Every prisoner entitled to receive basic medical care irrespective of Social Status: Delhi HC

Right to Basic Medical Care

Health care is a critical issue for prisoners as they cannot look after themselves due to the reason for their detention. Therefore, it is the responsibility of the state to provide adequate health services to the prisoners that are equivalent to those available to the free population. Delhi High Court, in a landmark and latest judgment titled Amandeep Singh Dhall vs Directorate of Enforcement in a bail application, held that every prisoner, regardless of his financial standing, is entitled to basic medical care. The Delhi High Court directed the Secretary (Home), Government of NCT of Delhi and Secretary, Health and Family Welfare, Government of NCT of Delhi, to ensure that the health care requirements of the prison inmates are met, and adequate medical infrastructure in the jail premises is maintained for ensuring that the right of prisoners to appropriate medical care. The judgment authored by the Single Judge, Hon’ble Ms Justice Swarana Kanta Sharma of the Delhi High Court

The grievance of the applicant is that he applicant is not being provided proper and appropriate treatment in terms of post-epidural care in the prison premises, and thus, the applicant seeks that he be released on interim bail in order to get appropriate treatment from Indian Spinal Injuries Centre, Vasant Kunj, Delhi.

The Bench envisages, after considering the medical history of the applicant and the medical status report filed on record, notes that the medical facility at the prison complex, at this stage, is not able to provide the appropriate medical care which is required by the applicant in terms of post-epidural care. The dispensary at Central Jail-07 does not have the medical equipment required for the applicant’s physiotherapy sessions. The Court notes that the applicant’s medical condition, which relates to his spine, cannot be taken to any outside hospital on an OPD basis, as the constant jerks and vibrations may further aggravate his medical condition. This Court observes, based on the medical history of the applicant and medical report, that the medical condition of the applicant is such that if the medical treatment as suggested to the applicant is not provided to him, the same may also lead to paralysis of his upper limb.

Highlights of the Bench Affirmations

• Every prisoner,  inmate, although such person is an accused or convict, possesses an inherent right to life and humane treatment. This includes the right to receive medical care that addresses his health needs and prevents unnecessary suffering. To neglect the medical well-being of prisoners is to deny them a fundamental right to life.
• Incarceration does not deprive individuals of their fundamental right to life, which includes right to appropriate health care.
• Prisoners, like all members of society, may face various health issues, both pre-existing and emergent, during incarceration. Denying them access to necessary medical care not only deteriorates their health conditions but can lead to preventable suffering and, in extreme cases, loss of life.This neglect not only undermines the principles of justice but also challenges the moral foundation of a society that values the dignity and worth of every human being, even if he is a prisoner.
• It is a common public perception that affluent individuals who find themselves incarcerated receive preferential treatment, including access to luxurious hospital facilities. However, it is crucial to dispel this misconception and highlight the fact that the provision of medical care within the criminal justice system is not determined by one’s economic status. Every inmate, regardless of his financial standing, is entitled to receive basic medical care, a fundamental human right that transcends socio-economic disparities. 
• In a just and equitable legal system, the principle of equality before the law is paramount. This means that every individual, regardless of their wealth or social status, is subject to the same legal standards and protections. The right to medical health care is intrinsic to this principle, ensuring that no prisoner is denied basic healthcare services solely based on their financial resources. It is essential to recognize that, in the eyes of the law, every prison inmate is equal and possesses the basic human right to receive adequate medical care, reinforcing the foundational principles of a legal system which is not only just but also humane.
•  A prisoners is a human being, too, and they retain some undeniable human rights which must be acknowledged by every Court of law and the State. Respect for and the resolute of the Court to unfalteringly uphold the human rights of the prisoners as a constitutional Court has traditionally been in India, evidenced in the various judgments of the Apex Court and this Court.
• It is important to recognize that the responsibility for ensuring the well-being of individuals in judicial custody lies squarely with the State Government. Prisons, as custodial institutions, must provide not only security but also essential medical facilities to meet the healthcare needs of prisoners. It is also the duty of the state to ensure and monitor not only the conditions of the prisoners in general but also their health issues and the health facilities provided in the prisons.

At the same time, this Court also acknowledges that it is not possible for the jail authorities, through the state, to have every kind of advanced medical equipment in the jail medical set up to meet the requirements of some prisoners, who may require special treatment for the diseases they suffer from. For this reason, this Court has directed that a high, however attainable standard of health care, which is part of the right to life, be ensured within the confines of the prison to the prisoners who depend on the state for health care.”

The report submitted by the prison dispensary in the present case points to a distressing reality– the lack of proper medical care facilities, i.e. physiotherapy equipment. The absence of these essential equipment not only signifies a lack of adequate medical infrastructure in the prisons but also the direct repercussions of the same on the health of the inmates requiring physiotherapy, etc.

In this Court’s opinion, in cases of a convicted prisoner contracting a disease or his health deteriorating and him being not extended, health care is not part of his sentence. Similarly, in the case of under-trial prisoners, this fact becomes even more significant as some of the trials may be suffering from serious diseases or may contract or suffer from serious diseases which may have the potential of being fatal or potentially disabling. This has led this Court to consider that the basic right of a citizen while being incarcerated to health care is not obliterated or surrendered to the state.

