Supreme Court Issues Show-Cause Notices to 28 States, UTs Over Delay in ICU Safety Standards

The Supreme Court has issued show-cause notices to 28 states and union territories for failing to comply with its orders to establish uniform standards for patient safety in Intensive Care Units (ICUs) and Critical Care Units (CCUs) across the country.

A bench comprising Justice Ahsanuddin Amanullah and Justice NK Singh expressed strong displeasure at the lack of seriousness shown by the defaulting states and UTs. The Court directed the additional chief secretaries or the senior-most officials of the health departments from each of these jurisdictions to appear personally before it on November 20, accompanied by personally affirmed show-cause affidavits explaining their inaction.

"Notice is issued to the additional chief secretary/senior-most official of the department of health of all states/UTs, as to why action should not be taken against them for such a casual approach shown towards the court,” the bench stated, adding that no excuses for non-appearance would be entertained, including prior official engagements.

The list of non-compliant states and UTs includes: Arunachal Pradesh, Assam, Chhattisgarh, Goa, Gujarat, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Manipur, Mizoram, Odisha, Punjab, Rajasthan, Sikkim, Telangana, Tripura, West Bengal, Chandigarh, Delhi, Jammu & Kashmir, Puducherry, Lakshadweep, Ladakh, Andaman & Nicobar Islands, and Dadra & Nagar Haveli and Daman & Diu.

The issue dates back to 2016, when the Court first took suo motu cognisance of widespread medical negligence in private hospitals and the absence of standardised ICU/CCU protocols nationwide. Although the main appeal was dismissed in early 2024, the Court continued to monitor the broader concern of critical care regulation and patient safety.

In recent years, the Court has issued multiple directions asking states to collaborate with the Centre to draft a uniform framework covering ICU admission protocols, treatment guidelines, staffing standards, hygiene norms, and infrastructure requirements. On August 5, 2025, it mandated each state to conduct consultations with major hospitals and ensure personal approval of resolutions by top health officials.

However, by October 13, the Court noted that over two dozen states and UTs had either failed to submit their reports or filed them late, despite repeated extensions. “We are more pained than shocked by the casualness shown… the orders of this Court have been taken very lightly by the officers concerned,” the bench remarked, expressing frustration over the continued delays.

To facilitate the process, the Court had previously appointed a three-member expert committee comprising Additional Solicitor General Aishwarya Bhati, amicus curiae Karan Bharihoke, and Dr Nitish Naik, professor of cardiology at AIIMS, New Delhi. States were instructed to submit draft reports by September 30 and forward them to the committee by October 5.

While issuing the latest notices, the Court warned that any further non-compliance or submission of inadequate reports would invite strict action against the officials and states involved. Simultaneously, it directed the expert committee to proceed with framing a draft national standard using the materials already submitted.

The matter is now scheduled for hearing on November 20, with personal appearances required from the top health officials of the defaulting states and union territories.