Holding

The State’s constitutional duty to ensure proper medical care requires effective management, and therefore the Court may appoint a Committee of Management with full powers to supervise the Mental Hospital.

Summary

A public‑interest writ under Article 32 of the Constitution was filed concerning the deplorable conditions at the Mental Hospital, Kanke, Ranchi. The Court ordered the State of Bihar to file a counter‑affidavit and directed a Chief Judicial Magistrate to inspect the hospital, whose report revealed severe shortages of water, electricity, sanitation, beds, medicines and staff, leading to high mortality. Despite several interim orders, the State’s scheme for improvement was found half‑hearted and ineffective. The Court held that the State’s constitutional duty to provide adequate medical care cannot be satisfied by mere expenditure; effective administration is essential. Consequently, the Court constituted a Committee of Management with representatives of Bihar, West Bengal, Orissa and the judiciary to oversee the hospital’s functioning and directed specific remedial measures, including increased diet allowance, water supply, sanitation, staffing and rehabilitation facilities.

Issues considered

The State of Bihar's failure to provide adequate medical care and facilities at the Mental Hospital violates its constitutional obligation under Article 32.
Whether the Court may intervene and appoint a Committee of Management to oversee the administration of a state‑run mental hospital.
Whether the directions previously issued by the Court have been complied with by the State.

Legislation cited

Constitution of Indias. Article 32
Indian Penal Code, 1860s. Section 302, s. Section 326

Subjects

public interest litigationmental healthhospital managementArticle 32welfare statehealth rightsCommittee of ManagementBiharNIMHANS

Judgment

I
'

RAKESH CHANDRA NARAYAN
A
V.
STATE OF BIHAR

SEPTEMBER 27, 1988
'
J!I [RANGANATH MISRA AND M.N. VENKATACHALIAH, JJ.)
.
Constitution of India, 1950-Article 32-Public Interest Litiga-
tion-Mental Hospital Ranchi-Chief Judicial Magistrate's report-
Considered-Committee of Management appointed for the hospital.

.·_,~
" A letter petition in regard to the Mental Hospital at Ranchi was
c considered as a pnblic interest application under Article 32 of the Con-
,-

stitntion, and the Conrt called npon the State of Bihar to me its connter
affidavit. At the same time, the Conrt directed the Chief Jndicial
Magistrate to visit the hospital and snbmit a report about the conditions
prevailing there. The hospital was in the sole management of the Health
D Department of the State of Bihar. The state of Bihar received fmancial
contributions from the States of West Bengal and Orissa on the basis of
the number of beds reserved for each State.

The report submitted by the Chief Judicial Magistrate made a
painful reading. In the affidavit submitted by the State of Bihar it was
E stated that the Government was aware of the conditions and had since
taken .some steps to improve the working of the hospital, and had also
drawn up a scheme to develop the hospital on the lines of NIMHANS in
Bangalore.

From time to time, the Court had issued directions and made
F specific orders regarding provision of better food, clothing, medical
treatment, honsing and improvement of sanitation, etc.

While keeping the matter pending, the Court,

HELD: (I) In a welfare State it is the obligation of the State to
G provide medical attention to every citizen. The State bas to realise its
obiigation and the Government of the day bas got to perform its duties
''
by running the hospital in a perfect standard and serving the patients in
an appropriate way. [318D-E)

(2)'1t is clear that inspite of several orders made by this Court
H and assurances held out by the State Government of Bihar, the defects
306
·!>-

R.C. NARAYAN·v. STATE OF BIHAR >307

were not being remedied. .The awareness of the governmental
A
authorities of the sordid situation prevailing in the hospital, as admitted
in the scheme furnished to the Court, the non-compliance in an effective
way with the directions made from time to time by the Court and the
general lethargy shown in rising from slumber leaves a clear impression
that the institution cannot be run as a mental hospital of that magnitude
unless there be change in the administrative set-up, the control is B
altered and a new service to patient-oriented thrust given to the
institution. [318B-C]

(3) The scheme which was furnished to the Court was a half-
hearted one and no attempt therein was made to bring about any
improvement except attending to certain obvious deficiencies and short-
falls. The Court had looked forward to a scheme of re-orientation which c
the scheme did not even remotely touch. [318F -GI

