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Prasuti Griha's Infection Scam : Administering fatal drugs: An Unhealthy practice

Shortly after a delivery through cesarean section, as many as 9-women admitted at Thapathali-based Paropakar maternity hospital popularly known as Prasuti-Griha, surmounted with suspicious symptoms like showing violent-behavior, nausea, high fever, severe pain at the spine--where spinal anesthesia was given and eventually they reached unto the juncture of life-or-death. -DEV KUMAR SUNUWAR: CIJ

Cij Nepal

March 1, 2013

Shortly after a delivery through cesarean section, as many as 9-women admitted at Thapathali-based Paropakar maternity hospital popularly known as Prasuti-Griha, surmounted with suspicious symptoms like showing violent-behavior, nausea, high fever, severe pain at the spine--where spinal anesthesia was given and eventually they reached unto the juncture of life-or-death.

-DEV KUMAR SUNUWAR: CIJ

Instead of finding the causes, attending doctors kept on administering high antibiotic and injection for reducing severe pain, but their health deteriorated rapidly rather than getting better. The shocking was that anxious doctors then referred each of them to different private hospital in around Kathmandu, without even obtaining the basic information on whether the hospital had capacity to cater the treatment.

Of them, Deepa Thapa was taken into Sinamangal-based Kathmandu Medical College (KMC). An attending doctor at the College, Dr. Dev Kumar Neupane says, "When we received Thapa, her brain was inflamed and diffused all over her brain wholly. She also had no consciousness. This was due to the bacteria."

But the doctors at Prasuti Griha concealed this fact. Instead, they spread rumor that infection surfaced in the theatre, had emergency meeting, and decided to close-down the operation theatre for 3-days.

This was an incidence occurred from September 10 to 14, 2012 at Prasuti-Griha, the hospital which was established 5-decade ago for complete safe delivery and neonatal care. But the doctors did not take the problem seriously that led life of women seeking delivery service and newly born babies into risk.

Following the incidence, officials at the hospital blamed workers of sanitation department. They stated that the infection had surfaced due to negligence of workers as they did not sterilize the equipments and gloves properly used in the operation.

But this rumor turned to be false, after the laboratory test of 39-different types of equipments including gloves used in the operation theatre confirmed that the infection was not surfaced from the equipments used in the theatre, neither from the gloves as the hospital administration then stated.

Then, administration spread another rumor that the incident was because of delivery complication and blamed to the women themselves of having weak immune power. By then, the officials at the hospital dislocated the medicines used in the delivery from store. The hospital remained silent for three days. The officials were in rush for hiding of 'suspecting' and 'low-quality' medicine. The medicines were located under the stair of old hospital building for one night and then the medicines dramatically hid-away. The meeting of Prasuti Griha Hospital developed board was called over night. At the same time, the hospital director and administrators seemed busy visiting health ministry and medicine suppliers.

Meanwhile, 24-year old Lata Gurung who sought delivery service at Prasuti Griha and was referred at Tinkune based Kantipur Hospital succumbed into death. The newly born two babies also died in same incident. Another woman Deepa Thapa shows madness and the rest are still facing one or other kinds of sufferings.

The shocking anguish

Lata Gurung, from Suichatar-2, Kathmandu was admitted in Prasuti Griha on September 13 and on the following day at the mid-night doctors had performed operation for her delivery. After merely 4-hour or so, the symptoms like nausea, high-fever, neck stiffness was developed on her and was fainted either. On the 14 September, she was referred at Tinkune based Kantipur Hospital, where she had succumbed into death on the 4th day. Gurung lost her life in her first delivery, while her baby is alive.

Attending doctor at Kantipur Hospital, Dr. Yubaraj Shrma says, 'When we received Gurung her brain had almost left working, her blood pressure was very low and imbalance of her heart. The ventilator and the medicine would not improve her control of her health.

Gurung's husband, Suman KC says, early morning, on September 14, her condition at Prasuti Griha was such critical that I was so worried. Only nurses were in the hospital. The hospital doctors did not care. The doctors arrived in the hospital late in the afternoon. Without even letting me know, they referred her at Kantpur hospital, where she passed away. I had taken her healthy, but but took back her dead body.

Two other women--28-year old Sushila Sharma and 19-year old Binda Ghimire who also were referred at the same hospital returned home after receiving long treatment and say that they still have to visit to the doctors.

24-year old Deepa Thapa who was referred at KMC had to receive treatment for almost one month in ventilator. Even after returning home, she shows madness. She runs away from home and behaves unwittingly. She has to be taken to the hospital for regular follow up. Another woman referred for treatment in the same hospital, 24-year old Sapana Parajuli had to receive treatment for one week. She also has to visit to the hospital for treatment.

Similarly, an another women referred at Sanepa based Star Hospital, 21-year old Diya Shrestha and 37-year old Chandra Kumari Kafle still have pain at the spine, where the spinal anesthesia was given and both have to visit to the doctor constantly for the consultation.

"At Prasuti Griha, my wife had lost her temper in such a way that doctors had tied her both the hands and legs," remembers, Arjun Kafle, Chandra Kumari's husband.

