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HUMAN RIGHTS

LAW NETWORK

A B H I S H E K D W I V E D I

M A Y A N K V E R M A

R U C H I R R A N J A N R A I

S U R A B H I M I S H R A

ALLAHABAD

A REPORT ON THE CASE OF MEDICAL

NEGLIGENCE IN A PRIMARY HEALTH CENTER OF

KARARI TOWN, KAUSHAMBI DISTRICT, U.P

Incident related to pregnant woman allegedly being thrown

out of the Primary Health Centre by the Nurse.


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FACT FINDING COMMITTEE

NAME E-MAIL CONTACT OCCUPATON

ABHISHEK DWIVEDI [email protected] 9721426258 Student,Dr.RMLNLU,Lucknow

MAYANK VERMA [email protected] 9889309908 Student,Dr.RMLNLU,

LucknowRUCHIR RANJAN RAI [email protected] 9415346505 Student,Dr.RMLNLU,

Lucknow

SURABHI MISHRA [email protected] 8149458377 Student, NLC,BVP,Pune

UNDER THE GUIDANCE OF:-

Mr. K.K.Roy, Advocate, Allahabad High Court


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SUBJECT MATTER OF INQUIRY

- On 12.11.2011, Smt. Saroja Devi w/o Dhanraj (Schedule Caste) R/o Ansarganj P.O.Karari, Kaushambi district was thrown out of the Primary Health Center, Karari by the

A.N.M of the hospital at 9. A.M. in the morning. This forced the victim to deliver the

baby at her home without any medical assistance between 3.00P.M -4.00 P.M on the

same day. The husband visited the hospital at 4.30 P.M to inform the nurse and ask her

for medical assistance but claims that he was denied any such medical assistance or

guidance. The victim despite being admitted in the hospital in the night of 11.11.2011was neither registered nor was issued a bedhead slip. The family of victim claims that the

victim was not given proper medical attention while being in the hospital. The Asha or

the village level health worker did not take any steps to ensure the availability of medical

assistance for the victim and her child.

DETAILS OF THE FACT FINDING VISIT

- The team comprising of Abhishek Dwivedi, Mayank Verma, Ruchir Ranjan Rai andSurabhi Mishra reached the Karari District at 12.05 oclock where they were received by

Mr. Rehan, co-coordinator of Doaba Kalyan Samiti, Kaushambi. The team first recorded

the testimonials of the victim and her husband at their home. Then the team visited the

local Anganwadi center which was a makeshift room in the house of the Anganwadi

worker. The worker was not present. So the team recorded the statements of the helper at

the Anganwadi center. The team then visited the Primary Health Center (PHC) to record

the statement of the accused nurse and the rest of the hospital staff. The team recorded

the statements of the accused, the M.O and the Asha who was called from her home. The

team also recorded the information regarding the investigation provided by the Station In

charge at the Karari Town Police Station. The testimonials are attached with the report.


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FACTS

1. There was gross negligence on the part of the hospital administration in admitting thevictim. No bed-head slip or any kind of registration slip was issued to the victim despite

the fact that she was admitted in the hospital.

2. Victim was not paid proper attention during her stay at the hospital. Nobody was there tomonitor her condition or her arrival or departure.

3. The village level health worker (Asha) failed miserably in discharging her duties.a. She was not regular in visiting the pregnant ladies in the area.b. She failed to take the victim to hospital thrice as given in the Janani Suraksha Yojana

guidelines. She was not there in the hospital when the victim was admitted.

c. She did not visit the victim even once during the whole pregnancy tenure. She failedto motivate the victim for institutional delivery.

d. She failed to take the victim to hospital during the delivery time. Husband took thepregnant lady on his own cycle.

e. She was not present with the victim during the delivery. Therefore, she also failed toregister the time and date of birth of the child.

f. She failed to arrange for the immunization of the new born baby. She did not visit thevictim post-delivery.

4. The victim was not given any kind of counseling regarding the pregnancy and child caredespite specific guidelines under Janani Suraksha Yojana.

5. The designated Medical Officer did not take necessary steps to ensure properimmunization of the child and counseling of the mother.