(4) The State Government authorities have not been able to assess
the pri11rities. There does not seem to be t!te slightest interest on the
part of the persons handling the matter, to improve the environment. In D
these circumstances, it is_ difficult to leave the management exclusively
to the Health Department of the State of Bihar if the institution has to
rnn as a good and useful hospital. Association of the States of West
Bengal and Orissa in the management is likely to bring about some
positive result. It would, therefore, be much better if a C<'mmittee of
Management is appointed with full powers to look after all aspects of E
the institution. [3I9A; B-D]

(5) The Court accordingly constituted a Committee of Manage-
ment for the Mental Hospital and gave directions regarding the finan-
cial contribution from the participating States, and also laid down
guidelines regarding the functioning and management of the hospital. F
The Court further directed that the Committee shall take expeditious
steps to explore the possibility of transforming the hosoital into the
pattern obtaining in the hospital run by NIMHANS at Bangalore. l321 C-D l

ORIGINAL JURISDICTION: Writ Petition (Civil) No. 339 of
1986. G

(Under Article 32 of the Constitution of India).

S.P. Pandey and Mrs. Rekha Pandey for the Petitioner.

J.R Dass, D.K. Sinha, D. Goburdhan and R.K. Mehta for the H
Respondent.
308 SUPREME COURT REPORTS [1988] Supp. 3 S.C.R.

T-he Judgment of the Court was delivered by

RANGANATH MISRA, J. A letter addressed to the learned
Chief Justice of this Court from two citizens of Patna in regard to the
Mental Hospital at Kanke near Ranchi in Bihar State was considered
as a public interest litigation and registered as an application under
B Article 32 of the Constitution. On 7.4.1986, this Court called upon the
State of Bihar to file its counter affidavit and the Chief Judicial Magis-
trate of Ranchi or any other Judicial Magistrate nominated by him to
visit the hospital and submit a report about the conditions prevailing in
the Hospital.

C The Chief Judicial Magistrate visited the hospital on 8.6.1986,
and on several other occasions thereafter and submitted a detailed
report on 15th of July, 1986. He found that there were 1580 bedsothe
Hospital was in the sole management of the Health Department of the
State of Bihar. The State received financial contributions from West
Bengal and Orissa. There is a Managing Committee of the Hospital
D consisting of 14 members in all with the Commissioner of South
Chotanagpur Division as its Chairman. The sanctioned strength of
medical officers was 16 but only 9 had been filled-up and there were 7
vacancies. In the Hospital the male patients wing had 10 blocks in all,
apart from the Isolation Ward, the Medical Ward and the Infirmary
Ward. These are in 10 d<>uble storied blocks and three single storied
E wards in charge of separate doctors. The female patients' unit con-
sisted of two double storied and two single storied blocks. Each block
had the capacity of 120 patients. Some of the patients had to pay for
their treatment while the treatment to the general category was
intended to be free. All the three residential quarters within the
complex meant for the medical officers were occupied by others, one
F by the suspended Superintendent, the other by the retired Superinten-
dent and the third one was by the Acting Superintendent. Three
doctors were residing in the quarters meant for non-gazetted officers
and the remaining doctors were staying in private houses at Ranchi
about 11 kilometers away.

G The Chief Judicial Magistrate found that there was acute
shortage of water in the Hospital. There was only one tubewell within
the campus located in the male block. There were five ordinary wells
but there was no motor pumps installed in any one of them. These
wells were the only source of supply of water. Several representations
had been made to the State Government for supplying watef on per-
H manent basis to the Hospital but there was no response from the
Government.

'
,,__, H-

R.C. NARAYAN v. STATE OF BIHAR [MISRA, J.J 309

The Chief Judicial Magistrate was surprised that none of the
A
toilets within the hospital complex was in order. The sanitary fittings
were not operating having got chocked. The patients were, therefore,.
forced to ease themselves in the ad_jacerifopen field. Consequently
the environment had become polluted and unhygienic. Though there
were fan points and even electric fans were hanging from the roof in
some places, no fan excepting the one in the chamber of the B
Superintendent was in working condition. tie also found that though
there were electric connections with bulbs and tubes yet light was not
available and, therefore, total darkness prevailed in the campus bet-
ween dusk and dawn. The Superintendent explained to the Chief
Judicial Magistrate that the Hospital had no electrician and the Institu-
tion had to depend upon the mercy of the State Electricity Board and
despite correspondence there was no response.
c
He found that old iron cots had been provided in the year 1925

- and only 300 more had been added by purchase. The total number of
patients were 1580. Most of the iron cots having been broken were out
of use and, therefore, only 300 beds were actllally available. D

None of the wards had doors and windows in w.orking condition.
The Superintendent pointed to him that he had made repeated
requests to the Public Works Department of the State Government but
no letter had even been acknowledged. Jn the absence of device to
close the doors and windows there had been occasions when mentally E
ill patients had jumped through the windows or had run out from the
rooms. To meet such situations, the broken cots were mostly used to
block the passages.

