi Hospital referred the child to NIMS on 12-10-2004. The child was examined at NIMS and treatment was given from October 2004 to March 2005. On 18 March 2005 the child was asked to consult the doctors after three months. However, no surgery was performed in NIMS. Subsequently baby Sharanya was admitted on 14-6-2005 at Gandhi Hospital for treatment of fever and the Cardiac Cell referred the baby again to Apollo Hospital. The patients preferred CARE Hospital to Apollo because of the past experience. Therefore the child was referred to CARE on 23-6-2005 and the child was taken to CARE Hospitals on 24-6-2005 where the baby was asked to come to hospital after two days. The unending tragedy of the child suffering from multiple problems of heart complaint being refused surgery and asked to go from door to door at different hospitals of the city without any sight of the actual surgical assistance for one reason or the other was published in the local newspaper- Eenadu on 25 June 2005. In response to the newspaper Mr. Srikanth from CARE Hospital visited the patient?s house on 25-6-05 and requested the parents to bring the child to the Hospital on 26-6-05 without fail. The baby was admitted in CARE Hospital on 27-6-05 who died subsequently in the hospital on 2nd July 2005 before the much needed surgery was performed.
26.3) Baby Santhosh s/o Dattu Ram, aged nine months, r/o Salura village of Bodhan mandal from Nizamabad district was referred by Osmania General Hospital on 12-03-05. On 24 March 2005 the child was examined at Apollo Hospital and the date of operation was given for 29-4-2005, which was subsequently postponed to 30-5-2005. Mr Murthy, Manager, Corportae Affairs of Apollo Hospital was asked about the reasons why the surgery was getting delayed. He has expressed that the surgery costs more than 4 lakhs and the amount that is available from the Government is inadequate to cover the entire treatment. On 30 May 2005 Mr Murthy insisted that operation would be taken up if the extra amount were to be paid. Unable to pay the extra amount that was demanded the parents along with the first petitioner met Dr. Ravinder Babu, Convenor, Cardiac Cell at DME and explained to him that Mr. Murthy was demanding payment of the extra amount for performing the required operation. Dr Ravinder Babu, Convenor, CC-DME did write to the Apollo Hospitals to look into the grievance. When the father of Baby Santhosh took the said letter with endorsement of the Convenor-CC to Mr Murthy the patient was sent home without out giving a further date. Now the child is still waiting for help to save the life.
26.4) Baby Sadhana d/o Gopal Reddy, aged 2 years, r/o Mittapally village, Siddipet Mandal, Medak district was screened on 13 January 2005 at Gandhi Hospital and referred to Apollo Hospital. She is making rounds to Apollo Hospitals for the medical aid where she is asked to come again at a later date only to be told to come again at a later date without any treatment and surgery. She had been to Apollo Hospital on 21-1-05, 23-2-05 and 30-5-05. Further, instead of free tests the child is charged Rs 200 towards consultation and 850/- towards ECO.
26.5) Baby Renuka d/o Mallayya, aged 12 years r/o Balemula village, Suryapet mandal of Nalgonda district is suffering from heart problem and does not know of the government scheme of special assistance for child heart diseases, as there was no proper guidance form the authorities. She was admitted for heart complaint on 6 December 2003 at Niloufer Hospital. Renuka was asked to visit after two weeks for review. As there was no concrete assistance available at Niloufer the child was taken to Apollo Hospital in August 2004. The child was examined on several occasions (18 August 2004, 16 November 2004, and 29 May 2005), and medicines prescribed for heart problem but the parents of the child were not informed of the scheme of assistance for heart operations till they explained to the authorities that the cannot pay or borrow from any sources to meet the costs of the operation. Probably on getting convinced that they cannot get any money from the poor parents who have been making rounds for about nine months, Apollo Hospital authorities advised the patent to approach Cardiac Cell for the advice and treatment with government assistance. The authorities of corporate hospitals are delaying heart operations and suppressing the information of free assistance with the hope of collecting money for which there is government assistance. This case illustrates the help to the child was delayed by several months for sheer reasons of greed.
26.6)Master Mahesh Kumar Gajjela s/o had been advised for a surgery at Medicity in 1997. Mahesh Kumar was diagnosed for VSD etc on 17-1-05 and estimation was made for Rs. 95,000/- on 18-1-05.He has consulted Dr. D.N. Kumar on 3-3-05 after paying consultation fee of Rs. 200. ECO test is also conducted. The patient received a letter from DME on 31-01-2005 for reporting Sup. Gandhi Hospital for obtaining referral card. This letter is also shown to CARE authorities on 3-3-05 but Care authorities did not bother to advise the patient to go to Government Hospital. Care Hospital authorities did not acted as per the G.O.
26.7)Corporate hospitals charging fee from the poor patients in spite of the special scheme of assistance for child heart operations is illustrated in a child aged two months baby of Vijaya from Warangal belonging to Lambada tribe. The child was admitted on 18 May 2005 at KIMS- Secunderabad and examined for which she was charged Rs 6,939.87 towards tests and pharmacy and was diagnosed as ?CHD Bilateral peripheral pulmonary artery stenosis, Dilated RA/RV/Severe PAH/ Mild TR, Significant RV dysfunction/ PFO with Bi-directional shunt? by Dr TNC Padmanabhan. The child was taken to CARE hospitals with the hope that the child may be operated upon. The baby was hospitalized from 21 to 25 May 2005. The baby was examined again at CARE hospitals and was charged more than Rs.14000/-. Parents of the child were not informed of the free assistance available under the special scheme nor was provided free services by KIMS and CARE hospitals. Even though the family belongs to BPL category. The child subsequently was screened at Cardiac Cell MGMH Warangal and referred to CARE on 2-6-05. The patient came to the Hospital on 27-6-2005 after medical tests was asked to come after some time. Still not operated upon.
27 The main grievance of the petitioners is that despite of the Government orders the official respondents have not discharged their duties to ensure the speedy implementation of the said G.Os i.e., providing treatment and surgeries by the private and Government teaching hospitals immediately not acted upon the inordinate delay. The petitioners have also brought to the notice of the Principal Secretary, Health & Medical, as well as the Director of Medical education but there was no favorable action.
28 The petitioners have no other alternative remedy except to approach this Hon’ble Court Under Article 226 of the constitution of India.
29 The petitioners have not filed any other write petition, direction, order or any application before any authority or Court for redressal of this grievance.
30 The petitioners herein pray that this Hon’ble High Court may be pleased to issue an order or direction more so in the nature of a writ of Mandamus declaring the action of the Respondents in not conducting the treatment and surgeries for the children suffering from heart ailments and delaying the said operations by demanding extra money from the patients or delaying the process of treatment and surgical operations without any sound reason as illegal and inhuman which is responsible for the suffering and even loss of lives of these vulnerable children from poor households. The petitioners herein further pray that this Hon?ble High Court may be pleased to direct the Respondents to enlist, if necessary, more such hospitals even outside the state of Andhra Pradesh to ensure the medical assistance to these suffering children within a year to prevent loss of further lives and suffering.
31 Pending disposal of the main writ petition, the petitioners herein pray that this Hon’ble High Court may be pleased to direct the Respondents to implement the Government Orders for child heart surgeries on a war footing without any further delay