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PETITIONER: RAKESH CHANDRA NARAYAN

       Vs.

RESPONDENT: STATE OF BIHAR

DATE OF JUDGMENT27/09/1988

BENCH: MISRA RANGNATH BENCH: MISRA RANGNATH VENKATACHALLIAH, M.N. (J)

CITATION:  1989 AIR  348            1988 SCR  Supl. (3) 306  1989 SCC  Supl.  (1) 644 JT 1988 (4)   233  1988 SCALE  (2)965

ACT:      Constitution   of   India,   l950--Article   32--Public Interest Litigation --Mental Hospital Ranchi--Chief Judicial Magistrate’s  report-- Considered--Committee  of  Management appointed for the hospital.

HEADNOTE:      A  letter petition in regard to the Mental Hospital  at Ranchi  was   considered as a  public  interest  application under Article 32 of  the Constitution, and the Court  called upon  the State of Bihar to  file its counter affidavit.  At the  same  time,  the Court  directed   the  Chief  Judicial Magistrate to visit the hospital and submit a  report  about the  conditions prevailing there. The hospital was  in   the sole  management  of the Health Department of the  State  of Bihar.  The State of Bihar received financial  contributions from   the States of West Bengal and Orissa on the basis  of the number  of beds reserved for each State.      The  report submitted by the Chief Judicial  Magistrate made  a painful reading. In the affidavit submitted  by  the State  of Bihar it was stated that the Government was  aware of the conditions and had since taken some steps to  improve the working of the hospital, and had also drawn up a  scheme to  develop  the  hospital  on  the  lines  of  NIMHANS   in Bangalore.      From time to time, the Court had issued directions  and made  specific  orders regarding provision of  better  food. clothing,  medical  treatment, housing  and  improvement  of sanitation, etc.          While keeping the matter pending, the Court,      HELD:  (1) In a welfare State it is the  obligation  of the  State to  provide medical attention to  every  citizen. The  State has to realise its obligation and the  Government of  the  day has got to perform its duties  by  running  the hospital  in a perfect standard and serving the patients  in an appropriate way. [318D-E]      (2) It is clear that inspite of several orders made  by this  Court and assurances held out by the State  Government of Bihar. the defects were not being remedied. The awareness                                                    PG NO 307 of  the  governmental  authorities of the  sordid  situation

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prevailing  in  the  hospital, as  admitted  in  the  scheme furnished  to the Court, the non-compliance in an  effective way with the directions made from time to time by the  Court and the general lethargy shown in rising from slumber leaves a  clear impression that the institution cannot be run as  a mental hospital of that magnitude unless there be change  in the administrative set-up, the control is altered and a  new service to patient-oriented thrust given to the institution. [3I8-C]      (3)  The scheme which was furnished to the Court was  a halfhearted  one  and no attempt therein was made  to  bring about  any improvement except attending to  certain  obvious deficiencies and short- falls. The Court had looked  forward to a scheme of re-orientation which the scheme did not  even remotely touch. [318F-G]     (4) The State Government authorities have not been  able to  assess  the priorities. There does not seem  to  be  the slightest  interest on the part of the persons handling  the matter, to improve the environment. In these  circumstances, it  is difficult to leave the management exclusively to  the Health  Department of the State of Bihar if the  institution has to run as a good and useful hospital. Association of the States of West Bengal and Orissa in the management is likely to bring about some positive result. It would, therefore, be much  better if a Committee of Management is appointed  with full  powers to look after all aspects of  the  institution. [319A; B-D]      (5)  The Court accordingly constituted a  Committee  of Management  for  the  Mental Hospital  and  gave  directions regarding the financial contribution from the  participating States,   and  also  laid  down  guidelines  regarding   the functioning  and  management  of  the  hospital.  The  Court further  directed that the Committee shall take  expeditious steps  to  explore  the  possibility  of  transforming   the hospital  into the pattern obtaining in the hospital run  by NIMHANS at Bangalore. [321C-D]

