06 May 1996
Supreme Court


Bench: AGRAWAL,S.C. (J)
Case number: W.P.(C) No.-000796-000796 / 1992
Diary number: 61338 / 1992






DATE OF JUDGMENT:       06/05/1996


CITATION:  1996 SCC  (4)  37        JT 1996 (6)    43  1996 SCALE  (4)282



JUDGMENT:                       J U D G M E N T S.C. AGRAWAL. J.      In Pt.  Paramanand Katara  vs. Union  of India  & Ors., 1989 (4)  SCC 286. this Court in the context of medico-legal cases. has  emphasized  the  need  for  rendering  immediate medical aid  to injured  persons to  preserve life  and  the obligations of  the State as well as doctors in that regard. This petition  filed under  Article 32  of the  Constitution raises  this   issue  in  the  context  of  availability  of facilities in  Government-hospitals for treatment of persons sustaining serious injuries.      Hakim Seikh  [petitioner No.  2] who  is  a  member  of Paschim Banga  Khet Mazdoor  Samity [petitioner  No. 1],  an organization of  agricultural labourers, fell off a train at Mathurapur Station in West Bengal at about 7.45 P.M. on July 8, 1992.  As a  result of the said fall Hakim Seikh suffered serious head injuries and brain haemorrhage. He was taken to the Primary  Health Centre  at Mathurapur.  Since  necessary facilities for  treatment were  not available at the Primary Health Centre,  the medical  officer in charge of the Centre referred him  to the Diamond Harbour Sub-Divisional Hospital or any  other State  hospital for  better  treatment.  Hakim Seikh was  taken to  N.R.S. Medical  College  Hospital  near Sealdah Railway  Station, Calcutta  at about  11.45 P.M.  on July 8,  1992. The  Emergency Medical  Officer in  the  said Hospital, after  examining him  and after  taking two  X-ray prints of  his skull  recommended  immediate  admission  for further treatment.  But Hakim Seikh could not be admitted in the said  hospital as  no vacant  bed was  available in  the Surgical Emergency  ward and  the regular  Surgery Ward  was also full.  He was  thereafter  taken  to  Calcutta  Medical College Hospital  at about  12.20 A.M.  on July  9, 1992 but there also  he was not admitted on the ground that no vacant bed was  available. He was then taken to Shambhu Nath Pandit Hospital at  about 1.00  A.M. on  July 9,  1992. He  was not



admitted  in  that  hospital  and  referred  to  a  teaching hospital in  the ENT, Neuro Surgeon Department on the ground that the  hospital has  no ENT  Emergency or Neuro Emergency Department. At  about 2.00 A.M. on July 9, 1992 he was taken to the  Calcutta National Medical College Hospital but there also he  was not  admitted on account of non-availability of bed. At  about 8.00 A.M. on July 9, 1992 he was taken to the Bangur Institute  of Neurology  but on  seeing the  CT  Scan (which was  got done at a private hospital on payment of Rs. 1310/-) it was found that there was haemorrhage condition in the frontal  region of the head and that it was an emergency case which  could not  be handled  in the said Institute. At about 10.00  A.m. on  July 9,  1992 he  was  taken  to  SSKM Hospital but  there also  he was  not admitted on the ground that  the   hospital  has  no  facility  of  neuro  surgery. Ultimately he  was admitted  in  Calcutta  Medical  Research Institute, a  private hospital,  where he received treatment as an  indoor patient from July 9, 1992 to July 22, 1992 and he had incurred an expenditure of approximately Rs. 17,000/- in his treatment.      Feeling  aggrieved   by  the  indifferent  and  callous attitude on  the part  of the  medical  authorities  at  the various  State   run  hospitals  in  Calcutta  in  providing treatment for  the serious injuries sustained by Hakim Seikh the petitioners have filed this writ petition.      In the writ petition the petitioners have also assailed the decision  of the  National Consumer  Disputes  Redressal Commission dated December 15, 1989 in Consumer Unity & Trust Society. Jaipur vs. State of Rajasthan & Ors and it has been submitted that  the  expression  ’consumer’  as  defined  in section 2(1)(d)(ii)  of the  Consumer Protection  Act,  1986 includes persons  getting or  eligible for medical treatment in Government  hospitals and  that the expression ’services’ as defined  in section  2(1)(o) of the Act includes services provided in the Government hospitals also. The said question has been  considered in the recent decision of this Court in Indian Medical  Association vs.  V.P.Shantha, 1995  (6)  SCC 651. In  view of  the said  decision the only question which needs to  be considered  is whether  the non-availability of facilities for  treatment of  the serious injuries sustained by Hakim  Seikh  in  the  various  Government  hospitals  in Calcutta has  resulted in  denial of  his fundamental  right guaranteed under Article 21 of the Constitution.      There is not much dispute on facts. In the affidavit of Ms. Lina  Chakraborti, filed  on behalf of the State of West Bengal, respondent  No. 1, it is stated that the rural areas of the  State are  served by the Block Health Centres and by the Subsidiary Health Centres since redesignated as "Primary Health Centres"  where  primary  and  general  treatment  is provided but  no specialist  treatment is  available.  Hakim Seikh was  examined by  the medical  officer  at  the  Block Health Centre  at Mathurapur  and after giving him first-aid the Medical Officer referred him to the Diamond Harbour Sub- Divisional  Hospital   or  any  State  hospital  for  better treatment. It  is also admitted that Hakim Seikh was brought to Neel  Ratan Sircar Medical College Hospital at 11.45 P.M. on July  8, 1992  and there he was examined and two skull X- rays were  also taken.  The medical officer who attended him at that hospital recommended immediate admission for further treatment but  he could  not be  admitted in  the particular Department, i.e.,  Surgery  Department  having  neurosurgery facilities as  at the  material point  of time  there was no vacant bed  in the  Surgical Emergency  Ward and the regular surgery ward  was also  full. It is also admitted that Hakim Seikh was  thereafter taken  to the Calcutta Medical College



