Gujarat government's notification on distribution of mucormycosis medicine 'vague and defective': High Court

The Gujarat High Court on Wednesday said the state government's notification on the distribution of Amphotericin B injections to hospitals for the treatment of mucormycosis is "quite vague and defective".

All districts should have their own expert committees to decide on the requirement of the medicine, the court said.

Cases of mucormycosis, also known as 'black fungus', a serious infection, have been found in Covid-19 patients in various states.

Also read — Covid-19: Is mucormycosis contagious?

Gujarat has the maximum number of fungal infection patients in the country, as per data shared by Union Minister for Chemicals and Fertilisers D V Sadananda Gowda on Wednesday.

A division bench of Justices Bela Trivedi and Bhargav D Karia said the Gujarat government needs to be more specific and precise with regard to the distribution of Amphotericin B injections to government, corporation (civic-run) and private hospitals where patients with mucormycosis are being treated.

While hearing a PIL taken up suo motu (on its own) on Covid-19 and issues related to the pandemic, the court said more explanation is also required regarding the structure of the 'expert committee', on whose assessment of the "criticality and seriousness" of the patient the allocation of the injections will be made. "According to us, (the notification) is quite vague and defective," the court said.

The High Court also said the notification, issued by the Gujarat government on May 19 about the distribution of injections to private hospitals, only covers seven districts as the government or corporation hospitals from where the injections can be procured are based in these seven districts. All the districts should have their own expert committees to decide on the requirement of the medicine, the court said. It also said the notification only talks about the distribution of injections only to private hospitals and not government and civic-run hospitals. The court wondered how the decision was made as to how much should go to the government and corporation hospitals and how much to private hospitals from the available stock of the injections being supplied by the Centre.

"The notification seems to be a little vague, in the sense that who will appoint the expert committee, when will it be appointed, and who will be the members of the expert committee? And what about the districts (other than seven where government hospitals have been named for the supply of the injections) for the distribution of Amphotericin B?" the court asked.

There is no such mechanism provided in this circular about recommendations being sent by the government and corporation hospitals, it noted. "Probably, you (government) will have to be more specific and precise with regard to the distribution (of the injections) to the government, corporation and private hospitals," the court said.

The court further asked the government to specify who will be the members of the expert committee to decide on the criticality of patients for the recommendation of these injections. "There has to be a pulmonologist, an ENT surgeon, a physician, an anesthesiologist in the committee. For each district there has to be a separate expert committee, and it has to go to them and they should decide," it said.

Noting that the notification only talks about seven hospitals in as many districts from where injections can be procured, the court asked what will happen to the remaining districts. "Each district must have an expert committee, consisting of specialised doctors, and they will decide the criticality. Every government, as well as corporation hospitals, will have to send requisition," the court said.

The government said in its affidavit that on May 19, it formulated a policy for "equitable distribution" of this medicine which is being used for the treatment of mucormycosis. Under the policy, a distribution system has been established for the Amphotericin B injections in all districts/corporations for the government as well as private hospitals.

In his submission, Advocate General Kamal Trivedi said the government follows the same policy with regard to the distribution of Amphotericin B that it is doing with Remdesivir injections, being used for the treatment of Covid-19 patients. He said like in the case of Remdesivir, the Centre has taken over the supply and distribution of Amphotericin B to states, and the state is distributing the injections on the basis of "criticality and seriousness" of patients, as per suggestions of the expert committee. He said the quota of the medicine, which is being supplied inconsistently to the state on a day-to-day basis, is not being bifurcated between government, civic-run and private hospitals, but decided on the basis of its urgent requirement for patients.