BHARGAWA, J. - (1.) CONSUMER Unity and Trust Society (hereinafter referred to as the 'cuts') sent a letter on 9. 2. 1988 addressed to the then acting Chief Justice, bringing to his notice that Smt. Manbhari (Ajmer) and Smt. Mano (Bharatpur) died on account of the negligence on the part of the medical authorities, after sterilization operations, as per the newspaper report and prayed that an interim compensation in cash, amounting to Rs. 5 lacs be awarded to the husband and family members of the victims and to establish a high level Medical-cum-Administrative Investigation Board to go into the causes of various mishaps and apportion responsibility in a fixed time frame of sixty day. It has further been prayed to appoint a Commission of Inquiry to go into the genesis of the various mishaps which have occurred now and in the past, in the scheme of family welfare. This letter was registered as a writ petition as a matter of public interest litigation. Notices were issued to the State of Rajasthan, Director, Medical and Health, Family Planning to show cause as to why this writ petition should not be admitted. Shri G. S. Singhvi, Advocate (as he then was) was requested to assist the Court, who informed that in the same matter, proper writ petition has been filed being writ petition No. 4955/1988, by CUTS on 4. 10. 1988, giving some more details and enclosing certain documents. Therefore, these two writ petitions were clubbed together. After the elevation of Shri G. S. Singhvi, Advocate, as he then was, as a High Court Judge, Shri C. K. Garg and Shri G. K. Garg Advocates are assisting the court in these matters. The State Government has filed reply in both these petitions separately. Since both these petitions involves the same matter, they are being disposed of this common order. Arguments have been heard.
(2.) LEARNED counsel for the petitioner has submitted that in pursuance of the national policy of building a Welfare State, the population control by family planning is one of the most important programmes of the Government of India and the State Government and therefore, it has been included in the 20 Points Programme. Medical and Health Directorate of Government of Rajasthan has issued detailed instructions as to how this programme has to be carried out. A copy of such instructions has been annexed as Annexure-1. The Director, Medical and Health (Family Planning) imparts necessary training to the staff of the Medical Department. Various Schemes have also been sanctioned for motivation and for giving awards to the persons under different categories for this programme, details whereof have been mentioned as Annexure-2. The Director, Medical and Health Services fixed targets of the years 1986-97 and 1987-88 district-wise and also monitored the programme of sterilization cases but since they were much below the targets, a telegram was also issued by the Directorate, Medical and Health, to all concerned officers requesting them to achieve 100% targets. According to the petitioner, these targets were illusory and not realistic. Even the expert, and trained staff and proper medical facilities were not available and in its over-zeal and over enthusiasm the. Medical Department was trying hard to not only achieve 100% targets but to over shoot the same and they were advised to take support from other government departments and voluntary organizations. Motivators and persons of voluntary organisations tried their level best and persons who were not eligible or qualified to be operated as per the instructions issued and had come for treatment of ordinary diseases in the Medical Department, were forced to go for sterilization operations. According to the petitioner, proper septic precautions were not taken and therefore, there are several instances of mortality in these family planning operations. There was negligence at the time of operation as also no proper medical care was provided after the operation and as such, there was great public dissatisfaction against the Medical Department and on this subject, even Assembly Questions were raised at the floor of the house. Government admitted deaths of 44 women on account of sterilizaiton operations during 1986-87 and 1987-88. It was also stated on the floor of the house that families of the deceased patients have been given Rs. 10,000/- each. It was also denied on the floor of the house that any staff was found to be at fault after the enquiry. Thereafter, it is stated that the Government of Rajasthan has reduced its targets of family planning operations and the Chief Minister has admitted in public that there had been certain lapses and that now onwards, the Chief Medical and Health Officer of the District will be held responsible for the negligence in the sterilization operations and for the post operative care. It has been submitted in the petition that the amount of compensation is only nominal and not adequate and cannot be said to be even proper and had been fixed without any rational criteria. In reply to the writ petition, learned Government Advocate has submitted that it is true that the Government was very keen to fulfill the targets fixed for family planning operations and did its best to persuade and motivate people for the same which is the need of the hour. It has further been asserted that proper care was taken and ample planning was done for the family planning operations and all facilities both at the time of operation as well as after operation were provided. It has also been submitted that proper care is being taken in pre-operative and post-operative stages. Coming to the particular eases of Smt. Manbhari (Ajmer) and Mano (Bharatpur), it has been submitted that it is true that both died after sterilization operations. But their condition worsen due to insertion of veris needle and all precautions were taken and efforts were made by the doctors attending on them but they could not be saved. Smt. Manbhari was shifted immediately to J. L. N. Hospital, Ajmer. They have further asserted in their reply that a sterilisation camp was organised on 4. 