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Judgment
Honourable Mr. Justice K.K. Sasidharan
These two Writ Petitions raise a question as to whether the female Nursing Assistants and female Sanitary Workers would come under the
direct control of Resident Medical Officers or the Nursing Superintendent of Government Rajaji Hospital at Madurai.
The Writ Petition in W.P.(MD)No.1960 of 2011 at the instance of Tamil Nadu Medical Department of All Workers and Sanitary Workers
Association challenges the proceedings dated 06.01.2010 on the file of Director of Medical Education, Directorate of Medical Education,
Kilpauk, Chennai-10, whereby and whereunder, the female Sanitary workers were made to work under the control of the Nursing Superintendent.
The Writ Petition in W.P.(MD)No.6037 of 2011 is at the instance of Tamil Nadu Government Nurses Association and their challenge is to the
proceedings dated 27.05.2011 issued by the Medical Superintendent, Madurai Government Rajaji Hospital, Madurai, indicating that the female
Sanitary Workers would work under the control of Health Inspector and over all control of Resident Medical Officer.
BRIEF FACTS:
W.P.(MD)No.1960 of 2011:
The petitioner is an Association of Sanitary and other workers on the rolls of Madurai Government Rajaji Hospital, Madurai. There are 165
Sanitary Workers, working under the control of the Medical Inspector, who is under the supervision of Resident Medical Officer. There are 75
male Sanitary Workers and 90 female Sanitary Workers and they have been satisfactorily working under the control of the Medical Inspector, of
course, under the administrative control of the Resident Medical Officer. While the matters stood thus, the nurses working in the Government
Rajaji Hospital, Madurai conducted an agitation with a demand that the female Sanitary Workers should be put under their control. Their plea was
accepted by the Hospital authorities and accordingly, the Director of Medical Education issued a proceeding on 06.01.2010 indicating that all the
Sanitary Workers would come under the control of Nursing Superintendent. The said order is challenged on various grounds and more
particularly, as violative of Section 92(b)(IV)(5) of the Tamil Nadu Medical Code, which provides that the last Grade Workers should work under
the control of Resident Medical Officers.
When the Writ Petition came up for hearing on 20.04.2011, this Court granted an interim stay of operation of the impugned proceedings dated
06.01.2010. This made the Medical Superintendent to pass an order on 27.05.2011 putting the female Sanitary Workers under the control of the
Health Inspector, who would work under the over all control of Resident Medical Officer. The said order was challenged by the Tamil Nadu
Government Nurses Association in W.P.(MD)No.6037 of 2011.
W.P.(MD)No.6037 of 2011:
The petitioner is an Association of Government Nurses working in Madurai Government Rajaji Hospital. According to the petitioner, nurses are
working for 24 hours on shift basis and attending all cases especially emergency, accidental and maternity cases. In case the female Sanitary
Workers are made to work under them, it would enable them to look after the cleaning work in a more effective manner and that was the reason
for putting the Sanitary Workers under the direct control of Nursing Superintendent. It is their grievance that during the pendency of the Writ
Petition filed by the Sanitary Workers, the Medical Superintendent has issued the impugned order changing the existing system and thereby, putting
the Sanitary Workers under the direct control of Health Inspector.
DEFENCE:
The Medical Superintendent, Madurai Government Rajaji Hospital filed a counter in answer to the contentions raised in the affidavit filed in
support of the Writ Petition in W.P.(MD)No.1960 of 2011. According to the Medical Superintendent, the duty hours of Health Inspector is from
07.00 a.m. to 02.00 p.m. and in case the female Sanitary Workers are made to work under their control, it is not possible to supervise the work of
sanitary staff round the clock. On the other hand, if they are made to work under the control of Nursing Superintendent, the work could be
supervised by the Nursing staff working in wards with over all supervision of Nursing Superintendent. The practice of supervising the Sanitary
Workers by the Nursing Superintendent and the nursing staff was done in public interest, as the sanitation in the hospitals need to be very clean.
The nursing staff have three shifts commencing from 07.00 a.m. and they are supervised by the Nursing Superintendent Grade III round the clock
everyday. So the work of the female Sanitary Workers could be supervised by the Nursing staff at all times with the over all supervision of Nursing
Superintendent. In major wards like maternity wards, ortho wards and ICU wards, the service of the female Sanitary Workers are very essential,
as they had to clean the toilets, bathrooms and remove the waste materials then and there under the supervision of the Nursing staff. Accordingly,
the Medical Superintendent justified the order making the Sanitary Workers to work under the control of Nursing Superintendent.
SUBMISSIONS:
The learned counsel appearing for the petitioner in W.P.(MD)No.1960 of 2011 submitted that all along it has been the practice of the Sanitary
Workers to work under the control of Resident Medical Officer and the said officer used to exercise his authority through the Health Inspector.
