Ensuring Medical Facilities in Govt Hospitals Constitutional Obligation of State, Courts can intervene if neglected: HC

Chennai: The Madras High Court bench recently observed that the State Government was constitutionally obligated to ensure the availability of medical facilities in government hospitals and make such facilities available to the underprivileged citizens of the country.

Further, the HC bench comprising Justices MS Ramesh and AD Maria Clete noted that when the State would neglect such obligations, the Court had authority under Article 226 of the Constitution of India to issue positive directions for such provisions.

“On an overall appraisal of all the decisions of the Hon’ble Supreme Court, we have no difficulty in holding that the provision of a medical facility in the Government Hospitals, so as to reach the poor, downtrodden and underprivileged citizens of the society, is a constitutional obligation of the State and when such facilities are neglected by the State Government, this Court would be well within its powers under Article 226 of the Constitution of India to issue positive directions for such provisions,” observed the High Court bench.

These observations were made by the High Court bench while considering the public interest litigations regarding the absence of guidelines in respect of standards of medical and infrastructural facilities available in the Government Hospitals and for the establishment of Bone Marrow Transplantation facilities in government hospitals.

In their pleas, the petitioners informed the High Court that apart from the Rajiv Gandhi General Hospital, Chennai, the Institute of Child Health and Hospital for Children in Egmore, and the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), no other government hospitals in the State had facilities for free bone marrow transplant.

The petitioners further pointed out that the Bone Marrow Transplant procedure is used to treat rare medical conditions, and it involves a huge expenditure. They submitted that since the facilities were available only in Chennai, people from the southern districts of the State had to face hardship to avail of this facility.

Meanwhile, the Additional Advocate General relied on the status report filed by the Directorate of Medical Education which said that the total estimated cost for Civil Structure, Equipment, and Staff sanctioning would be Rs 13,52,76,000 and the Annual Expenditure for the medical and non-medical staff would be an additional sum of Rs 3,63,76,000. 

Further, the AAG informed that the equipment for blood bank, oncopathology, etc. would cost Rs 4,99,00,000. It was further submitted that the medical officers were also deputed from Dindigul and Madurai for a three-month training programme.

He also added that the Medical Officers in the rank of Professor from Government Medical College, Dindigul and two Associate Professors from Madurai Medical College have been deputed to undergo the Bone Marrow Training Programme at ICHHC, Chennai. However, the AAG submitted that the estimated cost for the proposal for Civil Structure, Equipment and Human Resource for establishment of BMT at Government Rajaji Hospital, Madurai is subject to the approval of the Government.

Apart from this, the AAG also informed the Court that the State was not in a position to give a probable time limit for such establishment of the facility, since it involves the policy decision of the Government.

After taking note of the submissions, the Court noted that even though the State report began with a positive note, the rider that the proposals as well as time-limit were the policy decision of the government was not appreciable.

The HC bench noted that there was no dispute regarding the fact that apart from RGGH and ICHHC at Chennai, no other Government Hospital, within the State of Tamil Nadu, had the facility to provide free BMT procedure. 

“In the status report dated 30.09.2024, the Government have set out a proposal submitted by the Dean, Government Rajaji Hospital, Madurai and have estimated the proposal for civil structure, equipments and human resource for establishment of BMT in Government Rajaji Hospital, Madurai at Rs. 13.53 crores. The facility of BMT requires to be extended to atleast one General Hospital in each district, by taking into account the unavailability of such a facility in any of the districts, except Chennai. The Government shall take into consideration all the imminent and crucial medical procedures, which have been deprived to the poor and underprivileged section of the public in the remotest districts and shall endeavour to extend the facilities at the earliest,” observed the Court.

