Legal Principle & Question Decided

Ruling Summary: This decision was rendered by the Sindh High Court, officially reported as 2026 SHC 570. In this matter between Const. P. 264/2026 (D.B.) Sindh High Court, Bench at Sukkur - Saeed Jahan alias Lala Asad & Another (Petitioner) and the Respondent, the court adjudicated key questions of statutory construction, procedural regularity, and legal precedent under Pakistani law.

Core Holding: The honorable bench evaluated governing statutory provisions and judicial authorities to establish the rights of the parties, delivering the binding reasoning set out below.

Full Judgment Text & Judicial Ruling

COURT: Sindh High Court CASE NO: Const. P. 264/2026 (D.B.) Sindh High Court, Bench at Sukkur CITATION: 2026 SHC SUK 570 PARTIES: Saeed Jahan alias Lala Asad & Another (Petitioner) ORDER DATE: 11-MAR-26 BENCH: Hon'ble Mr. Justice Amjad Ali Bohio, Hon'ble Mr. Justice Ali Haider 'Ada'(Author) A.F.R: Yes ------------------------------------------------------------ IN THE HIGH COURT OF SINDH BENCH AT SUKKUR Constitution Petition No.D-264 of 2026 [Saeed Jahan alias Lala Asad and another v. Province of Sindh and others]

Before:- Mr. Justice Amjad Ali Bohio Mr. Justice Ali Haider ‘Ada’

Petitioners : Saeed Jahan alias Lala Asad and another, through Mr. Khan Abdul Ghaffar Khan, Advocate.

Respondents No.1 to 5. : Through Mr. Ali Raza Balouch, Additional Advocate General Sindh, alongwith Zuhaib Hassan Shaikh, Additional Secretary (Health Department), Dr. Ahmed Mujtaba, Medical Superintendent GMMMC Hospital Sukkur, Dr. Saleh Muhammad Channa, Principal GMMMC Sukkur.

Respondent No.6 : Dr. Azizullah Bhayo, Head of the Orthopedic Department. GMC Hospital Sukkur. (In Person).

Intervener : Dr. Muhammad Sabir Memon, SMBB, Institute of Trauma Karachi, through Mr. Mehfooz Ahmed Awan, Advocate.

Date of Hearing : 05.03.2026.

Date of decision : 11.03.2026.

O R D E R Ali Haider ‘Ada’ J; The petitioners, asserting their status as pro bono litigants, have filed the instant petition primarily seeking a declaration that the newly constructed building meant for the Orthopedic Department at Ghulam Muhammad Mahar Medical College (GMMMC) Hospital, Sukkur, be re -allotted to the said department. The petitioners further seek a declaration that the proposed allotment of the said building to Shaheed Mohtarma Benazir Bhutto Institute of Trauma for the establishment of a Satellite Trauma Center is illegal and without lawful authority. Their principal contention is that the development scheme had originally been approved under the Annual Development Programme (ADP) , specifically in the name of the Orthopedic Department .

Therefore, the purpose of the scheme cannot be altered by the Health Department through a mere administrative letter dated 27.01.2025. 2. After issuance of notices, Respondent No.4, the Medical Superintendent of GMMMC Hospital, Sukkur, filed para-wise comments stating that directions had been issued by the Health Department for establishment of a Satellite Trauma Center in the newly constructed building, and relevant correspondence in this regard was annexed with the comments. On behalf of Respondent No.1, the Secretary, Health Department, Government of Sindh, comments were also filed wherein it was contended that the Orthopedic Department in the previous structure is already functional. It was further stated that the Health Department has released Maintenance and Repair (M&R) funds amounting to Rs. 46,048,500/- in favour of the Medical Superintendent for repair and renovation of the existing building, and the relevant record has also been placed on file. 3. The record further revealed that Respondent No.6, who appeared in person as Head of the Orthopedic Department, also filed comments asserting that the newly constructed building had , in fact, been approved under the ADP scheme for the establishment of the Orthopedic Department. According to him, without any co gent reason or justification, and even without approval of a revised PC-I by the University Syndicate , which, according to him, has authority over such property, the building was diverted for use by the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi. 4. During the course of proceedings, learned counsel for the petitioners placed on record certain documents , including extracts from the Planning Manual, the Budget for the year 2024 –25, and other relevant material. In compliance with earlier dire ctions of this Court, the respondents also filed additional comments and supporting documents. Moreover, an application bearing No.1491 of 2026 was filed through counsel on behalf of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, seeking its impleadment as a party in the present proceedings, which application was moved by its authorized representative. 5. Learned counsel for the petitioners argued that the scheme had originally been approved under a proper ADP scheme for the establishment of an Orthopedic Department at GMMMC, Civil Hospital, Sukkur, keeping in view the

