Aparesh Kumar Singh, J.:— Appellant was granted provisional bail on medical grounds by order dated 11.05.2018 on consideration of the submissions of the parties and the grounds urged on behalf of the appellant on the basis of the pathological report and discharge summary of RIMS and AIMS. It was submitted that the Chronic Kidney disease had reached to a stage where further deterioration may have serious complication on his overall health. The level of GFR i.e. 38 was shown to be indicative of Chronic Kidney Disease Stage-III. If it went down below 30, it would entail more serious complication. Other parameters of pathological report relating to Hemoglobin level, platelet count, TLC count, Urea level, Creatinine level were also relied upon by the appellant to seek permission to undertake treatment at any Super Specialty Hospital where such diseases are treated in particular. Four serious ailments were essentially projected on behalf of the appellant i.e. (i) Chronic Kidney disease, (ii) Uncontrolled Diabetes, (iii) Per-anal abscess and (iv) Concentric LVH Grade-II Diastolic dysfunction.
2. This Court upon consideration of the submissions of the learned Senior Counsel for the appellant and learned ASGI as well as reports, was of the opinion that it would be rather safe from the point of view of life and overall health of an individual, even if he is a convict undergoing sentence of an offence of serious nature, to avail of any better treatment in the Super Specialty Hospital within the country. Such a course appeared to be advisable at that stage before his medical condition may become more serious or critical. Accordingly, provisional bail was granted to the appellant for a period of six weeks, which was extended by order dated 22.06.2018 up to 03.07.2018 by a Coordinate Bench presided by Hon'ble the Acting Chief Justice.
3. Appellant again prayed for further extension of the provisional bail through I.A. No. 5189/2018. It was submitted on behalf of the appellant that he had been admitted in Asian Heart Institute, Mumbai for treatment on 23.05.2018. The medical team of Asian Heart Institute, Mumbai made an evaluation of his medical conditions and also examined the pathological reports. Based on the investigation report, M.R. Fistulogram was also conducted. It was opined that anal fistula and persistent/recurrent infection in the presence of artificial aortic valve had a potential for infective endocarditis which can be life threatening in view of his poorly controlled diabetes, compromised renal function and low immunity. He was advised surgery of Fistula in Ano and other treatment to control blood sugar, apart from dietary advice. He was asked to follow up after two weeks. The appellant got himself admitted on 19.06.2018 and underwent surgery on 24.06.2018. He was undergoing recovery in the same hospital. The GFR count had gone up to 55. The medical team of Asian Heart Institute was of the opinion that his diabetic condition is to be stabilized and infection caused due to recurrent anal abscess (Fistula) had to be controlled, so as to address the other two issues relating to Chronic Kidney disease and Heart condition. He was on daily dose of insulin.
4. Learned counsel representing the appellant, after referring to this report, prayed for extension of provisional bail for four months, stating that the issues which require attention in order to stabilize his condition, were being gradually addressed. He was under close monitoring for control of diabetes and kidney function and recovery from surgery and there is no allegation of any misuse of provisional bail from any quarters.
5. Learned ASGI countered the submissions made on behalf of learned Senior Counsel for the appellant by stating that the appellant is not facing any such life threatening disease which could not be treated and addressed at RIMS. This court took note of the reports of Asian Heart Institute that he had undergone surgery on 24.06.2018 at the said hospital and his GRF count had also improved from 38 to 55 which is an index of the condition of Kidney (CKD). Appellant was undergoing recovery at Asian Heart Institute under monitoring by the doctors there and there was no allegation of misuse of provisional bail.
6. Considering the progress in the medical condition of the appellant and improvement in GRF count from 38 to 55, this Court came to the opinion that extension of provisional bail for a period of further six weeks would suffice. Appellant was asked to submit a report on his medical condition one week before the expiry of six weeks period with copy to the learned ASGI to enable him to seek instructions in the meantime as well.
7. Thereafter on 10.08.2018, appellant prayed for further extension of provisional bail by I.A. No. 6978/2018, stating that he has been admitted on 06.08.2018 in Asian Heart Institute, as per the advice of the doctors of the Institute. Learned ASGI also sought time to take instruction on the document enclosed to the Interlocutory application and supplementary affidavit filed on 08.08.2018. Since there was a Full Court Reference at 11.30 am on 10.08.2018 to condole the sad demise of a Senior Advocate of this Court, due to paucity of time as well, provisional bail of the appellant which was to expire on 15.08.2018, was extended till 20.08.2018 on the same conditions.