The Chief Judicial Magistrate further found that the mattresses
and linen were in very bad shape, he noticed several patients to be F
lying on the bare floor; some of the patients were using a single
blanket both as mattress and cover. Some patients were naked in the
absence of clothing and others were found wearing torn shirts and
pants. Mosquito nets were not available; pillows were not provided
and the patients were left to their fate. The Chief Judicial Magistrate
noticed marks of bug bitings as also mosquito biting on the body of the G
patients. In the absence of clothing the patients were forced to wear
the same shirt and pant for four to six weeks without a wash on account
of unavailability of water. The Superintendent told the Chief Judicial
Magistrate that Government of Bihar had sanctioned Rs.3 a day per
patient for the two meals and breakfast and it was wholly inadequate.
The Managing Committee had recommended for sanction of Rs.10 per H
310 SUPREME COURT REPORTS I1988] Supp. 3 S.C.R.

A patient per day but there had been no response. The diet as prescribed
included an egg, 250 gms. of milk every day and meat and fish, once in
a week, but in the absence of appropriate funds those had been discon-
tinued for years.

The Chief Judicial Magistrate having visited the place on several
B occasions noticed that there was no account of the stock of medicines;
life-saving drugs were not stored properly in the absence of a
refrigerator. The instruments were not in working condition and the
employees meant for working the instruments were idlying away their
time.'The patients were now referred to Medical College Hospital at
Ranchi for X-ray and E.C.G. as and when necessary. Many of the
C patients told the Chief Judicial Magistrate that they had not been
getting any medicine for months together.

The Chief Judicial Magistrate had noticed that several doctors
were not available in the Hospital for days together. Some of the
patients in the wards complaind to him that the doctor was not visiting
I) the ward even for one hour in a week; he came across a weak and
emaciated patient who told him that he had not been given any food
for two days on the plea that he was suffering from diarrhoea and he
had not even been given any treatment. On the 11th of July, 1980,
when he visited. the Hospital along with the local Additional District
Magistrate, he found not a single doctor on duty though that was the
E time when all the doctors, were supposed to be on duty within the
campus. Though this was the actual position, the attendance register
showed all the doctors to be present as required according to the duty
chart.

The Chief Judicial Magistrate collected the death rate from the
F Superintendent for the period between 1977 and 1986 which are as per
the. particulars given below:

Year Male Female Total

G 1977 38 11 49
1978 72 12 84
1979 74 31 105
1980 66 24 90
H 1981 39 33 172
R.C. NARAYAN v. STATE OF BIHAR (MISRA, J.] 311

[ 1982
1983
173
87
50
44
231
131
A

1984 152 94 246
1985 90 69 159
From
1-1-1986 B
to
30-6-1986 49 25 74
In Paragraph 28 of the Report the Chief Judicial Magistrate stated:
"This chart clearly shows abrupt rise in the graph of death-
rate after 1980. 1984 was the most unfortunate year. for C
Arogyashala, when maximum escapes and sJeaths took
place. Mass scale escapes and deaths of patients in 1984 is
said to be the result of internal politics in the Arogyashala
campus, for which, the then Superintendent and Dr. Durga
Bhagat and Deputy Superintendent, Dr. B.B. Singh are
said to be largely responsible." D

The Magistrate further reported that the present acting Superin-
tendent had failed to improve the administration. He lacked adequate
control over his colleagues and the staff. The out-going Superintendent
residing within the campus was inciting the people and the acting
Superintendent was gradually losing his grip and control over the E
administration. The innocent, miserable and vioceless patients were
the victims of the situation. The practice prevailing in the Hospital had
been that the Superintendent alone was competent to admit patients
and as such the guardians and· attendants of the patients seeking
admission into the Hospital had been exploited by a group of persons
friendly with the Superintendent and those who did not come to terms F
with the Superintendent had been denied the benefits of the Hospital.
This led to friction and unpleasant relationship. He recommended that
a non-medical man, if possible, a retired army officer or a District
Judge could be posted as the head of the Hospital to take control and
tone up the deteriorating situation. He found that a large garden was
attached to the Hospital but on account of the all-pervading misman- G
agement there was no return but one Dr. Buxy had recently been put
in charge of the garden and had improved the same.
Last of all in his report he adverted to the fact that some petients
who had recovered-and their number he found was about 300, being
both men and women-were not in a position either to return to their
H
families or take to any employment in the absence of any facility. He
l
,I,
!'
312 SUPREME COURT REPORTS [1988] Supp. 3 S.C.R.