JUDGMENT:    ORIGINAL  JURISDICTION: Writ Petition (Civil) No. 339  of 1986.      (Under Article 32 of the Constitution of India)      S.P. Pandey and Mrs Rekha Pandey for the Petitioner.      J.R Dass, D.K Sinha, D Goburdhan and R.K. Mehta for the Respondent.                                                    PG NO 308      The Judgment of the Court was delivered by      RANGANATH  MISRA, J. A letter addressed to the  learned Chief  Justice of this Court from two citizens of  Patna  in regard to the Mental Hospital at Kanke near Ranchi in  Bihar State  was  considered as a public interest  litigation  and registered  as  an  application  under  Article  32  of  the Constitution. On 7.4.1986, this Court called upon the  State of  Bihar  to  file  its counter  affidavit  and  the  Chief Judicial   Magistrate  of  Ranchi  or  any  other   Judicial Magistrate nominated by him to visit the hospital and submit a report about the conditions prevailing in the Hospital.      The  Chief Judicial Magistrate visited the hospital  on 8.6.1986,  and  on several other  occasions  thereafter  and submitted a detailed report on 15th of July, 1986. He  found that  there  were 1580 beds. The Hospital was  in  the  sole management  of the Health Department of the State of  Bihar. The State received financial contributions from West  Bengal and  Orissa. There is a Managing Committee of  the  Hospital

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consisting  of  14 members in all with the  Commissioner  of South  Chotanagpur Division as its Chairman. The  sanctioned strength  of  medical officers was 16 but only  9  had  been filled-up  and there were 7 vacancies. In the  Hospital  the male  patients  wing had 10 blocks in all,  apart  from  the Isolation  Ward,  the Medical Ward and the  Infirmary  Ward. These  are  in  10 double storied blocks  and  three  single storied  wards  in charge of separate  doctors.  The  female patients’  unit  consisted  of two double  storied  and  two single  storied blocks. Each block had the capacity  of  120 patients.  Some  of  the  patients  had  to  pay  for  their treatment  while the treatment to the general  category  was intended  to  be free. All the  three  residential  quarters within  the  complex  meant for the  medical  officers  were occupied by others, one by the suspended Superintendent, the other by the retired Superintendent and the third one was by the  Acting Superintendent. Three doctors were  residing  in the  quarters  meant  for  non-gazetted  officers  and   the remaining  doctors were staying in private houses at  Ranchi about 11 kilometers away.      The  Chief  Judicial Magistrate found  that  there  was acute shortage of water in the Hospital. There was only  one tubewell within the campus located in the male block.  There were  five  ordinary  wells but there  was  no  motor  pumps installed  in  any one of them. These wells  were  the  only source of supply of water. Several representations had  been made  to  the  State  Government  for  supplying  water   on permanent  basis to the Hospital but there was  no  response from the Government.                                                    PG NO 309      The  Chief Judicial Magistrate was surprised that  none of the toilets within the hospital complex was in order. The sanitary fittings were not operating having got chocked. The patients  were, therefor, forced to ease themselves  in  the adjacent open field. Consequently the environment had become polluted  and unhygienic. Though there were fan  points  and even  electric  fans  were hanging from  the  roof  in  some places,  no  fan  excepting the one in the  chamber  of  the Superintendent was in working condition. He also found  that though there were electric connections with bulbs and  tubes yet  light was not available and, therefore, total  darkness prevailed   in  the  campus  between  dusk  and  dawn.   The Superintendent  explained to the Chief  Judicial  Magistrate that the Hospital had no electrician and the Institution had to depend upon the mercy of the State Electricity Board  and despite correspondence there was no response.      He  found that old iron cots had been provided  in  the year 1925 and only 300 more had been added by purchase.  The total  number of patients were 1580. Most of the  iron  cots having been broken were out of use and, therefore, only  300 beds were actually available.      None  of  the wards had doors and  windows  in  working condition.  The  Superintendent pointed to him that  he  had made repeated requests to the Public Works Department of the State  Government but no letter had even been  acknowledged. In  the  absence of device to close the  doors  and  windows there  had  been occasions when mentally  ill  patients  had jumped through the windows or had run out from the rooms. To meet  such situations, the broken cots were mostly  used  to block the passages.      The  Chief Judicial Magistrate further found  that  the mattresses  and  linen were in very bad  shape,  he  noticed several patients to be lying on the bare floor; some of  the patients  were using a single blanket both as  mattress  and cover.  Some patients were naked in the absence of  clothing