20-year old Bhagwati Amatya from Palung in Makawanpur district, who had undergone operation for delivery on September 10, the symptoms witnessed in hr within mere 5-hours of operation. Then, she was also referred to Star Hospital. After the health of Amatya deteriorated, her newly born baby got less or no care, eventually the neonatal (baby) succumbed into death on September 15 at Prasuti Griha.

Even though she returned home, she still has severe pain on her spine. She did not get the information what reason her baby died, who was born healthy in the hospital. This was her first baby. Similarly, another 26-year old Deepa Shrestha who was referred at Tripureswore based Blue Cross Hospital returned home after about a week treatment, but her newly born baby who was sick on the fifth day of birth eventually succumbed into death on October 29, 2012. This was also the first child of Shrestha.

"Her baby died, although the mother is alive," says Rajendra Shrestha, brother in Law of Thapa, who is also a member of probe committee formed by the Prasuti Griha after the protest from the victims.

The mystery on the cause of sufferings of delivery women was exposed when the probe committee submitted the investigation report to the Prasuti Griha Administration on November 18, 2012. The report clearly mentions that the hospital had procured low quality medicines and recommends for making transparent in producing the quality medicine.

The very same 'low quality' medicines were used to the women and neonatal who succumbed into death and suffered a lot. During the investigation of the incidence, a piles of powder-milk, Lactogen, fed to the newly born babies and the sprit used for sanitization before giving the injection or prior to the operation was stored in the safe mother program store, which were date expired.

Deadly game in medicine

After kin of victims raised the issues of negligence in the medicine and treatment, Prasuti Griha had formed a probe committee led by Dr. Amir Babur Shrestha, the attending doctor at the Prasuti Griha. The very same committee then sent 11-different kinds of medicines for laboratory test at National Medicine Laboratory via Department of Drug Administration (DDA), the medicines which were used during the operation, which confirmed harmful injections used during the operation.

The head of Laboratory, Mohan Prasad Amatya told to Centre for Investigative Journalism, "We spent about 2-weeks for conducting tests of those medicines. We retested those medicines on which we found some sort of suspicion. Then we confirmed that two medicines--Ranitidine (Emtec) injection (manufactured by Sanjivani Parental India Limited) and Oxytocine 1 ml Injection (manufacture by Hindustan Pharmaceuticals India), where there were bacteria and fungus in them and those were not sterile either. We have also sent the very same lab report to Prasuti Griha."

According to Anesthesiologist Dr. Chhatra Krishna Shrestha at Prasuti Griha, both the injections were administered to all those 9-victim delivery women at Prasuti Griha.

According to the doctors, Ranitidine injection is given to prevent the gastritis which is generated by the side effect of the antibiotic given during the operation of delivery, while the oxytocine injection is given to stop the excessive bleeding from womb.

It was obvious that the harmful medicine (confirmed by lab) likely to cause suffering to delivery women admitted for delivery at Prasuti Griha, But the irony is that the hospital officials spread the rumor of surfacing of infection to conceal own mistakes.

Even more shocking was, the director of Prasuti Griha, Dr. Shila Verma denied talking to the media persons about the incident, while the chairperson of Prasuti Griha Hospital Development Committee, Dr. Shyam Sundar Misra also expressed of being unknown of the whole incident.

Meanwhile, DDA has issued the directives to the injection importers of those respective batches to call from the market which were found of harmful.

"We have already called back the Ranitidine injection (batch no. SRA 113) from the market, as those were said to have been harmful in the lab test. We were given the letter by DDA, which reads that lab confirms there were presence of bacteria and fungus in our injection and that the injection also was not sterile," says Shes Kant Subedi, Chairman of Injection Nepal, the importer of Ranitidine injection in Nepali market.

Chhetrapati-based Minko Pharmaceuticals is the importer of Oxytocine injection which was found to have been harmful. The proprietor Minko, Mrigendra Shrestha says, we also received letter from DDA that directed us to call back the medicine from the market which were found to have been harmful. Immediately after we got the letter, we called back as many as 800 Ampules of Oxytocine injections (batch no. 402) from the market.

Deadly Injection

The discharge sheet of delivery women who were referred and treated at different private hospital clearly mentioned that they had suffered from Menengitis or meningiusmus. They were healthy and fit prior to the delivery and had yielded problem after they were given Bupivacine, spinal anesthesia used to numb a part of body to block pain before operation for delivery.

Prasuti Griha had bought 25 Ampules of Bupivacine titled 'Bupitroy' Batch No. 15152 manufactured by Troikaa Pharmaceuticals India, on September 11, 2012 and administered in the operation for delivery of those women admitted at Prasuti Griha lately. Earlier, the hospital had bought, B 1514 on Sept. 5, from same company.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, while Meningismus is an initial stage of the disease, and where only a part of membrane of brain is inflamed.

"Those patients who were referred at me had Meningsmus. The causes seem that anything affecting entered directly to the brain through spine," says Dr. Yubaraj Sharma, a senior doctor at Kantipur Hospital, who attended late Lata Gurung, Shusila Sharma, and Binda Ghimire, who were referred from Prasuti Griha.