A found that these persons who no more required treatment should be
removed from the Hospital so that there would be room available for
patients who required treatment; unnecessary expenditure on such
large number of people could be avoided and the standard of discipline
within the Institution could be improved and there could be a general
toning up of the atmosphere.
B
Nqp~ with the report he gave various relevant details in the
annexures. Anne.xµr,e-11 is a list of criminal patients_, who had come
from different jails for treatment and had been declared fit for
discharge.

C We may refer to the case of one Rupa Santhal. This person was
admitted to the Hospital on 28.9. 1947 at the instance of the
Superintendent of Chittagang Hill Tract Jail, where on being convic-
ted by the Deputy Commissioner of Chittagang Hill Tract for an
offence punishable under Section 326 !PC, he had been imprisoned for
undergoing the sentence. Obviously he could not have been detained
D in jail for 41 years for the offence under Section 326 !PC. Several
letters were sent from the Hospital but there was no response, We may
also refer to the case of Madhu Mahanta who was admitted to .the
Hospital on 15.11.1950 at the instance of the Superintendent, District
Jail, Keonjhar in the State of Orissa. He had been convicted under
Section 302 IPC and was languishing in the Hospital for 36 years
E though he had been cured several years back. The Magistrate has
given a list of 13 persons of this category.

We are astonished that even when prisoners are transferred for
treatment from jails where they were undergoing sentences of im-
prisonment, no follow-up action has been taken from the jails on their
F own and even when the Hospital authorities had required the prisoners
to be taken back no response has been made. This only exhibits total
callousness. We have given sumptuous extracts from the report of the
Chief Judicial Magistrate with a view to bringing out as clear a picture
as possible of the shocking and savage conditions that prevail in the
mental hospital. There can be no two opinion that the hospital was in a
G shape-a shade worse than Oliver Twist's Orphanage. From all
accounts, perhaps, many of the zoos housing animals have better con-
ditions than those that prevail in this hospital. While the mentally-ill
require a soothing environment for treatment, as psychatrists say, the
State of Bihar has converted what was once a prestigious mental hospi-
tal into a den to house about sixteen hundred patients. The report of
H the Chief Judicial Magistrate gives the reader the feeling of a medieval
torture-house.
R.C. NARAYAN v. STATE OF BIHAR [MISRA, J.] 313

On 11.8. 1986, the Court noticed the report and observed:
A
"The report makes a painful reading and shows how badly
is this institution managed ·and in what in human condition
the patients are made to live & work there. It is surprising
that the State of Bihar has allowed this institution to de-
generate into the present condition. It is necessary that B
immediate steps should be taken to improve the function-
ing of this institution in all respects. We would therefore
direct the Chief Secretary and Health Secretary to the
Government of Bihar to file affidavit or affidavits putting
forth a definite scheme for improving the working of the
Institution and for remedying the drawbacks and deficien-
cies pointed out in the report, including the neglect of c
patients by the MediCal Superintendent attached to the
Institution. This matter must have urgent priority since it
concerns. the well-being of the mentally handicapped. We
would therefore direct that the affidavit be filed within
three weeks from today setting out a time bound pro- D
gramme for improving the functioning of the Institution.
We would like to observe that the Chief Judicial Magistrate
has made an excellent job of the task assigned to him and
we dpress our sense of appreciation for the work done by
him. These observations may be sent to the High Court of
Patna and the Chief Judicial Magistrate". E
On 1. 9.1986, the Health Secretary filed a short affidavit together
with a scheme for the improvement of the Hospital. The opening
words of the scheme have to be. quoted to be believed:

"The Government of Bihar are aware of the conditions F
pn!vailing in the Mansik Arogyashala, Kanke, and the
Government for sometime in past have been discussing
measures to be taken for improvement of the same. The
subject was discussed by the representatives of the State of
Bihar with the members of the Planning Commission at a
-i
meeting held at New Delhi in the month of January, 1986, G
and accordingly it is contemplated to develop the Mansik
Arogyashala, Ranchi on the lines of NIMHANS in Banga-
lore ..... "

The scheme indicated that a letter had been written to the Director,
NIMHANS at Bangalore for information on 17th of April, 1986, i.e. 4. H
314 SUPREME COURT REPORTS [1988] Supp. 3 S.C.R.

