Chhattisgarh sterilisation tragedy: Besides medical negligence, guidelines for operations also violated

These women had undergone operation at a family planning camp organized by the state government in Bilaspur on Saturday.

Written by Ashutosh Bhardwaj | Bilaspur | Updated: November 12, 2014 9:11 am
A woman being taken to hospital on Monday. (Source: Express photo) A woman being taken to hospital on Monday. (Source: Express photo)

As the death toll rose to 12 on Tuesday, three days after the sterilisation camp organised by the state government in Takhatpur block of Bilaspur district on Saturday, enquiries revealed that besides medical negligence, guidelines and procedures outlined for such operations were also seemingly violated.

Of the 83 women who underwent laparoscopic tubectomies, over 50 are still in hospital. Twenty-five of them are reported to be critical.
According to the central government’s guidelines, a medical team cannot conduct more than 30 laparoscopic tubectomies in a day, with three separate laparoscopes — that means not more than 10 tubectomies with a single instrument, as each instrument needs to be properly sterilised after every operation.

The guidelines state that if there are additional surgeons, instruments and supplies, the number of operations per team can be increased, but in no case should it exceed 50. Even then, it puts a cap of 10 operations by a single surgeon with a single instrument.

The hospital where camp was held has been sealed The hospital where camp was held has been sealed

But in Bilaspur, just one doctor, Dr R K Gupta, conducted 83 operations with one instrument in five hours — less than four minutes per operation. Dr Gupta is considered an expert in such cases, and was awarded by Chief Minister Raman Singh on January 26 this year for conducting 50,000 laparoscopic tubectomies.

The government’s guidelines also state that all sterilisation camps must be organised only at “established healthcare facilities” recognised by the Government of India. However, the Bilaspur operations were conducted at a private charitable hospital in Pendri village which has remained closed, almost abandoned, for about a year now.

A health worker who was present at the camp said one room of the hospital was opened, and all the women were made to lie down on the floor for the tubectomies. Though the government claimed to have sealed the hospital yesterday, many people visited it today.

While State Health Minister Amar Agarwal denied pressure to meet targets set under the central government’s family planning scheme, health officials pointed at the data to indicate that they face routine pressure to hurriedly meet the targets.

According to the available records, this was not the first time that so many tubectomies were conducted in a single day. Officers of the family planning department noted that there has not been a single instance in the last several years when the number of laparoscopic tubectomies conducted at a camp by a doctor in a day was less than the prescribed ten. “This figure often crosses 100,” said an official.

Meanwhile, Prime Minister Narendra Modi called up Chhattisgarh Chief Minister Raman Singh on Tuesday and is learnt to have taken strong exception to the incident. “The PM has asked Singh to ensure a thorough investigation & action in the entire issue,” the PMO tweeted.

Significantly, until Modi’s call, the government was reluctant to even admit negligence in the case. Bilaspur CMO R K Bhange had defended Gupta yesterday, saying he is a “senior doctor”. Responding to the demand for the Health Minister’s removal, the Chief Minister had said: “Operations are conducted by doctors, not ministers.”

The state government’s tone seemed to have changed today. Singh suspended Dr Gupta, Block Medical Officer of Takhatpur Dr Pramod Tiwari, Bilaspur CMO R K Bhange and State Coordinator of Family Planning Programme K C Uraon, and ordered an FIR against them. Director, Health Services, Dr Kamalpreet Singh has also been transferred.

While the government announced a compensation of Rs 2 lakh each for the families of the dead yesterday, Singh today raised it to Rs 4 lakh.

In New Delhi, sources in AIIMS confirmed that they had received orders from the Union Health Ministry to send a team of four doctors to Chhattisgarh to attend to the women in hospital. “A multi-disciplinary team of four doctors, including surgeons, critical care specialists and gynecologists, will be travelling to Chhattisgarh tomorrow morning,” said a senior AIIMS official.