Thread by @barandbench

Delhi High Court will continue hearing batch of petitions to deal with issues arising out of COVID 19 in the national capital.

Hearing before Justices Vipin Sanghi and Jasmeet Singh.

@CMODelhi @LtGovDelhi

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#COVID19

Adv Iqra Khalid: My grandfather was discharged yesterday. We're extremely grateful for the time and intervention. It truly is miracle.

You can withdraw the Petition: Court

Yes : Khalid

#DelhiHighCourt #BlackFungus

Petiton was moved seeking black fungus medicines for Khalid's grandfather.

We'll take it up with other matters: Court

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Hearing begins.

Amicus Rajshekhar Rao: Amphotericin B is priority.

What Union says.. this report is shocking..with regard to the medicine. You say figure of 230 is just fanciful: Justice Singh

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There are two reports. One is respect of black fungus and other on IGST: Adv Kirtiman Singh for Central Government

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The issue has been considered hy GST council.. if individual is importing for personal use, there is IGST of 5%. There is no duty if imported free of cost. If for donation after purchase, both duty and IGST have been exempted. If for commercial purposes, 5% GST: Singh

IGST for commerical purposes and basic gst has been waived in all : Singh

Court dictates order in Khalid's Petition.

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Court records that exemption has been given with certain conditions.

Writ petition stands disposed of : Court

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We still don't have visibility of projections and numbers we'll get in June : Rao

I'll just explain.. domestic production from April of Liposmal AmphotericinB has gone from 62k...in June to 3.25 lakh. It includes five new licensees: Singh

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Conventional AmphotericinB should be 3.52 lakh in June. The alternative drug Posaconazole will go up from 10 lakh to 67 lakh in June. The imports were 7lakh from Mylan.. in addition.. in the past few days 50k have been received: Singh

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2 lakh order has also been placed additionally.. there are other channels that were opened up... These will include formal and informal sources : Singh

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50 odd potential leads were shortlisted by MEA and given to Health Ministry. ministry asked MEA to procure 230 vials. There were eight companies that were picked up : Singh

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There is some issue with respect to the disclosure of the company names. It adds up to 2 lakh 30 thousand : Singh

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Companies in Germany said they will make some supplies. Company in Argentina and Australia.. (also have issues) Belgium said it would supply. We've identified other companies also : Singh

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Response from Russia was still awaited.. : Singh

Are you kidding us here? You don't know of the figure is 2.30 or 30? There is no clarity. How is this system working.. the company says sorry we can't give you: Justice Singh

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We don't have know, you don't know. The ministry doens't know what the figure is. We don't know how this figure of 230.. we categorically asked you how you came to this figure. There is no clarity anywhere : Court

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If the company says we can't provide, the figure of 230 is just notional.. we are seeking your status report. Are you satisfied with those paragraphs? : Justice Singh

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You started with the figure.. now that was a few days ago...one week has gone. What is it that you have been able to procure out of 230 and when is it arriving.. what is the 230 as of today? : Justice Sanghi

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There is a question of disclosure.. : Singh

You redact that information.. even we have no interest in seeing the names : Court

They are retailers..we can't force them : Singh

Then we clear.. you are are completely vague : Court

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How much has India got out of 230 : Court

I won't be able to tell off hand.. we'll share. We are not trying to shy away from this : Singh

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I want to show how 230 came about : Singh as he proceeds to share an OM.

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This is not indicating on what basis this 230 came about...these were the leads.. when you went out scouting, there were rejections. We wanted you to tell us what is the position: Court

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Singh says he would explain the steps that were taken.

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This is admission that 230 is not available: Court

Yes, no doubt : Singh

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It is not as if after this nothing else has happened.. 10k from Zydus has arrived : Singh

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Singh says manufacturing license has been given to another local entity.

Shortage is still acute : Court

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Shortage is there. No doubt.. there are alternative available. There will be areas that will not have Liposmal. There will be conventional AmphotericinB: Singh

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We are in a city that is up to speed .. in other areas there will be using (alternatives). This is an area that has to be considered: Singh

Then ICMR should come up.. which alternative is best suited: Court

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Even when you talk of AmphotericinB or some other drug, you must lay down a policy. This falls on you that you must prioritise. You are handling the supply chain. You know particulars of patients: Court

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You have to come up with a policy to say that drug is in short supply.. you must do it : Court

Singh agrees.

We are in conversation: Singh

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Adv Rakesh Malhotra says that the Pfizer alternative is also in short supply.

But Posaconazole is available a lot...: Singh

But something has to be done...there has to be a policy. ICMR should.. there has to be a finality. People are losing lives every day: Court

Singh says age group could be 18-45 years..

Say so but when.. we can't be conjecturing. Put it on paper: Court

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Court explains that distribution right now is pro rata which may mean that no one patient is getting the full dose.