healthcare requirements of the city. It was submitted that the existing building of the Orthopedic Department is in a dilapidated and unsafe condition and is not suitable fo r proper functioning. According to the petitioners, the new building was constructed precisely to establish a modern orthopedic facility for strengthening orthopedic services for the population of the region. However, without following any lawful procedure , the said building has now been handed over to the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, for the establishment of a Satellite Trauma Center. It was contended that such diversion of the building is contrary to the approved scheme an d relevant policy. Learned counsel further argued that although the establishment of a trauma center is indeed a genuine public requirement , the same should be established in a separate building rather than in a building specifically constructed for the Orthopedic Department. He therefore prayed that the instant petition be allowed and that the respondents be restrained from handing over possession of the building to the trauma center. 6. On the other hand, learned Additional Advocate General, in complian ce with the directions of this Court, produced certain documents including a PC -I form relating to ADP Scheme No.1240 (2011 –12), under which the original scheme was approved for establishment of a 5 0-bedded Medical and Surgical ICU and expansion of the cas ualty and OPD departments at GMMMC Hospital, Sukkur. It was further submitted that the said scheme was subsequently revised under ADP Scheme No.1241 and again modified under ADP Scheme No.627 during the year 2014 –15. The record further indicate s that under ADP Scheme No.450 for the year 2018 –19, the project continued in modified form, and later under ADP Scheme No.1257 for the year 2023 –24, it was again revised for the establishment of the Orthopedic Department at GMMMC Hospital, Sukkur. It was also pointed out that a feasibility study report had been prepared by the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, proposing the conversion of the newly constructed building into a Satellite Trauma and Emergency Response Center at GMMMC Hospital, Sukkur. The learned Additional Advocate General contended that although the building had initially been planned for the establishment of a 50 -bedded Medical and Surgical ICU along with expansion of the casualty and OPD departments at GMMMC Hospital, Sukkur, the scheme was subsequently modified and the building was earmarked for the establishment of the Orthopedic Department due to certain

administrative requirements and maintenance considerations. Later on, the Government of Sindh allocated a substantial am ount of Rs.46,048,500/ - for repair, renovation, and maintenance of the existing orthopedic facility, which work is presently in progress. In these circumstances, the policy decision was taken by the Health Department to utilize the newly constructed buildi ng for the establishment of a Satellite Trauma Center. According to him, such a decision is aimed at providing better emergency and trauma care facilities to the public and does not prejudice the functioning of the Orthopedic Department, which will continue to operate from its existing building after renovation. He contended that the petition is misconceived and liable to be dismissed, particularly when the public interest lies in the establishment of additional trauma care facilities. 7. Learned counsel ap pearing on behalf of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, also supported the stance of the provincial government. He submitted that, pursuant to the feasibility study report, it was found more appropriate to utilize the newly c onstructed building for a Satellite Trauma and Emergency Response Center so that the facility may provide a broader range of medical emergencies instead of being confined to a single specialty. He further submitted that orthopedic services themselves form an essential component of trauma care, and therefore , the establishment of a trauma center would not diminish orthopedic services but would rather strengthen them within a broader and more specialized emergency care framework. It was emphasized that the In stitute of Trauma possesses the requisite expertise and experience in managing such facilities across the P rovince, and the proposed center would significantly benefit the public at large. 8. We have heard the learned counsel for the parties and have caref ully examined the entire material available on record. 9. First and foremost, it is essential to examine the specific requirements that the government intends to address in establishing the trauma center in the newly constructed building at the Civil Hospi tal area in Sukkur. In this regard, a thorough examination of the issue has been conducted, drawing on various studies and reports. As part of this assessment, the Assessment of Pakistan's Emergency Care System held on 14-15 November 2017, highlighted serious gaps in the country's trauma care infrastructure. Specifically, it was noted that while many provinces have trauma centers, most are non -functional, undermining the