8. It is pertinent to mention that, as per the present distribution of roster, this Court is sitting in single only on Friday when such matters are listed before it. On 17.08.2018 i.e. Friday when the matter was taken up, learned Senior Counsel for the appellant pointed out that the provisional bail of the appellant is going to expire by 20.08.2018 and that he is presently admitted in Asian Heart Institute, Mumbai. On that day also, as per the Resolution of this Court, this Court and its offices as well as Subordinate Civil and Criminal Courts of the State were declared to be closed from 11.00 am as a mark of respect to the departed soul of former Prime Minister Late Atal Bihari Vajpayee. Again due to paucity of time, matter could not be heard on merits. As such, it was posted on next Friday i.e. today and provisional bail of the appellant was extended till 27.08.2018.
9. Learned Senior counsel for the appellant has today sought to press the prayer for extension of provisional bail of the appellant for another four months. He has drawn attention of this court to the reasons recorded in the orders dated 11.05.2018 and 29.06.2018 and the investigation reports/medical opinion of the doctors at Asian Heart Institute, Mumbai which persuaded this Court to extend the provisional bail of the appellant till 15.08.2018 as his medical conditions were improving. Learned counsel has referred to the opinion of the doctors contained in the supplementary affidavit dated 14.08.2018 and also in the supplementary affidavit dated 21.08.2018. He has placed the case summary of the appellant recorded on 13.08.2018 by the doctors of Asian Heart Institute at page-9 of supplementary affidavit dated 14.08.2018. According to him, appellant has been found to be suffering from Bactereamia. He had also complaints of Abscess in Supra Pubic Area and was suffering from uncontrolled Diabetes Mellitus; Pus culture was sent on 08.08.2018 which showed gram negative bacteria. Doctors at Asian Heart Institute, Mumbai upon ultrasonography (KUV) done on 07.08.2018 found right renal non obstructive calculus at lower calyx; severely enlarged prostate (prostate volume 90CC) with medium lobe hypertrophy of prostate and post void residue as 20cc. He was advised to continue medical management. They also opined that there was need for Trans Urethral Prostatic Resection on further progression of symptoms or intolerance of medication in view of past history of postural hypotension as after he had undergone fistulectomy, rectal examination revealed that surgical part is partially healed and was advised to continue laxative; appellant had high urine micro albumin level of 2564 mg/litre, Urin Albumin/micro albumin/creatinine ratio was high (3637 mg/d), which showed active infection. In view of Diabetic Nephropathy and Chronic Kidney disease, he had been admitted in Asian Heart Institute for further management. Another opinion of the doctor of Asian Heart Institute dated 16.08.2018 enclosed to the supplementary affidavit dated 21.08.2018 has also been placed by the learned Senior Counsel for the appellant in order to impress that the appellant is required to undergo at least three surgeries (i) for removal of cataract (ii) for correction of enlarged prostate and (iii) to remove kidney stone. Doctors have been following his treatment to monitor his infection. Appellant for such reasons, requires further treatment at Asian Heart Institute, Mumbai. There has been no allegation of misuse of provisional bail by him. As such, the provisional bail granted on medical grounds be extended for four months.
10. Learned ASGI has referred to the treatment papers of the appellant obtained by the CBI from the medical records of Asian Heart Institute & Research Centre Pvt. Ltd., Mumbai. Learned ASGI has made specific reference to the original case summary reports of patient for current admission and also the reports, treatment sheet, progress report, etc. enclosed to it. In particular, learned ASGI has referred to the Daily Nursing Assessment of the appellant starting from 09.08.2018 till 13.08.2018 on his readmission to the Institute on 06.08.2018. He has further made reference to the pain assessment sheet apparently for the same period. He also refers to the summary of opinion of the doctors of the Institute dated 13.08.2018 which incorporates his medical history on multiple admission to the Institute for the period 23.05.2018 to 04.06.2018; 20.06.2018 to 08.07.2018; and lastly on 06.08.2018. This summary is on the same lines as referred to in the medical opinion of the doctors of the Institute dated 13.08.2018 enclosed to the supplementary affidavit of the appellant. Learned ASGI has drawn the attention of the court to these reports and emphasized that even by the opinion of the medical experts of Asian Heart Institute, Mumbai, patient requires monitoring and medical treatment in view of Diabetic nephropathy and Chronic Kidney disease. There are no life threatening situation at the present which the appellant faces. Appellant requires control of infection through management and monitoring of his medical condition. It does not require extended treatment at a Super Specialty Hospital. The opinion of the doctors of Asian Heart Institute, Mumbai do not convey that ultrasonography (KUV) done on 07.08.2018 which revealed right renal non obstructive calculus at lower Calyx and severely enlarged prostate require immediate intervention. Doctors have advised continued medical management and that there is need for Trans Urethral Prostatic Resection on further progression of symptoms or intolerance of medication in view of past history of postural hypotension. Learned ASGI further submits that this court while taking note of the specific medical condition of the appellant, had granted indulgence to him to avail of Super Specialty treatment at any hospital, keeping into mind that further deterioration of his ailment like Chronic Kidney disease may lead to serious complication on his overall health. It was considered safe to allow him to undergo treatment for such medical condition before it may become more serious or critical. Appellant has availed of the provisional bail granted on medical grounds to undertake such treatment for considerable period of time. The opinion of doctors and investigation reports taken together, do not convey an impression that the appellant could not be treated by continued medical management at Ranchi itself. The benefit of provisional bail therefore should not be extended further.