It was observed by the HC bench that the Director of Medical Education had come out with a proposal with estimation for extending the BMT facility at the Government Rajaji Hospital, Madurai. Accordingly, the bench held that “Now that the Director of Medical Education has come out with a proposal with estimation for extending the BMT facility at the Government Rajaji Hospital, Madurai, the Principal Secretary, Health and Family Welfare Department, Government of Tamil Nadu, shall consider the proposal, extracted in their status report dated 30.09.2024 and allocate the necessary funds at the earliest, in any event, within a period of three months from the date of receipt of a copy of this order.”

Regarding the prayer for framing necessary guidelines in respect of the Standards of medical and infrastructural facilities in all the Government Hospitals, the Court noted that the High Court, through an interim order dated 17.06.2019, had constituted a three-member committee to conduct an inspection as to the availability of basic infrastructures and maintenance of the hospitals in a neat and tidy sanitary condition and also as to the availability of adequate manpower with the basic functions.

The Court observed that after the interim order, the committee had visited the Government Hospitals at Srivilliputhur, Ramanathapuram, and Paramakudi and through their report dated 22.07.2019, it proposed certain recommendations for improving these hospitals.

“However, several years have lapsed, since the inspection was conducted and it would not be conducive to act upon the suggestions and recommendations made by the Committee,” noted the Court.

Taking note of this, the bench granted liberty to the petitioner to make a representation to the authorities for framing of guidelines, touching upon the standards of medical and infrastructural facilities in the Government Hospitals with a consequential direction to the Government to consider the same, to secure the ends of justice.

Accordingly, the bench issued the following directions:

 (a) the respondents shall allocate the necessary funds for civil structure, equipments and human resource for establishment of BMT facility at Government Rajaji Hospital, Madurai, within a period of three months from the date of receipt of a copy of this order.

(b) on such allocation of funds, the respondents shall ensure that the facility of BMT is established at Government Rajaji Hospital, Madurai, within a period of six months from the date of allocation of the funds.

(c) the petitioners herein are granted liberty to make an appropriate representation to the respondents, seeking for framing of suitable guidelines, in respect of the standards of medical and infrastructural facilities in all the Government Hospitals in the State of Tamil Nadu and on receipt of the same, the Principal Secretary, Health and Family Welfare Department, Government of Tamil Nadu, shall consider it and pass suitable orders in accordance with law, within a period of three months from the date of receipt of such representation

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/gurushankar-v-the-chief-secretary-597259-284579.pdf

Also Read: HC orders TN medical council to update records Over MD Upgrade Delay Due to Seat Dispute

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Release Revised Internship List: FMGs Urge Bihar Govt

Patna: The foreign medical graduates have urged the Bihar Health Department to urgently release the corrected list of the mandatory internship programme, which is mandatory for all the medical graduates from abroad.

Even though the Bihar Medical Council had released the internship lists, recently the State Health Department cancelled two such lists for the FMGs due to errors. 

Consequently, a notice was issued by the Deputy Secretary of the Bihar Government on 22.04.2025. In that said communication, the Deputy Secretary wrote to the Principal of all Government Medical Colleges regarding the cancellation of allotment of medical college hospitals allotted by Bihar Council of Medical Registration, Patna, for internship of FMG students.

Addressing the issue, the Government had mentioned how the FMGs were allotted internship opportunities at private and government medical colleges through various letters of the Registrar of Bihar Council of Medical Registration, Patna.

However, the letter mentioned how “This allotment of the Registrar, Bihar Council of Medical Registration, Patna is contrary to the provision mentioned in clause-03 of letter No. U-15024/9/2023-UGMEB, dated-07.12.2023 of National Medical Commission, New Delhi.”

Accordingly, it cancelled the internship allotment and informed that the process of FMG internship allocation would be done separately by the Department. “In view of the above, the allocation of medical colleges for Compulsory Rotating Medical Internship to FMG students by the Registrar, Bihar Council of Medical Registration, Patna is cancelled with immediate effect. The process of allocation of medical colleges to FMG students under Compulsory Rotating Medical Internship will be done separately by the department,” the communication dated 22.04.2025 had mentioned.