Hospital, Calcutta  National Medical  College  Hospital  and Bangur Institute  of Neurology  in the early morning of July 9, 1992  but he  could not  be  admitted  in  any  of  these hospitals because  of non-availability of bed. It was stated that Hakim  Seikh could Not be admitted in all the hospitals having facility of neuro surgery as all such beds were fully occupied on the date/dates and that such a patient cannot be given proper  treatment if  he is  kept on  the floor  of  a hospital or  a trolley because such arrangement of treatment is fraught  with grave  risks of cross infection and lack of facility  of   proper  post-operative   care.  In  the  said affidavit it  is also  stated  that  total  number  of  beds maintained by  the State  Government all  over the  State is 57,875, out of which 90% are free beds for treatment of poor and indigent  patients and  all the  beds in  the  concerned wings in  the Government  hospitals in  Calcutta where Hakim Seikh reported  for treatment  were occupied on the relevant date/dates.      During the pendency of this writ petition in this Court the State Government decided to make a complete and thorough investigation of the incident and take suitable departmental action against  the persons  responsible for the same and to take  suitable  remedial  measures  in  order  to    prevent recurrence  of   similar  incidents.  The  State  Government appointed  an  Enquiry  Committee  headed  by  Shri  Justice Lilamoy Ghose,  a retired  Judge of the Calcutta High Court. The terms and reference of the said Committee were :      "A. Enquiry  into the circumstances      under which  the  said  Shri  Hakim      Seikh was  denied admission  to the      State Government hospitals.      B.  Fixing   responsibilities   for      dereliction of  duties if  any,  on      the part of any Government official      in this respect.      C.   Recommendations   on   actions      against  the  Government  officials      who  have   found  wanting  in  the      discharge of  their official duties      in this respect.      D. Recommendations  on actions that      should  be   taken  by   the  State      Government   to    rule   out   the      recurrence  of   such  incident  in      future  and   to  ensure  immediate      medical attention  and treatment to      patients in real need."      The Committee  submitted its  report  dated  March  21, 1995. In  the said  report, the  Committee, after  examining the relevant record at the various hospitals, has found :      i) The Primary Health Centre at Mathurapur was not very           much equipped  to deal  with such types of serious           patients and  the nurses at the Centre attended on           Hakim Seikh and gave some treatment.      ii) At  the N.R.S. Medical College Hospital Hakim Seikh           was registered,  Registration No.  63649,  but  no           time was  mentioned. The admission register of the           said hospital  shows that one patient was admitted           at 12.15  A.M. on July 9, 1992 and another patient           was admitted  at 4.20  A.M. on July 9, 1992. There           could not  have been  any discharge during the odd           hours i.e.  between the  time when Hakim Seikh was           taken to  the said  hospital and 4.20 A.M. on July           9, 1992.   If  two other  patients  were  admitted           after Hakim  Seikh was  taken there and it was not