11. I have considered the submissions of the learned counsel for the appellant and learned ASGI representing the CBI and taken note of the reports and opinion of the doctors of Asian Heart Institute, Mumbai brought on record by the appellant and also reflected through the compilation furnished by the learned ASGI obtained by the CBI from the medical records of Asian Heart Institute and Research Centre, Mumbai. The reasons for grant of provisional bail on medical grounds have been dealt with in the orders dated 11.05.2018 and 29.06.2018. GRF count of the appellant has improved from 38 to 55. Appellant had undergone Fistulectomy on 24.08.2018 to treat recurrent peri-anal abscess which was considered necessary to control infection as it had a potential for infective endocarditis which could be life threatening in view of his poorly controlled diabetes, compromised renal function and artificial aortic value. He was undergoing recovery in Asian Heart Institute from where he was released on 08.07.2018. The opinion of the doctors of Asian Heart Institute dated 13.08.2018 and 16.08.2018, referred to above in some detail, has primarily found him suffering from infection for which he has been started with anti-biotic treatment. Ultrasonography (KUV) done on him revealed right renal non obstructive calculus at lower Calyx, severely enlarged prostate. Doctors advised him to continue medical management. They are of the opinion that Trans Urethral Prostatic Resection could be required on further progression of symptoms or intolerance of medication in view of past history of postural hypotension. Patient requires monitoring and meticulous treatment in view of Diabetic nephropathy and Chronic Kidney disease. Evidently, appellant has availed of Super Specialty treatment during the period of his provisional bail for twelve weeks and more by now. He has been attended by the doctors at Asian Heart Institute, Mumbai for treating his infection which could be a cause for concern considering the GRF count of 38 which was an indication of Chronic Kidney disease. His GRF count has improved and so has he been attended upon recurrent peri-anal abscess. The prognosis of the doctors of Asian Heart Institute, as evident from the reports dated 13.08.2018 and 16.08.2018, do not create an impression that the appellant is either facing life threatening situation or requires immediate intervention. Continued medical management and monitoring has been advised to him. This can very well be taken care of while he is in custody at Ranchi in Rajendra Institute of Medical Sciences (RIMS) under close supervision of doctors. Doctors at RIMS may, if required, also keep in touch with the doctors of Asian Heart Institute and Research Centre, Mumbai for continued medical management and monitoring. Doctors at RIMS would undertake the assessment of the medical condition of the appellant for the purposes of monitoring and medical management of his conditions. Whether any specialized treatment is required in future would depend on the evaluation and opinion of the doctors at RIMS, Ranchi. If his condition is found to be satisfactory and improving, it would be open for the doctors at RIMS to refer him back to Birsa Munda Central Jail, Hotwar, Ranchi on such evaluation of his treatment.
12. Considering these facts and circumstances, this Court is of the opinion that no further extension of the provisional bail of the appellant is required. Doctors at RIMS, Ranchi are required to address his medical condition by monitoring his treatment for infection. As such, this Court is not inclined to accede to the prayer for extension of provisional bail granted to the appellant. I.A. 6978/2018 stands rejected. The provisional bail of the appellant is going to expire on 27.08.2018. Learned counsel for the appellant has prayed for few more days' time for him to surrender as he is to be discharged from the Asian Heart Institute, Mumbai where he is admitted. As such, appellant should surrender before the Learned CBI Court on or before 30.08.2018 without fail.