system’s capacity to make informed decisions regarding the initial transport or transfer of injured patients. For ready refernce the relevant Para is reproduced as under:- 4.4. SCENE CARE, TRANSPORT AND TRANSFER Stakeholders reported that there is a single emergency access telephone number for health emergencies in some provinces i.e. Baluchistan, Punjab, KPK, Gilgat Baltistan (Rescue 1122) with full coverage especially in urban areas and good linkage with service s throughout above mentioned province additionally Sindh province has three different emergency access telephone number i.e. Aman Fourndation -1021, Chhipa Ambulance -1020, Edhi -115, fire brigade Rescue - 1299 . There is also legislation that requires fixed an d mobile telephone carriers to provide free connection to this emergency access telephone number, and this legislation is enforced. Further, it is estimated that the large majority urban of the population knows and can properly use the emergency access number by memory however rural population don’t have access and many of them, none memories these number eventually, though respondents felt that public education on when to utilise emergency care services could help decrease unnecessary calls and unnecessary visits to emergency units. Overall, respondents estimate that one third of the population has coverage by a formal pre-hospital ambulance system in both urban and rural settings, though response times may increase at peak hours in urban settings and are l onger in rural areas where the ambulance available to an extent that impacts care. There is no automated caller location functionality, and dispatch centres cannot reliably link prehospital providers to receiving facilities for communication, due to limita tions of technology at facilities. There is no any kind of laws to protect bystanders who provide help to the actually ill or injured, but there is currently very limited availability of real -time clinical decision support for ambulance providers, with the exception of the control room system(Sindh, Punjab), which could serve as a potential model for expansion to other areas. In general, information about patient presentation, care provided during transport, and immediate clinical care needs is rarely provi ded to the receiving facility prior to arrival, but there is a systematic handover protocol that is usually followed on arrival. Participants felt that developing automated caller localization and improving field -to-facility communication technology would be critical innovations, in particular to facilitate better clinical decision support for prehospital providers and receiving facility preparation. Dispatch of public ambulances to the scene is coordinated centrally for both scene response and inter-facility transfer. Private ambulances also provide inter - facility transfer, but are not coordinated by central dispatch, and the group felt that central coordination of public and private dispatch would be helpful for decreasing inter-facility transfer delays. There are no currently system -wide protocols governing pre -hospital clinical care, and not for destination triage. Discussants report that there are unnecessary delays that impact care when patients are initially taken to facilities that cannot meet their needs and subsequently require transfer. Participants felt that clear system -wide protocols in this area, especially regarding a requirement to confirm facility capacity via dispatchers prior to transport, could improve delivery of patients to the facility best able to provide timely needed care. There is already an inadequate system of trauma centre (most of the province have trauma centre but not functional) inspection to guide decision -making about initial transport or transfer of injured patients, and t here is general consensus amongst dispatchers and providers regarding the capacity of facilities in other

