Anil K. Narendran, J.

1. The Special Commissioner, Sabarimala has filed this report regarding the suggestions made by the Kerala Government Medical Officer Association for improvement of infrastructure and other facilities for medical care during Mandala-Makaravilakku festival season on 1200ME (2024-25) at Sabarimala.

2. On 21.06.2024, when this matter came up for consideration, the learned Senior Government Pleader sought time to get instructions from the 2nd respondent Director of Health Services. An affidavit dated 26.07.2024 has been sworn to by the 2 nd respondent pointing out various suggestions. Paragraphs 3 to 11 of that affidavit read thus;

“3. It is submitted that the grievance projected by the Medical Officers, who are appointed at different stations to support Sabarimala pilgrimage during the Mandala Makaravilakku season, was discussed in detail, and the followings suggestions were proposed by this respondent for the kind consideration of this Honourable Court.

General Suggestions: -

1) Regarding Providing Basic Amenities Around 1500-2000 healthcare personnel are posted to render healthcare services during the Mandala Makaravilakku pilgrimage season from November to January. The doctors are posted continuously for a period of 7 days and all other staff are posted continuously for a period of 15 days.

The hospitals where health care services staff are posted are

1. PHC Nilakkal

2. Govt Hospital Pamba

3. Cardiology centre Appachimed

4. Cardiology centre Neelimala

5. Special Dispensary Charalmedu

6. Govt Hospital Sannidhanam

7. CHC Erumely

8. GH Pathanamthitta

4. It is submitted that, as no separate accommodation facility is available at the various duty stations in Sabarimala, the posted staff are given accommodation within the hospital premises. As the health care staff posted are providing uninterrupted essential and emergency health care services, food is currently supplied by the Devaswom Board.

5. lt is submitted that many of our Health Services staff posted in Sabarimala during Sabarimala Festival and monthly special pooja suffer from Diabetes, High Blood pressure, Cholesterol, etc., and food control and medication are required. As they daily have common food supplied by the Devaswom Board and food control is impossible, many have health conditions. So, a letter will be sent to the Devaswom Board requesting more quality food considering their health conditions also.

6. The amount allotted for Sabarimala related activities in various non plan head of accounts is as follows:

Head of account	Activity	Budget Amount
2215-02-105-99- 00-04- 01-N-V	Tour TA	Rs.10,215,000/-
2215-02-105-99- 00-24-00-N-V	Materials and Supplies	Rs.1,575,000/-
2215-02-105-99- 00-45—00-N-V	Fuel Charges	Rs.2,700,000/-
2215-02-105-99- 00-34-03-N-V	Other Charges	Rs. 1,200,000/-

Most of the funds allotted during 2023-24 were allotted to DMO Pathanamthitta to settle the pending TA DA bills of the previous financial year.

7. The District Medical Officer, Health, Pathanamthitta had submitted a proposal to the Director of Health Service on 27.07.2023 for allotting Rs.1,23,66,300/- for disbursing TA/DA for the employees posted for special duty in Sabarimala for the 2023-24 financial year.

8. It is submitted that, based on the said proposal, the Director of Health Service's amount of Rs.35,00,000/- the remaining available amount from among the total allotted amount was allotted on 16.10.2023. In addition, an amount of Rs. 50,955/- was also allotted on 13.02.2024. Using this fund, the TA/DA for 425 employees who were posted for duty up to 30.11.2023 were fully disbursed through SPARK. The balance remained in the proposal were allotted using funds allotted in 2024-25 to DHS as follows on 30.05.2024 - 15,52,099/- and on 05.07.2024 72,65,521/-

9. It is submitted that, after receiving the above fund, TA/DA of 290 employees were disbursed up to 18.07.2024. The total number of employees engaged for special duty in Sabarimala season 2023-24 is 1520, and TA/DA for 715 were paid up to 18.07.2024. The balance amount remaining in the allotment is 59,73.536/-. Necessary urgent measures are being taken to disburse the entire TA/DA of the remaining 795 employees.

10. The TA/DA bills are processed at Pathanamthitta through SPARK. The main limitation in paying the TA/DA is that the SPARK will not allow bulk bill processing. SPARK stipulates that the bills are for one employee. Hence, the total number of bills processed will be the same as the number of employees posted for duty. This is the main limitation we are facing. As per DMO Pathanamthitta, the time expected to complete the disbursement is two months.