2. 1988 at village Kathsura in Ajmer District, about 16-20 women offered themselves to be operated for sterilization. After thorough examination and routine clinical check-up, like pulse, B. P. , blood, urine test, they were also subjected to gynaecological examinations and Smt. Manbhari who had herself offered was found physically fit and absolutely normal for the operation. They have given technical details as to how the operation was done and under what circumstances she died which show that the doctors attending on her, were not negligent and made all efforts and tried their level best to save her life. They have also submitted a copy of the report by Dr. M. P. Pandey, Sr. Specialist (Surgery) and Smt. Agya Ambhali Singh, Specialist (Gyneacology) who were appointed to make enquiry for the cause of death of Smt. Manbhari. They found cause of death to be vagal shock due to peritoeo cardia reflex. Similarly, as regards Mana (Bharatpur) they have given details of the operation and the medical care and also annexed with the reply, sterilization cases card and post mortem report. The Government had also ordered an enquiry into her death, by the Chief Medical and Health Officer, Bharatpur who recorded the statement of Dr. C. P. Sharma and Mrs. Rajrani Hada and after enquiry, the Chief Medical and Health Officer, Bharatpur, has come to the conclusion that the doctors operating and attending on the patients were not careless or negligent. I have carefully gone through the record of the case. It must be appreciated that the Government of India as well as the State Government have been trying to control the population explosion which is very necessary for the Welfare State. All the planning and efforts made by the government with regard to production of necessary articles like clothes and food and other essential articles which are necessary for living, gets upset and therefore, it is in the national interest that the government should do its best to control population and the only way is by adopting family panning and also making the public aware about the necessity of family welfare schemes. A thorough drive should be taken throughout the country to make people understand and realise that our country cannot progress unless we control birth rate and effective efforts should be made in this regard. I do not see any harm if the government fixes some targets but such targets should be very practical, reasonable and not imaginative but based on true assessment. Thus, no objection can be taken if the government issues instructions in this regard or issue circulars or grant. some schemes to motivate people to fulfill its targets of family planning but at the same time, it is also very necessary that the government should take all steps and precautions that there is no casuality in the sterilization operations. Full care must be taken at the time of operation and after operation. Before operating, the doctors concerned should be very vigilant and cautious enough and should not force anybody for the operation. It should be only when a person is ready and willing and is eligible as per the instructions issued that such person should be operated. The Government should also issue necessary instructions to it's officers and department concerned as to what precautions should be taken. It should also trained its staff and full facilities should be provided for the operation as well as post operative care. The staff should not be over confident and over zealous and should not operate a person who is not eligible as per the instructions issued by the government, so as to get an award or some benefit under the welfare schemes. The motivators and the voluntary organisations should also be requested not to force anybody to undergo family planning operation but make the people understand and persuade them to go for sterilization operation. This is very unfortunate that casualties had taken place during sterilization operations. As soon as any casuality is reported, the State Government or the Chief Medical and Health Officer of the District should immediately get the matter investigated thoroughly by an independent Board not belonging to that District in which the casuality has taken place but the experts in the subject should be from outside the District. The State Government should issue instructions well in advance appointing such Boards for every District so that it can come into action as soon as any casuality is reported. It is expected from those experts that they will do their duty irrespective of personalities involved and find out the guilt. In such matters, if anyone is found guilty, howsoever high he may be, he should not go unpunished so that others can get a lesson.
(3.) LOOKING to the fact that two of the instances brought to the notice of this Court, were of the year 1988 and the government has already held inquiry into that matter and it has been found that none of the doctors or the staff was negligent. I do not think it necessary to appoint any other Inquiry Commission or a Committee to go into this aspect. For future, it is directed that the State Government should nominate a High Power Committee to monitor these family welfare operations and also nominate Inquiry Committees for every District, consisting of experts not concerned with that particular district. Standing instructions should also be issued that as and when any casuality is reported after such sterilization operations, the Inquiry Committee should immediately proceed with the inquiry and submit it's report to the government and the Government should thereafter, punish the persons who are found guilty of being negligent for the said occurrence. With these observations, these writ petitions are disposed of. .;