6. No enquiry was conducted by the M.O in concern with not registering the victim in thehospital. Despite the clear evidence of negligence on the part of nurses, no action was

taken by any of the Medical officers or the Chef Medical officer or his office.


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7. The C.M.O did not conduct any enquiry in the matter despite the fact that the news waspublished in leading newspapers of the state.

8. The District Magistrate and the S.P of Kaushambi District did not take any steps toensure action in the present case despite letters from the father-in-law of the victim.

9. There was no proper Anganwadi center. A makeshift center was run in the house of theAnganwadi worker in a small room. No proper diet charts and other information were

available in the center.

10. The Anganwadi worker was not present at the Anganwadi center. The helper presentthere did not have any knowledge about the diet chart, quantity or any other technicalities

related to the distribution.

11.There was no measurement mechanism in place in Anganwadi center to determine thequantity of the food provided to the beneficiaries of the Jananni Suraksha Yojana.

12.The distribution register showed an entry of the victim on the date of 19.11.2011 in thepregnant section. This means that the victim was given nutritional food on 19.11.2011

claiming that she was pregnant at that time. But the delivery had already taken place on

12.11.2011. This clearly highlights the negligence and anomaly on the part of Anganwadi

worker.

13.The A.N.M failed to supervise the working of the Asha and to direct her to undertake allthe omitted actions as mentioned above.

14.The Anganwadi worker as well as the ANM failed to provide the folic acid and irontablets for three months to the victim in violation of the Janani Suraksha Yojana

guidelines.

15.The Janani Suraksha Yojana talks about providing Rs. 500 to the women who deliver thebaby in their home and not in institutions. But the victim was not provided any such

money or any kind of compensation.

16.The provision for the counseling of the pregnant lades to motivate them for institutionaldelivery and to educate them about proper child care has not been implemented in the

village as most of the women in the village were apprehensive about the institutional

delivery if they will be taken to horror chambers. They complained about rude and harsh

behavior on the part of hospital staff during the delivery.


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17.The Primary Health Center, Karari was not properly maintained. The campus had noboundary wall with stray animals roaming inside the campus. The campus hygiene was

not up to the level of a hospital.

18.The hospital lacked the facility of a proper waste disposal system. There was nomechanism to refuse the waste from the hospital premises.

19.The hospital lacked the facility of electricity back up due to which it was very difficult tohandle the complicated cases within the hospital as most of the equipment requires

electricity to work.

20.The hospital did not have an ambulance to move the patients. This is one of the biggestproblems in determining feasibility of hospital to the pregnant women. In the present

case, the victim was brought to hospital on a cycle.


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RECOMMENDATIONS

1. The state must take action against the hospital staff for gross negligence as the hospitalstaff failed to admit the victim or even register her. The victim was denied her right to

choose the time and place of her delivery. She was subjected to physical and verbal

abuse.

2. The State must hold the C.M.O and his office accountable for not taking action againstthe hospital staff despite information of the anomaly in the hospital working.

3. The state must pay compensation to the victim for the difficulties she faced during herdelivery time. She was not only denied her fundamental reproductive rights but was also

subjected to mental abuse. Anything could have happened due to the absence of the

medical assistance which is her right.

4. The state must take steps to ensure that victim is provided all the medication and care sheis entitled to by the Anganwadi center and the PHC.

5. The Asha must be supervised to undertake the work she has been allotted. She must bemade accountable along with the A.N.M. There should be a performance report of the

activities of Asha and ANM.

6. A committee of local citizens should be made to monitor the activities of the Asha andANM and submit a monthly report to C.M.O and the district Ombudsman.

7. A system of performance based incentive should be started to motivate the Ashas toperform their duties in a systematic and regular way.

8. The Primary Health centers should be properly maintained and a monthly inspectionshould be done by the District Magistrate. The C.M.O should visit each of the Health

Centers under his supervision, every week.

9. The PHC should be enclosed with a boundary to protect it from stray animals which isnecessary to maintain the hygiene in the hospital.

10.An ambulance should be allotted to the PHC to facilitate the movement of patents fromhome to the hospital as the condition of a pregnant lady is generally very delicate during


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the last month of the pregnancy.