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and  others  were  found  wearing  torn  shirts  and  pants. Mosquito  nets were not available pillows were not  provided and the patients were left to their fate. The Chief Judicial Magistrate  noticed  marks of buy bitings as  also  mosquito biting  on  the  body of the patients.  In  the  absence  of clothing the patients were forced to wear the same shirt and pant  for  four to six weeks without a wash  on  account  of unavailabiliy  of water. The Superintendent told  the  Chief Judicial Magistrate that Government of Bihar had  sanctioned Rs. 3 a day per patient for the two meals and breakfast  and it  was  wholly  inadequate.  The  Managing  Committee   had recommended  for sanction of Rs. 10 per patient per day  but                                                    PG NO 310 there had been no response. The diet as  prescribed included an  egg, 250 gms. of milk every day and meat and fish,  once in a week, but in the absence of appropriate funds those had been discontinued for years.      The Chief Judicial Magistrate having visited the  place on  several occasions noticed that there was no  account  of the  stock of medicines; life-saving drugs were  not  stored properly  in the absence of a refrigerator. The  instruments were  not in working condition and the employees  meant  for working  the instruments were idlying away their  time.  The patients  were now referred to Medical College  Hospital  at Ranchi  for X-ray and E.C.G. as and when necessary. Many  of the  patients told the Chief Judicial Magistrate  that  they had not been getting any medicine for months together.      The   Chief   Judicial  Magistrate  had   noticed  that several doctors were not available in the Hospital for  days together. Some of the patients in the wards complaind to him that the doctor was not visiting the ward even for one  hour in a week; he carne across a weak and emaciated patient  who told him that he had not been given any food for two days on the plea that he was suffering from diarrhoea and he had not even  been given any treatment. C)n the 11th of July,  1980, when he visited the Hospital along with the local Additional District  Magistrate? he found not a single doctor  on  duty though that was the time when all the doctors, were supposed to be on duty within the campus. Though this was the  actual position. the attendance register showed all the doctors  to be present as required according to the duty chart .      The Chief Judicial Magistrate collected the death  rate from the Superintendent for the period between 1977 and 1986 which are as per the particulars given below: -------------------------------------------         Year    Male    Female  Total -------------------------------------------     1977     38 11      49     1978        72      12      84     1979        74      31      l05     1980        66      24      90     1981        39      33      172                                                  PG NO 311     1982        173     50      231     1983        87      44      131     1984        152     94      246     1985        90      69      159     From     1-1- 1986     30-6- 1986  49      25      74 In Paragraph 28 of the Report the Chief Judicial  Magistrate stated: "This  chart  clearly  shows abrupt rise  in  the  graph  of death  rate after 1980. 1984 was the most  unfortunate  year for Arogyashala, when maximum escapes and deaths took place.

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Mass scale escapes and deaths of patients in 1984 is said to be  the  result  of internal  politics  in  the  Arogyashala campus,  for  which, the then Superintendent and  Dr.  Durga Bhagat and Deputy Superintendent. Dr. B.B. Singh are said to be largely responsible."     The Magistrate further reported that the present  acting Superintendent had failed to improve the administration.  He lacked  adequate control over his colleagues and the  staff. The out-going Superintendent residing within the campus  was inciting  the  people  and  the  acting  Superintendent  was gradually   losing   his   grip   and   control   over   the administration.   The  innocent,  miserable  and   vioceless patients  were  the victims of the situation.  The  practice prevailing in the Hospital had been that the  Superintendent alone  was  competent  to admit patients  and  as  such  the guardians  and attendants of the patients seeking  admission into  the Hospital had been exploited by a group of  persons friendly with the Superintendent and those who did not  come to  terms  with  the  Superintendent  had  been  denied  the benefits   of  the  Hospital.  This  led  to  friction   and unpleasant  relationship. He recommended that a  non-medical man, if possible, a retired army officer or a District Judge could be posted as the head of the Hospital to take  control and  tone  up the deteriorating situation. He found  that  a large garden was attached to the Hospital but on account  of the all-pervading mismanagement there was no return but  one Dr.  Buxy had recently been put in charge of the garden  and had improved the same.     Last  of all in his report he adverted to the fact  that some  petients who had recovered--and their number he  found was  about  300, being  both men and women--were  not  in  a position either to return to their take to any employment in the absence of any facility. He found that these persons who                                                   PG NO 312 no  more  required  treatment should  be  removed  from  the Hospital so that there would be room available for  patients who  required  treatment; unnecessary  expenditure  on  such large number of people could be avoided and the standard  of discipline  within  the Institution could  be  improved  and there could be a general toning up of the atmosphere.     Along  with the report he gave various relevant  details in  the  annexures.  Annexure  -11 is  a  list  of  criminal patients who had come from different jails for treatment and had been declared fit for discharge.     We may refer to the cue of one Rupa Santhal. This person was admitted to the Hospital on 28.9.1947 at the instance of the  Superintendent of Chittagang Hill Tract Jail, where  on being  convicted  by the Deputy Commissioner  of  Chittagang Hill Tract for an offence punishable under Section 326  IPC, he   had  been  imprisoned  for  undergoing  the   sentence. Obviously  he  could not have been detained in jail  for  41 years for the offence under Section 326 IPC. Several letters were  sent from the Hospital but there was no  response.  We may also refer to the case of Madhu Mahanta who was admitted to  the  Hospital  on  15.11.1950 at  the  instance  of  the Superintendent,  District  Jail, Keonjhar in  the  State  of Orissa. He had been convicted under Section 302 IPC and  was languishing in the Hospital for 36 years though he had  been cured several years back. The Magistrate has given a list of 13 persons of this category.     We   are  astonished  that  even  when   prisoners   are transferred  for  treatment  from  jails  where  they   were undergoing  sentences of imprisonment, no  follow-up  action has been taken from the jails on their own and even when the Hospital authorities had required the prisoners to be  taken