A 1/2 months before the scheme was filed in this Court. There is no
indication as to what was received-from the Director or as to what
further follow-up action was taken during the 4 1/2 months. The
scheme indicated that out of 16 sanctioned posts three posts were
earm_arked for West Bengal Government and were vacant; out of 13
posts, 9 had been filled up and 4 were vacant and were to be filled-up
B by October, 1986. The scheme admitted with reference to the water
supply system that the internal system was choked and was not func-
tioning. In the year 1985-86, Rs.10 lakhs had been sanctioned for
renovation of water supply system and the Public Health Engineering
Department could utilise only Rs.61,000 during the financial year;
therefore, the balance amount of Rs.9,39,000 was again to be sanc-
C tioned in the year 1986-87.

The lavatories and bathrooms were not in working condition as
accepted and the scheme proposed that the Superintendent of the
Hospital is to supervise the sanitary system.

D In regard to electricity it was indicated that the electric fittings,
fixtures and other equipments would be replaced by March, 1987
which meant six months beyond the date when the scheme was
framed. It was proposed that a 100 KV Generator s\'t was to be instal-
led. In regard to cots and mattresses it was stated that 400 of them
would be acquired in the year 1986-87 and the remainder in the year
E 1987-88. It was stated that the doors and windows required total
replacement and it was indicated that Rupees six lakhs were sanc-
tioned during the financial year for repair work. In regard to diet it was
indicated in the scheme:

"In the State of Bihar, the rate of the diet per patient for
F the hospital is Rs.3.00 per day except the.T.B. patient to
whom the rate of diet is Rs.4.15 per day. In the year 1986-
87, rate of diet per patient has been increased to Rs.3.55.
The Superintendent of Kanke hospital has been directed to
improve dietary management".

G It was admitted that E.C.G. machine was out of order and efforts
would be made to instal the machine in the financial year. It was also
proposed in the scheme that there would be a regular Superintendent
posted soon. In regard to supply of medicines it was stated that the
prescribed rate was Rs.1.00 per patient per day and it has been
H increased to Rs.1.90 per patient per day from 1986.
. f:

R.C. NARAYAN v. STATE OF BIHAR (MISRA, J.] 315

On 20th of October, 1986, this Court made the following order:
A
"1. In respect of each patient in the Ranchi Mansik
Arogayashala the daily allocation for diet will be increased
from the existing inadequate articles of that value shall be
supplied to each patient.
B
2. Arrangements should be made forthwith to supply
adequate quantity of pure drinking water to the hospital, if
necessary, by engaging water tankers to transport potable
water from outside.

3. Immediate arrangements should be made for the
restoration of proper sanitary conditions in the lavoratories c
and bathrooms of the hospital.

4. All patients in. the hospital who are not at present
having mattresses and blankets should be immediately sup-
plied the same within 15 days from today. Such of the D
patients who have not been given cots should also be pro-
vided cots within six weeks from today so that no patient
shall be thereafter without a cot.

5. The ceiling limit at present invogue in respect of
cost of medicines allowable for each patient will stand E
removed, with immediate effect and the patients will be
supplied medecines according to the prescription made by
the doctors irrespective of the costs.

6. The State Government shall forthwith take steps
to appoint a qualified Psychiatrist and a Medical Superin- F
tendent for the hospital and they should be posted and take
charge in the Institution within six weeks from today.

The Chief Judicial Magistrate, Ranchi to whom a
copy of this order will be forwarded by the Registry shall
visit the hospital once in 3 weeks and submit quarterly G
reports to this Court as to whether the aforesaid directions
given by us are being complied with.''

On 20th of November, 1986, the Health Secretary gave a report
as to programme relating to aspects covered by the scheme. It indicated
that no reply had been received from NIMHANS and therefore, an H
316 SUPREME COURT REPORTS [1988] Supp. 3 S.C.R.

A officer had been sent from Bihar to obtain the information. The medi·
cal officers against the vacant posts had been posted; water supply and
electricity were yet to be attended to. The repair to the building was in
progress and other aspects were yet to be attended. A Superintendent
in the rank of Civil Surgeon had been posted.

