News Tamil Nadu

Maternal Deaths And Alleged Medical Manipulations Rock Madurai Govt Hospital, Dravidian Model Of Healthcare In Question Once Again

October 2, 2023
The Commune

Three maternal deaths occurred at Madurai Medical College Hospital / Government Rajaji Hospital (GRH), and it has been alleged that doctors manipulated the case sheets and patient records after the deaths. As a result of the investigation by the Madurai Collector, there is a recommendation to suspend one of the doctors involved. In protest of this recommendation, the doctors at GRH have decided to halt elective surgeries. Here is a look at each of these maternal deaths in detail which has been brought to light by The New Indian Express journalist Thinakaran Rajamani.

Death Of Semmalar

Regarding the maternal death of Semmalar, the Madurai Collector conducted an audit on 3 September 2023, with the Corporation Health Officer, JD Health, and a Duty Assistant Professor from GRH present. During this audit, a copy of the case sheet was photocopied. The Collector then instructed the Duty Assistant OG to provide a copy of the case sheet for a detailed audit, which was received by the PHC medical officer on 4 September 2023.

Image Source – Thinakaran Rajamani Twitter Handle

Upon comparing the case sheet from 3 September 2023 to the one received on 4 September 2023, the Collector identified several discrepancies, including:

  1. Rewriting of notes and deletion of treatment prescriptions on 28 August 2023, at 05:15 p.m.
  2. Rewriting of the call-over to the cardiologist on 28 August 2023.
  3. Full notes rewritten on 28 August 2023, at 7 p.m.
  4. Rewriting of the full page and deletion of treatment prescription on 29 August 2023, at 7 a.m.
  5. Addition of signatures to notes on 29 August 2023, at 1 pm and 7 pm.
  6. Absence of documented BT (Bleeding time)/CT (Clotting time) on 31 August 2023, but subsequent documentation after an inquiry by the Collector.
  7. Inclusion of new notes on 31 August 2023, at 5 p.m. and 5.15 p.m., detailing episodes of chills & rigors, vomiting, and abdominal distension.
  8. Documentation of ‘Chief Informed’ after death on 31 August 2023, at 5.45 pm, along with the insertion of a signature.
  9. Addition of ‘On Mechanical Ventilator’ after death on 31 August 2023, at 06.00 pm.
  10. Inclusion of notes about TEG and ordering cryo in the notes on 31 August 2023, at 02:00 a.m.
  11. Complete page change on 1 September 2023, at 07.00 am.
  12. Complete page insertion on 1 September 2023, at 08.00 am.
  13. Complete rewriting of the cardiology and radiology call-over page on 1 September 2023.

The Madurai Collector concludes that it is evident that the OG department at GRH fabricated the case sheet after the maternal death to favor their position.

Death Of Kuppi

On 7 September 2023, Collector Sangeetha held a maternal death audit for Kuppi, who had passed away on 5 September 2023 at GRH in Madurai. During the audit, she discovered that the hospital had manipulated the patient’s records.

Image Source: Thinakaran Rajamani Twitter Handle

Changes made before and after the patient’s death included:

Initially, there were no treatment notes recorded for the patient’s visit to Unit (II) OG on 18 July 2023, only the unit seal was entered. However, after the patient’s death, the HR number, along with a description/diagnosis, was entered into the patient’s treatment notes, as if a diagnosis had been made previously. Additionally, ECHO notes were entered on the same page. Advice regarding admission was also retrospectively entered into the patient’s treatment notes after the maternal death.

Collector Sangeetha also noted that the Department of OG at GRH Madurai did not assign an OG specialist to conduct PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan) high-risk camps at Zonal PHCs (Primary Health Centers) as per the guidelines. This was in contrast to GH doctors who were conducting camps at Block PHCs in Madurai District.

In response to these findings, instructions were given to suspend the Medical Officer at GRH Madurai responsible for fabricating the case sheet and patient records. It was also mandated that PMSMA high-risk camps be conducted at Zonal PHCs in accordance with the guidelines.

However, as of the date of this communication, no action had been taken by the Dean and Head of Department (HOD) of OG at GRH. Therefore, a request was made to instruct the Dean of GRH Madurai to take appropriate action in this matter.

Death Of Thilagavathi & Subsequent Complaints By Medical College And PHC Doctors

On 29 September 2023, the unfortunate maternal death of Thilagavathi occurred. Sources indicated that there was a dispute between the Corporation Health Officer (CHO) and PHC doctors, who believed the cause of death to be postpartum hemorrhage (PPH), and the medical college (GRH) doctors, who suspected dengue as the cause. This suspicion arose because Thilagavathi’s husband had received dengue treatment at a private hospital. The CHO’s team reportedly took a blood sample from Thilagavathi’s body at GRH in an attempt to support their claim.

In response to this situation, the medical college doctors at GRH wrote a letter to the Dean of the institution, expressing their opposition to the actions taken by the CHO’s team. They criticized the CHO’s team for entering GRH, making photocopies of patient records, and other activities.

Following this, 22 Primary Health Center (PHC) Medical Officers composed a letter addressed to their Corporation Commissioner. In the letter, they pointed out that a significant number of maternal deaths in Madurai district had occurred at the medical college (GRH) hospital after referrals from their PHCs. They highlighted the district Collector’s findings regarding the fabrication of case sheets as part of their concerns.

The Tamil Nadu Government Doctors Association (TNGDA) has adopted a resolution in which they call for the suspension of the Corporation Health Officer (CHO) and request that approximately three out of six Maternal Death Audits be discontinued.

TNGDA has accused the CHO of providing information to a newspaper, claiming that maternal deaths are being concealed. In the event that their demands are not met, TNGDA decided to cease conducting elective surgeries starting from 3 September 2023.

This news comes at a time when there is a visible spike in the cases of alleged medical negligence in government hospitals in the state, some involving women and children. Very recently, a woman who went to the Rajiv Gandhi Government Hospital in Chennai for an angio treatment had to get her arm amputated allegedly due to medical negligence of the doctors.

The healthcare system in Tamil Nadu is facing severe challenges, particularly affecting the underprivileged population. It is crucial for the DMK government, which takes pride in the “Dravidian Model” and portrays Tamil Nadu as a pioneer in healthcare, to address these issues promptly.

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