Nanded Hospital Death Row: Dean, Doctor Booked on Culpable Homicide Charge, High Court pulls up State
Mumbai: Amid the backlash from the public for multiple deaths of patients at Nanded Government Hospital and the protest from the medical fraternity for the humiliation of the Hospital Dean, the Chhatrapati Sambhajinagar Police have now registered an FIR against the acting dean of the hospital and a head paediatrician on the charge of culpable homicide not amounting to murder.
An official informed the PTI on Thursday that the case was lodged against Dr Shankarrao Chavan Government Medical College and Hospital's acting dean S R Wakode and a head paediatrician, following a complaint by a person in connection with the death of his daughter and her newborn child at the facility.
This comes after 31 patients who were being treated at the hospital died in 48 hours, between September 30, 2023, and October 02, 2023. Medical Dialogues had earlier reported that among the deceased, 24 patients including 12 newborns died between September 30 and October 1 and seven more patients passed away between October 1 and 2, 2023. They were booked under Indian Penal Code sections 304 (culpable homicide not amounting to murder) and 34 (common intention), the official said.
Amid the outrage among the Opposition over the deaths, the Dean of Dr Shankarrao Chavan Government Medical College and Hospital Nanded, rejected allegations of negligence against the hospital on Tuesday, claiming that deceased patients were suffering from different ailments such as diabetes, liver failure, and kidney failure. He further emphasized that there was no shortage of medicines or doctors, and the patients were given proper care, but their bodies did not respond to the treatment.
Also Read: 31 deaths in 48 hours at Nanded Govt Hospital, probe ordered
Dean & Doctor Booked by Police:
Police have registered an FIR against the acting dean and a doctor of a government hospital in Maharashtra's Nanded district, where 31 patients died in 48 hours, on the charge of culpable homicide not amounting to murder, an official told PTI on Thursday. They were booked after a complaint was lodged by a person in connection with the death of his daughter and her newborn child at the facility, the official said.
As per the FIR, 21-year-old pregnant woman Anjali was taken to the hospital at around 8 p.m. on September 30. She delivered a baby girl at around 1 am on October 1. Doctors later said the mother and the child were fine, Anjali's father Kamaji Tompe said in the complaint.
Later in the morning, Anjali started bleeding and the baby was also not well, hence doctors asked the family members to get medicines, blood bag and other required items from outside.
When the items were brought, doctors were not present in the ward, Tompe claimed. He further claimed in the complaint that Wakode deliberately made him sit and did not send a doctor or a staff nurse to check on Anjali.
"The doctors declared Anjali's baby dead and handed over the body to us at 6 am on October 2. Later, Anjali was declared dead at 10.30 am on October 4," the complaint said.
Tompe alleged that the dean deliberately did not let doctors treat Anjali. The doctors asked the family members to get medicines worth Rs 45,000 from outside, he said in the complaint.
He also claimed that many patients died in front of him due to lack of availability of doctors, nurses and medicines. Wakode could not be contacted for a reaction in the matter.
Chief Minister Eknath Shinde on Tuesday said his government had taken the deaths at the Nanded hospital very seriously, and appropriate action would be taken after a detailed inquiry while denying that there were shortages of medicines and staff.
High Court Takes Cognisance, Holds State Can't Escape Responsibility:
A division bench of Chief Justice D K Upadhyaya and Justice Arif Doctor has now taken cognisance of the deaths at the state government-run hospitals at Nanded and Chhatrapati Sambhajinagar. The matter came to be considered by the HC bench after an advocate, Mohit Khanna submitted a letter requesting the bench to take suo motu cognizance of the deaths.
During the hearing of the case on Friday, the Maharashtra Government told the Bombay High Court that the state-run hospitals in Nanded and Chhatrapati Sambhajinagar which recently saw a spurt in patient deaths faced a heavy inflow of extremely critical patients from private hospitals. However, the court said the state can’t escape its responsibility, adds PTI.