         understandable why  Hakim Seikh  was not  admitted           since it  is not  disputed that  the condition  of           Hakim Seikh  was grave.  Even  in  excess  of  the           sanctioned beds  some patients  were kept  on  the           trolley beds  in the  morning and  that even if it           was dangerous to keep a patient with head injuries           on trolley  bed he could very well be kept for the           time being  on the  floor and could be transferred           to the  cold  ward,  as  the  situation  demanded,           temporarily.   The   Emergency   Medical   Officer           concerned should  have taken some measure to admit           Hakim Seikh  and he is, therefore, responsible for           his  non-admission   in  the  said  Hospital.  The           Superintendent of  the hospital  should have taken           some measures to give guidelines to the respective           medical officers  so that a patient is not refused           admission although  his condition is grave and the           Superintendent of  the N.R.S.  Medical College  is           also, to  some extent,  responsible in  a  general           way.      (iii)  Hakim   Seikh  should   not  have  been  refused           admission  in   the  Medical   College   Hospital,           Calcutta when  the condition  was so grave. In not           accommodating Hakim  Seikh the  Emergency  medical           Officer of  the said  Hospital is  responsible. He           should have  contacted the superior authority over           the telephone  if there  was any  stringency as to           the beds  available and  admit the patient inspite           of  total   sanctioned  beds   not   having   been           available. The  Superintendent should  have  given           guidelines to  the respective medical officers for           admitting serious  cases under  any  circumstances           and  thus   in  a   way  the   Superintendent  was           responsible for this general administration.      (iv) At the National Medical College Hospital, Calcutta           the relevant admission register was missing and in           the absence  of the  same the responsibility could           not be  fixed on  the  Emergency  Medical  Officer           concerned. The then Superintendent of the Hospital           must be held responsible for this general state of           affairs that  no provision  was made for admitting           any patient even if his condition was serious.      (v) The  hospital authorities have submitted that Hakim           Seikh did  not  attend  the  Shambhu  Nath  Pandit           Hospital at  all. From the out-door patient ticket           it cannot  be definitely Said that Hakim Seikh was           taken to the said Hospital.      (vi) No responsibility could be fixed on any officer of           the Bangur Institute of Neurology because the said           Institute  does   not  deal   with   neuro-surgery           emergency cases  and it  is meant  for cold  cases           only.      (vii) At  SSKM Hospital,  no record is maintained as to           the condition  of the  patient and the steps taken           with regard to his treatment. It is necessary that           such  record   is  maintained.   Even  though  the           patients inside  the ward  were in  excess of  the           limit  of  the  sanctioned  beds  but  still  some           arrangements could  be made  and admission  should           not have  been refused  when the  condition was so           grave. The  Emergency Medical Officer who attended           Hakim Seikh  should be  held responsible  for  not           admitting the  patient in  the said  Hospital  and           that the  Surgeon  Superintendent  is  also  in  a           general way  responsible for this unhappy state of



