Thread by @barandbench

#BombayHighCourt to hear clutch of petitions pertaining to management of #COVID19 in #Maharashtra.

Hearing before Bench of Justices AA Sayed and GS Kulkarni.

#COVIDEmergency2021 #MaharashtraFightsCorona

@CMOMaharashtra
@mybmc

Adv General Ashutosh Kumbhakoni appears for State, ASG Anil Singh appears for Centre, Sr Adv Anil Sakhare appears for BMC.

Advocates Simil Purohit, Arshil Shah, Rajesh Inamdar, Ajinkya Udane appear for petitioners.

#BombayHighCourt

@ArshilAjay
@rajinamdar22

Bench assembles.

State and Municipal Corporation have filed affidavits, Court told.

#BombayHighCourt #COVID19India

Union of India has filed an affidavit yesterday, Court informed.

Anybody appearing for the petitioners? There are so many petitioners: Court

#BombayHighCourt #COVID19India

Adv Pankaj Kandhari makes submissions in an application concerning the treatment of #BlackFungus, COVID-19 treatment in rural areas, among other issues.

He informs that the application could not be filed yesterday. Court asks him to file the application first

#BombayHighCourt

Adv Rajesh Inamdar raises concern over medical treatment of #BlackFungus: People are struggling milord, there are no medicines at all.. This Black Fungus is more serious, if the medicine is not treated on time, his eyes will be removed ...

#BombayHighCourt

Which is the medicine for #BlackFungus? How many cases are there today? Are the medicines approved, all of this will have to be put on record: Court tells Adv Inamdar.

#BombayHighCourt

Details are contained in the application, Court told.

Let the application be filed, let it be served on authorities, let them respond to it, Court says.

What is the protocol to be followed for supply of medicines for #BlackFungus, Court asks

#BombayHighCourt

Medicine is Amphotericin, State is giving it district collectors, collectors are supplying to hospitals based on need, Court told.

#BombayHighCourt #BlackFungus

Court says it hopes State is taking all steps to augment the supply of medicines for #BlackFungus. Notes that the infection has been seen in Pune, Kohlapur, now in Bombay.

#BombayHighCourt #BlackFungus

There are 3,200 cases of #BlackFungus now, AG tells #BombayHighCourt

Mucormycosis has been declared a notified disease, means when healthcare establishment receives a patient, they have to inform public health officials so at state level, we can have complete data of patients.

AG: We have already started an online portal for making entries of patients suffering from Mucormycosis

#BlackFungus #BombayHighCourt

Mr Inamdar is right, there is a short supply of Amphotericin because its manufacture is in short supply. The problem is not with the distribution. It takes 20 days to get the drug completely manufactured, AG informs #BombayHighCourt

#BlackFungus #COVID19India

Our state has taken initiative to start in-house manufacturing of this drug (Amphotericin) in Haffkine biopharma: AG

Procurement of raw material completed yesterday. The first batch will be available around June 6, AG adds

#BlackFungus #COVID19India #BombayHighCourt

40,000 vials of Amphotericin to be manufactured in Haffkine biopharma in the State, AG informs

#BombayHighCourt

4-5k avg Amphotericine per day is got from the Centre. Saying this is average as one day we receive 7k, another day we did not receive a single vial: AG

#BombayHighCourt

I am not complaining, Mr. Singh can relax. I could see Singh just getting ready to reply. It is his difficulty also. If the drug is not being manufactured, where will the central govt get it? AG

#BombayHighCourt #BlackFungus #COVID19India

As per the present arrangement, will have to give entire supply of Amphotericin manufactured in Haffkin within State to Centre, AG informs.

#BombayHighCourt #BlackFungus #COVID19India

Court says then there may not be a lot of difference, since the newly manufactured supply of Amphotericin wont be for the State. AG replies that the situation may become more comfortable than it is today.

#BombayHighCourt #BlackFungus #COVID19India

AG informs #BombayHighCourt that a Government resolution has been passed on May 18 to provide cashless and free treatment for #BlackFungus in 131, identified empannelled hospitals throughout the state.

