Personal Protective Equipment Guidelines - Protect those who protect us!

 09 June 2020   |    Common Post Research

Apex Court's direction on use, distribution and augmentation of domestic production of protective gears and materials


Soldier always fought for protecting territorial borders of countries. The artillery, protection and protocols for battles are considerably legislated in past and as actual occurrence of physical wars enabled settled benchmarks. But for doctors, nurses and medical staff including ambulance drivers who are attending to Corona (Covid 19) affected patients are facing a crisis situation which may have happened to India exactly 100 years after the Spanish flu hit the shores of Mumbai in 1918.

The Govt, The Ministry of Health and Family Welfare, Directorate General of Health Services has issued guidelines dated 24th March, 2020 on "Rational use of Personal Protective Equipment" 'Usage of PPE Guidelines” exactly two days after the Janata Curfew on 22nd March, 2020.

The Hon’ble Supreme Court (“Apex Court”) pursuant to Public Interest Litigation filed by a Medical Professional praying for various directions in reference to pandemic COVID-19 heard the matter. In Jerryl Banait vs. Union of India (UOI) and Ors. (08.04.2020 - SC Order): MANU/SCOR/24152/2020 Apex Court passed certain interim direction on 8th April, 2020 in Writ Petition (Civil) Diary Nos. 10795, 10830 and 10852/2020 (IA Nos. 48243, 48242 and 48249/2020].

The interim order issued valuable directions on PPE Usage and also extending security for doctors, nurses and other paramedical staff performing their duties to treat the disease.

On the Aspect of Personal Protective Equipment for Doctors, Nurses, Ward Boys, other medical and paramedical professionals actively attending to, and treating patients suffering from COVID-19 in India:

Members of public have a generic understanding of what is Personal Protective Equipment but it is dynamic and subject to further changes to add and alter words within what comprises within the definition of ‘PPE’ as the disease Novel Coronavirus has unfolded itself during 1st week of February, 2020 in India.

The Petitioner in the above case, prayed for issuing a direction to the Union Government to ensure that PPE Guidelines issued by World Health Organisation and the Usage of PPE Guidelines to be implemented. A direction was sought in the petition to make available - Personal Protective Equipment, including sterile medical/Nitrile gloves, starch apparels, medical masks, goggles, face shield, respirators (i.e. N-95 Respirator Mask or Triple Layer Medical Mask or equivalent), shoe covers, head covers and coveralls/gowns to all Health Workers including Doctors, Nurses, Ward Boys, other medical and paramedical professionals actively attending to, and treating patients suffering from COVID-19 in India, in Metro cities, Tier-2 and Tier-3 cities
 

The prayer in the above case did not mention about several towns and villages which do not come within the ambit of Tier 2 or Tier 3 cities.  Health Workers will work in such areas as well to treat Covid 19 patients. It is to be seen in coming months the use of PPE in such places, geographic locations and villages which do not come within Tier 2 and Tier 3 cities. 

The Apex Court passed direction to Union of India to follow the Guidelines and to ensure availability of appropriate Personal Protective Equipments, including sterile medical/Nitrile gloves, starch apparels, medical masks, goggles, face shield, respirators (i.e. N-95 Respirator Mask or Triple Layer Medical Mask or equivalent), shoe covers, head covers and coveralls/gowns to all Health Workers including Doctors, Nurses, Ward Boys, other medical and paramedical professionals actively attending to, and treating patients suffering from COVID-19 in India, in Metro cities, Tier-2 and Tier-3 cities.

The Apex Court’s direction urging augmentation of domestic production of protective gears and materials (detailed below) oscillates our memory to President Donald Trump invoking the Defense Production Act, 1950 which empowers the president to control the civilian economy so that scarce and critical materials necessary to the national defense effort are available for defense needs

 

 

Hear the full Article

The Apex Court in its order passed on 8th April, 2020 clearly stated  'The Government shall explore all alternatives including enabling and augmenting domestic production of protective clothing and gear to medical professional.