11.The PHC should have an electricity backup system to ensure smooth functioning of thePHC even when there is no electricity in the area. This is very critical in handling the

complicated cases and the cases which are reported in night.

12.The state must ensure that this kind of incidence is not repeated as it will not only act asan obstacle in promoting institutional deliveries. The state must act to make people

believe in the institutional deliveries. But such incidences will only worsen the situation.


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for 40 days after the delivery to save the child and mother from evil powers. This custom is one

of the biggest hurdles in institutional deliveries. But a custom can be changed by creating a more

strong public consciousness in favor of a reform. A custom which is irrational and which is

against the public welfare has to be eliminated. This can be achieved only by proper counseling

and motivation of the women, specifically the women of the vulnerable group. The drafters of

the JSY guidelines were very clear in this regard and have incorporated the above as a function

of the village level health worker (Asha). But, leave counseling aside; the Asha is not even

regular in visiting the pregnant ladies, as highlighted by the present case. The victim was not

given proper medication, counseling or even basic health guidelines even after the delivery. The

husband informed the ANM about the delivery but the ANM failed to discharge her duties by not

directing the Asha to visit the home of the victim. The husband of the victim also informed about

the delivery to the M.O after two days but the M.O herself failed to direct the ANM to take

proper measures in this direction. The victim also complains of misbehavior on the part of the

ANM which is not surprising as there have been a number of cases where the violation of right to

privacy and freedom from degrading treatment has come up in which the women who try toaccess the services guaranteed by JSY or NRHM have met with physical and verbal violence at

the hands of the hospital staff. This kind of misbehavior is more in case of the vulnerable groups.

Another important factor is the poor condition of the Anganwadi center in the villages. There is a

state of arbitrariness in their functioning. For example, the Anganwadi center in the above case

was a makeshift small room in the house of the Anganwadi worker herself. The Anganwadi

center had no proper system for the distribution of the nutritional food. The women were

provided food by a small bowl which itself was not in proper shape. The helper present there had

no information about anything related to the distribution standards. The Anganwadi worker was

absent when the team visited the center. Her leave application was pinned up on a board insidethe makeshift center and had no signature or sanction from the designated authority to which it

was addressed. The situation was an indication to the deep rooted non-accountability in the

system. There was anomaly in the distribution register also. The success of the bottom up

approach of the JSY and NRHM totally depends on the village level workers. Any anomaly on

their part will be lethal for the success of the mission.

India despite being one of the fastest growing economies has a place in the five countries that

have the worst mortality rate at 250-300 per lakh. And State of U.P. is among the 10 low

performing states under the JSY with a mother mortality rate of 440. The arbitrariness itself is an

indicator of discrimination. Justice Bhagwati had said in one of his judgments Any act which isarbitrary in itself, is a violation of the right to equality. His statement summarizes the situation in

one line. The vulnerable and the poor are being put to suffering due to the lack of accountability

and this widely present arbitrariness. To achieve better results in this field planned strategy is

required. State will have to take measures in a war footing. The health development has to be

inclusive of the poor and neglected. Its time that we synchronize our developmental goals with

uplifting and social welfare policies. Reform must begin from the lower level. These kinds of


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incidences are a threat to the concept of inclusive growth and the availability of the health rights

to the poor and thus, must be checked. The dignity and respect of the women must be restored.

And for achieving this goal, availability, promotion and protection of the sexual and reproductive

rights is necessary.

Abhishek Dwivedi

Mayank Verma

Ruchir Ranjan Rai

Surabhi Mishra


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TESTIMONIALS

TESTIMONIAL OF THE VICTIM: SMT. SAROJA DEVI W/O DHANRAJ (SCHEDULE

CASTE)

Place: Ansarganj, Karari Town, Kaushambi Distt.

