Admission of COVID-19 patients, Oxygen, Remdesivir, Insurance claims and more: Delhi High Court issues directions

Upon various urgent pleas being moved amid the COVID-19 crisis in Delhi, the Delhi High Court today issued directions concerning the processing of insurance claims, supply of Remdesivir and publication of information regarding oxygenated hospital beds. .Justice Prathiba M Singh today also took up individual pleas raising grievances concerning admission to hospitals for COVID-19 treatment..The directions issued by the Court today include:.1. Expeditious approval of insurance claims by patients amid COVID crisis: IRDAI has been instructed to issue a direction to all insurance companies that the maximum time within which insurance claims of patients are to be approved is within 30 to 60 mins. This is done so that there is no time lag in allocating beds to new patients. .2. Remdesivir: (a) The Court noted that there are three aspects at play i.e. protocol for administration of the drug, allocation, distribution, and sale. (b) As far as allocation is concerned, there is an availability of 16 lakh vials of Remsidivir, out of which 72,000 vials were allocated to Delhi. (c) Total supply made to Delhi was 52, 000. It is expected that next time, the number of vials supplied would increase, the Court said. (d) Till yesterday, the total supply was done through private distribution channels and not centralized. As of yesterday, a fresh circular was issued, which said that all allocation for Delhi is intended to be taken up by the Government, the Court recorded. (e) In so far as distribution is concerned, the Court noted, again, that it was through private channels till yesterday. Yesterday, the Government created a portal to closely monitor the distribution. (f) The Court further directed that the Patient/family member/attendant of the Patient should be allowed to put in a request on the portal for availing Remsidivir along with the following data: Name of the Patient Adhaar Number Name of Hospital (prescription of the Hospitak would be uploaded. COVID-19 positive report Name and mobile number of the attendant .However, after passing the above direction, the Court was informed that a Division Bench of the High Court was considering issues on the portal as well. This prompted the Single Judge to direct "Let the portal not be activated today as was decided earlier, seek instructions for modifying the portal in order ensure that the patient/attendant is able to obtain the drug immediately.".3. Online Portal showing the availability of hospital beds should reflect whether bed is oxygenated or not: The Court noted the concern that the portal can be misleading as there are large numbers of persons in queues before hospitals. Even when vacancies are shown, there are actually no vacancies and most beds are not oxygenated, the Court recorded. It proceeded to observe that there are two separate categories of beds: COVID-19 beds and COVID-19 ICU beds. It can be confusing for the patients, the Judge pointed out, further noting that some COVID-19 beds don't have oxygen. As such it has stated, “It is a matter of common knowledge, most of the patients who do not require oxygen are isolating in their homes unless they suffer from comorbidities.....It will be useful, if against each of the name of the Hospital, if it can be indicated as to whether the beds being provided are capable of providing oxygen facilities or not. For this purpose, the portal would have to be amended to this extent.”.Read more on the Courtroom discussion today.On admission of individual patients .Appearing for a petitioner stated to be running from pillar to post for hospital admission, Advocate Sachin Puri today emotionally told the Court,"The petitioner is saying that he cannot go to any more hospitals. The petitioner is tired of going to hospitals and not being able to secure a bed. What is the Delhi Government doing? ... They have to get their house in order. Why are we going to DROs? I am sorry, Ladyship. If a lawyer is suffering so much, think about the situation of the common man.".Appearing for the Delhi Government, Advocate Gautam Narayan expressed that the administration is doing what it can."The statements on Delhi Government is uncalled for. My staff, about 2-3 of them are COVID-19 positive. My staff has been working for the past 48 hours continuously", he said..As tensions in the courtroom rose, Justice Singh was prompted to step in."Mr Gautam Narayan, please don't raise your voice. I can hear you. You are a senior officer. The whole city is making comments on the Government. The petitioner is emotional, such are the times", she said..Availability of Beds.Advocate Puri went on to argue that the information as regards availability of beds on the website delhifightscorona.in does not portray accurate information, leaving patients in a lurch."Now in this website, 21 vacant ICU beds with oxygen are shown. Actually, in reality, there are never any vacant beds. Because of this information, people keep running on the roads", he said..Justice Singh, however, subsequently checked the information available on the website to direct the hospital admission of one of the patients before the Court..Advocate Mridual Chakravarty argued that it is not as if people are opting to stay at home because their medical condition does not require hospital admission."It's not that people who are at homes are not critical. They are just hanging in there. The situation is very scary. We have nowhere else to go. We only have Court", he argued..What is the point of having beds without oxygen? : Court.Pursuant to the Judge's queries, Advocate Narayan told the Court that 500 beds are being added by the Government. The Court, however, emphasised that all beds must be accompanied with supply of oxygen. "What is the point of beds if you cannot give oxygen? Those who don't need oxygen won't come to hospital...", Justice Singh remarked.Narayan responded,"Even after Centre increased Oxygen supply to Delhi Government, we can only cater oxygen to these many beds.""This is unbelievable!", Justice Singh remarked, adding "What is the point of having a bed without oxygen? I am not finding it rational to have a bed without oxygen.".Answering a question posed by the Court, a hospital also told the Court that while it has vacant beds, it does not have enough oxygen to cater to more patients."We are struggling with supplying oxygen for existing patients", the Court was told..On approval of insurance claims.Appearing for the hospital, Advocate Datta also urged the Court to look into matters concerning insurance amid the ongoing crisis."These insurance companies take one whole day for approving the insurance claims (of patients). It should be done in half an hour. During this time, they are still in the room, utilizing beds", he submitted.Justice Singh, in turn, sought for the presence of the counsel IRDAI and sought for more details on the issue..On blackmarketting of Remdesivir.The hearing further saw the Court raise concerns over mismanagement in the distribution of Remdesivir."This is what is resulting in the black marketing of the drug. Because you are not distributing. You are not acting in a proper systemic manner. There are only complaints, not the drug. This is complete mismanagement, I am sorry", Justice Singh said..While Dr Vinod Kotwal, Member Secretary of the National Pharmaceutical Pricing Authority submitted that over 50,000 vials of Remsidivir was sent, the Court pointed out that this statement contradicted the stance of the Delhi government."That is not true. Government is saying 2,500. Where did the remaining 50,000 go? This is between you and the State", she said..She went on to observe,"We have at least identified the problem now ... What is the way we streamline this (Remsidivirs distribution)? ... How do we get stockists and distributors in line and ensure that it is not black-marketed?".On being appraised that there are 6 manufacturers. 30 stockists and 7 distributors or Remdesivir in Delhi by Advocate Raj Kumar, the Judge remarked,"This is an easy list to manage, only 37 entities....to ensure that they don't misuse, I'll pass some directions.".The matter will next heard on April 29.