B The Chief Judicial Magistrate furnished a further report in
December, 1986. While he noticed certain improvements, he pointed
out that there were 400 female patients and there was only one lady
doctor in the Hospital. There was no lady Psychiatrist or Psychologist.
The. Superintendent had written to the Government about it but there
has been no response.
c On 14th of September, 1987, the Court noticed the fact that the
State of West Bengal was in huge arrears in the matter of payment of
contribution to the running of the Hospital. Counsel for State of Bihar
had agreed to send details of the arrears to the State of West Bengal
within a fortnight and the Court directed the West Bengal Govern·
D ment to pay the same.

The State of West Bengal filed its affidavit through the Joint
Secretary in the Department of Health and Family Welfare. The
affidavit while accepting the fact that 38% of the seats in the hospital
were reserved for West Bengal alleged that in the absence of furnish·
E ing of proper accounts by the State of Bihar, the payment of contribu·
tion had not been made in time by the State of West Bengal after
1979-80. It agreed to pay Rs.20 lakhs during the year and the balance
in sui:able instalments in future.

The State of Orissa has pointed out in its affidavit that it has been
F regularly paying its contribution of Rs.3 lakhs and was.not in arrears.

· The Deputy Director (Medical) Health Services, Government of
Bihar filed .an affidavit claiming that the rate of diet had been
enhanced with effect from 1.12.1986 and in diet all the patients were
provided rice, bread, dal, vegetable, egg, milk, loaf, biscutt, tea, fruit.
(; Fish, meat and chicken were being provided alternatively thrice a
week. Old Pipe lines had been replaced and the flow of water was
increased; storage facility for· water had been arranged. Medicine as
per requirement is being provided without refering to any ceiling limit.
A new X-ray machine· has been purchased; the old E.C.G. machine
has been condemned and a new one has been purchased. One of the
H petitioners filed an affidavit denying ~any of the aforesaid claims. On
. ~ .;;:~ "

,,
'\l~.- R.C. NARAYAN v. STATE OF BIHAR (MISRA, J,J 317

14th of March, 1988, this Court made the following order: A
Y.,4
"We have perused the affidavit filed by Shri Subodh
Chandhra Nary11yan, one of the petitioners, wherein
several allegations of mismanagement have been made. It
has also been alleged that in spite of the direction of this
Court that the daily diet expenses should be Rs.10 per B
patient actually Rs. 7 is being spent and though this Court
-1 had directed that there should be no ceiling of expenses for
medicines beyond Rs.2 per patient is not being issued. We
are of the view that copy of the affidavit should be sent to
the Chief Secretary, State of Bihar with a direction that he
would personally look into tho matter and should send a
report within four weeks." c
A report, beyond tho time indicated In the order dated 14th of
>
March, 1988, was furished by the Chief Secretary and the same was
covered by an affidavit of tho Joint Secretary of Department of Health
and Family Welfare of the State Oovernmont. The Chief Secretary D
reported:

"The entire ho~pital complex IR spread over a spmwi·
Ina area. The buildin~s are old, but they have been exten·
sively repaired and white-washed. Many old cots, mMrei·
aes linen etc. have been replaced by new ones. Ol'lvemment E
· has spent aeverni lokhs l'lf rupees l'ln improvements Jn the
running of the A~rn~yashala during the last two years. Jn
course of my visit. I did not find that patients were being
given inadequate food or medicine."
"
He also found that the toilets had not been attended to, tre position of F
water supply was not satisfactory, the automatic .boiler had not yet
been repaired or replaced. Tho Court's Order of 14th of March, 1988,
indicated that the affidavit filed by Subodh Chandra Narayan contain·
ing several allegations of mismanagement was to be forwarded to the
Chief Secretary and with reference to the allegations therein, he was to
send his report. We do not find that the report of the Chief Secretary G
covers all the aspects. The hospital authorities would not, in their own
interests, be too ready to expose their own deficiencies during the visit
of the Chief Secretary. Therefore, to have been satisfied and to report .
t_hat during his visit he did not find any patient being given inadequate
food or medicine is no appraisal of the situation. The fact that lakhs of
rupees had been spent on improvement is indeed of no consequence H
31.8 SUPREME COURT REPORTS [ 1988] Supp. 3 S.C.R.

until the Agorgyashala is restored to acceptable hospital standards.
A
The report gives us a feeling that the Chief Secretary was more con-
scious about the expenditure made by the State Government than
assessing the actual situation. From his report, however, it is clear that
inspite of several orders made by this Court and assurances held out by
the State Government of Bihar, the defects were not being remedied.
B The awareness of the governmental authorities of the sordid situation
prevailing in the hospital, as admitted in the scheme furnished to this
Court, the non-compliance in an effective way with the directions
made from time to time by this Court and the general lethargy shown
in rising from slumber leaves a clear impression in our mind that the
institution cannot be run as a mental hospital of that magnitude unless
C there be change in the administrative set-up, the control is altered and
a total new service to patient-oriented thrust given to the institution.