Date: 10.12.2011

Time: 12.06 A.M

I was taken to the hospital by my husband, mother-in-law and my father-in-law in the night of

11.11.2011. I stayed in the hospital for whole night. The pain was minimal during the night. The

hospital staff was not providing proper attention to me despite continuous requests by my

mother-in-law. In morning, around 9.A.M, the nurse Sarojini Amma came to my bed and asked

my mother-in-law what has happened to me. My mother-in-law replied that it is visible what has

happened to her. She inspected me and said that there is a lot of time in the delivery and asked us

to leave. My mother-in-law asked her about the time and she replied that it will be at least 2-3

days before the baby is born. She asked us to leave again. I and my mother-in-law told her that

we would like to stay. But she asked us to leave and forcibly moved me out of the bed by pulling

my hand. There was heated exchange between Sarojini Amma and my mother-in-law. She asked

us to leave again. After that she left. We kept standing there. She came again after sometime and

asked us that why are we standing there when she asked us to leave. My mother-in-law requestedher to let me be admitted but she refused. She warned us to leave and left again. We kept waiting

there as my husband was not there. She came again after some time and scolded us for still

standing there. After sometime, my husband came and brought me back to home on his cycle.

The pain had increased from morning and it kept on increasing. Finally, after noon, the baby was

born. No doctor, nurse, Asha Bahu, or helper came to provide any medical assistance.

Question: What is your age?

Answer: 24 years.

Question: What is your education?

Answer: I have never gone to school.

Question: How do you know the name of the nurse?

Answer: My mother-in-law was calling her sarojini Amma.


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Question: Did Sarojini Amma abuse you?

Answer: Yes. She also shouted on us.

Question: Did she hurt you physically?

Answer: She pulled me forcibly by my hand. She pushed me.

Question: Did you complain of the pain in the morning to the nurse?

Answer: There was not much pain in the morning. But I told her about my condition.

Question: Did she give you any medicine?

Answer: No.

Question: Did you ask the nurse about the reason why she asked you to leave?

Answer: My mother-in-law Sonia asked her repeatedly but Sarojini Amma kept on asking us to

leave. She was not listening to anything.

Question: How was the behavior of the hospital staff during the night?Answer: Nobody was paying attention towards me.

Question: Did any doctor attend you during your stay in the hospital?

Answer: No.

Question: Did you requested for a doctor?

Answer: No.

Question: How did you come to home?

Answer: My husband brought me home on his cycle.

Question: Did Asha Bahu visit you ever?

Answer: No.

Question: Did the Helper visit you ever?

Answer: Yes. Sometimes, to call me for Anganbari ration.

Question: Did you get any medicine by the Anganbari Center or by the hospital?

Answer: No.

(Note: This question was asked in concern with the iron tablets)

Question: How many times you have visited Anganbari center?Answer: Once or twice.

Question: Did you get the porridge or any other nutritional food?

Answer: Yes. I got some porridge.


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Question: Can you recall the quantity you received?

Answer: I cannot tell in a clear way. We are given by bowls.

Question: Were you given any injections?Answer: Yes. Two.

Question: Do you get food every day?

Answer: Yes.

Question: What do you get?

Answer: What everyone eats. Vegetable, Chapatti, Pulse and Rice.

Question: Any problem related to food?

Answers: No.

Question: Is your child healthy?

Answer: Yes.

Question: How old is he?

Answer: He will be completing one month in one or two days.

Question: Any other problem you want to talk about?

Answer: No.


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TESTIMONIAL OF HUSBAND OF THE VICTIM: DHANRAJ (SCHEDULE CASTE) S/O

PRABHU

Place: Ansarganj, Karari Town, Kaushambi Distt.Date: 10.12.2011

Time: 12.20 A.M

I took my wife to the hospital on Friday evening around 6 P.M. She was in pain. She was

admitted in the hospital by the nurses on duty. I was with her all the night along with my mother.

The hospital staff was not paying proper attention towards my wife despite repeated requests by

my mother. I left in the morning to get fresh around 7 A.M. I came back around 9.30 A.M. My

mother and my wife told me that the nurse has asked them to leave. Then Sarojini amma came

and asked us to leave. I brought my wife to home by 10 A.M. I stayed at home for one to two

hours. Then I left for work. At 3.30 P.M, I got a call from my father-in-law that the delivery hastaken place. I came back by 4 P.M. I checked if everything was okay and then left for the

hospital to inform the nurse and for the T.T.E injections. I told her about the pain and asked her

for the injections. She gave me two tablets and refused for the injections saying that there is no

need for them. I came back home. I got the child administered T.T.E injections from private

doctor at the cost of Rs.200.