According to the learned counsel, the Nursing staff used to compel the Sanitary Workers to do menial work even at their residence and such
inhuman act prompted the Workers to raise their fingers against the Nursing staff. It was only as a counter-blast, the Sanitary Workers were made
to work under the control of Nursing Superintendent, who in turn, would control them through the Nursing Staff. The learned counsel further
contended that the practice of putting the Sanitary Workers under the control of Nursing Superintendent is per se violative of the provisions of
Tamil Nadu Medical Code and as such, the impugned order is liable to be set aside.
The learned counsel for the petitioner in W.P.(MD)No.6037 of 2011, while justifying the order passed by the Director of Medical Education
dated 06.01.2010 and attacking the order dated 27.05.2011, submitted that in matters relating to administration of hospital, supervisory powers
should be given to the Nursing Superintendent and as such, the authorities were fully justified in directing the Sanitary Workers to work under the
Nursing Superintendent and Nursing staff. According to the learned counsel, the Nursing staff are working round the clock and they are directly
dealing with the patients. The Nursing staff requires the assistance of Sanitary Workers for the purpose of cleaning and at no point of time, such
workers were made to work at the residence of Nurses.
The learned Special Government Pleader submitted that the hospital authorities are bound to safeguard the interest of patients and the Sanitary
Workers were made to work under the Nursing Superintendent only in larger public interest. The Resident Medial Officer would not be available
at all point of time and it is practically impossible for him to assign the work directly to the Sanitary Workers. According to the learned Special
Government Pleader, instead of putting the Sanitary Workers under the control of Nursing staff, the hospital is prepared to put them under the
direct control of Nursing Superintendent in-charge, who would ultimately be under the administrative control of Resident Medical Officer. The
learned Special Government Pleader, on instructions from the third respondent submitted that the Medical Superintendent is prepared to abide by
a workable order in larger public interest and accordingly, prayed for appropriate orders in the facts and circumstances of the case.
DISCUSSION:
The Tamil Nadu Medical Department workers and Sanitary Workers Association is aggrieved by the decision taken by the Director of
Medical Education to put the female Nursing Assistants and female Sanitary Workers under the direct control of the Nursing Superintendent.
According to the Association, the said decision was taken at the instance of the Nursing staff, as they wanted the female Nursing Assistants and
female Sanitary Workers to work under their control and even at their residence. The apprehension raised by the Sanitary Workers'' Association
appears to be without any basis. The impugned order dated 06.01.2010 was passed only in accordance with the direction given by the
Government. The Director of Medical Education issued a communication to all Heads of Medical Institutions under the Directorate on
29.08.2008, which reads thus:
It has been brought to the notice of this Directorate that some of the Heads of the Medical Institutions have issued orders to the effect that the
Female Nursing Assistants and Female Sanitary Workers should be under the control of the Residential Medical Officer.
In this connection, attention of the Heads of Medical Institutions is invited to the orders issued in sl.no.110 of the Hospitals Standing Orders
which is narrated below:
The Female Nursing Assistants and Female Sanitary Workers are under the control of the Nursing Superintendent. She is responsible to the
Superintendent for the proper discharge of duties. A defaulter book for these servants will be maintained by Matron in which all punishments
inflicted by the Superintendents will be recorded by her (against the Female Nursing Assistants and Female Sanitary Workers).
Therefore, the Heads of Medical Institutions who have issued earlier orders against the above guidelines are requested to issue revised orders
bringing Female Nursing Assistants, Female Sanitary Workers under the control of Nursing Superintendent.
Any deviation in this regard would be viewed seriously.
The female Nursing Assistants and female Sanitary Workers were made to work under the control of the Nursing Superintendent with a
definite purpose. The Nursing Superintendent would be available throughout the day and they would be working in different shifts. It is not possible
for the Resident Medical Officer to assign the work to the individual female Nursing Assistants and female Sanitary Workers. The Nursing
Superintendent, who is in-charge of the Nursing staff as well as Nursing Assistants and Sanitary Workers, would be in a position to coordinate the
work. After all, it is only in the interest of patients, the hospital and its functionaries are working. The hospital premises should be kept in a clean
and neat condition and the Sanitary Workers are expected to work with a Mission. The possible misuse of a provision is not a valid reason to
quash the decisions taken in larger public interest.
The Nursing Superintendents are working under the control of Resident Medical Officer. The Resident Medical Officer would be implementing
decisions through the Nursing Superintendent. Merely because the female Nursing Assistants and female Sanitary Workers are made to work
under the immediate supervision of Nursing Superintendent, it would not mean that they are not under the control of Resident Medical Officer. The
Resident Medical Officer would be the ultimate authority to take action against female Nursing Assistants and female Sanitary Workers, in case
they are found negligent. Similarly, it is the said authority who is vested with power to look into the complaints of Nursing Assistants and Sanitary
Workers and to redress their grievances.