In a welfare State-and we take it that the State of Bihar consi-
ders itself to be one such-it is the obligation of the State to provide
medical attention to every citizen. Running of the mental hospital,
D therefore, is in the discharge of the State's obligation to the citizens
and the fact that lakhs of rupees have been spent from the public
exchequer (perhaps without or inadequate return) is not of any conse-
quence. The State has to realise its obligation and the Government of
the day has got to perform its duties by running the hospital in a
perfect standard and serving the petients in an appropriate way. The
E reports and affidavits of the Government of Bihar and its officers (not
the reports furnished to the Court by the judicial officers) have not
given us the satisfaction of the touch of appropriate sincerity in action.

The scheme which was furnished to the Court was a half-hearted
one and no attempt therein was made to bring about any improvement
F except attending to certain obvious deficiencies and shortfalls. The
hospital has been in existence from pre-independence period. There
have been epoch making breaks-through in the field of psychiatry
and treatment of psychiatric patients. The approach to mental health
and the techniques of psychiatry have changed. Psychologists have
developed their art and their tools. The method of care arid attention
G for the me11tl)lly'ill has also undergone a sea change. When we had
called upon the State of Bihar to give a scheme for improving the
conditions of the .hospital, this Court had not intended a scheme for
removing the deficiencies in the old hospital; we had really intended to
look forward to a scheme of re-orientation which the scheme did not
even remotely touch except to say that NIMHANS at Bangalore has
H been contacted.
!: w:::
~·~
R.C. NARAYAN v. STATE OF BIHAR [MISJ;lA, J.] 319

The State Government authorities have not been able to assess A
the priorities. Provision of beds, though the scheme indicated had to
be fully made by end of March, 1988, the report of the Chief Secretary
and the accommpanying affidavit have not cleared that position. Pro-
vision for electricity and water has taken too long, though both are
basic necessities of life. The fact that the existing lavatories have t~ken
B
more than two years to repair is a slur on the administration. There
does not seem to be the slightest interest on the part of the persons
handling the matter, to improve the environment. In these cir-
cumstances, it becomes difficult for the Court with any sense of confi-
dence to leave the management to the Health Department of the State
of Bihar if the institution has to run as a good and useful hospital.
', c
We are cognizant of the position that it is difficult for the Court
to monitor the management of a hospital-particularly. when it is
located a thousand kilometres away; but since there have been some
improvements with the Court's intervention, to get out of the picture
at this stage would only mean that the situation will again deteriorate D
no sooner the Court's attention is withdrawn. As we have already
pointed out mere restoration of the hospital to its old position would
only bring into existence an archaic institution sans modernism. In our
opinion, it will be much better if a Committee of Management is
appointed with full powers to look after all aspects of the institution. It
is appropriate to take note of the position that this institution receives E
contribution from two other States. 38% of these beds, being about
600, are reserved for the State of West Bengal and the Government of
West Bengal is to pay for the same. Similarly 75 beds are reserved for
the State of Orissa and a sum of Rs. 3 lakhs is payable by the Orissa
Government. There is no reason why the management of the hospital
should be left exclusively to the Health Department of State cf Bihar F
and the participating Governments should not be associated in such
management. Taking note of the performances of the State administ-
ration of Bihar in regard to the hospital we are of the view that associa-
tion of the States of West Bengal and Orissa in the management is
likely to bring about some positive result. We would, accordingly,
constitute a Committee of Management for the Mental Hospital in the G
manner indicated below.

Chairman-A consenting sitting Judge of the Patna High Court,
Ranchi Bench, to be nominated by the Chief Justice of Patna High
Court.
H
'

320 SUPREME COURT REPORTS

Members
[1988] Supp. 3 S.C.R.
..
A ( 1) Commissioner of Ranchi Division.
;
(2) Station Commander, Ramgarh area, Ranchi.

(3) Secretary of Health, Bihar Government. Ji
B 1,1
(4) Secretary of Health, West Bengal Government.

(S) Secretary of Heftlth, Orissa Government.