areas (e.g., for cardiovascular emergencies and MNCH emergencies). Stakeholders reported that the number of ambulances is generally adequate to transport patients between facilities, but that the system for transport from the scene is stretched at peak times an d would benefit from additional ambulances and/or better distribution of ambulance stations. There is regulation on the use of ambulances, and it covers licensing as well as norms and standards. Many participants were agreed time targets for responding to highest priority emergency calls, and there are efforts underway to decrease response times. There is written act especially in one province (Punjab Rescue -1122) that requires both a driver and a care provider for ambulance transport, and there are equipme nt standards for ambulances but they run with all kind of protocol which derived from international standards. There is systematic process for healthcare facilities to communicate with one another regarding transfers, and it is generally used, though not universally in rural areas. There are no specific system -wide protocols on emergency conditions to guide first level facility providers in initial recognition, resuscitation, and transfer of patients, and the decision to transfer is usually based on individ ual provider judgment although in some urban areas its appropriate system. Discussants felt that systematic condition -specific protocols to support transfer decisions would be a priority, and that review and better dissemination of the guidance addressing communication around transfers could improve the process and reduce delays to advanced care. There is training and certification of professional prehospital providers in some universities and school of three levels: basic, intermediate and paramedic. It wa s noted that there is urgent near-term need for expanded numbers of professional prehospital providers. There neither is some community -based first aid training courses/medical first response trained for para medical staff for lay -people provided by differ ent groups i.e. Rescue-1122, PRC, some universities and school in Pakistan however, these are not widely available nor are they regulated or delivered in coordinated fashion. Pakistan Red Crescent (PRC) has a training program for volunteer lay (non - medical) ambulance providers who are formally dispatched during disasters, or very occasionally at other times in areas with limited service. The discussion group felt that general community -based training was not a priority and might even cause bystanders to intervene in harmful ways, but felt that targeted training of professional drivers would be valuable to improving timely care. There is currently no ’Good Samaritan’ Law to protect by -standers who provide assistance to the ill or injured, and discussants felt that establishing such a law would be an important priority action.

10. Moreover, the study on the establishment and evaluation of trauma care in Pakistan, published in the International Journal of Health Sciences in 2023, offers valuable insights into t he country's emergency care system. The manuscript was submitted on January 9, 2023, revised on March 18, 2023, and ultimately accepted for publication on April 27, 2023. Conducted by a group of doctors, this research assesses the gaps and challenges in tr auma care, providing recommendations for improving the trauma system in Pakistan. This research emphasizes the need for strengthening trauma care infrastructure, ensuring proper evaluation, and integrating international best practices to enhance patient outcomes across the country. For ease of understanding, the study/article is summarized as follows:

Establishment and evaluation of Pakistan's trauma registry: Insights from a public sector trauma institute.

Dr. Muhammad Sabir Memon Chief Orthopedic Surgeon, Dr. Ruth K. M. Pfau, Civil Hospital Karachi. Executive Director, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Ms. Humera Ismail Epidemiologist & Biostatistician, Manager Research and Development, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan Corresponding author email: humera. 5june@gmail.com

Professor Shehla Baqi Consultant Infectious Diseases, Bronxcare Health Systems, Bronx, New York, USA

Mr. Abdul Mannan Software Engineer, Department of Information Technology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Mr. Ghulam Murtaza Nurse Researcher, Post RN BSCN, Department of Research & Development, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Mr. Nooruddin Rahujo Research and Development Assistant, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Dr. Sehrish Zeeshan Senior Medical Officer, Department of Research & Development, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Mr. Tanveer Ahmed Research and Development Assistant, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Mr. Nooruddin Bhatti System Analysist, Department of Information Technology, Shaheed Moh tarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan

Abstract---Background: The need for a trustworthy Trauma Registry (TR) to enhance patient care and direct trauma prevention strategies has been recognized for a very long time. Objectives: This r esearch sought to establish, develop, and assess Pakistan's first Digital TR at SMBB Institute of Trauma. Methods: Using U.S. DIv5 TR model as starting point, locally adapted digital TR was developed, and several methodologies were used to analyze prevalen ce, characters, and first aid care of trauma, as well as the feasibility of establishing a national TR. The research was conducted at SMBBIT for the period from November 2016 to December 2022. Results: A total of 15,217 patient records were entered into th e TR of whom Majority of patients suffering trauma were youthful 46% and predominantly male 86%, according to the demographic analysis. Direct admission from the accident scene was common 68%, and the preponderance of incidents involved 59% road accidents. In the majority of cases, 64% family

