On Tuesday, newspapers across the state carried front page reports that there were at least 9 maternal deaths in Tamil Nadu, due to the transfusion of lysed blood in three government hospitals. According to medical practitioners, 'lysed' essentially means components of the collected blood have broken down. This could happen because it turned stale due to exposure to inappropriate temperatures during storage or due to contamination.
Doctors treating the expectant mothers in the Dharmapuri, Hosur and Krishnagiri government hospitals allegedly certified this 'spoiled' blood safe and the resultant transfusion led to immediate death or complications during delivery, resulting in the loss of the mother's life.
This news comes just months after a pregnant woman was administered HIV positive blood at a government hospital in Virudhunagar district and adds to the allegations of negligence by medical professionals during transfusions. It further raises important questions about the state of infrastructure for storage of blood and procedures followed before transfusion.
However, medical practitioners say that state health officials are allegedly attempting to play down the problem at hand and make blood bank technicians and doctors scapegoats for crumbling infrastructure.
No clarity on number of deaths
The news of maternal deaths is based on a regular audit conducted by the Tamil Nadu State AIDS Control Society and Tamil Nadu State Blood Transfusion Council. While Times of India has reported that at least 15 pregnant women have died in four months, The New Indian Express has stated that the number stands at 9 over the last year. Given the discrepancy, officials in the National Health Mission and Directorate of Medical Service, when contacted by TNM, allege that the deaths have been 'grossly misreported'. But a short conversation reveals that even health authorities lack clarity on the matter.
"First of all it was not lysed blood," says Dr N Rukmini, Director of Medical Services. "When blood is not compatible, there is a possibility of a transfusion reaction. The body goes into shock and reacts adversely. There have been only three such cases in six months. Reports of there being 15 maternal deaths are wrong and if it were true there would have been protests in the state," she points out.
A highly placed official in the National Health Mission, however, quotes the number of deaths related to transfusion as 7 in six months. He too, however, remains defensive on the subject.
"As of now, after ruling out other possibilities seven deaths have been linked to transfusions and blood quality not being right," says the official, who did not want to be named. "We have tried to find the cause and the reports show that there have been oversights in the blood bank. There are 600 maternal deaths every year and of this there are about 50 for which I can't pinpoint the cause. Deaths due to transfusion reaction form a minuscule amount," he argues.
While officials are dismissive over the issue, medical practitioners like Dr Ravindranath from the Doctors' Association for Social Equality say this only exposes the negligence of the government.
"How does it matter if it is one death or seven? Does the loss of life only have value in numbers?" asks Dr Ravindranath. "This entire incident exposes the government's carelessness and in order to shift blame that are making scapegoats of the hospital and blood bank staff," he alleges.
Criminal complaint against staff
According to documents available with TNM, Health Secretary Beela Rajesh has directed the Health Department to initiate disciplinary action and file a criminal complaint against three doctors and multiple other blood bank officials and staff involved in the transfusions. The move appears to show that the deaths are a more serious issue than authorities are letting on.
The official from the National Health Mission however asks, "If they (blood bank authorities) don't switch on the refrigerators (where blood is stored), what can we do?"
Dr Rukmini, when asked if the situation was not worrisome, says, "Transfusions are still happening and we can't stop it. We have to be more careful and give repeated training to the people handling the blood."
But the Tamil Nadu Government Doctors Association (TNGDA) has already voiced its opposition to the decision on a criminal complaint.
"TNGDA vehemently opposes the decision of the Government for hasty action. The order for criminal action is unheard of and that too after a team visit and very preliminary inquiry. Such criminal action is a retrograde step and will make all medical officers incharge to resort to defensive actions," says the association's statement. It further points to flaws in the process. "An audit after months based on records is too incomplete and that too after 15 deaths (as official sources claim) is too lethargic. If at all any death diagnosed of due to transfusion reaction should have been investigated in detail with a team of specialists next day or two and samples from the said blood bag should have been done," it points out.
Sources in the Medical Council of India also tell TNM that such action against the medical professionals are uncalled for and that a thorough probe must be conducted. The Health Department confirms that the Directorate of Medical Services and Directorate of Medical Education will be forming a team within a day to enquire the matter further.
But Dr Ravindranath points out that the larger problem is being ignored.
The larger issue
"Government labs for blood banks and the kits they are given are not of good quality for testing. If the Health Department is saying that the blood was not compatible then that is also an infrastructural issue. Currently, they conduct slide tests to check compatibility and not the more sophisticated tube test because that would mean an additional expense for the government and they don't want to spend for the people," he says. "The World Health Organisation says that transfusion should be 90% components of blood but here we give up to 80% whole blood. In addition to this, there is clearly rampant corruption in procurement of blood bags and kits. Will the government also audit all this?" he asks.
But despite campaigning for the Lok Sabha polls being underway across the state, most political parties have been silent on the matter except the DMK, which blamed the government for the deaths. The administration led by Edappadi Palaniswami is yet to give a reassurance to people on the matter and promise quality treatment in government hospitals.
"Would the number of women who have been affected matter if one of them was a Minister's pregnant wife?" asks Dr. Ravindranath. "Since it is just a poor woman who can't afford treatment at a private hospital, her life lacks value."
Another case of negligence in Tamil Nadu blood transfusions
Late last year, the Tamil Nadu Health Department came under fire after a 23-year-old pregnant woman was transfused with HIV infected blood at a state government hospital in Sattur, Virudhunagar in December. It was a case of negligence that shocked the state and the country. The woman had been transfused with blood from a 19-year-old HIV positive man, who discovered the diagnosis through a visa application screening process after he had donated blood. The woman was immediately admitted to Government Rajaji Hospital, Madurai to be treated and for her child’s delivery.
After the case came to light, the Health Department ordered all blood samples in the state, in both government and private hospitals, to be tested.
Three staff members, as well as the lab technician, were terminated as a result of the incident. An expert committee was formed by the state government under the leadership of Dr Sindha, senior blood bank officer and the Madurai Government Rajaji Hospital, to examine the case of negligent exposure to HIV infected blood. Then Health Secretary J Radhakrishnan also rushed to Sattur and conducted an inquiry into the case.
Soon after details of the case emerged, the Madras High Court took suo motu cognizance of the matter. A bench comprising Justice S Vaidyanathan and Justice PT Asha asked the Tamil Nadu Health Department to file a report on the case.
In January, the woman gave birth to a girl child and the first test for HIV was recently conducted. The test came back negative for HIV, though further tests will be conducted six months after the baby’s birth.
In another recent case, the parents of a 2-year-old child alleged that the child was transfused with HIV infected blood at Coimbatore Medical College and Hospital in July last year. When the child was examined this year, the doctors informed the parents, who are daily wage workers, that the baby was HIV positive. The Tamil Nadu Health Minister Vijayabhaskar however stepped in and ruled out any error in the blood transfusion. “We have checked Donor blood. It is completely negative. It has been made sure that the HIV infection did not happen due to blood transfusion,” he said, speaking to the media in February.