However, more than a week has passed since the State cancelled the FMG internship allotments and no revised internship list has been released yet. Highlighting this, the All FMGs Association recently urged the Bihar Health Department to immediately released the revised list. The association pointed out how the delay in internship allotment was affecting the career of several aspiring doctors, who need to complete their mandatory internship training to be able to register themselves as doctors in India and practice.

Also Read: ESIC Patna FMG interns awaiting Stipend for 8 Months seek govt intervention

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Not a Nice Time For Dr Reddy’s? DTAB, CDSCO Recommend Stringent Restrictions on Nimesulide

New Delhi: Nimesulide, a widely used painkiller in India, is facing renewed regulatory scrutiny over its safety profile, with India’s apex drug advisory committee, recommending that the drug not be used as a first-line treatment and that high-dose oral formulations above 100 mg be prohibited.

However, Dr Reddy’s Laboratories, one of the largest marketers of the drug under the brand name ‘Nise’, has defended its safety and efficacy, asserting that the drug is supported by years of clinical research and that it does not sell formulations exceeding 100 mg. The company has also submitted detailed representations to regulatory authorities and expert panels to prevent a blanket ban.

During a recent meeting, the DTAB examined an Indian Council of Medical Research (ICMR) report on the drug’s effects in adults and recommended several restrictions. While acknowledging that Nimesulide remains effective for short-term fever relief, the board advised that it should only be used as a second-line treatment, after exhausting first-line options.

The DTAB also supported ICMR’s recommendations to prohibit oral formulations of Nimesulide above 100 mg in immediate release form and advised against its use in pregnant or lactating women, those planning pregnancy, and patients with liver or kidney impairment. It also recommended avoiding co-administration with other hepatotoxic or nephrotoxic drugs. Further, the committee has asked ICMR to conduct a systematic review of the drug’s use in vulnerable age groups—including children below 12, adolescents between 12 and 18, and seniors above 60—for future deliberation.

Nimesulide, a non-steroidal anti-inflammatory drug (NSAID), was launched in Italy in 1985 but has never been approved in the US, UK, Canada, Australia, Japan, or New Zealand due to safety concerns. Approved in India in 1995 for treating pain, inflammation, and fever, it became popular for its rapid onset of action. It is marketed under various brand names in India, including Nise, Nimrest, Nimopen, Nicip, and others, in 100- or 200-mg dosage strengths.

Also Read: Revise Phase IV Clinical Trial Protocol Of Nimesulide Granules For Oral Suspension: CDSCO Panel Tells Dr Reddys

Last year, amid concerns over its potential to cause liver damage, the Union Health Ministry asked the ICMR to assess its safety in adults. The ICMR had earlier considered recommending a nationwide ban but was instead directed by the DTAB to conduct a detailed review in specific populations.

In its report, the ICMR proposed banning all formulations above 100 mg and suggested adding a “black box” warning on all products containing the drug.

According to a News18 report, an 11-page ICMR report called upon nimesulide’s poor safety profile and recommended that it be reserved only as a second-line treatment.

Dr Reddy’s Defends Nimesulide Amid Safety Concerns

Despite these concerns, Hyderabad-based pharmaceutical company Dr Reddy’s Laboratories—India’s largest seller of branded nimesulide—has strongly defended the drug.

In a statement to News18, the company said, “Robust research and clinical trials have consistently established the safety and efficacy of Nimesulide, when used as prescribed.” It also stated that it does not market doses above 100 mg and clarified its prescribing guidelines: “Nimesulide is not recommended for use in pregnant or lactating women and patients with renal or hepatic impairments.”

In a letter submitted to the Drug Controller General of India, ICMR, and Directorate General of Health Services, the company argued against banning the drug, citing multiple court rulings and past DTAB evaluations affirming its safety.

“We wish to highlight that the subject matter of the safety of Nimesulide came before various courts such as the High Court of Judicature at Delhi and Madras in 2004, and again in 2008, and most recently before the Delhi High Court in 2023,” the letter stated.