Question: What is your age?

Answer: 27 years.

Question: What is your education?

Answer: I can read and write.

Question: Did you asked the reason of misbehavior to Sarojini Amma?

Answer: No. She just asked us to leave.

Question: Did you visit the doctor on Saturday?

Answer: No. there was no doctor in the office when the incident took place.

Question: Did you get any registration slip or any kind of registration papers from the hospital?

Answer: No.

Question: Did you take your wife to any doctor after the delivery?

Answer: No. Both, my wife and child were healthy.

Question: Did any of the hospital staff asked you for any money?

Answer: No.


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Question: Were you asked for any money for the medicines?

Answers: All medicines were given free of cost.

Queston: How many children you have?

Answer: Two. One is Suraj who is two and a half years old. This is the second one.

Question: What is the age of this child?

Answer: 28 days.

Question: Did you have the B.C.G injection administered to your child?

Answer: Not yet. The mother and child cannot go out of the house for 41 days.

Question: Why cannot they leave the house?

Answer: It is a custom. It is followed as it ensures that our child is safe.

Question: Do you know that the child should be administered the B.C.G within 20 days?

Answer: No. But whatever the reason be, we cannot allow our child to leave the house.

Question: What is your occupation?

Answer: I am a mystery.

Question: What is your income?

Answer: It fluctuates between Rs.2500-Rs.4000.

Question: Are you the only source of income in the family?

Answer: No. My father also works in the Brick factory. He ears Rs.50-Rs.60 daily. The income

is seasonal. Sometimes its for 6 months while sometimes its only for 3 months.

Question: Where is he right now?

Answer: He is at the Chimney.

Question: Where is your mother?

Answer: She has gone Gangapar to her paternal home.

Question: Did you complain in police?

Answer: My father did.

Question: Did you go with him to the police station?

Answer: No. I was not there.

Question: Where was the child born?

Answer: At home.


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Question: The application to police says that the child was born on road. Is it true?

Answer: No. The child was born at home. I dont know about the application.


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TESTEMONIAL OF THE HELPER: MITHILESH DEVI R/O ANSARGANJ, KARARI

TOWN, KAUSHAMBI DISTRICT

Place: Primary Health Center, Karari Town, Kaushambi Distt.

Date: 10.12.2011

Time: 12.45 A.M

I was not present when the incident took place. I had gone to another village. I was told about the

incident later when I came back. I went to their house and asked about their health. I also

provided them with Panjiri I have visited their house regularly to inform them about the schedule

for porridge and panjiri.

Question: What is your educational qualification?

Answer: 8th Pass.

Question: Where is your in-charge madam?

Answer: She has gone to Allahabad for treatment.

Question: Is there any application?

Answer: Yes.

(Note: The application was pinned up on a board inside the makeshift office inside the residential

house of the in-charge madam)

Question: What amount of porridge and panjiri is allotted per head?

Answer: Madam deals with this.

Question: Do you have any idea about the standards and quantities of the sanctioned amount?

Answer: We use a bowl to distribute the food.

Question: Who is the Asha Bahu in this area?

Answer: Rajkali.

Question: Does she come to visit?

Answer: Yes. Regularly.

Question: But it was the responsibility of the Asha Bahu to take Saroja to hospital.

Answer: I cannot say about it.

Question: Do you give cooked meal to women?

Answer: Yes. It is cooked inside in-charge madams home.