(6) Deputy Commission of Ranchi.
c (7) Principal of the Ranchi Medical Colleae.

(8) District Judge, Ranchi.

,(9) Superintendent of the Hospital. dA
D The CommiHionor of Ranchi Division and the Station Commander
shall be Vlce•Chairmcn ond In the absence of the Chnlrman, shall In ~,
·J...
the order Indicated act 11s Chairman when any of them too Is absent.
The Superintendent shall act as tho Secretary. We hope a11d expect
that the eoneerned Governments and authorltlee would accord the
necessary conaont/permlsslon to the nominated offleen to act on the
I'! Committee nnd the CommlttH would be nble to hav~ it§ first meetlns
in the flnt half of November, 1988. The Committee shouh.I meet every
month In the first six months wltlu view to removing th~ dcfeeti and
deflchmelcs within a time frnme-say of six months at the most and for
reviewing the Improvements In the conditions of the hospital. If It Is
. satisfied that the situation has Improved, the meetlnas thereafter may
F be quarterly. The Commissioner of the Ranchi Division shall make a
monthly report with in 2 weeks of the end of every month about the state
of the hospital during the first year and such reports as and when
received by the Registry should be placed before the Court
The State of West Bengal Is In arrears in regard to Its contrlbu·
0 tlon for several years. Though counsel for the State of Bihar had
undertaken to furnish accounts, the ·same has not .yet been done. The
Committee shall ensure that the accounts are furnished to the State of
West Bengal by the 15th of December, 1988. In its affidavit, the State
of West Bengal has indicated that it would pay Rs.20 lakhs out of the
dues duting the current financial year and would pay the balance in
H suitable instalments. As the improvement to the hospital would '
R.C. NARAYAN v. STATE OF BIHAR [MISRA, i.J 321

involve huge expenditure: we direct the. State of Wesi Bengal to pay A
E.s.50 lakhs out Of.its dues by 31st of March, 1989 and the balance
amount shall be paid in two six~monthly instalments, one by :iOth of
September, 1989, and the other by 31st of Marchl 1990. The Govern-
ment of West Bengal and the Committee shall ensure that this time-
frame is adhered to. The entire arrears collected. from the West Bengal
Government shall be .earmarked for development of the hospital to be B
expended in the manner approved by the Committee and no portion
thereof would be otherwise spent. ·

We are of the view that if the hospital is transformed into a better
one, just as the hospital run by NIMHANS at Bangalore, the quality of
the hospital would improve and the patients would have the benefit of
modern scientific treatment. The Committee shall, therefore, take
c
expeditious steps to explore the possibility of transforming the Mental
Hospital at Ranchi into the pattern obtaining in the hospital run by
NIMHANS at Bangalore by taking such steps as are necessary and
furnish a report to this Court by the end of February, 1989 when that
question will have to be considered by this Court after hearing the D
concerned State Governments and the parties. The State of Bihar shall
provide a basic fund of Rs.50 lakhs in the year ending 31st of March,
1989, to be spent for improvement of the Hospital in the manner
approved by the Committee and in case the Committee is of the view
that further funds are necessary, it would be open to the Committee to
make a report to this Court whereupon appropriate directions shall be E
given.

There have been repeated allegations that the lady patients who
have already been cured are not being released from the hospital. At
one stage the explanation offered by the hospital authorities and the
State administration was that the relations, even though notified, are F
not taking them back. The hospital is not a place where cured people
should be allowed to stay. It is, thereiore, necessary that there should
be a rehabilitation centre for those who after being cured are not in a
position to return to their families or on their own seek useful employ-
, ment. The Committee shall, therefore, take immediate steps to have a
rehabilitation centre at a convenient place around Ranchi where G ·
appropriate rehabilitation schemes may be operated and the patients
after being cured, irrespective of being male or female, if they are not
being taken back by the members of their families could be rehabili-
tated. The funds made available to the Committee may be utilised for
such purpose. ·
H
322 SUPREME COURT REPORTS [1988] Supp. 3 S.C.R.

A We must reiterate that Court-monitoring of an institution like
the present one is indeed difficult but we cannot close the proceedings
at this stage for the reasons we have already indicated. Parties includ·
ing the Committee shall have liberty to move this Court from time to
time. We make it clear that the directions regarding ·payment of the
El funds are pre·emptory in nature and no application for modification
thereof shall be entertained.

This matter shall be deemed to be pending to deal with the
various reports from the Committee and for purposes of giving other
directions.

C R,S.S.
_.:......--- - -