COVID-19 test must be free in private labs: Supreme Court

At Dr. Dangs Lab in New Delhi, lab technicians demonstrate the collection of oral samples from a mock-patient in a car to test for COVID-19.

A Supreme Court bench Justices Ashok Bhushan and S. Ravindra Bhat, on April 8, issued interim orders to the Central government to ensure, one, that tests for COVID-19 in government laboratories and in accredited private laboratories were done free of cost and, two, that there would be no shortages of personal protective equipment (PPE) for health care workers, whose safety and security as well, the bench said, was the responsibility of the State. The bench was hearing two different petitions. It asked the government file a reply in two weeks on the order regarding free testing by private laboratories.

The court found “prima facie substance in the petitioner’s submission that permitting private laboratories to charge Rs.4,500 for screening and confirmation of COVID-19 may not be within the means of a large part of the population and no person be deprived to undergo the COVID-19 test due to the non-payment of capped amount of Rs.4,500.”

It also held that “private hospitals including laboratories had an important role to play in containing the scale of the pandemic by extending philanthropic services in the hour of national crisis.” The court said it would consider later whether the private labs conducting the free tests were entitled to reimbursement of expenses.

At present, screening for COVID was under way in 223 laboratories across the country, of which 157 were government laboratories and the rest were managed by private operators. The cost for the test in private laboratories had been fixed at Rs.4,500 by the government, which many public health experts felt was prohibitive for ordinary people. It was argued that the steep costs would be a deterrent to testing, defeating the purpose of checking the spread of the virus. As it is, for a country the size of India, the number of testing centres was abysmally small.

As of April 10, the ICMR said, a total of 1,30,000 samples had been tested, of which 5,434 were confirmed cases, which translated to an infection rate of between 3 and 5 per cent.

In a separate order relating to the availability of PPE, the bench asked the government to ensure availability of appropriate PPE to all health workers, including doctors, nurses, ward boys and other medical and paramedical professionals, attending to and treating COVID-19 patients in metros, and two tier and three tier cities. It directed the government to “explore all alternatives enabling and augmenting domestic production of protective clothing and gear to medical professionals”, including alternative modes of production of masks, suits, caps, gloves, etc., and permitting movement of such raw materials.

It also suggested that the government could “restrict exports of such materials to augment inventory and domestic stock”. On its part, the government held that health and other workers were placed in three categories, high-, moderate- and low-risk, depending on the degree of health risks they had with patients, and the allocation of PPE was based on that categorisation.

On April 9, joint secretary (health) Lav Agarwal reiterated the government’s position on PPE and told the media not to create a scare about PPE shortages. However, the fact is that more than the media, the shortages of PPE had been pointed out by members of the medical fraternity themselves in leading institutions in the country.

Besides, lakhs of Anganwadi workers and helpers under the Integrated Child Development Services scheme, the Auxiliary Nurse Midwives and the Accredited Social Health Activists carry on with their routine responsibilities vis-a-vis child and maternal health in rural populations, apart from informing the public about COVID-19, without any PPE.

The court made it clear that the government had to provide police security to doctors and medical staff who visited places for screening of people. The state was also empowered to take action against those who committed any offence in respect to “performance of duties by doctors, medical staff and other government officials”. The petitioner had pleaded for protection for doctors while pointing out a specific instance where a team of doctors was attacked by a mob in Indore.