Most urgent / Time Limit

No.S0(Gen)/P&SHD/1-36/2016 GOVERNMENT OF THE PUNJAB

PRIMARY & SECONDARY HEALTHCARE DEPARTMENT

Dated Lahore the 18th April, 2018

CIRCULAR

Subject: HUMAN RIGHTS CASE NO. 10633-P/2018

I am directed to enclose herewith a copy of Letter No.

DL(P&SHD)/239/4-2018 dated 17.04.2018, on the subject cited above, received from

Director Legal, P&SH Department alongwith enclosures received from Additional

Advocate General Punjab, Supreme Court Building, Islamabad, for information and strict

compliance / adherence as contained in letter and spirit.

1\ 1WA I

SECTION OFTFICER ERAL)

The DG, Health Services, Punjab

All Chief Executive Officers (DHA), Punjab

All Project Directors P&SHD

All MS, DHQ Hospitals, Punjab

CC

The Project Director, HISDU, P&SHD with the request to upload the said circular on official website as well as on Whats'ap group of all CEO, MS etc. PSO to Secretary, P&SH Department. PA to Special Secretary, P&SHD. PA to Deputy Secretary (General), P&SHD

ttel (LOA O. 114,41.1 Oil M II 1174

NO. DL(P&SHD)/ 1-31 /4-2018 GOVERNMENT OF THE PUNJAB

Dated: Lahore, 17- April, 2018 Primary & Secondary Healthcare Department

To,

The Section Officer, (General) Primary & Secondary Healthcare Department, Lahore.

HRC NO. 10633-P/2018 (In the matter regarding affordable Standard Prescription of Cheap Medical Treatment for the Heart Surgery Patient).

With reference to the subject cited above and to enclose herewith copy of letter No. 478, Addl. A.A.G/S.C/ISB dated 11.04.2018 (received on 13.04.2018) from the office of Ms. Asma Hamid learned Additional Advocate General, Punjab Supreme Court Building, Islamabad and letter No.P.A/DS(SM)4-385/2018 dated 13.04.2018 received from S&GAD Department.

That the above mentioned case was fixed for hearing on 27.03.2018 before the Honorable Supreme Court, of Pakistan and on the said date of hearing the Honorable Court, has issued following direction:-

"6. Let a copy of this order be handed over to the Attorney General for Pakistan as well as all the Advocates General of the Provinces and Islamabad Capital Territory. They shall circulate/arrange for circulation for this order amongst all concerned officers including the concerned ministries, heads of Public and private hospitals etc. They shall ensure that the equipment listed in the order is made available in emergencies of all public and private hospitals as soon as

possible. 7. In case any public or private hospital or any expert or health professional wishes to provide any additional in put in the matter, it/he may file the same before this Court within thirty days of the publication thereof".

In view of above, you are requested to comply with above said order of the Honourable Supreme Court of Pakistan on top propriety basis and submit the reply/response, if any, to the undersigned for filling the same before the Honourable Supreme Court of Pakistan.

An early response in this regard is required.

/714/%1P Director Legal

CC:- Copy forwarded for information to;

P.S.0, to Secretary Primary & Secondary Healthcare Department with reference to

diary No.1077 dated 12.04.2018.

P.A to A.S (Admin) Primary & Secondary Healthcare Department.

/7/yip Director Legal

P&SHD, 15-Birdwood Road, Lahore

Subject:

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Director L

File No

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FROM :ADVOCATE GENERAL PUNJAB FAX NO. :0519219968

11 Apr. 2018 0306PM P1

NO. -1787Atici1. A.G/SC/ISli ADDITIONAL ADVOCATE GENERAL, PUNJAB

SUPREME COURT BUILDING, ISLAMAHAD Ph; 051-9208184 & 920825 1ax; 9219968

DAM): 11,04.2018

To

The Secretary, C;overnment of the Punjab, Specialized I lealth Caro and Medical F,ducation, Lahore.

pop Subject: HUMAN RIGHTS CAF. NO 1O63/2018

(hi the iiiaI1ir rerrding (7.0brdu1;le.s1millard prescription Of clump medico' trerthilWIt for the hen rt sltrgery patient)

RL..ifcronce., to tho above captioned case, order clutod 27.3.2018 is attached

for your porusal and necessa.r.y. action.