#BombayHighCourt #BlackFungus #COVID19India

Court suggests that manufacturers abroad be identified for the manufacture of Amphotericin. Court suggests Centre also take instructions on this aspec.

#BombayHighCourt #BlackFungus #COVID19India

Court asks about any other compliances.

AG: Another compliance was with M/s Sood foundation and M/s Zeeshan Siddiqui.
That is shown at page 62 and we have told them about the order of this court and the PILs.
They have replied saying they have played role of only facilitator.

Court: These medicines have not been handed over to them?

AG: They have not purchased, stocked or stored.
They have only facilitated in procuring the medicines and sometimes paid the cost of the medicine.

Court: Paid to whom?

#BombayHighCourt #COVID19India

Court: The drug was only available with the Centre..

AG: That is what they say. The details are in their reply.

Court: Can this reply be accepted? Can the authorities accept such reply?

AG: I am not justifying them here. We have not accepted their reply.

#BombayHighCourt

AG: We have issued notices to the companies - Jubiliant Cipla and Hetero foundation.

Court: So the investigation is ongoing. And what if they say they have not given?

AG: Then we go back to Sood Foundation and the other and confront them with the companies’ reply.

Court: So this inquiry will proceed in accordance with law?

AG: It will reach its logical end.

Court: And there is no shortage..? This is only Mumbai or Maharashtra?

AG: This is all over Maharashtra

#BombayHighCourt #COVID19India

Court: This is availability for present demand.
What is the average requirement per day?

AG: I will put that in the next affidavit.

#BombayHighCourt #COVID19India

AG: We increased our production day by day.

Court: and there is price control, I believe?

AG: Yes

#BombayHighCourt #COVID19India

Court: And what about the importing of Remdesivir? Is that going on or have we ramped up?

AG: We have received permission for one manufacturer.
The last time, Mr Singh had shown us the permission.

#BombayHighCourt #COVID19India

Court: any other point from the earlier order?

AG: About oxygen, the position appears to be comfortable, decline in number of patients. And the steps which the State took to augment manufacturing within the State.

#BombayHighCourt #COVID19India

Court: Last hearing we recorded the number of patients.

AG: Yes that there is decline in number of patients yet demand has not gone down.

Court: Today what is the position?

#BombayHighCourt #COVID19India

AG: 3,17,733 are active patients.

Court: How much is oxygen need? And the patients who need?

#BombayHighCourt #COVID19India

AG: During the first wave, the requirement of oxygenated patient and the quantum was less. The virus underwent mutation in the second wave, the patients needing oxygen increased and the amount also increased.

#BombayHighCourt #COVID19India

Court: How much is the requirement now?

AG: The exact number of patients I will let you know in few minutes, the figure is dynamic.

Court: For the present it is adequate?

AG: It is adequate for the present. Milords may not record more, Centre may reduce.

#BombayHighCourt

Court: If not figures at least give us the amount of oxygen in MT.
You were to take some instructions on the feedback on the oxygen generation plants in hospitals can be made obligatory. We read somewhere it is 1 crore per hospital installation.

#BombayHighCourt #COVID19India

AG: In the absorption plants the capacity to generate oxygen is 1 MT per day, and installation cost is 1 crore and it takes 1-2 weeks to install.

Court: So this is feasible..? There is a third wave coming. We ought to be prepared for that ..

#BombayHighCourt #COVID19India

Court: You have had a longer time.. You could possibly issue an order making it mandatory..
Instead of amending the act, just pass an ordinance for hospitals who can install can do so..

#BombayHighCourt #COVID19India

Court: Giving assistance to hospitals who can install, so that we are prepared for any untoward future.

#BombayHighCourt #COVID19India

AG: Milords may see the compliance for the dashboard.

Court: This was something which was very crucial. And our anxiety was to ensure this is a permanent phenomenon.