The state government also told a division bench of Chief Justice D K Upadhyaya and Justice Arif Doctor that there does not seem to be any gross negligence on the part of the state-run hospitals. The State Counsel Birendra Saraf also informed the Court that all medicines and other equipment required at the hospitals for the management of patients were available and administered as per protocol. The patients who died had been brought in critical condition from other hospitals.
He also said the doctors and medical staff at the hospitals were burdened. The bench sought to know how the government plans to strengthen public healthcare.
“How to strengthen it? Everything is there on paper but if it is not trickling down then there is no point. This is not just about procurement (of medicines and equipment) but the general state of healthcare in Maharashtra,” CJ Upadhyaya said.
“You (Maharashtra government) cannot escape by saying there is a burden. You are the State. You cannot shift the responsibility to the private player,” he added.
The court also noted that the state government has issued good policies but not implemented them. The bench sought to know the cause of deaths in the hospitals in Nanded and Chhatrapati Sambhajinagar. “How did the situation come to this? What happened?” Justice Doctor asked.
Saraf said smaller and private hospitals refer patients to public hospitals when their condition becomes critical. “Most of the patients (who died in Nanded and Chhatrapati Sambhajinagar state hospitals) were referred to these hospitals when their condition was severely critical. Most of them died within a day...this includes infants,” Saraf said.
He claimed that earlier too there had been 11 to 20 deaths in a day in these hospitals. “Public hospitals cannot ask people to go away. They try to accommodate everyone. At Nanded, there were 12 cases of infant deaths. Of this, only three were born at the government hospital. The remaining were brought in extremely critical condition from other hospitals,” Saraf said.
He added the government has formed a three-member committee, which will visit all government hospitals and submit reports. The bench noted that the government has flagged the reasons behind the deaths as heavy inflow of patients, referral from private and smaller hospitals and patients being brought in extremely critical condition.
The bench also rued the decline in budgetary allocation for public healthcare in Maharashtra in the last three years. “As per the report submitted by the government, in 2020- 21, 4.78 per cent of the total budget was allocated to public health. In 2021-22, it was 5.09 per cent, in 2022-23 it was 4.24 per cent and now in 2023-24 it is 4.01 per cent. The decline is thus visible,” the court said.
The court further lamented the vacancies in government hospitals and said in such hospitals, patient care work is mostly done by senior and junior resident doctors and staff. “See the vacancy for senior residents (at the Nanded government hospital). Out of 97 posts for senior residents, only 49 posts are filled. 50 per cent vacancy...is this justifiable? How do you (government) justify this,” the court said.
The senior and junior doctors have heavy responsibilities and keeping these posts vacant cannot be accepted in any situation, CJ Upadhyaya said. Saraf said additional posts were created in January this year due to which there were substantial vacancies. He said the posts would be filled soon.
The bench directed the Principal Secretaries of the Public Health Department and the Medical Education and Drugs Department to file affidavits furnishing details of sanctioned posts in all government hospitals and the vacancies against such posts.
The affidavits shall give details of the steps taken in the last six months to ensure the vacancies are filled, the court said. The affidavits shall also disclose demands for medicines, medical goods and equipment made by the hospitals in Nanded and Chhatrapati Sambhajinagar in the last year and supplies made against such demands.
The affidavits shall be filed by October 30 when the court will hear the matter further. The court also pulled up the Maharashtra government for not appointing a full-fledged Chief Executive Officer (CEO) for the Maharashtra Medicines Procurement Authority set up in May this year.
“The authority was set up in May. We are in October and still it does not have a full-fledged CEO. This is the problem. You (government) come up with good policies but when it comes to implementing nothing is done,” the HC said.
The bench directed for the CEO to be appointed within two weeks. The court in its order noted that the incident has brought to the fore certain issues with regard to the state healthcare system that needs to be addressed by the Maharashtra government. These include crucial problems faced by the hospitals such as vacancies, procurement of medicines and medical goods and equipment.
Hospital Records Indicate Huge Vacancy of Staff:
Meanwhile, amid the controversy, the records of Nanded Government Hospital have suggested that the facility is dealing with a substantial staff shortage.