Add SU pre

------__

B ./

(MS. SIVIA LIAMID) dvocate Co.meral Punjab,

(::ourt Buildine„ Islamabad.

The Chief Secretary, Government of Punjab, I ahoro, The Worthy Advocate General Punjab, Lahore, PSO to CM Punjab, Lahoro.

CC:

„ATE GENERAL PUNJAB FAX NO. :0519219968

11 Apr. 2018 03:06PM P2

IN THE SUPREME COURT OF PAKISTAN (ORIGINAL ,JURIS1)ICTION1

PRESENT: MR. JUSTICE MIAN SAQIB NISAR, HCJ MR JUSTICE UMAR ATA BANDIAL MR. JUSTICE WAZ UL AliSAN

HUMAN RIGHTS CASE NO.10633 OF 2018 (In the matter regarding affordable standard prescription of cheap medical treatment for the heart surgery patient.)

In attendance: Syed Na.yyar Abbas Rizvi, Addl. A.G.'''.

Ms. Asmaliamid, Addl. A.G., Punjab Mr. Za.hid Yousaf Qureshi, Addl, A.G., KPK Mr. Ayaz Swati, Addl. A.G., Balochistan Mr. Akrarn All Khawaja, Addl. Secy. Health, Sindh

Lt. Gen. Dr, Azhar Kiyani, Head of Rawalpindi Institute of Cardiology

Dr. Minhaj Qudrai, CEO Sindh Health Care Commission Mr. Asadllah Khan, Chief Inspector KP I-Tealth Care Commission

Date of Hearing: 27.03.2018

ORDER

Pursuant to our order, Lt. Gen. (R) 1Dr. Azhar Kiyani,

Head of Rawalpindi Institute of Cardiology (R/C) has provided a write

up about the minimum facilities/equipment which must be available

in the emergencies of public and private hospitals. A list of such

equipment has also been placed on record.

2. Lt. Gen. Kiyani has provided a standard template of

prescriptions for patients of certain chronic diseases including

hypertension and cardiovascular diseases who may have undergone

any heart related procedure (bye-pass surgery/angioplasty etc). The

standard prescriptions contain drugs readily available in the market

at affordable rates so that patients suffering from hypertension and

cardiovascular diseases are not burdened by unbearable costs over

extended periods of time. The standard prescriptions cost around

Rs.500/- to R.3.1100/ - per month for diseases mentioned below: ATT W,,S.

TESTED

cATE GENERAL PUNJAB FAX NO. :0519219968 11 Apr. 2018.03:06PM P3

Sample of Prescriptions for Ischernic Heart Disease/Hypertension (High Blood Pressurc)/Heart Failure

Heart Failure (CCF) Treatment Tab Spironoiactone/Frusomide 40/40 Tab Rarnipril 5mg Tab Carvedilol 3.125rog Tab ASA (Acctyl salicylic acid) 75 mg

01 Month cost (MR) 1+1/21.0 370.00 1 x OD 360.00 1 x OD 160.00 ix OD 23.00 Total: 013.00

Ischerulc Iics.rt Disease (Angina) 01 Month cost (PKR) Treatment Tab ASA (Acctyl salicylic acid) 75mg 1 x OD 23,00 Tab Glyceryl Trinitrale 2.6mg 5 x BD 198.00 Tab AtorvaeLatin lOrng 1 x OD 201.00 Tab Bisoprolol 5mg 1 x OD 190.00

Total: 512.00

High Blood Pressure Treatment 01 Month cost (PKR) Tab AmlodopinerValsarLara 5/80 1 x OD 540.00

After Angioplasty (stenting) Tab ASA (Acetyl salicylic Clopiclogrol Tab Glyocryl Trinitralc 2.6mg Tab Atorvastatin 10mg Tab Bisoprelol