Primary Health Centre, Nilakkal: -

Nilakkal Primary Health Centre is functioning in the Devaswom Board Building. During the festival time, more than 35 staff are deputed for special duty. But only limited accommodation facilities are available. According to the master plan, the land allocated for the hospital building was not suitable. A new spot was identified and requested for government sanction for the same. Government sanction is currently obtained as per GO 276/2023/RD dated 5/12/2023. Travancore Devaswom Board is yet to allot the spot so that construction activities can be initiated.

Government Hospital, Pamba: -

Maintenance work and additional fitting of the building was done using NHM fund so far. Now, NHM has given letters to hand over the building to the health department. To complete the handing over process of the building to the Health Services Department, the Building Completion plan, Stability Certificate, Plumbing and Electrical Drawing, Valuation of the Building, etc., submitted to the Director of Health Services on May 2024 and requested the Director of Health Services to handover the building to PWD. DHS has submitted a letter to the Government to get the approval regarding the same. Regarding other points raised

1. Additional standby pump already installed.

2. Receiving Area: Requested the water authority department to arrange RO-UV drinking water.

3. For resolving the space constraints and other maintenance work requests given to the PWD building section on 27.06.2024.

Cardiology Centre, Neelimala: -

For civil and electrical works, an improvement of infrastructure and maintenance request was given to the Travancore Devaswom Board on 28.06.2024.

Cardiology Centre, Appachimedu: -

For Civil and Electrical works, improvement of infrastructure and maintenance request given to ‘Travancore Devaswom Board on 28.06.2024.

Government Hospital, Sannidhanam: -

Letter given to PWD on 27.06.2024 for Civil and Electrical works, improvement of infrastructure, and maintenance.

Temporary Dispensary, Charalmedu: -

Letter given to the Deputy Director (Periyar Tiger Reserve, Peerumedu) on 01.07.2024 for Civil and Electrical Works, infrastructure improvement, and maintenance.

Temporary Dispensary, Karimala: -

Letter given to the Deputy Director (Periyar Tiger Reserve, Peerumedu) on 01.07.2024 for Civil and Electrical Works, infrastructure improvement and maintenance.

Public Health Activities: -

1. Through DMO Pathanamthitta, the health department gives letters ‘to the Travancore Devaswom Board regarding the need for health cards and ensuring them. Devaswom Board is intimated regarding the same to include the above-said condition in the License agreement while leasing shops. Employees without the abovementioned should be barred from working in such shops.

2. Widespread publicity is given well in advance to ensure that all Pilgrims should carry their previous treatment details while undertaking the pilgrimage. Ensure to bring treatment details and regular drugs (to be Integrated in the reminder with virtual queue booking will be requested to ‘Travancore DB).

Regarding the accommodation for health care staff, no separate facilities are available. Regarding the suggestion on utilisation of SAHAS, the decision is to be taken at the government level.

It is submitted that this respondent reserves the right to file a detailed affidavit, in case it is found necessary. This respondent is ready to extend all the support facilities to the pilgrimage as directed by this Honourable Court without fail. The affidavit most humbly submitted may kindly be accepted.”

3. The Kerala Government Medical Officer's Association submitted I.A.No.1 of 2024 seeking an order to get itself impleaded as additional 8th respondent. That application was allowed by order dated 30.07.2024.

4. On 23.10.2024, when this matter came up for consideration, the learned Senior Government Pleader submitted that a report of the 4th respondent, the District Medical Officer, with specific reference to the Government Hospital at Sannidhanam shall be placed on record within two days. A report dated 28.10.2024 of the 2nd respondent is placed on record, which reads thus;

“As part of the 2024-25 Sabarimala Pilgrimage, Different Specialty Doctors, Cardiologist, Paramedical Staff and technical staff are being posted for special duty from November 14. Also, services including state-of-the-art lifesaving equipment are made available to pilgrims who come for treatment. The facility has 18 beds, 5 ICU beds and an operation theatre facility. Devaswom Board also provides an off-road ambulance service at Sannidhanam Government Hospital to provide better treatment to the patients who are referred to Pampa Government Hospital. More than 80 Employees are on duty daily during the pilgrimage period. Therefore, the accommodation facility is very limited. At present, we are facing a shortage of space for setting up a trauma care system in the hospital. Accommodation for doctors has now been arranged in the place where the wards are set up. If the Sannidhanam SAHAS Cardiology centre is allotted to the health service department, accommodation facilities can be arranged. Pharmacy store, Laboratory and X-ray Unit now at Sannidhanam Hospital building can be shifted so SAHAS building and in turn Sannidhanam Government Hospital can be equipped with an ICU ward and provide better treatment facilities to Ayyappa Devotees. It is also submitted an Isolation ward and a green area on Makaravilakku day in SAHAS Cardiology Centre.