Dr Reddy’s noted that “no causal relationship with serious liver toxicity or Reye’s Syndrome… was reported by any of these experts” and that “DTAB and other independent bodies have consistently found no significant adverse effects.”

The company reiterated that the drug remains safe when used appropriately and submitted additional safety data from Indian and international sources, including the WHO, to support its claim.

“We submit that the data enclosed clearly establish Nimesulide’s safety as one of the highest in its category,” stated Sandeep Khandelwal, Head – India Sub-Continent, Dr Reddy’s Laboratories.

According to market data from Pharmarack, Dr Reddy’s ‘Nise’ brand generated a moving annual turnover (MAT) of Rs 94 crore as of March 2025, followed by Mankind Pharma, Maneesh Pharmaceuticals, and IPCA Labs.

The International Society of Drug Bulletins (ISDB), supported by the World Health Organization, had in 2008 called for a global withdrawal of nimesulide. “It offers no therapeutic advantage or better gastrointestinal safety compared with other NSAIDs, whereas it exposes patients to a higher risk of fatal hepatic disorders,” the ISDB had noted.

In response to these concerns, India banned nimesulide for children under 12 in 2011. More recently, the Union Health Ministry, following advisory board recommendations, banned its veterinary use in January 2025 to protect the vulture population.

Also Read: Have taken opinion for all formulation of drug Nimesulide for vulture conservation: Health Ministry to Delhi HC

Globally, the European Medicines Agency restricted nimesulide’s use to adults in 2002, and many countries, including the UK, US, Canada, Australia, Singapore, and Japan, have either banned or severely restricted it. Today, India and Pakistan remain among the few countries where it is still widely available for adult use.

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7 Years of Commission Service, Rs 69 Lakh Penalty: AFMC Pune Bond policy for MBBS 2025

Pune: MBBS aspirants getting admitted to the Armed Forces Medical College (AFMC), Pune, this year will have to compulsorily serve as Medical Officers in the Armed Forces Medical Services (AFMS) for seven years after completing their course.

At the time of getting admitted to the MBBS course at AFMC, the candidates will have to sign a bond agreement of Rs 69 lakh and if the candidates withdraw from the college after 7 days of admission, or if they fail to fulfill their bond service liabilities, they will have to pay the bond money as a penalty. 

Since last year, the bond amount set by AFMC has increased by Rs 2 lakh. Medical Dialogues had earlier reported that while last year, the MBBS aspirants were required to pay a bond fee of Rs 67 lakh, the year before that the amount was Rs 65 lakh.

“Candidates admitted to AFMC for MBBS course have a compulsory liability to serve as Commissioned Officers in the Armed Forces Medical Services. The offer of the type of commission will depend upon the vacancies available and shall be determined on merit-cum-option at the final MBBS examination. The liability of the SSC officers passing out of AFMC to serve in the Armed Forces Medical Services (AFMS) would be 7 (seven) years. The Permanent Commission (PC) Officers will have to serve in AFMS till date of superannuation. Complete details of Service Liability & Bond Agreement will be given to the candidates shortlisted for the screening,” stated the AFMC Information Brochure for Admission to MBBS Course 2025.

“At the time of admission, parents/guardians of the candidates are required to sign a bond agreement for Rs 69,00,000/- (Rupees Sixty-Nine Lakhs only). Any candidate withdrawing from the college after 7 days of admission [after 1600hrs (4PM)] will have to pay Bond Money as per existing rules,” the Brochure mentioned.

Removal from Service Liability: 

The Information Brochure for MBBS admission 2025 stated that any medical cadet declared Non-Service Liability (NSL) due to medical grounds where he/she contracted the disease/disability in the circumstances over which he/she has no control and for which he/she has not refused treatment will not be liable to pay the Bond money but will have to pay the cost of training, tuition fees and other charges as applicable for further period of study from the date they are declared NSL. NOC to undergo internship will be issued only after clearing all dues.