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back  no  response has been made. This only  exhibits  total callousness.  We  have  given sumptuous  extracts  from  the report  of  the  Chief Judicial Magistrate with  a  view  to bringing out as clear a picture as possible of the  shocking and  savage conditions that prevail in the mental  hospital. There  can   be no two opinion that the hospital  was  in  a shape- a shade worse than Oliver Twist’s Orphanage. From all accounts, perhaps. many of zoos housing animals have  better conditions  than those that prevail in this hospital.  While the   mentally-ill  require  a  soothing   environment   for treatment,  as  psychatrists  say, the  State  of  Bihar  as converted what was once a prestigious mental hospital Into a den to house about sixteen hundred patients. The reports  of the  Chief Judicial Magistrate gives the reader the  feeling of  a  medieval  torture- house.  On  11.8.1986,  the  Court noticed the report and observed:                                                   PG NO 313     "The report makes a painful reading and shows how  badly is  this institution managed and in what in human  condition the patients are made to live & work there. It is surprising that the State of Bihar has allowed this institution to  de- generate  into the present condition. It is  necessary  that immediate  steps should be taken to improve the  functioning of  this  institution in all respects.  We  would  therefore direct  the  Chief  Secretary and Health  Secretary  to  the Government of Bihar to file affidavit or affidavits  putting forth  a  definite scheme for improving the working  of  the Institution  and for remedying the drawbacks  and  deficien- cies  pointed  out in the report, including the  neglect  of patients  by  the  Medical Superintendent  attached  to  the Institution. This matter must have urgent priority since  it concerns  the  well-being of the  mentally  handicapped.  We would  therefore direct that the affidavit be  filed  within three  weeks from today setting out a time  bound  programme for  improving the functioning of the Institution. We  would like to observe that the Chief Judicial Magistrate has  made an excellent job of the task assigned to him and we  express our  sense of appreciation for the work done by  him.  These observations may be sent to the High Court of Patna and  the Chief Judicial Magistrate".     On   1.9.1986,  the  Health  Secretary  filed  a   short affidavit together with a scheme for the improvement of  the Hospital. The opening words of the scheme have to be  quoted to be believed: "The  Government  of  Bihar  are  aware  of  the  conditions prevailing  in  the  Mansik  Arogyashala,  Kanke,  and   the Government  for  sometime  in  past  have  been   discussing measures  to  be  taken for improvement  of  the  same.  The subject was discussed by the representatives of the State of Bihar  with  the  members of the Planning  Commission  at  a meeting held at New Delhi in the month of january, 1986, and accordingly  it  is  contemplated  to  develop  the   Mansik Arogyashala,  Ranchi  on the lines of NIMHANS  in  Bangalore The  scheme indicated that a letter had been written to  the Director,  NIMHANS at Bangalore for information on  17th  of April,  1986, i.e. 4 1/2 months before the scheme was  filed                                                   PG NO 314 in  this  Court.  There  is no indication  as  to  what  was received  from the Director or as to what further  follow-up action  was  taken  during  the 4  1/2  months.  The  scheme indicated  that out of 16 sanctioned posts three posts  were earmarked for West Bengal Government and were vacant; out of 13 posts, 9 had been filled up and 4 were vacant and were to be  filled-up  by October, 1986. The  scheme  admitted  with reference  to  the  water supply system  that  the  internal

