The Telangana government has ordered the filing of a criminal case against a surgeon of the community health centre (CHC) in Rangareddy district’s Ibrahimpatnam, where four women died after a tubectomy procedure on August 25.
The government also ordered disciplinary action against 13 people, including the superintendent (now under suspension) of the CHC, Rangareddy district coordinator of health services, district medical and health officer (DMHO), deputy DMHO, deputy civil surgeon, head nurse, medical officers and supervisors who were found to be at fault.
Without divulging the findings of the inquiry report, the government orders dated September 23 – released Saturday – detailed a slew of recommendations, including mandatory 24-hour post-operative care at the facility, follow-up visits by supervisors for a week, latest infection control procedures and protocols, refresher training for supervisors, quarterly review of sterilisation services and activities, and yearly skill assessment for surgeons, to be followed.
Four women, aged 22 to 26 years, had died in a span of two to four days post the double puncture laparoscopic (DPL) surgery or tubectomy procedure conducted as part of a special camp organised by the state government at the Ibrahimpatnam CHC. Several others developed complications and were treated at private hospitals in the following days. On the day, thirty-four surgeries were performed at the CHC by a single surgeon.
On August 29, the government ordered an inquiry into the incident, following which the state director of public health (DPH) submitted an inquiry report on September 6.
Following this, the government directed the DPH to file a criminal case against the DPL surgeon Dr Joel Sunil Kumar, and directed the Telangana Vaidya Vidhana Parishad (TVVP) to initiate action against Dr Sridhar, the superintendent of the CHC, and furnish a compliance report.
The government order from health secretary S A M Rizvi, dated September 23, also directed the TVVP to furnish draft articles of charge along with relevant material for initiating disciplinary action against Dr Jhansi Lakshmi, in-charge district coordinator of Health Services in Rangareddy district. She was relieved from the post and sent back to the CHC in Shadnagar where she will continue as a civil surgeon (specialist) in her original post.
Another official, Dr Swaraja Lakshmi, the DMHO of Rangareddy district, was transferred and posted as joint director at the office of the commissioner of health and family welfare in Hyderabad. The DPH is directed to furnish articles of charge along with relevant material for initiating disciplinary action against her under rule 20 of Telangana Civil Services (Classification, Control and Appeal) Rules, 1991.
In the order, the DPH has been directed to initiate disciplinary action against Dr Naga Jyothi, deputy DMHO, Ibrahimpatnam, and the DPL camp officer. It has further sought disciplinary action against Chandrakala, head nurse at CHC Ibrahimpatnam; Dr Geeta, deputy civil surgeon, CHC Ibrahimpatnam; Dr Srinivas, medical officer at PHC Madgul; Dr Kiran, medical officer at PHC Manchal; Dr Poonam, medical officer at PHC Dandumailaram; and Alivlu, Mangamma, Jayalatha, and Janakamma, who are supervisors at the PHCs at Madgul, Manchal, and Dandumailaram, respectively.
24-hour post-op care, follow-ups recommended
In the recommendations to the government, the DPH has suggested that DPL surgeries be conducted as fixed-day services along with other services in the hospital and that the DPL beneficiary be mandatorily kept in post-operative care for at least 24 hours at the facility.
His report suggested that the supervisor concerned visit the house of the beneficiary at least once within 24 hours of discharge and at least twice within a week post-surgery. The medical officer, apart from ensuring the supervisors’ visits, is also recommended to visit the beneficiary at least once at home within the first two days post-surgery. He suggested that the superintendent, surgeon and deputy DHMO verify the processes as per SOPs for pre-operative, intra-operative and post-operative care.
The DPH also found a need for refresher training for all supervisory staff on the identification of possible signs of complications in the procedure. Besides, the report recommended that the commissioner (health and family welfare) get DPL surgeons’ skills and knowledge assessed once a year by a competent authority. As per SOPs, only 30 family planning surgeries are to be performed on a single day by a surgeon or institute. The report said the hospital infection control committee, chaired by the superintendent, shall meet every Monday and review the infection control protocols, and a refresher training course shall be conducted for all infection control officers.
Health director Rizvi asked the commissioner of health and family welfare, the director of public health and family welfare, the director of medical education, and the TVVP commissioner to take necessary actions as per the recommendations.
On August 29, the government ordered an inquiry into the incident, following which the state director of public health (DPH) submitted an inquiry report on September 6. (Representational image) 
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