8 Emergency Medical Centres in addition to Neelimala and Appachimedu Cardiology Centre along the road from Pamba to Sannidhanam via Neelimala, 2 Emergency medical Centres are operated by an offroad ambulance service and 2 Emergency Medical Centres to Sanndihanam via Saramkuthi during the pilgrim period. Apart from Charalmedu Dispensary on Swami Ayyappan Road 3 Emergency medical centres and an off-road ambulance is also being operated at Charalmedu path. A letter dated 26.09.2024 has been sent from this office to Devaswom Board and Forest Department to construct and provide Emergency Medical Centres including water connection, Electricity, Telephone connection and e-toilet facility before November 15 Sabarimala Mandala Pooja. Neelimala, Charalmedu during Makaravilakku Pilgrim although offroad ambulance is deployed on roads, it would be very helpful if the Devaswom Board could provide additional stretcher on the lanes or provide the services of some voluntary organizations to operate manually.”

5. On 01.11.2024, the learned Senior Government Pleader submitted that the Medical Officers and Paramedical staff in respect of Government Hospitals at Pamba and Sannidhanam, Cardiology Centres, Primary Health Centres etc., have already been identified and posting orders are being issued.

6. Heard the learned Senior Government Pleader for R1 to R4, the learned Standing Counsel for Travancore Devaswom Board for R5 to R7, learned Counsel for the additional R8 and also the learned Amicus Curiae for the learned Ombudsman.

7. In the judgment dated 09.10.2024 in W.P.(C) No.17716 of 2024, in respect of SAHAS Cardiology Centre at Sannidhanam, this Court noticed that when the entire medical facilities at Sabarimala are being provided with Medical Officers, Paramedical staff and Technical staff of the Health Services Department, who are being, posted at the Government Hospital, Sannidhanam; Government Hospital, Pamba; Primary Health Centre, Nilakkal; Cardiology Centre, Neelimala; Cardiology Centre, Appachimedu and also in the temporary hospitals at Charalmedu and Karimala, on special duty, who are under the direct control of the additional 8 th respondent District Medical Officer (Health), Pathanamthitta, the petitioner Society cannot be permitted to have a free Medical Aid Centre at Sannidhanam, with the help of Doctors and Paramedical staff provided by SRM Institute of Medical College (SIMS), Chennai. Paragraphs 33, 34 and also the last paragraph read thus:

“33. When the entire medical facilities at Sabarimala are being provided with the Medical Officers, Paramedical staff and Technical staff of the Health Services Department, who are being posted at the Government Hospital, Sannidhanam; Government Hospital, Pamba; Primary Health Centre, Nilakkal; Cardiology Centre, Neelimala; Cardiology Centre, Appachimedu and also in the temporary hospitals at Charalmedu and Karimala, on special duty, who are under the direct control of the additional 8th respondent District Medical Officer (Health), Pathanamthitta, the petitioner Society cannot be permitted to have a free medical aid centre at Sannidhanam, with the help of Doctors and Paramedical staff provided by SRM Institute of Medical College (SIMS), Chennai. As already noticed hereinbefore, the petitioner has not chosen to produce any document to substantiate the fact that, after the renovation of Government Hospital, Sannidhanam, in the year 2019, medical facilities are being provided to pilgrims at SAHAS Cardiology Centre, Sannidhanam, with the assistance of the Paramedical staff provided by SIMS, Chennai. The documents marked as Exts.P9 and P10 in the writ petition are two reports dated 18.01.2024 and 18.04.2024 regarding the functioning of SAHAS Cardiology Centre, Sannidhanam during MandalaMakaravilakku festival season of 1199ME (2023-24). The said reports are filed by Dr.O.Vasudevan, who is the Secretary of the petitioner Society.