The Apex Court also emphasized that -

  • government includes the exploring of alternative modes of production of such clothing (masks, suits, caps, gloves etc.) and permitting movement of raw materials.  
  • Govt may also restrict export of such materials to augment inventory and domestic stock.’                                                                                                                                                       The Apex Court’s directions categorically resounded economic principles of self sufficiency and laid meaningful pillars for state action.

Security for Doctors/Paramedical Professionals

The Petitioner prayed for a direction to be issued to provide security to Doctors and other paramedical professionals. The Apex Court consequently directed

  • The Government of India, respective States/Union Territories and respective Police authorities are directed to provide the necessary Police security to the Doctors and medical staff.
  • Such protection should be extended to Hospitals and places where patients who have been diagnosed COVID-19 or patients suspected of COVID-19 or those quarantined are housed.
  • Such protection of police security should be also extended to Doctors and other medical staff who visit places to conduct screening of people to find out symptoms of disease.

The present demand of Doctors, nurses, medical staff and paramedical staff to pass a law to expressly protect attacks against them by groups from public etc is now being considered by government. In the Direction passed by Apex Court, the state was directed to

  • take necessary action against those persons who obstruct and commit any offence in respect to performance of duties by Doctors, medical staff and other Government Officials deputed to contain COVID-19.’

 

Since last decade several states in India have passed acts for Protection of Medicare Service Persons and Medicare Service Institution Acts including the Karnataka Prohibition of Violence Against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act, 2009 ("the Act").
The definition of ‘medical personnel’ in the Act is exhaustive but the penalty amount which may extend to Rs.50,000/- and imprisonment of upto 3 years may not be sufficient deterrent to handle the present crisis. Importantly it geographically and physically restricts mostly to violence committed within or in the vicinity of ‘medical service institutions’  which includes government and private hospitals as well

However at present we are talking about instances of violence beyond the physical boundaries of ‘medical service institutions’. Exactly one year back there were deliberations on Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019. The definition of ‘medical personnel’ in this Bill is further refined and exhaustive keeping in view the present circumstances. However, the Bill seeks to address violence causing danger or injury to lives of ‘medical personnel’ during discharge of their duties within the premises of clinical establishment or ‘medical service institutions or loss or damage to the property of such clinic or institution.’

Drawing from the overarching directions issued by Supreme Court set out above, any new statute protecting ‘doctors and medical personnel’ from violence have to contemplate their seamless protection even outside the physical boundary of a institution or clinic. Also the definition of ‘violence’ needs to extend to verbal abuse, stigma, gestures and other verbal, written or even manner of conducting before ‘doctors and medical personnel’.

The Landlord/Lessor or Licensor’s reluctance to rent premises to ‘medical personnel’ can even tomorrow manifest in stigmas against such medical personnel traveling in public transport or visiting public places like a shopping mall, multiplex or such other enclosed spaces. To restraint such behavior and actions from private parties involves strong principle of ‘anti - discrimination’ being enforced on private parties. It also means extending ‘immunity’ to certain profession for certain emergency circumstances. Such additional concepts may have to be embedded at the time of structuring the statute to protect ‘doctors and medical personnel’

The directions of Apex Court is a harbinger of new statutes and specific government orders which will firm up the legal framework to control the pandemic.

The direction creates a constructive ecosystem with four main actors ‘ domestic organization coming forward to manufacture PPE and patient care devices and equipment‘ ‘doctors and medical personnel’, ‘patients (affected with the pandemic or suspected to have been affected’ and ‘perpetrators of violence’.   
 



The article was written on 21st April, 2020. Just a day later an ordinance was passed Epidemic Diseases (Amendment) Ordinance, 2020 making attach on healthcare personnel 'non bailable' and cognizable offence imposing fines ranging between 50,000 INR to 5,00,000 INR (about 6595 USD).
The ordinance received Presidential Assent on 27th May, 2020.  

Further reading
The security of doctors, medical professionals and paramedicals were being debated not only in India but in other countries including Turkey. On or about 17th April, 2020 - Turkey passed a law which will punish physical attacks on healthcare workers with 1.5 and 4.5 years in prison without a parole. Threats or insults against health care officials will have a maximum punishment of three years.
The above news on Turkey is extracted from Middle East News Platform www.al-monitor.com


 

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