Victims of the numbers game

25 March, 2016

More than a year after 13 women died in a mass sterilisation camp in Chhattisgarh, it is far from clear whether lessons have been learnt or justice done

Sixteen months after a mass sterilisation camp conducted by the government of Chhattisgarh resulted in 13 deaths and 65 injuries, viscera reports — from the Central Forensic Science Laboratory in Ramanthapur, Hyderabad, and from the Central Drugs Laboratory, Kolkata, to go with an earlier one from the State Forensic Science Laboratory in Raipur — have dismissed the ‘rat poison’ theory. Mounting evidence indicates that the surgical staff had used the same hand gloves, injections, syringes, sutures on all the 83 women, resulting in life-threatening infections.

The turn of events

On November 8, 2014, Dr. R.K. Gupta, a surgeon at Bilaspur District Hospital, conducted laparoscopic tubectomies on 83 women in the space of 90 minutes in an abandoned building. Amidst reports of medical negligence — Dr. Gupta had spent approximately three-four minutes per patient, and not followed infection control protocols — the State Health Department claimed at a press conference that the drugs Ibuprofen and Ciprocin, prescribed to the victims as post-operative care, were laced with rat poison.

A situational assessment report ordered by the State government that month established that the premises where the tubectomies were conducted had not been disinfected properly: “A sweeper had mopped the walls. None of the surgical staff changed their hand gloves. The same injection, needle and suture were used for all the women. Neither were they sterilised nor new needles taken for each case.” It further added that Dr. Gupta used only one laparoscope, without disinfecting it after each use. A laparoscopic surgery is a minimally invasive surgery where a thin surgical instrument is inserted into the abdomen. The report was authored by experts from Population Foundation of India (PFI), Family Planning Association of India, and Parivar Sewa Sanstha. (Dr. Gupta was released on December 5, 2014.)

Besides criminal medical negligence, the Takhatpur sterilisation camp brings to attention the reality of India’s family planning programme — which achieved notoriety during the Emergency years (1975-77) when a compulsory sterilisation programme to limit population growth was introduced by the Indira Gandhi government.

The deaths in Takhatpur camp reveal that, on paper, the policy might have evolved but the programme still continues to be driven by targets, threats and coercion. The stress of targets brought to bear upon government doctors is immense. For 2013-2014, every district in Chhattisgarh was given a sterilisation target to meet, in violation of Union Health Ministry norms. Doctors in Bilaspur had an ‘ELA’ (Expected Level of Achievement) of 3,000 sterilisations and 3,000 Intrauterine Contraceptive Device (IUCD) insertions within a fortnight. For Takhatpur nagar panchayat, the doctors had to sterilise 300 women or risk losing the budget for the next year.

On February 27, 2013, a memo issued by Chief Medical and Health Officer (CMHO), Bilaspur, expressed disappointment at the government doctors not meeting targets, calling their performance “atyant niraashajanak” (extremely disappointing) for having met only 33-79 per cent of the targets in various districts of Chhattisgarh. It added that the doctors had “only 38 days in the current financial year to meet the targets, failing which they will, personally, be held responsible”.

“If these targets are not achieved, the staff is threatened and, in some cases, their salaries and increments withheld,” the multi-organisational report stated.

When asked about targets, Dr. Gupta told The Hindu: “If I am wrong, all my senior officials are also in the wrong. They gave me these targets. They knew exactly what was happening.”

Or as Poonam Muttreja, Executive Director of PFI, puts it, “The policy is designed to kill women. While the doctor cannot absolve himself of negligence by pointing fingers at the administration, it is correct that the system is at fault and targets are in place. Legally, targets are not allowed in India but these programmes have ELAs, basically an estimation of how many women need family planning assistance. It is much the same as other diseases such as tuberculosis or malaria where you stock drugs keeping in mind the number of people needing these services. But in family planning, these numbers are being used as targets.”

According to Ms. Muttreja, while the Centre’s policy uses the right language, there is no effort made to ensure than lower-level staff understand it: “We are now working with the government, which has been receptive of our feedback. This incident is a wake-up call for us to rework our policy intervention.”

The cover-up

Death certificates, post-mortem reports, viscera reports (of parts of the small intestine, stomach, liver, spleen and kidney), forensic reports on the drugs’ toxicity and the police’s charge sheet indicate medical negligence by the doctor and the surgical staff.

While 15 drugs and 18 medical devices were used during the surgery, only Ciprocin and Ibuprofen were tested for contamination. Between December 2014 and January 2015, viscera reports from the State Forensic Science Laboratory in Raipur of all 13 women established that there was only Ciprofloxacin and Ibuprofen in the organs, categorically stating that no “raasaynic vish” (chemical poison) was detected from the organs.

The Chhattisgarh government gave Rs.4 lakh each to the families of the dead women; those injured received Rs.50,000 each. A fixed deposit of Rs.2 lakh was opened for children of the women who had died and the State government announced that it would “adopt” the children of all affected families. Neither has happened. Meanwhile, since his dismissal from Bilaspur District Hospital, Dr. Gupta sees patients in his private clinic in Bilaspur.