“Such NSL cadets will be permitted to avail hostel facility at the discretion of DGAFMS,” it stated.

According to the Brochure, the current current cost of training is Rs 28,166/- per week and it may be revised in future based on training cost approved by the Govt of India.

“In case of medical cadets removed / opted out from service liability after passing final MBBS examination, the NOC for joining internship training will only be issued after the Bond Money is paid in full. 20. Medical cadets who have been removed/opted out from service liability after passing final MBBS examination, will be permitted to join internship training in any of the approved AFMS Internship Hospitals,” it added.

As per the Brochure, altogether 150 candidates (including 5 Government Sponsored candidates from Friendly Foreign Countries) will be selected in the year 2025. Among these 145 candidates 115 boys and 30 girls) will be selected as Medical Cadets for undergoing MBBS at the Armed Forces Medical College, Pune with liability to serve in the Armed Forces Medical Services as Medical Officers. The candidates selected in addition to becoming doctors will also be commissioned as officers of the Indian Armed Forces, wherein they have to be both physically and psychologically robust to be able to undergo the rigors of life in the Armed Forces.

The selected candidates need to have leadership qualities, effective communication skills and exacting physical standards, as the same are prime requisites for serving officers of the Armed Forces, stated the Brochure.

Also Read: 7 years of Commission Service, Rs 67 lakh bond penalty: AFMS Bond policy for MBBS candidates 2024

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SC backs direction to prescribe only generic medicines, suggests countrywide adoption

While hearing a Public Interest Litigation that sought enforcement of a statutory code to regulate unethical marketing practices by pharma companies, the Supreme Court has recently observed that doctors across India should be directed to mandatorily prescribe only generic medicines to patients, instead of the brand names of medicines.

The top court bench orally remarked that if there was a statutory mandate for doctors to prescribe generic medicines, the issue of pharmaceutical companies allegedly bribing doctors to prescribe excessive or irrational drugs and push for high-cost, overpriced brands would be resolved, Live Law has reported.

For more information, click on the link below:

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Court rejects bail plea of doctor in Rs 35 crore online investment fraud

Noting that the investigation is still at an early and sensitive stage, a local court in Kangan has rejected the bail plea of a doctor along with three others accused in a large-scale online investment scam, in which they allegedly cheated several people out of Rs 35 crore by offering false promises of high returns.

The four accused allegedly benefited from the money taken from the victims, with each of them keeping portions of the defrauded amount in their bank accounts, as per the Kashmir News Trust investigation report.

For more information, click on the link below:

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CDSCO Panel Approves Dr Reddy’s Laboratories Protocol Amendment Proposal to study Abatacept

New Delhi: The Subject Expert Committee (SEC), functional under the Central Drug Standard Control Organisation (CDSCO), has approved Dr Reddys Laboratories protocol amendment proposal of the clinical trial titled “A randomised, double-blind, multicenter study comparing the efficacy, safety and immunogenicity of proposed Abatacept biosimilar (DRL_AB) with Orencia administered by the intravenous route as an add-on to methotrexate in the treatment of patients with moderate to severe rheumatoid arthritis”,

This came after Dr. Reddy’s Laboratories presented protocol amendment Version 3.0 dated 02 Sep 2024, protocol no. AB-01-004.

Abatacept is a disease-modifying antirheumatic drug (DMARD) used in the management of rheumatic conditions, such as rheumatoid or psoriatic arthritis, and for the prophylaxis of acute graft-versus-host disease.

Abatacept is a selective costimulation modulator – like CTLA-4, the drug has been shown to inhibit T-cell (T lymphocyte) activation by binding to CD80 and CD86, thereby blocking interaction with CD28. Blockade of this interaction has been shown to inhibit the delivery of the second co-stimulatory signal required for optimal activation of T-cells. This results in the inhibition of autoimmune T-cell activation that has been implicated in the pathogenesis of rheumatoid arthritis.