         affairs  and   he  should   have  given   specific           guidelines in that regard.      The Committee  has suggested  remedial measures to rule out recurrence  of such  incidents in  future and  to ensure immediate medical  attention and  treatment to  patients  in real need. We will advert to it later. We will first examine whether the  failure to  provide medical  treatment to Hakim Seikh by  the Government  hospitals in Calcutta has resulted in violation  of his rights and, if so, to what relief he is entitled.      The  Constitution  envisages  the  establishment  of  a welfare state  at the  federal level as well as at the state level. In a welfare state the primary duty of the Government is to  secure the  welfare of the people. Providing adequate medical facilities  for the  people is  an essential part of the obligations  undertaken by  the Government  in a welfare state. The  Government discharges this obligation by running hospitals and  health centres  which provide medical care to the person  seeking to  avail those  facilities. Article  21 imposes an obligation on the State to safeguard the right to life of  every person. Preservation of human life is thus of paramount importance.  The Government  hospitals run  by the State and  the medical  officers employed  therein are  duty bound to  extend medical  assistance  for  preserving  human life. Failure  on the  part  of  a  Government  hospital  to provide timely medical treatment to a person in need of such treatment  results   in  violation  of  his  right  to  life guaranteed under  Article 21.  In the present case there was breach of  the said  right of  Hakim Seikh  guaranteed under Article 21  when he  was denied  treatment  at  the  various Government hospitals  which were  approached even though his condition was  very serious  at that time and he was in need of immediate medical attention. Since the said denial of the right of  Hakim Seikh  guaranteed under  Article 21  was  by officers of  the State  in hospitals  run by  the State  the State cannot avoid its responsibility for such denial of the constitutional  right   of  Hakim   Seikh.  In   respect  of deprivation of  the constitutional  rights guaranteed  under Part III  of the  Constitution the  position is well settled that adequate  compensation can  be awarded by the court for such violation  by  way  of  redress  in  proceedings  under Articles 32 and 226 of the Constitution. [See : Rudal Sah v. State of Bihar, 1983 (3) SCR 508 Nilabati Behara v. State of Orissa. 1993 (2) SCC 746: Consumer Education and Research Centre v.  Union of  India, 1995  (3) SCC  42].  Hakim Seikh should, therefore, be suitably compensated for the breach of his right  guaranteed under  Article 21 of the Constitution. Having regard to the facts and circumstances of the case, we fix the  amount of  such compensation at Rs. 25,000/-. A sum of Rs.  15,000/- was  directed to  be paid to Hakim Seikh as interim compensation  under the  orders of  this Court dated April 22,  1994.  The  balance  amount  should  be  paid  by respondent No. 1 to Hakim Seikh within one month.      We may  now come  to the  remedial measures to rule out recurrence  of  such  incidents  in  future  and  to  ensure immediate medical attention and treatment to persons in real need. The  Committee has  made the following recommendations in this regard :      (i)  The  Primary  Health  Centres  should  attend  the           patient and give proper medical aid, if equipped.      (ii) At the hospitals the emergency Medical Officer, in           consultation with the Specialist concerned on duty           in  the   Emergency  Department,  should  admit  a           patient whose  condition is  moribund/serious.  If           necessary the patient concerned may be kept on the



         floor or  on the trolley beds and then loan can be           taken from  the cold  ward.  Subsequent  necessary           adjustment  should   be  made   by  the   hospital           authorities by way of transfer/discharge.      (iii) A  Central Bed  Bureau should  be  set  up  which           should  be   equipped  with   wireless  or   other           communication  facilities  to  find  out  where  a           particular emergency  patient can  be accommodated           when a particular hospital finds itself absolutely           helpless to  admit a  patient because  of physical           limitations. In  such cases the hospital concerned           should contact  immediately the Central Bed Bureau           which will  communicate with  the other  hospitals           and  decide   in  which   hospital  an   emergency           moribund/serious patient is to be admitted.      (iv) Some  casualty  hospitals  or  Traumatology  Units           should be set up at some points on regional basis.      (v) The  intermediate group  of  hospitals,  viz.,  the           district, the  sub-division and  the State General           Hospitals should  be upgraded so that a patient in           a serious condition may get treatment locally.      The recommendations of the Committee have been accepted by the State Government and memorandum dated August 22, 1995 has been  issued wherein  the following directions have been given  for   dealing  with   patients   approaching   health centres/OPD/Emergency Departments of hospitals :      (1) Proper  medical aid  within the      scope   of   the   equipments   and      facilities  available   at   Health      Centres  and  Hospitals  should  be      provided  to   such  patients   and      proper records of such aid provided      should be  preserved in office. The      guiding principle  should be to see      that no emergency patient is denied      medical  care.   All  possibilities      should be  explored to  accommodate      emergency   patients   in   serious      condition.      (2) Emergency Medical Officers will      get       in       touch       with      Superintendent/Deputy      Superintendent/  Specialist Medical      Officer for  taking beds  on  loans      from cold  wards for  accommodating      such  patients  as  Extra-temporary      measures.      (3)  Superintendents  of  hospitals      will  issue  regulatory  guidelines      for  admitting   such  patients  on      internal    adjustments     amongst      various wards  and different  kinds      of beds  including  cold  beds  and      Will hold  regular weekly  meetings      for monitoring  and  reviewing  the      situation.   A    model   of   such      guidelines is  enclosed  with  this      memorandum which  may  be  suitably      amended before  issue according  to      local  arrangements  prevailing  in      various establishments.      (4)  If   feasible,  such  patients      should be  accommodated in trolley-      beds and,  even, on  the floor when      it is  absolutely necessary  during