As per the latest media report by Indian Express, there is a 42 percent vacancy at the hospital in respect of the positions of medical personnel in various departments such as paediatrics, general medicine, psychiatry, orthopaedics and others. Apart from this, more than 60 per cent of the positions for senior resident doctors are also lying vacant at the medical college. Ideally, the hospital should have 60 senior residents, but at present only 23 of those positions are filled and 37 positions are vacant.
The Daily adds that there is a 33.5 percent deficit in respect of the faculty positions as well. This includes vacancies in the posts of professors, associate professors and assistant professors. While there are 140 sanctioned posts, 47 posts are lying vacant.
Currently, various departments such as anatomy, physiology, pharmacology, ophthalmology and dentistry do not have professors, who usually head the departments. In case of the gynaecology department, there are four sanctioned positions for associate professors. However, three of these positions are vacant. Only two out of the seven positions for assistant professors are filled. Further, the Daily adds that several specialised doctors have been assigned to the newly constructed medical colleges in Parbhani and Osmanabad for the purpose of National Medical Commission (NMC) inspection.
Zero Utilisation of Budgetary Allocation:
In another report, Indian Express adds that the State's real-time budget allocation and utilization data revealed that the hospital has an annual budget for supplies and materials of Rs 1.16 crore and Rs 35 lakh has been disbursed till now, this year. However, the data revealed that the hospital has not even utilised a single rupee.
Another Rs 67 lakh was allocated to the hospital in the budget for machinery, equipment, and repairs and Rs 15 lakh from the same has already been released. However, the data revealed that there was no expenditure in this regard as well.
Controversy regarding the humiliation of Dean, MARD holds Pan-Maharashtra Protest:
Amid the public backlash and the High Court taking cognisance of the matter, the medical fraternity recently expressed their protest against the public humiliation of the Dean of the Hospital by Shiv Sena MP Hemant Patil.
The Maharashtra Association of Resident Doctors (MARD) on Thursday held a Pan-Maharashtra protest at 2 PM as a response to the widely circulated video, in which the dean of the hospital was seen being forced to clean toilets and urinals by MP Patil. The association announced its decision to hold the protest after meeting with the Minister of Medical Education Shri Hasan Mushrif recently. It has also announced its plans to further escalate the protest if a public apology is not issued by MP Patil.
"Doctors will be wearing Black ribbons on their arms as a sign of Remonstrance. The protest will occur after OPD hours to prevent any kind of compromise to patient care. Faculty, Senior residents, Junior Residents, Private practitioners, interns and students all will be present in this protest. If a public apology is not issued by the aforementioned MP then Central Mard will be forced to escalate the PAN MAHARASHTRA PROTEST," the association warned.
Earlier issuing a Press Release, MARD pointed out that the unfortunate incident of multiple mortality that occurred at the hospital was investigated by Central MARD after having elaborate discussions with the resident doctors of multiple departments of the said hospital. "...it was clearly apparent that the reasons for the unfortunate event was primarily due to multifactorial causes which include shortage of Medical faculty, shortage of class 3 and class 4 staff, medical servants, overall manpower, life saving medicines and resources. This severe loss of critical resources is not confined to GMC Nanded but can also be seen in rest of the GMCs of the state."
The association demanded an unconditional apology from MP Hemant Patil "for abusing, harassing and humiliating the Dean of the Medical college without waiting for proper investigation to seek out the root cause of the tragedy."
Meanwhile, the Maharashtra chapter of the Indian Medical Association (IMA) has also issued a warning to initiate a protest unless the government of Maharashtra takes appropriate measures in response to a widely circulated video depicting the acting dean of the hospital being forced to undertake the task of cleaning toilets and urinals by MP Patil.
The Maharashtra chapter of the Indian Medical Association (IMA) said in a release that a memorandum has been submitted to Chief Minister Eknath Shinde demanding necessary action into the treatment meted out to the acting dean. IMA (Maharashtra) president Dr Ravindra Kute said the medical fraternity also wants a proper investigation into Nanded hospital deaths.