Abatacept is used to treat rheumatoid arthritis (RA), psoriatic arthritis (PsA), and polyarticular juvenile idiopathic arthritis (pJIA), which are autoimmune disorders and is also used to prevent acute graft versus host disease (aGVHD).

At the recent SEC meeting for Analgesic and Rheumatology held on 19th March 2025, the expert panel reviewed protocol amendment Version 3.0 dated 02 Sep 2024, protocol no. AB-01-004

After detailed deliberation, the committee recommended approval of the protocol amendment as presented by the firm.

Also Read: CDSCO panel grants clearance to Morepen Labs to conduct BE studies for fatty liver disease drug Resmetirom

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AIIMS Delhi pioneers India’s first TEM-Based diagnostic method for Primary Ciliary Dyskinesia

Researchers at the All India Institute of Medical Sciences (AIIMS), New Delhi have achieved a major breakthrough in India’s diagnostic capabilities by developing a cutting-edge method to diagnose Primary Ciliary Dyskinesia (PCD) – a rare and often misdiagnosed genetic disorder affecting the respiratory system – using transmission electron microscopy (TEM).

According to Dr Subhash Chandra Yadav from the Electron Microscope Facility, Department of Anatomy, AIIMS Delhi, this method is the first of its kind in India.

For more information, click on the link below:

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CDSCO Panel Approves Novartis Healthcare’s Protocol Amendment to study Iptacopan

New Delhi: The Subject Expert Committee (SEC), functional under the Central Drug Standard Control Organization (CDSCO), has approved the protocol amendment proposal presented by Novartis Healthcare for Iptacopan (LNP023) study.

This came after the firm presented protocol amendment version 04 dated 30 Nov 2023, protocol no. CLNP023B12001B. This is an open-label, non-randomized extension study to evaluate the long-term efficacy, safety, and tolerability of iptacopan (LNP023) in C3 glomerulopathy or idiopathic immune-complex-membranoproliferative glomerulonephritis.

Glomerulopathy refers to any disease of the glomeruli, the tiny filters in the kidneys. Idiopathic immune-complex-membranoproliferative glomerulonephritis (IC-MPGN) is a specific type of glomerular disease where immune complexes and complement proteins are deposited in the kidney, potentially due to overactivation of the alternative complement pathway.

Iptacopan is a member of the class of indoles that is 1H-indole substituted by [(2S,4S)-2-(4-carboxyphenyl)-4-ethoxypiperidin-1-yl]methyl, methoxy, and methyl groups at positions 4, 5, and 6, respectively. It is a potent inhibitor of complement factor B with potential immunomodulatory activity. It has a role as a complement factor B inhibitor and an immunomodulator.

Iptacopan is a small-molecule factor B inhibitor previously investigated as a potential treatment for the rare blood disease paroxysmal nocturnal hemoglobinuria (PNH) by inhibiting the complement factor B. Factor B is a positive regulator of the alternative complement pathway, where it activates C3 convertase and subsequently C5 convertase.

At the recent SEC meeting for Renal held on 18th March 2024, the expert panel reviewed the protocol amendment version 04 dated 30 Nov 2023 protocol no. CLNP023B12001B.

After detailed deliberation, the committee recommended approval of the protocol amendment as presented by the firm.

Also Read: CDSCO panel rejects USV Pharmaceuticals’ proposal of CT study waiver for fenofibrate tablets in diabetic retinopathy

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NEET PG 2025: 2 petitions filed in SC demanding single-shift exam

Doctors’ demand for holding the upcoming National Eligibility-Entrance Test Postgraduate (NEET-PG) examination in a single shift has now reached the Supreme Court.

The United Doctors’ Front (UDF) has filed a petition with the Supreme Court. In the plea, UDF, a registered medical association representing thousands of doctors and medical aspirants, has urged the Apex Court to issue directions to conduct the upcoming NEET PG 2025 exam in a single shift across the country.

For more information, click on the link below:

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