The principal contention raised by the petitioner in W.P.(MD)No.6037 of 2011 is in respect of the alleged practice of the Nursing staff to
entrust menial work to the Female Sanitary Workers. The female Sanitary workers are not expected to do menial work at the residence of Nursing
staff. In case such directions are issued by the Nursing staff, Sanitary Workers are not bound to do such acts. However, the reason that they
would be compelled to work at the residence of the Nursing staff cannot be a valid ground to set aside the practice of controlling the female
Nursing Assistants and Female Sanitary Workers by the Nursing Superintendent.
Therefore, on a careful consideration of the entire factual matrix, I am of the view that the Director of Medical Education was fully justified in
passing the order impugned in W.P.(MD)No.1960 of 2011.
The Medical Superintendent, through the learned Special Government Pleader, informed this Court that appropriate directions could be issued
to streamline the functioning of female sanitary workers in larger public interest.
RESOLUTION:
Accordingly, while upholding the order passed by the Director of Medical Education, Directorate of Medical Education, Kilpauk, Chennai-10
dated 06.01.2010 and setting aside the order passed by the Medical Superintendent, Madurai Government Rajaji Hospital, Madurai dated
27.05.2011, I am inclined to tailor the directions to make it workable.
(i) The female Nursing Assistants and female Sanitary workers would work under the over all control of Resident Medical Officer. However, in
accordance with Serial No.110 of the Hospitals Standing Orders and the circular issued by the Director of Medical Education dated 29.08.2008,
the female Nursing Assistants and the female Sanitary Workers would work under the immediate control of Nursing Superintendent. The Nursing
Superintendent would, in turn, report to the Resident Medical Officer. The Nursing Superintendent would allot work to the female Nursing
Assistants and female Sanitary Workers. The work would be confined to the hospital and its premises and it would not cover any kind of menial
work at the residence of Nursing staff, Nursing Superintendent or other officers of the hospital.
(ii) The Nursing Superintendent, Nursing staff, female Nursing Assistants and the female Sanitary Workers should work in a coordinated manner
keeping in mind that they are Government servants and their duty is to serve the patients and to see that the patients are given treatment in a
congenial and healthy atmosphere.
(iii) In case the female Nursing Assistants and the female Sanitary Workers are having any grievance, it is open to them to report the matter to the
Nursing Superintendent, who, in turn, would take up the matter with the Resident Medical Officer. However, in extra ordinary situations, if it is
made out that the Nursing Superintendent is not acting as per their request, it is open to them to approach the Resident Medical Officer directly
and the said authority would take up the matter and try to resolve the issues so as to maintain cordial relationship between the employees.
(iv) The control as made mentioned in the circular issued by the Director of Medical Education dated 29.08.2008 and the order dated 06.01.2010
should be construed as supervision for the purpose of carrying out the designated work at the hospital.
(v) It is open to the Medical Superintendent and the Resident Medical Officers to convene meetings of the Nursing staff, female Nursing Assistants
and female Sanitary Workers periodically to ensure their co-operation to administer the affairs of the hospital in an effective and efficient manner.
CONCLUDING REMARKS:
Government servants like the Nursing staff, female Nursing Assistants and female Sanitary Workers appointed for the precise purpose of
rendering specific service to the patients, to maintain cleanness and hygienic condition in hospitals cannot run away from their principal duty by
pleading working difficulties various constraints and difference of opinion between them and the consequential unrest. In case the staff Nurse and
Sanitary Workers engage in fighting each other, it would create an intolerable situation for the hospital administration and the patients in particular
and their habitation in the hospital would be miserable. The initiative should come from the medical, para medical and Sanitary Workers, to work
unitedly and in a coordinated manner, to make the Government Rajaji Hospital at Madurai an advanced Centre of Medical Science both in terms
of treatment and upkeeping. The welfare of the patients should be the paramount consideration of hospital employees. The Nursing staff have
taken a pledge that they would serve the patients to the best of their ability. Similarly, the Sanitary Workers should also rise to the occasion and
without waiting for formal orders from their superiors, they should work to maintain cleanness in the hospital. The differences and disputes would
arise only in case impracticable orders are issued by the superiors to the dislike of subordinates. In case the Sanitary Workers themselves take up
the work assigned to them, as per their terms of appointment and as per requirement, it would avoid a possible rift between different sections of
hospital employees. Therefore, the mind set of the employees should undergo a sea change. The welfare of the patients should be their paramount
consideration and every other thing should just be ignored in the larger interest of hospital administration.
The Writ Petitions are disposed of as indicated above. Consequently, the connected miscellaneous petitions are closed. No costs.