Davangere District Hospital alone reported 28 maternal deaths in the past seven months.
Published Dec 07, 2024 | 7:00 AM ⚊ Updated Dec 07, 2024 | 10:38 PM
Pregnancy. Representative image.
The recent maternal deaths at the Ballari District Hospital have sent shockwaves through the state, highlighting the fragility of Karnataka’s public healthcare system.
While the government’s attention appears to be solely focused on the incidents in Ballari, the Karnataka Drug Action Forum (K-DAF), an advocate for rational drug policies and usage, has released a startling report suggesting that similar maternal deaths may have occurred in other districts of the state.
The forum, citing data gathered from healthcare workers at various district hospitals and through its independent investigations, revealed alarming statistics.
According to its findings, the Davangere District Hospital alone reported 28 maternal deaths in the past seven months.
These numbers underscore the urgent need for a comprehensive review of maternal and infant care services statewide.
“Although the state government is investigating the Ballari maternal deaths, we at K-DAF have gathered information and believe that there have been deaths in other districts, earlier this year and the previous year. We have collected information from speaking to health workers in various health facilities and district drug warehouses. If investigated thoroughly, reasons will be out,” Dr Swathi SB of K-DAF told South First.
While the timeline being looked at by the state government is from 7 November onwards at Ballari Hospital, the K-DAF insists that the state government must look into the previous year’s deaths and not just those that occurred in Ballari.
Infant and maternal deaths have occurred in other districts too, in numbers that the government ought to take note of.
Citing evidence from the Davangere district, Dr Swathi said, “In Chitageri hospital of Davanagere district there have been five maternal deaths in February 2024.”
A report by K-DAF available with South First read, “Five maternal deaths occurred in February 2024 post-C-section due to Acute Kidney Injury (AKI) and reduced urine output and there were conversations that this was possibly due to substandard ringer lactate (RL) solution.”
The K-DAF report claimed that “another woman died due to AKI in Davanagere Hospital in December 2023 or early January 2024 in Chigateri Hospital who otherwise had an uneventful pregnancy and good antenatal care delivered in Harihara Taluk Hospital (government) through C-section in Nov 2023.”
After multiple referrals and hospitalisations including at Shivamogga district hospital, she lost her life, said a statement from K-DAF.
“A few health workers also stated that similar deaths were being recorded in other taluks and districts like Chitradurga during February/March 2024 due to sub-standard RL or fungal contamination of RL. 4,” said Dr Swathi.
The DAF members said that their investigation and initial conversations with a District Drug Warehouse worker in Davangere mentioned that quality control issues had occurred in March 2024.
“Quality testing of Ringer Lactate solution found it “Not of standard quality” in March 2024 itself and the state had then even prompted the decision to halt the supply of RL IV fluids. All centres were asked to stop using the RL IV fluids and the new batches were to come in April. It came to our notice that the retrieval of the affected batch from the centres had not occurred in April as well,” said Dr Swathi.
Coincidentally in March and April 2024 in Women and Children Hospital at Davangere, several women reportedly experienced drug reactions after tubectomy procedures.
The woman had to be stabilised and the procedure was paused. No reason was offered for why tubectomy procedures were stopped.
The members of the forum raised some serious concerns: “Since when is this substandard RL/drugs causing deaths? Could all the maternal deaths in the state have the same cause?”
The forum demands that detailed investigations and death audits of all maternal and infant deaths in government hospitals across the state be done from November 2023 till November 2024.
These investigations, they demand must not be limited to Ballari but must expand to all districts in the state.
“Patients admitted to government hospitals across districts and who died of Acute Kidney injury, anaphylaxis/drug reactions, sepsis, septic shock, endocarditis/ cardiac failure, etc especially if young and if it was an unexpected death, must be investigated in detail,” the K-DAF statement said.
K-DAF members demanded that the state government and health authorities properly evaluate the outcomes of all patients admitted to government hospitals administered RL IV fluids across districts in these months.
K-DAF also questioned why drug quality testing was done only after problems arose. In this case, deaths occurred after the faulty RL IV was administered.
“Is quality testing not part of the protocol of drug procurement by the Karnataka State Medical Supplies Corporation Limited (KSMSCL)? If quality testing and certification were done beforehand, how did this batch get through the process? This is in deep violation of patient safety and accountability,” the statement read.
Despite the problems with the drug why did the same company manufacture the distribution and usage of RL continued in the system?, they asked.