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system was choked and was not functioning. In the year 1985- 86, Rs.10 lakhs had been sanctioned for renovation of  water supply  system and the Public Health Engineering  Department could  utilise  only Rs.61,000 during  the  financial  year; therefore, the balance amount of Rs.9,39,000 was again to be sanctioned in the year 1986-87.     The  lavatories  and  bathrooms  were  not  in   working condition  as  accepted  and the scheme  proposed  that  the Superintendent of the Hospital is to supervise the  sanitary system.     In  regard  to  electricity it was  indicated  that  the electric  fittings, fixtures and other equipments  would  be replaced  by March, 1987 which meant six months  beyond  the date when the scheme was framed. It was proposed that a  100 KV Generator set was to be installed. In regard to cots  and mattresses it was stated that 400 of them would be  acquired in  the year 1986-87 and the remainder in the year  1987-88. It  was  stated that the doors and  windows  required  total replacement and it was indicated that Rupees six lakhs  were sanetioned  during  the financial year for repair  work.  In regard to diet it was indicated in the scheme: "In the State of Bihar, the rate of the diet per patient for the  hospital is Rs.3.00 per day except the T.B. patient  to whom the rate of diet is Rs.4.15 per day. In the year  1986- 87, rate of diet per patient has been increased to  Rs.3.55. The  Superintendent of Kanke hospital has been  directed  to improve dietary management".     It was admitted that E.C.G. machine was out of order and efforts would be made to instal the machine in the financial year. It was also proposed in the scheme that there would be a regular Superintendent posted soon. In regard to supply of medicines it was stated that the prescribed rate was Rs.1.00 per patient per day and it has been increased to Rs.1.90 per patient per day from 1986.                                                   PG NO 315 On  20th  of October, 1986, this Court  made  the  following order:     "1.  In  respect of each patient in  the  Ranchi  Mansik Arogayashala the daily allocation for diet will be increased from the existing inadequate articles of that value shall be supplied to each patient.     2.  Arrangements  should  be made  forthwith  to  supply adequate quantity of pure drinking water to the hospital, if necessary, by engaging water tankers to transport potable water from outside.     3.  Immediate  arrangements  should  be  made  for   the restoration   of   proper   sanitary   conditions   in   the lavoratories and bathrooms of the hospital.    4.  All patients in the hospital who are not  at  present having   mattresses  and  blankets  should  be   immediately supplied  the  same within 15 days from today. Such  of  the patients  who  have  not  been given  cots  should  also  be provided cots within six weeks from today so that no patient shall be thereafter without a cot.     5.  The ceiling limit at present invogue in  respect  of cost  of  medicines allowable for each  patient  will  stand removed,  with  immediate effect and the  patients  will  be supplied medecines according to the prescription made by the doctors irrespective of the costs.     6.  The State Government shall forthwith take  steps  to appoint    a   qualified   Psychiatrist   and   a    Medical Superintendent  for the hospital and they should  be  posted and  takecharge  in the Institution within  six  weeks  from today.     The Chief Judicial Magistrate, Ranchi to whom a copy  of