AG: We are creating a dashboard connecting over 3000 hospitals and 25 existing dashboard.

#BombayHighCourt

Court: It should be ideal, this will be one of its kind. Maharashtra will be the first state for this...
And it should be updated frequently?

AG: Real time update. My officers have told me it will be updated minimum thrice a day.

#BombayHighCourt #COVID19India

Court: And give us the outer limit, by when will you finish it?

AG: Give me 5 minutes.

Court: The real-time updates was crucial. Because what Mr. Sakhare submitted that the dashboard is updated once a day was worrisome.
Then we saw Nandurbar model.

Court: So then we thought maybe the best was to have one dashboard.
Hence we suggested ATC and railways..

AG: This dashboard can also work only once hospitals support.

#BombayHighCourt #COVID19India

Court: Accountability also needs to be added. Maybe highlight hospitals which are not updating.

#BombayHighCourt #COVID19India

Court: We urge you to have data from all collectors. Rural and tribal areas. And we will hear the details on the next date of hearing.

#BombayHighCourt #COVID19India

Court: What about the facts and figures of crematoriums?
What about the deaths in comparison to the crematoriums?
Are the deaths more in comparison to the area for cremations?

#BombayHighCourt #COVID19India

AG: Fortunately we do not have incidents like the Ganga incident.
There may not be immediate place available for cremations, but we are doing it.

Court: As long as there is respectful cremation of the bodies...

#BombayHighCourt #COVID19India

Court: But the problem is not just capacity, it is also about the type of the crematorium, gas or electric crematorium.
Because in one petition there is issue there is air pollution due to use of traditional methods.

#BombayHighCourt #COVID19India

Court: The bodies which a crematorium could manage was 24 and they received over 100.

#BombayHighCourt #COVID19India

Court: You may address it later.

AG: The UDD has issued a notification for gas ad electric crematoriums. The details of Gem Portal was provided.
To my pleasant surprise, this portal does away with tender process.

#BombayHighCourt #COVID19India

AG: so the local authority can directly place an order with the manufacture. We have finalised a manufacturer and also fixed the price.

#BombayHighCourt #COVID19India

Court: But what about the technology to handle the smoke in a scientific manner? We have systematic smoke controlling devices in the plants.
There are underground facilities and it is suppressed over there.

#BombayHighCourt #COVID19India

Court: Why is this not being considered for the crematoriums?

#BombayHighCourt #COVID19India

Court: About 3-4 years back this was discussed for the Walkeshwar crematoriums.
I do not think this was considered.
Corporations have to be sensitive to this issue. Technology has to be used.

#BombayHighCourt #COVID19India

AG: Milords are right.
Crematoriums were outside the city limits. But with increasing city limits, the crematoriums have come within the city.

Court: Now what about the fire audits?

#BombayHighCourt #COVID19India

AG points out the steps that are being taken.

#BombayHighCourt #COVID19India

Court: Most of these fire accidents happen due to the air conditioners.
So these conditioners that have to be installed should be with certification. It should not be casual. That it is installed and there is fire.

#BombayHighCourt #COVID19India

AG: Also hospitals have oxygen, and there are santizers. Hence a small spark leads to big fire accident.

#BombayHighCourt #COVID19India

Court: The Virar incident happened because there was alcohol on the curtains.

AG: Oxygen and sanitisers are deadly combination.

#BombayHighCourt #COVID19India

Court: and what about the permissions?

AG: We have clarified that there is bio hazard involved. There are norms that need to be followed. But we do not have any pending applications.

#BombayHighCourt #COVID19India

Court: And what about the Task Force for third wave which is likely to affect children?

AG: A pediatric task force has been created. The task force has interacted with normal doctors..

Court: So we take it something has been done in that aspect.

#BombayHighCourt

Court: What about the data of the smoking? The patients who are affected due to smoking.

AG: We received lot of representations from cigarette companies raising their concerns.

Court: We just want data on the vulnerability.