    the   exercise   towards   internal      adjustments as  referred to  at (3)      above.      Having  regard  to  the  drawbacks  in  the  system  of maintenance  of  admission  registers  of  patients  in  the hospitals it  has been directed that the Superintendents and Medical Officers  of the hospitals should take the following actions to  regularize the  system with  a view  to avoiding confusion  in   respect  of  Admission/Emergency  Attendance Registers :      " (a)  Clear recording of the name,      age, sex,  address, disease  of the      patient by  the  attending  medical      officers;      b) Clear recording of date and time      of attendance/examination/admission      of the patient;      (c) Clear  indication  whether  and      where   the    patient   has   been      admitted, transferred, referred:      (d) Safe custody of the Registers;      (e) Periodical  inspection  of  the      arrangement by the Superintendent;      (f)  Fixing  of  responsibility  of      maintenance and safe custody of the      Registers."      With  regard  to  identifying  the  individual  medical officers attending to the individual patient approaching Out Patients’ Department/Emergency  Department of  a hospital on the basis  of consulting  the hospital  records, it has been directed that  the following procedure should be followed in future :      "A. A  copy of  the Duty Roaster of      Medical    Officers    should    be      preserved  in  the  office  of  the      Superintendent  incorporating   the      modifications done  for unavoidable      circumstances;      B. Each Department shall maintain a      register    for    recording    the      signature  of   attending   medical      officers denoting their arrival and      departure time;      C. The  attending  medical  officer      shall write  his full  name clearly      and  put   his  signature   in  the      treatment document;      D.  The   Superintendent   of   the      hospital  shall   keep   all   such      records in safe custody;      E. A  copy of  the ticket issued to      the patient should be maintained or      the relevant  data in  this  regard      should be  noted in  an appropriate      record for future guidance.           It   is    appreciated    that      Hospital     Superintendent/Medical      Officers-in-charge     may     have      difficulty  in  implementing  these      guidelines    due     to    various      constraints  at  the  ground  level      and, as such, feed back is vital to      enable  Government  to  refine  and      modify the  order as  will ensure a      valid  working   plan  to  regulate



    admission on a just basis. Detailed      comments and,  therefore, requested      with constructive suggestions."      Shri Muralidhar,  the learned counsel appearing for the petitioners, and  Shri Rajeev  Dhavan,  the  learned  senior counsel appearing  for the  intervenors, in  the  course  of their  submissions,  have,  however,  made  certain  further suggestions in  this regard.  Shri Dhavan has submitted that in order  to  have  proper  and  adequate  emergency  health services and  to create  infra-structure for that purpose it is necessary to bear in mind the high risk occasions such as festivals and high risk seasons when there is a greater need for such  services. It  has also  been  submitted  that  the medical facilities  available at  the Primary Health Centres should be  upgraded and  the hospitals at the district level should be  suitably provided  to deal with serious cases and that the number of beds in the hospitals should be increased to meet the growing needs of the population. Shri Dhavan has also suggested  that a  centralized ambulance service may be created for  all the hospitals and that the ambulance should have all the facilities necessary for giving primary medical aid and  treatment to the patient. Shri Dhavan has submitted that the  emergency units  at the  hospital should  be fully equipped to  manage all  the emergency cases and the medical officer should  be available  there round  the  clock.  Shri Dhavan has  urged that  the denial of treatment to a patient should be  specifically  made  a    cognizable  Offence  and further it should also be made actionable as a tort. In this context Shri  Dhavan has invited our attention to the recent developments that  have taken  place in  this field  in  the United States.  There it  was found  that private  hospitals were turning  away uninsured  indigent persons  in  need  of urgent  medical   care  and   these  patients   were   often transferred to,  or  dumped  on  public  hospitals  and  the resulting  delay   or  denial  of  treatment  had  sometimes disastrous  consequences.   To  meet   this  situation   the U.S.Congress has  enacted the  Consolidated  Omnibus  Budget Reconciliation Act  of 1986  [for short  ’COBRA’] to prevent this practice of dumping of patients by private hospitals. By the said Act all hospitals that receive medicare benefits and maintain  emergency rooms  are required  to perform  two tasks before  they may transfer or discharge any individual; (i)  the   hospital  must   perform  a   medical   screening examination of all prospective patients, regardless of their ability to  pay; (ii)  if the  hospital  determines  that  a patient  suffers   from  an  emergency  condition.  the  law requires the  hospital to  stabilized that condition and the hospital  cannot   transfer  or  discharge  an  unstabilized patient unless  the transfer  or discharge an appropriate as defined by  the statute.  Provision  is  made  for  imposing penalties against  hospitals or  physicians that negligently violate  COBRA.  In  addition  the  individual  who  suffers personal  harm   as  a  direct  result  of  a  participating hospital’s violation  can bring  a civil  suit  for  damages against that hospital. According to Shri Dhavan the standard of care  in  emergency cases implies three obligations, viz. (i) screening  the patient  (ii) stabilizing  the  patient’s condition and (iii) transfer or discharge of the patient for better treatment.   The  submission of  Shri Dhavan  is that emergency health  services in  our country  must be provided keeping An view these three requirements.      We have  considered the  aforesaid submissions urged by Shri Dhavan.  A part  from the  recommendations made  by the Committee in  that regard  and   action taken  by the  State Government in  the memorandum  dated August  22, 1995 on the