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this order will be forwarded by the Registry shall visit the hospital  once  in 3 weeks and submit quarterly  reports  to this  Court as to whether the aforesaid directions given  by us are being complied with."     On  20th of November, 1986, the Health Secretary gave  a report  as to programme relating to aspects covered  by  the scheme.  It indicated that no reply had been  received  from NIMHANS  and therefore, an officer had been sent from  Bihar                                                   PG NO 316 to obtain the information. The medical officers against  the vacant  posts had been posted; water supply and  electricity were  yet to be attended to. The repair to the building  was in  progress  and other aspects were yet to be  attended.  A Superintendent in the rank of Civil Surgeon had been posted.     The Chief Judicial Magistrate furnished a further report in December, 1986. While he noticed certain improvements, he pointed  out that there were 400 female patients  and  there was only one lady doctor in the Hospital. There was no  lady Psychiatrist or Psychologist. The Superintendent had written to the Government about it but there has been no response.     On  14th of September, 1987, the Court noticed the  fact that  the  State of West Bengal was in huge arrears  in  the matter  of  payment of contribution to the  running  of  the Hospital.  Counsel  for State of Bihar had  agreed  to  send details of the arrears to the State of West Bengal within  a fortnight and the Court directed the West Bengal  Government to pay the same.     The State of West Bengal filed its affidavit through the Joint  Secretary  in  the Department of  Health  and  Family Welfare. The affidavit while accepting the fact that 38%  of the  seats  in the hospital were reserved  for  West  Bengal alleged that in the absence of furnishing of proper accounts by  the State of Bihar, the payment of contribution had  not been made in time by the State of West Bengal after 1979-80. It agreed to pay Rs.20 lakhs during the year and the balance in suitable instalments in future.     The  State  of Orissa has pointed out in  its  affidavit that  it has been regularly paying its contribution of  Rs.3 lakhs and was not in arrears.     The   Deputy   Director   (Medical)   Health   Services, Government  of  Bihar filed an affidavit claiming  that  the rate  of diet had been enhanced with effect  from  1.12.1986 and in diet all the patients were provided rice, bread, dal, vegetable, egg, milk, loaf, biscutt, tea, fruit . Fish, meat and chicken were being provided alternatively thrice a week. Old  Pipe lines had been replaced and the flow of water  was increased;  storage  facility for water had  been  arranged. Medicine  as  per  requirement  is  being  provided  without refering  to any ceiling limit. new X-ray machine  has  been purchased;  the old E.C.G. machine has been condemned and  a new one has been purchased. One of the petitioners filed  an affidavit  denying many of the aforesaid claims. On 14th  of March, 1988, this Court made the following order:                                                   PG NO 317     "We  have  perused the affidavit filed  by  Shri  Subodh Chandhra  Naryayan, one of the petitioners, wherein  several allegations  of  mismanagement have been made. It  has  also been  alleged that in spite of the direction of  this  Court that  the  daily diet expenses should be Rs.10  per  patient actually  Rs.7  is  being spent and though  this  Court  had directed  that  there should be no ceiling of  expenses  for medicines  beyond Rs.2 per patient is not being  issued.  We are of the view that copy of the affidavit should be sent to the Chief Secretary, State of Bihar with a direction that he would  personally  look into the matter and  should  send  a

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report within four weeks. "     A  report, beyond the time indicated in the order  dated 14th of March, 1988, was furished by the Chief Secretary and the same was covered by an affidavit of the Joint  Secretary of  Department  of Health and Family Welfare  of  the  State Government. The Chief Secretary reported:     "The entirc hospital complex is spread over a  sprawling area. The buildings are old. but they have been  extensively repaired  and white-washed. Many old cots.  matresses  linen etc.  have been replaced by new ones. Government  has  spent several  lakhs of rupees on improvements in the  running  of the Agrogyashala during the last two years. In course of  my visit,  l  did  not  find that  patients  were  being  given inadequate food or medicine.’’     He also found that the toilets had not been attended to, the  position  of  water supply was  not  satisfactory,  the automatic boiler had not yet been repaired or replaced.  The Court’s  Order  of 14th of March, 1988, indicated  that  the affidavit filed by Subodh Chandra Narayan containing several allegations  of  mismanagement was to be  forwarded  to  the Chief  Secretary  and  with  reference  to  the  allegations therein, he was to send his report. We do not find that  the report  of the Chief Secretary covers all the  aspects.  The hospital  authorities would not, in their own interests,  be too ready to expose their own deficiencies during the  visit of  the Chief Secretary. Therefore, to have  been  satisfied and  to  report that during his visit he did  not  find  any patient  being  given  inadequate food  or  medicine  is  no appraisal  of the situation. The fact that lakhs  of  rupees had  been spent on improvement is indeed of  no  consequence                                                   PG NO 318 until  the Agorgyashala is restored to  acceptable  hospital standards.  The  report gives us a feeling  that  the  Chief Secretary  was more conscious about the expenditure made  by the  State Government than assessing the  actual  situation. From  his  report,  however, it is  clear  that  inspite  of several orders made by this Court and assurances held out by the  State Government of Bihar, the defects were  not  being remedied.  The awareness of the governmental authorities  of the sordid situation prevailing in the hospital, as admitted in the scheme furnished to this Court, the non-compliance in an effective way with the directions made from time to  time by this Court and the general lethargy shown in rising  from slumber  leaves  a  clear impression in our  mind  that  the institution  cannot  be  run as a mental  hospital  of  that magnitude unless there be change in the administrative  set- up,  the  control  is altered and a  total  new  service  to patient-oriented thrust given to the institution.     In  a  welfare State--and we take it that the  State  of Bihar considers itself to be one such--it is the  obligation of the State to provide medical attention to every  citizen. Running  of  the  mental  hospital,  therefore,  is  in  the discharge of the State’s obligation to the citizens and  the fact  that lakhs of rupees have been spent from  the  public exchequer  (perhaps without or inadequate return) is not  of any consequence. The State has to realise its obligation and the  Government of the day has got to perform its duties  by running  the hospital in a perfect standard and serving  the petients  in an appropriate way. The reports and  affidavits of the Government of Bihar and its officers (not the reports furnished  to the Court by the judicial officers)  have  not given  us  the  satisfaction of  the  touch  of  appropriate sincerity in action.     The scheme which was furnished to the Court was a  half- hearted  one and no attempt therein was made to bring  about