#BombayHighCourt #COVID19India

AG: Milords my humble request to all petitioners and intervenors who are appearing to first send their suggestions to us first. They put all the hard work to place it all before the Court.

#BombayHighCourt #COVID19India

AG: I am sitting here with open arms for all suggestions. They place it before the Court and then ultimately the Court will ask the State to consider. So instead of wasting time, they can send to me first.

#BombayHighCourt #COVID19India

Court: And also do not bring up issues suddenly. This issue of Black Fungus, Yellow fungus, these are serious issues. But then it will have to be looked into. It should have been informed to them.

#BombayHighCourt #COVID19India

Court asks ASG Singh to make his submission.

#BombayHighCourt #COVID19India

ASG states they are working with the state on all issues.

AG: Despite political differences..

*all laugh*

Court: Here it is about the solutions on the suffering..

#BombayHighCourt #COVID19India

ASG submits that from May 11 to May 26 the allocation for Maharashtra was 42690 vials of medicine. The total supply has been around 80000 vials.

#BombayHighCourt #COVID19India

ASG: The states which are most affected by #BlackFungus are Maharashtra, Karnataka and Gujarat..
The supply will be increased to 3,52,000 vials for June.

#BombayHighCourt #COVID19India

Court: what is the manufacturing per day?
It cannot happen that from May 31 to June 1 there is nothing.

ASG: I will get details.

#BombayHighCourt #COVID19India

Court: So does it happen due to COVID or irrespective? Does it happen to people who never had COVID?

AG: It happens irrespective of COVID. People who have never had COVID can also get #BlackFungus

#BombayHighCourt #COVID19India

Court: Then this is a new issue. It is diverse from COVID.
We are concerned with the way it happening.

Inamdar: This was present in 2020 also. But not because of people getting COVID, when they are recovering they are getting infected that is what reports say.

#BlackFungus

ASG: No this is incorrect information. I agree with AG. Centre has issued an advisory giving details of the disease.
Patients who have suffered from COVID are vulnerable, but it can happen to anyone.

#BombayHighCourt #COVID19India #BlackFungus

ASG: As for the production of the drugs the Amphotericin, there were 7 manufacturers and 5 have been added.

We have also called for offers if anyone is interested, then they can apply and we will expeditiously consider.

#BombayHighCourt #COVID19India #BlackFungus

Court: Perhaps there should be something on the steroid. Based on clinical condition of patient.
We have heard there is so much indiscriminate use of steroid. There are contrary guidelines to that effect.

#BombayHighCourt #COVID19India #BlackFungus

Court: What I have read is during oxygen the immunity level is less, the steroid is given, they become more vulnerable to the #BlackFungus

ASG proceeds submissions on the issue of supply of Remdesivir drugs.

On #RemdesivirBlackMarketing ASG submits that the Centre wrote to the manufacturers and they have received responses. The Court is shown the responses.

#BombayHighCourt #COVID19India

Court: So you wrote to them and you have received responses.

ADG: Yes and the allocation is with the Centre, but the distribution is in our control.

#BombayHighCourt #COVID19India

Court: So then AG can consider your affidavit.

ASG: Because the response he showed clarified that the foundation approached the companies. But those may be subcontractors of the companies.

#BombayHighCourt #COVID19India

Court: Our anxiety is for people getting the drugs properly, more than the actual people getting caught. Because their responses which AG showed said that they have approached companies, your response say companies did not give.

#BombayHighCourt #COVID19India

Court: So now the AG has to consider this issue. The State can expedite the investigation. Let them look into it.

Inamdar: This issue was not only for #RemdesivirBlackMarketing. It was for all drugs.

#BombayHighCourt #COVID19India

Court: But then thy are not before us. We cannot pass directions against them.
The State has to consider, they have ample powers.
We are not disbelieving their good intentions. But help has to be given in a manner which the State accepts.

#BombayHighCourt #COVID19India

ASG submits that the Centre is also giving its co-operation to States for maintaining dashboards. Any assistance required.