34. SSCR No.15 of 2024 filed by the Special Commissioner, Sabarimala, based on a representation dated 15.06.2024 filed by the Kerala Government Medical Officers' Association, suggesting improvement of infrastructure and other facilities for medical care during Mandala-Makaravilakku festival season of 1200ME (2024- 25) is pending consideration before this Court, in which space constraints for expansion of clinical facilities in the Government Hospital, Sannidhanam has pointed out. The building of SAHAS Cardiology Centre is on the side of the Government Hospital, Sannidhanam, and the buildings are separated by a compound wall, which is evident from the photographs produced by the learned Standing Counsel for Travancore Devaswom Board, along with a memo dated 02.10.2024. In the absence of any reliable materials placed on record, the action of the 6th respondent Executive Officer in issuing Ext.P7 communication dated 07.05.2024, based on the decision taken in the meeting convened on 02.05.2024 in the Board Headquarters, requiring the petitioner Society to surrender the building of SAHAS Cardiology Centre, Sannidhanam, cannot be said to be either arbitrary or illegal, warranting an interference of this Court in exercise of the writ jurisdiction under Article 226 of the Constitution of India. Considering the fact that the number of footfall at Sabarimala Sannidhanam during Mandala-Makaravilakku festival season of 1199ME (2023-24) was more than 1,00,000 per day, which had gone up to 1,15,000 per day, as per records, it is for the Board to take necessary steps, in consultation with the 2nd respondent Director of Health Services and the 4th respondent District Medical Officer (Health) to utilise the building of SAHAS Cardiology Centre for providing additional medical facilities by the Health Services Department, for the Government Hospital, Sannidhanam by setting up additional ICU beds, etc. Since there is acute shortage of accommodation for the Medical Officers and Paramedical staff posted at the Government Hospital, Sannidhanam, it is for the Board to consider the question as to whether the second floor of the building, which is kept as open space, as evident from Ext.P24 plan, could be utilised for that purpose.

In the above circumstances, we find no reason to interfere with Ext.P7 communication dated 07.05.2024 issued by the 6th respondent Executive Officer, Sabarimala based on the decision taken in the meeting convened in the Board Headquarters on 02.05.2024. The petitioner is not entitled to any of the reliefs sought in this writ petition and the same is accordingly dismissed. Since the petitioner Society has provided medical equipment and other infrastructure in the building in question, it is for the Board to grant reasonable time to the Society to remove the same from the building in question.”

8. As already noticed, the entire medical facilities at the Government Hospital, Sannidhanam; Government Hospital, Pamba; Primary Health Centre, Nilakkal; Cardiology Centre, Neelimala; Cardiology Centre, Appachimedu and also in the temporary hospitals at Charalmedu and Karimala, etc., are being provided with the Medical Officers and Paramedical Staff and Technical Staff of the Health Services Department posted on special duty. The learned Senior Government Pleader, on instructions from the 2nd respondent Director of Health Services and the 4th respondent District Medical Officer, would submit that Medical Officers and Paramedical staff have already been identified for being posted at the Government Hospital, Sannidhanam; Government Hospital, Pamba; Primary Health Centre, Nilakkal; Cardiology Centre, Neelimala; Cardiology Centre, Appachimedu and also in the temporary hospitals at Charalmedu and Karimala, etc., during the Mandala-Makaravilakku festival season of 1200ME (2024-25), and the first batch of the officers and staff will take charge on 15.11.2024. In the report dated 28.02.2024 of the 2nd respondent Director of Health Services various aspects in providing proper medical facilities to pilgrims have been pointed out. It is for respondents 1 to 6 to take necessary steps to ensure proper medical facilities to Sabarimala pilgrims during MandalaMakaravilakku festival season of 1200ME (2024-25). With the above direction, this SSCR is disposed of.

9. Considering various aspects pointed out in the affidavit dated 26.07.2024 and the report dated 28.10.2024 of the 2nd respondent Director of Health Services, we deem it appropriate to direct the Special Commissioner, Sabarimala to file a separate report (SSCR) seeking appropriate directions to ensure proper medical facilities to pilgrims during Mandala-Makaravilakku festival season of 1200ME (2024-25), for consideration along with the general report (SSCR) regarding crowd management and other aspects. In the said SSCR, the State of Kerala, represented by the Principal Secretary to Government, Revenue (Devaswom) Department; Principal Secretary to Government, Health and Family Welfare Department; the Director of Health Services, Kerala; the District Medical Officer (Health), Pathanamthitta; the Deputy Director, Periyar Tiger West Division; Travancore Devaswom Board, represented by its Secretary; the Devaswom Commissioner, Travancore Devaswom Board; the Executive Officer, Sabarimala, Pathanamthitta, shall be arrayed as the respondents.