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any   improvement  except  attending  to   certain   obvious deficiencies  and  shortfalls.  The  hospital  has  been  in existence  from  pre-independence period.  There  have  been epoch making breaks--through in the field of psychiatry  and treatment  of psychiatric patients. The approach  to  mental health  and  the  techniques  of  psychiatry  have  changed. Psychologists have developed their art and their tools.  The method of care ar d attention for the mentally-ill has  also undergone a sea change. When we had called upon the State of Bihar  to give a scheme for improving the conditions of  the hospital, this Court had not intended a scheme for  removing the deficiencies in the old hospital; we had really intended to  look  forward to a scheme of  re-orientation  which  the scheme  did  not  even remotely touch  except  to  say  that NIMHANS at Bangalore has contacted.                                                   PG NO 319     The  state Government authorities have not been able  to assess the priorities. Provision of beds, though the  scheme indicated  had to be fully made by end of March,  1988,  the report   of  the  Chief  Secretary  and  the   accommpanying affidavit  have  not cleared that  position.  Provision  for electricity  and water has taken too long, though  both  are basic  necessities  of  life. The  fact  that  the  existing lavatories  have  taken more than two years to repair  is  a slur  on the administration. There does not seem to  be  the slightest  interest on the part of the persons handling  the matter,   to   improve  the  environment.  In   these   cir- cumstances,  it  becomes difficult for the  Court  with  any sense  of confidence to leave the management to  the  Health Department  of the State of Bihar if the institution has  to run as a good and useful hospital.      We  are cognizant of the position that it is  difficult for  the  Court  to monitor the management of  a  hospital-- particularly when it is located a thousand kilometres  away; but since there have been some improvements with the Court’s intervention, to get out of the picture at this stage  would only  mean  that  the situation will  again  deteriorate  no sooner  the  Court’s  attention is  withdrawn.  As  we  have already pointed out mere restoration of the hospital to  its old  position  would only bring into  existence  an  archaic institution sans modernism. In our opinion, it will be  much better  if a Committee of Management is appointed with  full powers  to look after all aspects of the institution. It  is appropriate   to  take  note  of  the  position  that   this institution receives contribution from two other States.  38 % of these beds, being about 600, are reserved for the State of  West Bengal and the Government of West Bengal is to  pay for  the same. Similarly 75 beds are reserved for the  State of Orissa and a sum of Rs. 3 lakhs is payable by the  Orissa Government.  There  is no reason why the management  of  the hospital should be left exclusively to the Health Department of  State of Bihar and the participating Governments  should not  be  associated in such management. Taking note  of  the performances of the State administration of Bihar in  regard to  the hospital we are of the view that association of  the States of West Bengal and Orissa in the management is likely to bring about some positive result. We would,  accordingly, constitute a Committee of Management for the Mental Hospital in the manner indicated below.     Chairman--A  consenting sitting Judge of the Patna  High Court, Ranchi Bench, to be nominated by the Chief Justice of Patna High Court.                                                   PG NO 320 Members (1) Commissioner of Ranchi Division.