Court: What about oxygen allocation?

ASG submits the demands are being met. There has been no grievance raised so far.

#BombayHighCourt #COVID19India

Court: And if you receive any permission for labs, and if their standard are met, expedite the permission.

ASG: Yes of course.

#BombayHighCourt #COVID19India

Bench has risen for lunch. Hearing to continue post the lunch break.

#BombayHighCourt #COVID19India

Bench has assembled.

Sr Adv Sakhare makes submissions on bed management of BMC.

#BombayHighCourt #COVID19

@mybmc

Sakhare: Various department send us data. In Mumbai there are 1037 patients.

#BombayHighCourt #COVID19

Sakhare: As for the dashboard, our website have been functional for over a year. It is updated every 2 hours.

#BombayHighCourt #COVID19

Court: If it is getting updated every 2 hours, then why is not available publicly.

Sakhare: The positive cases are uploaded on the ICMR website and then BMC looks into it, calls the patient first for requirement of hospitalisation. To avoid panic.

#BombayHighCourt #COVID19

Sakhare: Patients who do not require hospitalisation should not land up at hospitals. We do it to avoid panic.

Court: We had asked the BMC commissioner to have a meeting with other corporations, since BMC model is very effective.

#BombayHighCourt #COVID19

Court: What have other corporations done?

Sakhare: The AG can respond on this better. But then if the AG says, such meetings can be held faster.

Court: There is our order!
We had asked the BMC Commissioner to share their technical know how.

#BombayHighCourt #COVID19

Sakhare begins submissions on vaccination.

Court: That we will hear on June 2.

Sakhare: Then on the management for 3rd wave.

Sakhare reads out the figures showing their preparations.

#BombayHighCourt #COVID19

Court proceeds on fire audits.

Sakhre informs the Court that the notices have been issued to many hospitals. Says he will submit the complete details in the next hearing.

#BombayHighCourt #COVID19

Court asks Sakhare on the issue of #BlackFungus

Sakhare informs the Court that there are over 300 cases in Mumbai.
He submits that the purchase department of BMC are procuring drugs for the fungal disease.

#BombayHighCourt #COVID19

When Sakhare finishes, the Court asks who is next for submissions.

Parikhet Shah, petitioner in person makes submissions on home quarantine issues.

#BombayHighCourt #COVID19 #BlackFungus

Court: Your advocate has already made these submissions on the first day. Need not repeat. Do not go back to the day your petition was filed, we have come far from there. Do not make submissions if you have nothing new.

#BombayHighCourt #COVID19 #BlackFungus

Adv Aseem Sarode seeks audience. He submits that the fire engineer is present for hearing. The Court may consider what he is suggesting.

#BombayHighCourt #COVID19

Court: Why don’t you make these submissions to the corporations and State? We are not experts. Let them consider. We will permit you to make the suggestions to them.

#BombayHighCourt #COVID19

Inamdar begins his submissions on the Tocilozumab medicine.

Court: We expect you to serve this through an affidavit or application to the authorities. So that they are ready with the response.

#BombayHighCourt #COVID19

Court: Ok then you file the necessary pleadings and on the adjourned hearing, we will hear the other side on these issues.

Inamdar still continues his submissions on the bed management in the Solapur Municipal Corporation.

#BombayHighCourt #COVID19

Court: Is Solapur Municipal Corporation a party?

Inamdar: state is..

Court: But this is a corporation now.

#BombayHighCourt #COVID19

Inamdar submits that there are issues of beds in Satara as well.

#BombayHighCourt #COVID19

Court adjourns the pleas in COVID management to June 2, 2021.

#BombayHighCourt #COVID19

On the issue of COVID masks the court notes that they have been shown a sample mask to be used by the deaf and dumb persons.

The petitioners however did not have the chance to look at the mask. But they stated that the mark on the mask was not prominent.

#BombayHighCourt

Court: The government states that they will look into this issue and a better mask can be designed.

#BombayHighCourt #COVID19