Explainer: How Kejriwal tried to justify reserving Delhi hospitals for residents only

Delhi Chief Minister Arvind Kejriwal’s attempt to reserve the bulk of beds in Delhi hospitals for residents of the capital looks unlikely to be enforced, after the Lieutenant Governor on Monday passed a parallel order directing authorities to ensure that “treatment is not denied to any patient on the ground of not being a resident of Delhi”.

The Lt Governor’s order came a day after the Delhi government passed directions to all state government and private hospitals in the capital, telling them to only provide treatment to “bonafide residents” of the city.

Here is what we know:

What was in the Delhi government’s order?

This is the text of the government’s order, dated June 7:

“Whereas interstate movement is expected to further increase... which would increase load on Covid & non-Covid hospitals as patients from other parts of the country would approach hospitals of Delhi.

And, whereas, it has been observed that there has been a surge in the number of positive cases of Covid-19 in the last few days in Delhi, resulting in additional demand of hospital beds, consumables & infrastructure.

Now therefore... it is hereby ordered that all the hospitals operating under Government of National Capital Territory of Delhi and all the private hospitals and nursing home shall ensure that only bonafide residents of NCT of Delhi are admitted for treatment in these hospitals.”

Who qualified as a ‘bonafide resident’ of Delhi?

The order lists out documents that could count as residence proof:

• Voter ID.
• Bank/Kisan/Post Office current passbook
• Patient Ration card/Passport/Driving Licence/Income Tax Return filed or Assessment Order.
• Latest water/telephone/electricity/gas connection bill for that address, either in the name of the patient or that of his/her immediate relations like parents, etc.
• Postal department’s post received/delivered in the patient’s name at the given address.
• In case of minors, above-mentioned documents in the name of parents.
• Aadhaar card made prior to June 7.

Were there any exceptions?

According to the government order, “treatment relating to oncology, transplantation, neuro-surgery shall continue for all patients irrespective of the place of residence. Also, any Medico-Legal victims of road accidents, acid-attack happening within NCT of Delhi will continue for all patients, irrespective of place of residence.”

The order also does not apply to hospitals run by the Centre in Delhi, which includes four that are dedicated to Covid-19 treatment.

How did the government justify this?

A week before making the decision, Delhi Chief Minsiter Arvind Kejriwal, in an online address, spoke about whether to open the city’s borders – a decision that the Centre had left to individual states. His decision to keep them shut for a while had led to chaos on the borders with Noida and Ghaziabad (in Uttar Pradesh) and Gurugram and Faridabad (in Haryana), cities that are part of the National Capital Region.

Kejriwal tried to directly connect the question of opening borders to the potential pressure on the city’s hospitals.

“With borders opening up but corona cases rising, can Delhi open its hospitals for treatment of people from across the country?” he asked. “Will it put pressure on capacity to handle corona? Should Delhi’s hospitals be reserved for Delhi residents? We seek your suggestions on these issues.”

Later that day, Kejriwal expanded on the idea.

“Since afternoon, around 2 lakh people have sent us feedback, and overwhelmingly, they say that Delhi government hospitals should be reserved for people of Delhi while the Centre’s hospitals be open to everybody,” Kejriwal said. “The system we have created is enough for Delhi but if we open borders and people from other states start coming to Delhi for treatment, these beds will run out in about two days.”

Kejriwal also consulted a five-member committee of doctors to look at the same question.

According to various media reports, the panel concluded that “Delhi’s healthcare infrastructure to be used only for Delhi residents. If Delhi’s healthcare infrastructure is opened for outsiders, then all the beds will be filled within three days.”

Announcing the decision on Sunday, Kejriwal said that more than 90% of the people who responded to his call for suggestions wanted Delhi’s hospital beds reserved for residents until the pandemic had passed.

“The people of Delhi have never refused treatment to those from other states who, at any given time, form 60% to 70% of patients in Delhi government hospitals,” Kejriwal said. “But corona cases are now rising alarmingly in the city. In a situation like this, if hospitals are open to people from all states, where will the people of Delhi go?”

A day after this announcement, Delhi Health Minister Satyendar Jain said that “neighbouring states say they do not even have coronavirus cases. If they are not even saying they have virus cases then what is the issue?” He also blamed the Centre for failing to stop international flights earlier.

What is in the Lt Governor’s order?

A day after the Delhi government order, the Lieutenant Governor of Delhi passed a parallel order, under the Disaster Management Act, directing hospitals not to deny treatment to any patient even if they are not residents of the capital.

These are they key portions of the order:

“Whereas the Supreme Court has invariably held in several judgments that Right to Health is an integral part of Right to Life... and whereas, the Delhi High Court... has held that denying patients medical treatment on grounds of not being a resident of NCT of Delhi is impermissible... the undersigned in his capacity as the Chairperson of the [Delhi Disaster Management Authority] hereby directs departments and authorities concerned of NCT of Delhi to ensure that treatment is not denied to any patient on the ground of not being a resident of Delhi.”

How have others responded?

The Delhi units of the Bharatiya Janata Party and the Congress criticised Kejriwal’s move, albeit without coming out strongly against it.

“This decision of the Kejriwal government is insensitive,” said Delhi BJP President Adesh Kumar Gupta, who insisted that any person should be able to get treatment in the capital. The Congress called it a “diversionary tactic” to distract from the Kejriwal’s failure to create sufficient health infrastructure.

Haryana Health Minister Anil Vij said his state would not copy the “harsh” approach chosen by Kejriwal. And former Meghalaya Chief Minister Mukul Sangma came out strongly against it on Twitter.

“How can Delhi’s beds be reserved for people of Delhi?” asked Union Minister Mukhtar Naqvi. “How can Mumbai’s beds be only for Mumbaikars? How can Kolkata’s beds be only for people of Kolkata? People from all across the country come to the national capital for treatment. There shouldn’t be any politics in this.”

Is the Delhi government’s move legal?

Questions have been raised about the legality behind the Delhi government’s decision. The order was issued under the Epidemic Disease Act, which provides a wide swath of powers to the government to act as it sees fit in the face of an epidemic.

Yet, it is likely to be challenged, particularly since courts have repeatedly ruled that Article 21 of the Indian Constitution – the fundamental right to protection of life and liberty – includes a right of access to healthcare.

What is the status of the Covid-19 crisis in Delhi?

As of June 7, the capital had a total count of 28,936 cases, of which 17,125 were active, 10,999 people had recovered and 812 had died.

On June 8, Health Minister Satyendar Jain said, “since the doubling rate of cases is 14-15 days, we think coronavirus cases will reach 56,000 in the next 15 days.” The panel set up by the government had predicted a peak in cases by late July.

Kejriwal last week also unveiled an online dashboard to convey the number of available hospital beds as well as ventilators.

Despite these figures, there are numerous stories of peoplestruggling to find hospitals that are willing to take them in around the capital, with the response usually being that there are no available beds.

Last week, the Delhi government filed a criminal case against one hospital for not following official guidelines on testing. On the same day, Kejriwal complained about alleged “black marketing” by private hospitals:

“A few days ago, a person came to me and informed me he was denied a bed by a private hospital, and after many requests, they gave him admission after charging him Rs 2 lakhs,” the chief minister said. “I am not saying all private hospitals are bad. Private hospitals in the city have played an important role in our battle against coronavirus. But there are some hospitals which are asking for money from patients to provide them a bed. This is called black marketing of beds and we will not allow it.”

Despite the soaring number of cases and lack of beds, Kejriwal has been adamant that the city had to re-open, with the borders now having no restrictions, and restaurants and shopping malls operational again.