01 Month cost (PKR)

aeid) + 1 x OD

444,00

1 x BD 198.00

I x OD 201.00

1 x OD 190.00

Total; 1033.00

3. The Attorncy General as also all the Advocates Generals

shall arrange for circulation of these prescriptions to all public and

private hospitals who may submit their comments, .if any. These

prescriptions may also be published in different newspapers

conspicuously so that the public may have an idea about the price of

prescription medication for treatment/ management of the aforesaid

health conditions. Patients must be made aware that necessary

medicines are available at affordable prices. A suitably worded and

easily understandable caviat may however, be included in newspaper

publications etc to the effect that the public should not take the risk

of indulging sclf-medieation. Further, before changing their current

medication patients must consult their doctor to avoid any

undesirable complications. The doctor may after assessing the

condition and requirement of the patient change or modify the

prescription in the best interest of the patient. In changing the

prescription the doctor may prescribe alternate and / or additional

drugs but in doing so care must be taken to prescribe the least

expensive drug from the available options. 0‘-

-17kATE GENERAL PUNJAB ,

FAX NO. :0519219968 11 Apr. 2018 03:07PM P4

4. On hearing various experts in the filed, we are of the

view that in cases of emergencies, healthcare facilities need to

respond with minimal delay and maximum life support and

management / treatment facilities as in such situations seconds and

minutes count. All healthcare facilities should be well located and

equipped to deal with emergencies 24/7. Following steps should

progressively he taken: -

The Eznergenc.:y Department of all DI-IQ and THQ hospitals should be upgraded to cater for the needs of the local population.

A model should be developed which can then be replicated across the Province. '

A proper referral system should be developed for more advanced care like Primary PCI OR Aortic surgery or plastic surgery for burns or trauma.

Proper SOPs and local Guidelines for management of every emergency should be Prepared and displayed at each emergency departmc;nt of all the hospitals.

5. A list of necessary equipment which must be

available in every emergency, provided by IA. Gen(R) Dr,

Azha.r. Kiyani is reproduced below:-

Sr. No. - Fouipment Requirement

THQH DHQH 1 CPR trolley 1 . 1 2 C-ARM (leluoroscopy) 1 1 .. 3 X-ray Machine (Portable) - 1 4 Ventilators 2 . 5 5 Dialysis Machines 2 8 6 _. ABC1's Machine 1 . ,.....

1 • ' i _ . !I 7. Endoscope

8 Bronchoscope - 9 EchocardiorapaMachine p; - 1 10 Operation Theaters 1 2 11 Incubators , 4 la 12 Pediatric Ventilators 4 .. , ....

1 10 ..,... , 2 13 Ultrasound Machine

14 k."..C5 -Machine 1 2 15 Nebulizers 4 8 16 Portable Ventilators . 1 2 17 CT Scan - 1 .. 18 Cardiac Monitors 4 12 19 Defibrillators 1 2 • 20 Infusion Pumps 4i .. 12 21 Temporary Pacemaker 1 5

6. Let a copy of this order be handed Over to the Attorney

General for Pakistan as well as all the Advocates General of the ATTc:' ED

-

AD 7th March, 2018.

Auclaz3arr''

GENERAL PUNJAB FAX NO. :0519219968 G8 t..:Etn. 1\10.3.0633 cif 2016

11 Apr. 2018 03:07PM P5

4 :-

Provinces and Islamabad Capital Territory. They shall

circulate/arrange for circulation of this order amongst all concerned

officers including the concerned ministries, heads of public and.

\P. private hospitals etc. They shall ensure that the equipment listedithe

order is made available in emergencies of all public and private

hospitals as soon as.possible.

7 In case any public or private hospital or any expert or

health professional wishes to provide any additional in put in the

matter, it / he may file the same before this Court within thirty days

of the publication thereof. .•

Re list,

Sd/-,HCJ Sd/-,J

Certified to be True Copy (

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ee COI.Jrt of Pakistan Islamabad

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Date of Presentol.i!JL:•,-..,•,, ...,

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Copy Fee

Court Fee Stamp:

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