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TESTIMONIAL OF THE NURSE, PRIMARY HEALTH CENTER, KARARI: SAROJINI


Date: 10.12.2011

Time: 1.30 P.M

I came to hospital at 9 A.M on Saturday morning. The mother-in-law of Saroja Devi asked me

about the baby and after inspection, I told her that the delivery will take place in the second shift

i.e. after 2 oclock. Then I left to check for other patients. When I came back after sometime,

they had already left. The husband came to me in the evening to inform me about the child and

asked for medicine and T.T.E injection. I gave him two ibruphen tablets i.e. pain killer and

informed him that there is no need of T.T.E injections as Saroja had been already given two

injections. He then asked me for Rs.1400 under the Janani Suraksha Yojna. I told him that since

the child has been born outside the hospital campus, no money can be given. He left with the

medicines. I came to know about the complaint via the newspaper itself. I have worked in Karari

for 33 years. No one has ever complained about my actions. I will retire in March 2011. Why Iwill ruin my record in the last stage? These are all false allegations just because I refused to

provide them with the money.

Question: Did you pull the victim?

Answer: No. No such incident took place.

Question: Did you abuse the victim?

Answer: No. I have never abused or misbehaved with any patient.

Question: Why the patient was not registered?

Answer: I have no idea about it. It was the duty of the three nurses who were here at duty in the

night. Their names areRanno Maurya, Shiv Kumari and Rita.

Question: Did police contact you?

Answer: Police came to the hospital for questioning but I was not present in the hospital. So they

talked to M.O. Dr. Chitra Singh.

Question: Did C.M.O or any other senior officer investigated or questioned you about the

incident?

Answer: Yes. Our M.O madam and Deputy C.M.O sir questioned me about the incident.

Question: Did you talk to the newspaper about the news report?

Answer: No. I do my work. It is not my job to inform press or talk to them.


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TESTEMONIAL OF MEDICAL OFFICER OF PRIMARY HEALTH CENTER, KARARI:

DR.CHITRA SINGH, B.A.M.S


Date: 10.12.2011

Time: 2 P.M

I was not in the hospital when the incident took place. I was informed about the incident through

the newspapers. I enquired about the matter and found that the allegations were baseless and

framed. The husband of the victim came to me two days after the delivery for Rs.1400 under the

Janani Suraksha Yojana. But I explained him that no money can be given to him as the child is

born outside the hospital premises.

Question: What is the reporting time in the hospital?

Answer: We have to arrive at 10 A.M and leave at 4 P.M.

Question: Why the patient was not issued a bed-head slip?

Answer: This is the only mistake on the part of hospital.

Question: What action have you taken on this matter?

Answer: I dont have any administrative power.

Question: What did police asked you about the incident?

Answer: Nothing different from what you are asking.

Question: Did C.M.O asked about this incident?

Answer: No. He did not ask me anything regarding this matte r. I dont know about Sarojini

Amma.

Question: Did the patient visit you after delivery?

Answer: No.


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TESTEMONIAL OF LOCAL VILLAGE LEVEL HEALTH WORKER, ANSARGANJ,

KARARI - (ASHA)RAJKALI.


Date: 10.12.2011

Time: 2.30 P.M

I was not informed about the delivery. I was not present during the incidence. I Visit the family

regularly but no one informed me anything. I dont know anything.

Question: Did you visit the victim regularly?

Answer: Yes.

Question: But the family says you never visited them.

Answer: I dont know.

Question: Why didnt you visit the victim on the delivery day?

Answer: Did anyone inform me?

Question: But it is your duty to identify and visit the pregnant ladies in the village.

Answer: I know.

Question: Why didnt you visit the lady post-delivery?

Answer: It was my mistake.

Question: But why havent you visited the victim till now, even after one month?Answer: The people in the locality misbehave with me.

Question: Did the victim or her family ever misbehaved with you?

Answer: No.

Question: You accept your negligence?

Answer: Yes. But I was not informed.


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TESTEMONIAL OF THE STATION INCHARGE OF POLICE STATION, KARARI TOWN,

KAUSHAMBI DISTRICT

Place: Police Station, Karari Town, Kaushambi Distt.

Date: 10.12.2011

Time: 4.30 P.M

There was no report filed. Only one application was submitted to our police station by a local

Danik Jagran reporter on behalf of the father-in-law of the victim. None of the family members

of the victim or victim herself came to us. We still sent an investigative officer to the victims

house. Our officer also visited the Hospital where it was established that there was negligence on

the part of the hospital staff. We also requested the victim to present herself for medical

examination but the family was unable to do so. So administrative action was suggested to the

M.O and investigation was closed.

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