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(2) Station Commander, Ramgarh area, Ranchi. (3) Secretary of Health, Bihar Government. (4) Secretary of Health, West Bengal Government. (5) Secretary of Health, Orissa Government. (6) Deputy Commission of Ranchi. (7) Principal of the Ranchi Medical College. (8) District Judge, Ranchi. (9) Superintendent of the Hospital.     The  Commissioner  of Ranchi Division  and  the  Station Commander  shall be Vice-Chairmen and in the absence of  the Chairman, shall in the order indicated act as Chairman  when any  of them too is absent. The Superintendent shall act  as the  Secretary.  We  hope  and  expect  that  the  concerned Governments  and  authorities  would  accord  the  necessary consent/permission  to the nominated officers to act on  the Committee and the Committee would be able to have its  first meeting  in the first half of November, 1988. The  Committee should meet every month in the first six months with a  view to  removing  the  defects and deficiencies  within  a  time frame--say  of six months at the most and for reviewing  the improvements  in  the conditions of the hospital. If  it  is satisfied  that  the situation has  improved,  the  meetings thereafter may be quarterly. The Commissioner of the  Ranchi Division shall make a monthly report with in 2 weeks of  the end  of every month about the state of the  hospital  during the first year and such reports as and when received by  the Registry should be placed before the Court.     The State of West Bengal is in arrears in regard to  its contribution for several years. Though counsel for the State of  Bihar had undertaken to furnish accounts, the  same  has not  yet  been  done. The Committee shall  ensure  that  the accounts  are furnished to the State of West Bengal  by  the 15th of December, 1988. In its affidavit, the State of  West Bengal  has indicated that it would pay Rs.20 lakhs  out  of the dues during the current financial year and would pay the balance  in suitable instalments. As the improvement to  the hospital would involve huge expenditure, we direct the State                                                   PG NO 321 of West Bengal to pay Rs.50 lakhs out of its dues by 31st of March, 1989 and the balance amount shall be paid in two six- monthly instalments, one by 30th of September, 1989, and the other by 31st of March, 1990. The Government of West  Bengal and  the  Committee shall ensure that this  time-  frame  is adhered  to.  The  entire arrears collected  from  the  West Bengal Government shall be earmarked for development of  the hospital  to  be  expended in the  manner  approved  by  the Committee and no portion thereof would be otherwise spent.     We  are of the view that if the hospital is  transformed into  a better one, just as the hospital run by  NIMHANS  at Bangalore, the quality of the hospital would improve and the patients  would  have  the  benefit  of  modern   scientific treatment. The Committee shall, therefore, take  expeditious steps to explore the possibility of transforming the  Mental Hospital  at  Ranchi  into  the  pattern  obtaining  in  the hospital run by NIMHANS at Bangalore by taking such steps as are necessary and furnish a report to this Court by the  end of  February,  1989  when  that question  will  have  to  be considered  by this Court after hearing the concerned  State Governments  and  the  parties. The  State  of  Bihar  shall provide a basic fund of Rs.50 lakhs in the year ending  31st of March, 1989, to be spent for improvement of the  Hospital in  the  manner approved by the Committee and  in  case  the Committee  is of the view that further funds are  necessary, it  would be open to the Committee to make a report to  this Court whereupon appropriate directions shall be given.

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   There  have  been  repeated allegations  that  the  lady patients who have already been cured are not being  released from  the hospital. At one stage the explanation offered  by the  hospital authorities and the State  administration  was that  the  relations, even though notified, are  not  taking them  back. The hospital is not a place where  cured  people should be allowed to stay. It is, therefore, necessary  that there should be a rehabilitation centre for those who  after being  cured  are  not  in a position  to  return  to  their families  or  on  their  own  seek  useful  employment.  The Committee  shall, therefore, take immediate steps to have  a rehabilitation  centre at a convenient place  around  Ranchi where appropriate rehabilitation schemes may be operated and the  patients after being cured, irrespective of being  male or  female, if they are not being taken back by the  members of  their  families could be rehabilitated. The  funds  made available to the Committee may be utilised for such purpose.                                                   PG NO 322     We   must   reiterate  that   Court-monitoring   of   an institution like the present one is indeed difficult but  we cannot  close the proceedings at this stage for the  reasons we  have already indicated. Parties including the  Committee shall have liberty to move this Court from time to time.  We make  it clear that the directions regarding payment of  the funds  are  pre-emptory  in nature and  no  application  for modification thereof shall be entertained.     This  matter shall be deemed to be pending to deal  with the  various reports from the Committee and for purposes  of giving other directions. C R.S.S.