Madurai collector recommends suspension of GRH doctors for covering up maternal deaths 

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What got the ball rolling? 

District collector Sangeetha, while auditing the maternal deaths, found on 3 September discrepancies in the case sheets of one Semmalar, a mother who died during pregnancy at the GRH on 31 August.

The next day, she ordered a detailed audit of the case, and sought copies of the original records preserved in the hospital.

The collector, herself a medical doctor, found that the medical records of the deceased mother were fabricated. Following this, she instructed the dean of GRH to take necessary action against the medical officer.

In late September, Sangeetha submitted a report to the Health Department’s Principal Secretary Gangandeep Singh Bedi, seeking action against the erring doctors as no action had been initiated against them.

In the report, accessed by South First, the collector Sangeetha mentioned that after comparing the case sheet submitted for the audit and the case sheet kept in the hospital, it was found that the doctor had tried to cover up the maternal death.

She pointed out:

1. 28.08.23, 05.15 pm notes: The full page is rewritten. Tablet Aspirin is deleted from the treatment prescription.
2. 28.08.23: Call-over to cardiologist. The call-over is rewritten.
3. 28.08.23, 7 pm notes: The full notes are rewritten.
4. 29.08.23, 7 am notes: The full page is rewritten. Tablet Aspirin is deleted from the treatment prescription.
5. 29.08.23, 1 pm and 7 pm notes: Signature is added.
6. 31.08.23, 7 am: It was observed by the collector that, BT (Bleeding time)/CT (Clotting time) was not documented in the case sheet. But, it was found that the values were documented in the case sheet after enquiry by the collector at the camp office.
7. 31.08.23, 5 pm and 5.15 pm notes: The notes were included after the maternal death. One episode of chills and rigours, vomiting, and abdominal distension were added to the new notes.
8. 31.08.23, 5.45 pm notes: “Chief informed” is documented post death. Signature is inserted.
9. 31.08.23, 6 pm notes: “On mechanical ventilator” is added after death.
10. 31.08.23, 2 am notes: Noted about TEG and ordering cryo are added in the notes.
11. 01.09.23, 7 am notes: Page changed completely.
12. 01.09.23, 8 am notes: Page inserted completely.
13. 01.09.23: Cardiology, radiology call-over page is rewritten completely.

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The second death

The collector also found that one Kuppi, who was admitted for delivery at GRH, died during her pregnancy on 5 September. During the audit of the medical records, the collector found that, too, was covered up.

In the treatment note of Kuppi, before her death, the collector found that the patient had attended Unit II of the Obstetrics and Gynaecology (OG) on 18 July but no notes were written, with only the unit seal noted.

After the death of Kuppi, it was altered with the HR number, with the description and diagnosis entered at the patient treatment note as if the diagnosis had been previously made. ECHO notes were entered on the same page, she noted.

The collector also found that the advice regarding admission was entered in the patent treatment note after the maternal death.

In the report to the principal secretary, Sangeetha stated that the Department of OG was not deputing OG specialists to conduct Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) camps and high-risk camps at zonal PHCs as per guidelines.

“This is in contrast to the GH doctors who are conducting camps at Block PHC’s in Madurai District. In continuation to this, it was instructed to suspend the Medical Officer at GRH Madurai who has fabricated the case sheets and patient records and to conduct PMSMA high-risk camp at Zonal, PHCs as per the guidelines. Even after the instruction, no action has been taken to date by the Dean and HOD, OG. Hence, I request that Dean, GRH, Madurai may be suitably instructed,” the collector said.

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The third case

On 29 September, one A Thilagavathy — a resident of Kallmedu in Madurai — succumbed to postpartum haemorrhage (PPH) during her delivery at GRH.

City Health Officer Dr Vinothkumar, with his team, took blood samples from Thilagavathy and also recorded a video of the patient in the labour ward.

A day later, the primary health centre medical officers, who referred these patients to the GRH, claimed that most of the maternal deaths occurred in the medical college hospital and the doctors at GRH were trying to cover them up.

However, the doctors at GRH claimed that Thilagavathy’s husband Arunkumar had contracted dengue and was admitted to a private hospital.

Further, patient Thilagavathy had a temperature before admission, her blood platelet count was 30,000, and her diagnosis was more in favour of dengue.

The GRH doctors made a complaint to the dean to take action against the CHO for trespassing into the labour ward, and also said that the CHO harassed the duty doctors and prevented them from performing their duty.

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Doctors’ association wants fewer audits

Following the clash between the city health officer and the GRH medical officers, the Madurai unit of the Tamil Nadu Government Doctors Association (TNGDA) passed a resolution seeking suspension of the Madurai CHO.

The association also said that a minimum of 50 maternity cases were handled by the GRH doctors per day, and pointing a finger at them for one or two unavoidable deaths — when the doctors gave their full effort to save the patients — was not acceptable.

The association also demanded a stop to maternal-death audits at various levels, and instead recommended only three audits — from the NHM, the district collector, and the concerned hospital.

The association also warned of agitation if their demands were not considered, and threatened to stop performing elective surgeries from Tuesday.