We are are making allocation proportionate to case load: Singh

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These are not satisfactory systems. We don't want to say something but personally, even this policy of Vaccination...when you did not have, why did you announce? We have to invest in future.. and we are side lagging them. We want to vaccinate those who are 70.. : Sanghi J

So many young people have lost their lives. It is the younger people who are the future. We are on our way out. I don't understand this policy at all : Justice Sanghi

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Some sort of protocol is required: Singh

Why are you feeling shy. It is the duty of the govt to lay down the way forward. Other countries have done it. It Italy, they said sorry for old people we don't have beds.. and rightly so : Court

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80 year olds are not going to take this country forward. They have lived their lives. Ideally we should be able to save everyone but if we have to choose, we have to save the younger people: Court

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God can.. : Singh

In this is the area where Gods can't help us (if we don't act).. the facts are figures are in front of us : Court

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Adv Amit Mahajan for Centre makes submissions, says issues is under consideration.

We discussed all these points. How are doctors giving prescriptions to patients when medicines are with the hospitals.. they have alternate medicine: Mahajan

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Then why is that guidance missing? We are not doctors..and why is it taking so long : Court

We've realised that doctors also need guidance: Mahajan

Lawyers are not going to guide the hospitals no : Justice Singh

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Court says it will pass the direction.

Senior Adv Krishnan Venugopal makes submissions, says alternate medicines are also not available.

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Ordinary AmphotericinB will harm the kidneys.. that's why Liposmal formulation.. : Venugopal

We're sure.. let's not forget that before Liposmal came, AmphotericinB was being used.. there is an option: Court

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We've said exactly that : Singh

On last Friday, there were were 620 cases in Delhi. Daily dose is roughly 6 vials per person or 3720 vials on Friday. Delhi got 1920 vials : Venugopal

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On Monday there were 940 cases in Delhi and we needed 5660 vials on Monday. Allocation went down to 1050 vials.. how is it that it is being distributed. It has to be on per person availability basis. The court may call for the report: Venugopal

We don't want to get into that issue. No reason to believe they are not doing it equitably: Court

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Centre has been inquiring from everyone.. only Gilliard and Mylan are manufacturing. What the court is not getting is that between June 1 to 20, how many vials are going to be available: Venugopal

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Mahajan says Dr Das from Health services has joined.

I'll only state scientific fact. Drug of choice is AmphotericinB.. per day requirement is 6 vials per day for 60kg person. Alternative drugs are plain AmphotericinB that is still being used in Western UP, Bihar : Dr UB Das

Das states other alternate drugs.

It is up to the treating doctors.. depending on the response the patient has : Das

Is there anything court wants to ask : Mahajan

What do we ask: Justice Sanghi

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Post COVID, black fungus is coming in case of diabetes or when the person is immunocompromised.. ICMR or any agency of Centre.. along with stakeholders.. that decision has to be taken : Senior Adv Rahul Mehra for Delhi govt

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I don't see why we will not follow those guidelines. There is lack of understanding and clarity at various levels.. these can't be produced just like that.. it is for the courts to look into (augmentation) : Mehra

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7260 is the total allocated quantity. 6060 is the stock received..latest patient load for Delhi govt hospital is 209 + 392. Total is 601 : Mehra

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We have added 40 odd patients over the weekend.. : Mehra

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Now all States ate supposed to follow a standardized format across India.. pro rata distribution is happening at State level. We're not saying give 1 vial, 2 vials. That is the discretion left with medical expert at ground level: Mehra

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For this 601 patients, what is the allocation? : Court

Moment allocation is done, we pass an anticipated order.. we have given as per Hospital on pro rata basis. The moment ICMR passes an order, we will do it : Mehra.

So it is 2 per patient: Court

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Yes : Mehra

Adv Satyakam explains there is a distribution factor.

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So we are getting about 1/3rd of dose required. We would like to know from ICMR is pro rata is a good policy.. does it serve anybody's purpose ..and what is to be done for the 2/3rd dose : Court

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For UoI, you have to take a policy decision because everyone can't be catered to. We need to protect our future, the youth. That is where our promise is. That is age group that is going to build the country.. : Court

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People in power are older by the time you acquire name, fame, you are 50.. you provide kind of protection to those who are serving the society..why should that situation arise (where a child loses bith parents) : Court

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Adv Rizwan says his client is 34 year old and needs vials.

The person is not wealthy. Each vial is 50-60k. We've to pay for transportation also: Rizwan

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Court begins dictating the order, notes submissions make in the status report.

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Made*

What transpires from a reading of these is that in fact most of the expected sources have failed and it appears that there are hardly any vials coming (from 2.30 lakh): Court

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Court records submissions made by Mehra.