The director of Star Hospital Dr. Anil Pokharel and Neurologist Dr. Dinesh Bikram Shah at Blue Cross Hospital said that the women who referred to them for treatment had the symptoms of Meningitis. This must have been because any bacteria entered directly to the brain showed the effect quickly.

Public Health expert, Dr. Sarad Raj Onta also opines, the symptoms seemed to have developed among the those patients in such a short period of delivery show that some bacteria causing Meningitis entered directly to the brain through the Injection given at spine.

Dr. Amir Babu Shrestha who himself had involved during the delivery including of Lata Gurung says that we had given Bupitroy, the spinal anesthesia Bupivacaine Injection of Troikaa Pharmaceuticals batch No. 15152 through spine, which had direct and instant connection with brain. After we had discovered such incidences at Prasuti Griha, immediately we could do was, we changed all the brands of medicines including this Bupitroy, then patients did not have any problem.

At a similar instance and during same period, on September 16, immediately after a few hours of delivery of a women through cesarean section at KMC had developed as similar systems that of delivery women referred at hospital from Prasuti Gria. Then, the attending doctors instantly conducted the Lumber Puncture, (a test to detect whether a patient had Meningitis or not) which confirmed that she had 'Bacterial Meningitis'. The patient was also administered Bupitroy, the spinal anesthesia Bupivacaine Injection of Troikaa Pharmaceuticals batch No. 15152 through spine, the very same batch medicine was administered to all those delivery women at Prasuti Griha. This substantiates the similar source of infection among the patients who surmounted the sufferings at Prasuti Griha.

"KMC then barred the respective batch also any other batch injections manufactured by Troikaa Pharmaceuticals," Dr. Chanda Karki, head of Gynecology Unit at KMC.

The director of Prasuti Grihas denied to talk anything about the incidence, she instantly utters, "We have formed the probe committee, ask them. The administration chief also had the similar response. The decision among duo director and administration chief, the Prasuti Griha procures the wholesome medicine in the hospital, including the very same spinal anesthesia. Bupitroy, the spinal anesthesia Bupivacaine Injection of Troikaa Pharmaceuticals batch No. 15152 at Prasuti Griha was supplied by Chhetrapati based Shanghai Pharmaceuticals Pvt. Ltd. The hospital management has been procuring medicine with monopoly under the Safe Motherhood program, much hyped donated program for safe motherhood.

The importer of the Bupitroy injection says that they already called back the respective batched Injection from Market, following the complaints.

Laboratory only for namesake

With the confirmation harmful injection, on November 20, the National Medicine Laboratory sent lab report and also instructed Prasuti Griha not to use injections namely Ranitidine Injection (batch no. SRA 113) and Oxytocine injection (batch no. 402)

The Laboratory chief Mohan Prasad Amatya says, "We can not detect whether the medicine contained the chemical that caused the Meningitis or Menigismus.

After the senior doctors suspicion of very same Bupitroy injection of causing Meningitis, the injection was also taken to laboratory of Nepal Academy of Science and Technology and Kupandole based Multi Pharmaceuticals Laboratory Pvt. Ltd, but the officials at both laboratories said that none had capacity to detect contamination of chemical causing the disease.

The Bupitroy Injection of Troikaa Pharmaceutical had permission to import the product in the Nepali market in 2010.

Director of DDA, Radha Raman Prasad says, we grant permission to pharmaceutical companies to import their product only after our laboratory test confirms safe and efficacy of the medicine. But, we do not conduct test to each batch of the medicine.

'It is the best example of irresponsibility of concerned authority" says Advocate and secretary of Kathmandu committee of Consumers Rights Protection Forum says, "Nowhere in the world grant permission to the medicine without approval from laboratory of each batch of medicine. The Essential Service Operation Act (ESOA)-1957 also provisions every single batch of medicine be approved from the laboratory. Each actors involved in the negligence of public health be punished as per the law. "

Irresponsibility and Impunity

There is no dearth of stringent law to protect the rights of consumer. If only the provisions of Muluki Ain-2020 BS and ESOA Act-1957 are implemented effectively--medicine manufacturer, importer, supplier, the concerned authority responsible in granting permission and health providers and hospital management-- all would be fined with 500,000 NRS and the jail term up until 14-years according to the level of involvement in the incident. The law also provisions life-term imprisonment with seizure of all property in case of death of mother and babies who succumbed into death during treatment at Prasuti Griha.

But, the government attorney who has jurisdiction of filing case against the culprit, neither has the Organizations said to have been working for the protection of consumer's rights nor the politicians or women's rights activists, all have turned to be blind eye to protect the rights of innocent women admitted for delivery service, which has impetus to increase impunity. If the violence and crime continues taking place in the medicine and health sector, many Lata Gurung would lose their lives and many Chandra Kumari Kafle would face horrific sufferings regularly all across Nepal.

http://e.myrepublica.com/component/flippingbook/book/1166-republica-01-march-2013/1-republica.html

Sunuwar is an investigative journalist associated with Centre for Investigative Journalism, Nepal.

(1 March,2013 Republica Daily)