basis of the recommendations of the Committee, we are of the view that  in  order  that  proper  medical  facilities  are available for dealing with emergency cases it must be that :      1. Adequate  facilities are  available at  the  Primary Health Centres  where the  patient can  be  given  immediate primary treatment so as to stabilize his condition;      2. Hospitals  at the  district level  and  Sub-Division level are  upgraded so  that serious  case  can  be  treated there;      3.  Facilities  for  giving  specialist  treatment  are increased and  are available  at the  hospitals at  District level and  Sub-Division level  having regard  to the growing needs.      4. In  order  to  ensure  availability  of  bed  in  an emergency at  State level  hospitals there  is a centralized communication  system  so  that  the  patient  can  be  sent immediately to  the  hospital  where  bed  is  available  in respect of the treatment which is required.      5.  Proper   arrangement  of   ambulance  is  made  for transport of a patient from the Primary Health Centre to the District hospital  or Sub-Division  hospital  and  from  the District hospital  or Sub  Division hospital  to  the  State hospital.      6. The  ambulance is adequately provided with necessary equipment and medical personnel.      7. The Health Centres and the hospitals and the medical personnel attached to these Centres and hospitals are geared to deal  with larger  number of  patients needing  emergency treatment on  account of higher risk of accidents on certain occasions and in certain seasons.      It is no doubt true that financial resources are needed for providing  these facilities.  But at  the same  time  it cannot be  ignored that  it is the constitutional obligation of the  State to  provide adequate  medical services  to the people. Whatever  is necessary  for this  purpose has  to be done. In  the context  of the  constitutional obligation  to provide free legal aid to a poor accused this Court has held that the State cannot avoid its constitutional obligation in that regard  on account  of financial  constraints.  [See  : Khatri (II)  v. State of Bihar, 1981 (1) SCC 627 at p. 631]. The  said  observations  would  apply  with  equal,  if  not greater, force  in the matter of discharge of constitutional obligation of  the State  to provide medical aid to preserve human life. In the matter of allocation of funds for medical services the said constitutional obligation of the State has to be  kept in  view. It is necessary that a time-bound plan for providing  these services  should be chalked out keeping in view  the recommendations of the Committee as well as the requirements for  ensuring availability  of  proper  medical services in  this regard as indicated by us and steps should be taken  to implement  the same.  The State  of West Bengal alone is  a party to these proceedings. Other States, though not parties,  should also  take necessary steps in the light of the recommendations made by the Committee, the directions contained in the Memorandum of the Government of West Bengal dated August  22, 1995  and  the  further  directions  given herein.      The Union  of India  is a  party to  these proceedings. Since it  is the  joint obligation  of the Centre as well as the States  to provide  medical services it is expected that the Union  of India would render the necessary assistance in the improvement  of the  medical services  in the country on these lines.      As regards the medical officers who have been found to be responsible for the lapse resulting in denial of



immediate medical aid to Hakim Seikh it is expected that the State Government will take appropriate administrative action against those officers.      A copy  of this  judgment be  sent for taking necessary action to the Secretary Medical and Health Department of the States.      The writ petition is disposed of with these directions. No order as to costs.