It is noteworthy that RL is a fluid given not only to pregnant women during C-sections but also commonly used for patients undergoing other types of procedures/surgeries when they are in need of hydration.
The K-DAF said it could well be that there were other deaths – besides the maternal deaths, caused by the faulty RL.
Those deaths too could have occurred across the state, in government facilities, between November 2023 and November 2024. However, this is not being investigated, said K-DAF.
Highlighting the glaring gaps KSMSCL, the K-DAF members, Dr Gopal Dadade, Dr Swathi SB, Karibasappa M, and Dr Shivanad Pawar, in their report highlighted some of the glaring gaps that need immediate attention.
Delayed procurement process: The last annual indenting and tendering process occurred in 2021, leaving the state unable to meet the increased demand for drugs post-COVID.
Severe drug shortages: Although KSMSCL is tasked with procuring 733 essential medicines, it manages only 300-500 drugs, and many of these are in short supply in public health institutions.
This forces patients to incur an average out-of-pocket expenditure of ₹433 per visit for medications, even in government hospitals.
Flawed quality control: KSMSCL’s quality control measures are riddled with inefficiencies. Random samples of drug batches are sent for testing in empaneled laboratories.
However, these batches are simultaneously deemed “eligible to issue to health institutions” before the test results are available.
If a drug is later found to be “Not of Standard Quality” (NSQ), it is withdrawn, but by then, thousands of patients across the state may have already consumed the substandard medication, putting their safety at serious risk.
Corruption allegations: KSMSCL faces allegations of procurement malpractices, such as unauthorised purchases, favouring blacklisted companies, diverting supplies, and corruption at various stages.
Inadequate indenting system: The e-Aushada software restricts peripheral health institutions from indenting required drugs, limiting them to available stock, thus masking actual shortages.
Lack of transparency: The processes of tendering, procurement, quality testing, pricing, and blacklisting by KSMSCL remain opaque, with no information available to the public.
Consumer groups have consistently demanded transparency and adoption of best practices, such as those used by the Tamil Nadu Medical Services Corporation. Despite promises from Karnataka’s Chief Minister, these demands have yet to be fulfilled.
The report by K-DAF called for urgent reforms to address these critical issues to improve public healthcare delivery in Karnataka.
The K-DAF called for the following measures to address these systemic failures:
Formation of a high-level committee: Led by the Chief Minister, with participation from bureaucrats and civil society representatives, to oversee KSMSCL’s operations.
Transparent processes: KSMSCL must publish all procurement, quality control, and financial details on its website.
Adopt best practices: Karnataka can draw inspiration from the Tamil Nadu Medical Services Corporation’s successful model for drug procurement and distribution.
The K-DAF emphasised the urgent need for legal action against KSMSCL and pharmaceutical companies involved in these lapses.
“The state government must prioritise public health by streamlining KSMSCL’s operations and ensuring accountability at every level. Without decisive action, the healthcare system will continue to fail its most vulnerable citizens,” said the statement.
Health minister Dinesh Gundu Rao agreed that the Karnataka government’s drug quality, sale and manufacture of drugs needs to be rectified and monitored strictly.
The minister emphasised the need for accountability and said, “There must be action against those responsible for negligence. Every death due to negligence or faulty medicines is unacceptable.”
The health minister said there will be a transparent tender process for selecting manufacturing companies for drug supplies.
“We are now working towards addressing all the discrepancies within the system,” Dinesh Gundurao said after the Cabinet meeting on Friday, 6 December.
“The role of the company supplying drugs is under suspicion. We are working to identify shortcomings in our system and the drug procurement process. Officials in charge of medical supplies and procurement are frequently transferred, within four to six months. Honest and competent officials must be deputed for these roles. We will work towards this,” he said.
Addressing the concerns raised by the Forum, he said he would resign, if that caused an improvement in the state’s healthcare system.
Gundrurao told reporters in Bengaluru: “I am ready to resign if it can set things right. This is not about prestige or power; it is about people’s lives. We have taken the maternal deaths in Ballari very seriously and implemented legal steps and measures to bring improvements.”
He said he had no objections to further probe into the maternal deaths.
So far Sumaya, Rojamma, Nadini, Muskaan, Mahalakshmi, and Lalitamma have succumbed to post-delivery complications in Ballari district.
(Edited by Rosamma Thomas).