The prisoner population, which includes vulnerable groups in terms of health conditions, needs to be considered, and adequate health facilities should be provided inside the jail as, due to various reasons, the under trials must remain within the confines of the jail. Inadequate access to medication and health care or delays in providing timely medical interventions may, at times, have permanent devastating effects on prisoners’ health.”

The Courts cannot allow an inadequate prison health care system to violate a prisoner’s right to timely and adequate medical health care. Preserving the health of the prisoners would require a mechanism to monitor and promote the health care system available in the prisons. In the face of increased health vulnerabilities, many prisoners have a heightened risk of permanent damage to their bodies. In this regard, it became important for this Court to review the protection and legal obligations of the state to provide high, however, the attainable standard of health care, which is part of the right to life.”

The Courts cannot allow an inadequate prison health care system to violate a prisoner’s right to timely and adequate medical health care. Preserving the health of the prisoners would require a mechanism to monitor and promote the health care system available in the prisons. In the face of increased health vulnerabilities, many prisoners have a heightened risk of permanent damage to their bodies. In this regard, it became important for this Court to review the protection and legal obligations of the state to provide high, however, the attainable standard of health care, which is part of the right to life.”

Thus, considering that at this stage, no immediate arrangement can be made by the jail dispensary to ensure appropriate medical care. Of the applicant, this Court deems it fit, for the purpose of ensuring that a balance is struck between the right of the prisoners to appropriate medical care and the right of the state to ensure the rule of law, to allow the request of the applicant to get the required physiotherapy treatment at the Safdarjung Hospital, Delhi. In case the required medical care is not available at Safdarjung Hospital, Delhi, the applicant may move a fresh application before this Court for being treated at Indian Spinal Injuries Centre, Vasant Kunj, Delhi.”

Directives to Ensure Healthcare for Jail Inmates

As a directive to the Government of NCT of Delhi, the Bench then notes that, “This case serves as a reminder that the quality of medical care within correctional facilities must be held to high standards, with a focus on the well-being and rehabilitation of inmates. The State Government has a moral and legal obligation to ensure that the healthcare needs of a prisoner are met with the same diligence and commitment as any other citizen.”

Finally and far most significantly, the Bench then concludes by holding in para 30 that, “This Court observes that Government of NCT of Delhi is responsible for the management and maintenance of the prison premises. Since it is crucial to have appropriate medical care system in the prisons which meets the requirements of the prisoner patients the following directions are being issued to the Government of NCT of Delhi by this Court:

a) This Court directs the Secretary (Home), Government of NCT of Delhi, and Secretary, Health and Family Welfare, Government of NCT of Delhi, to ensure that the health care requirements of the prison inmates are met and adequate medical infrastructure in the jail premises is maintained for ensuring the right of prisoners to appropriate medical care.

b) This Court further directs the concerned doctors in charge of respective jail dispensaries to furnish the list of requirements for adequate medical equipment, which is essential for the medical care of the prison inmates, to the concerned chief medical officers.

c) The Chief Medical Officers of all the prisons will submit a weekly report to the Director General of prisons, who will communicate this report to the Jail Visiting Judicial Officer/Judge concerned regarding inadequacies or urgent requirements in their respective jail hospital/dispensary, including the working or nonworking condition of the machines and medical equipment and availability of medicines, etc.

d) The weekly report prepared by the Chief Medical Officers of all the prisons will also be sent to the Secretary (Home), Government of NCT of Delhi, and Secretary of Health and Family Welfare, Government of NCT of Delhi. The issues pointed out in the report mentioned above will be addressed, and the necessary supplies, equipment, and medicines will be ensured to be provided within two days. The machines/medical equipment, if not in order, will be repaired, or a substitute will be provided immediately by the state.

e) The Secretary of Health and Family Welfare, Government of NCT of Delhi, will constitute a committee which, apart from him, will include the following:

1. Director General (Prisons)
2. The CMO of the Delhi Prisons
3.  Two senior Jail Visiting Judges of the District Courts to be nominated by the Principal District & Sessions Judge (Central District),
4. The Secretary, DSLSA
5. Sh. Sanjay Dewan, Advocate
6. Ms. Gayatri Puri, Advocate

f) The above committed will give suggestions to this Court regarding improving the health care facilities in the prisons and ways to promote equal health care to all prisoners within a period of one month.

g) The committee will also specifically inform the Court as to whether facilities are available in the jail hospital to deal with emergency situations such as cardiac arrest, hemorrhages, etc., as the first few minutes in such eventuality are crucial to saving the life of a person.”

The present case brings to light a critical issue concerning the standard of medical treatment within correctional facilities, shedding light on the alarming inadequacies in the healthcare infrastructure for prison inmates. In a nutshell, the Delhi High Court has made it indubitably clear that every prisoner is entitled to basic medical care. It rightly called upon the Government of NCT of Delhi to improve the medical infrastructure in jail so that the prisoners can get timely medical aid and don’t suffer from lack of it. The Court made clear that the State Government has a moral and legal obligation to ensure that the health care needs of inmates are met with the same diligence and commitment as that of any other citizen. It was also made crystal clear by the Court that there cannot be discrimination of any kind between the prisoners based on rich or poor! Very rightly so!