members provided primary care. The leading causes of injury were 75% blunt force trauma and 59% automobile collisions. Orthopedic 35%, neurosurgical 22%, and oro -maxillofacial 12% injuries were the most common. In term s of assault-related injuries, gunshot wounds were a prominent cause of trauma. Majority of 78% patients presented with a mild GCS score, mortality rate was 13%, and the vast majority 64% of patients were recovered. Practical implications: Important implic ations for trauma management, prevention strategies, policymaking, and health education were derived from this study. In regions with a high rate of road traffic accidents, policymakers and urban planners should prioritize enhancing road safety measures. P rioritize adequate training and resources for emergency medical services in trauma care and patient transport. Secure patient transport.

Conclusion: This study provided valuable insights into the demographics, injury patterns, treatments, and outcomes of trauma patients based on the extensive data compiled in TR. The findings emphasized the significance of pre -hospital trauma care and need for targeted interventions, safety measures, and healthcare education. These findings had practical implications for policymakers, city planners, healthcare professionals, and public health advocates, and will guide efforts to enhance trauma care and prevention strategies.

Keywords---database creation, digital health care, Pakistan, public health, trauma registry.

Introduction Trauma is a major cause of morbidity and mortality worldwide, especially in low - and middle -income countries (LMICs) such as Pakistan, where road traffic accidents, falls, burning, and violence are prevalent. These situations necessitate prompt, efficient, and coordinated medical responses. Unfortunately, systemic obstacles such as resource constraints, infrastructure deficits, and a lack of strategic planning based on accurate and pertinent data frequently impede the ability to respond effectively and provide adequate care. According to the World Health Organization (WHO), trauma is the leading cause of mortality worldwide, accounting for over five million deaths annually. This alarming number is projected to increase by the year 2030, primaril y due to the growing prevalence of road traffic injuries, which, as of 2012, are the eighth leading cause of disability-adjusted life years (DALYs), 3-4 Notably, the burden of such injuries falls disproportionately on those in their productive years, resul ting in substantial economic consequences. 5 -6 In Asia, injuries account for one out of every ten fatalities Compared to countries with a high standard of living, Southeast Asia has double the DALYs per 100,000 individuals. 5 This is a consequence of accel erated economic development and urbanization in developing nations, which are accompanied by an increase in injury -related mortality and morbidity. Pakistan, which is 2018 -2019 registered approximately two vehicles annually, is at the epicenter of this pub lic health crisis 9 According to current statistics, a traffic-related fatality occurs every five minutes, with a predicted 77% increase in incidents for 2020 and a 200% increase by 2030. This not only results in approximately 27,500 deaths and 500,000 inj uries annually on Pakistan's roads but also a 3% decline in GDP. The 15 -29 age bracket is substantially affected by road traffic accidents & A robust TR is a crucial tool that has proved effective in addressing these issues in many developed nations. A TR is a structured system

for acquiring, storing, and analyzing standardized data on hospitalized injured patients This information can provide an abundance of knowledge regarding the nature and cause of injuries, the care provided, and patient outcomes TRs c an inform evidence-based practice and policy, quality improvement initiatives, injury prevention strategies, and trauma research, thereby enhancing patient outcomes and decreasing the burden of trauma on society Established in 2016 in Karachi, Shaheed Moht arma Benazir Bhutto (SMBB) Institute of Trauma recognized the imperative need for a trauma registry to effectively respond to this escalating crisis. Trauma registries are systematic, exhaustive databases that document the hospital care provided to trauma patients 12 In addition to providing a valuable tool for evaluating patient care and monitoring hospitalization outcomes, they also provide invaluable data for enhancing the quality of trauma care in institutions. 13 Despite their benefits, trauma registri es can be difficult to maintain, especially in low and middle -income countries like Pakistan. Inadequate funding, infrastructure, and trained personnel…

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