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It appears that as on today there are 792 cases of black fungus, out of which 191 are being treated in central government hospitals. Allocation of drug for centre hospitals are made separately: Court

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As on June 1, there are 601 active cases (in GNCTD Hospitals and private hospitals)..: Court

Court records the submissions on allocated amount to 601 patients i.e 1230 vials

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It is seen that per patient, 2 vials are being made available.. : Court

Court records submissions by Dr UB Das.

He informed that Liposmal AmphotericinB is the drug of choice and recommend dosage is 5 ml per kg. For a person weighing 60 kg, 300 ml is required per day : Court

The number of vials could vary depending on the body weight. However the average is 6 vials per day. He also states there is an alternate called AmphotericinB.. plain AmphotericinB affects the kidneys : Court

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He also states that there is another medicine Posaconazole which can also be used to treat patients.. : Court

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Court records submissions made by Venugopal.

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Few questions which arise and which can be answered by medical experts.. 1. Whether it is medically prudent to administer two vials when requirement is 6 vials per day: Court

2. If a patient due to shortage is allocated only two vials, what are the other medicines that could be given if at all : Court

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If there is loss of any body part and possibly eventual death, whether it would be medically prudent to identify patients who should be given the dose at the cost of others: Court

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These issues can only be answered by an expert body like ICMR. The shortage of Liposmal AmphotericinB not only in the country but NCT has been continuing for two weeks now. It is high time that ICMR.. comes out with clear guidelines on use of the drugs: Court

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We can take cognizance of the fact that on account of non availability of choice of drug .. a large number of fatalities are taking place. Despite best efforts, availability of the drug in the country remains acutely short is evident: Court

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If data is anything to go by, there is shortage of 66%.. cases of black fungus are showing an upward trend. Number of active cases on May 31 st were 753 in Delhi and the same is today at 792 : Court

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It appears that Centre has been making efforts to procure the drugs by getting in touch with the primary manufacturer and the patent holder.. the manufacturing capacity in India has been augmented and fresh licenses have been issued.. : Court

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However the requirment of Liposmal AmphotericinB is far in excess of availability. In this situation, it has fallen on shoulders of Centre to take a policy decision with regard to manner in which the drug should be made available to those suffering: Court

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If all can't be treated - which would be an ideal situation- it falls of UOI to spill out its policy on priority of patients so that at least some lives can be saved if not all :Court

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Any policy decision has to be taken from inputs from medical professionals. Those who have better chance of survival, who are younger and hold the promise of future have to to be prioritised over older generation which has lived its lives and others may not be dependent: Court

We are not for a moment discounting the emotional support that the older generation provides familes particularly Indian families that are so closely bonded. In times like these, difficult choices have to be made and should be made by the State: Court

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Court directs UOI to frame the Policy on distribution of the drug.

We may also observe that there may be a category of persons who are serving the nation in high position and whose safety and security ks necessary in view of the pivotal role that they play: Court

UOI may carve out which exceptions for good reasons. Looking into the urgency, we direct UOI to place their status report.. we'll take it up on Friday. Order be served on ICMR : Court

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ICMR shall also place its report: Court

We would request that the order be not treated as a precedent.. when vial is available (in foreign countries), why can't UOI pick it up even if it saves one life: Adv Aditya N Prasad

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When Mr Rizwan is saying that he can't buy it.. with 5% IGST or whatever.. it is the duty of State to step in. We are giving data that some vials are available.. Court shouldn't step away from exercising 226 power : Prasad

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Either you say that you go to govt hospitals.. whatever medication is required will be given to you : Court

If it is available, let it be procured..and UOI may distribute : Prasad

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How do you expect.. just think : Court

It may be a logistical nightmare but it will save lives : Prasad

You are asking them to do the impossible: Court

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To the extent they can, they are providing.. so let's not put everything in a crisis. Resources of the Central government are flowing like the Ganga. Why is there hike in petrol price. Coffers are empty. We all have to be mindful : Court

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Prasad says the order shouldn't become a precedent.

It is with a very heavy heart that we are making the order.. : Court as it says that the order is passed in view of the facts that exist today.

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If there is a source, identify and put it forward: Singh for Centre

We don't yet have final info. Mr Venugopal has. Delhi govt will only forward it : Mehra

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If we all co-operate, job will become much easier : Singh

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If you have identified for a particular patient, say we want to import and it will be dealt with by the Centre: Court

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Venugopal : If I want to help this State, there is no reason why should I be prevented from doing so.

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If Delhi govt is willing to purchase, that is not permissible: Venugopal

Where have we said it? We don't have to permit anyone : Court

We are not supposed to do that. That's the affidavit: Mehra

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Venugopal says that actual numbers of allocation as against the patient load should be looked into.

We are doing all that we can. If there is a specific issue, bring it to our notice: Singh

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Court says there is no reason to doubt Centre's status report.

Mehra says States should be permitted to lift drugs available at sources which are not being looked into by the Centre.

We are not inclined: Court

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Bench rises.

Hearing adjourned till tomorrow.

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