In September last year, nine women admitted to Kathmandu’s Paropakar Hospital, also known as Prasuti Griha, went into a medical relapse after delivering babies through Caesarean Section. Besides exhibiting violent behavior, nausea and high fever, the patients complained of severe pain in the spinal cord, the anesthesia administration site. The attending doctors injected high doses of antibiotics to mitigate the pain, but the patients’ health deteriorated rapidly. The doctors knew that the patients were in grave danger and that it had something to do with the medicines they were administered. The anxious doctors then risked the lives of these patients by referring each of the unstable patients to different private hospitals in the Kathmandu Valley, without ensuring that these hospitals were in a position to cater effective treatment.
The doctors at Prasuti Griha concealed the facts of the case and spread rumors that infection had spread due to contamination inside the operation theatre, following which the hospital administration held an emergency meeting and decided to close down its surgical services for three days. Workers at the sanitation department were blamed for failing to sterilize the equipments and gloves used in the operations.[break]
But laboratory investigation which included testing of 39 different surgical equipments used in the operation theatre confirmed that the infection had not spread from contaminated equipments or gloves, as the hospital administration had stated.
While the officials at the hospital scrupulously removed the remaining stocks of the medicines which were used during the operations, the doctors blamed delivery complications and weak immune power of the patients for their conditions. The emergency meeting of Prasuti Griha Hospital Development Board was called and the administrators were busy visiting the Health Ministry and drug suppliers.
Lives unaccounted for
Lata Gurung, 24, from Siuchatar was admitted to Prasuti Griha on September 13 for delivery. The following midnight, doctors operated on her. A few hours after the operation, she developed symptoms like nausea, high fever, stiffness in the neck, and lost consciousness. The following day she was referred to Kantipur Hospital at Tin Kune where she died on the fourth day.
The attending doctor at Kantipur Hospital, Dr. Yubaraj Sharma says, “When we received Gurung, her blood pressure was very low and her heart was very weak. She was almost brain-dead. The ventilator and the medicine couldn’t improve her condition.” Luckily, her child survived.
Gurung’s husband, Suman KC, says that despite her critical condition, doctors at the hospital were careless and left her at the mercy of the nurses. When her condition began to deteriorate, they referred her to Kantipur Hospital.
“I took her in a healthy condition but came back with her dead body,” he says.
Deepa Thapa, 24, was also referred in a critical condition to Kathmandu Medical College (KMC) at Sinamangal where she was kept on ventilator for a month. The doctors managed to save her life but Deepa has become mentally unstable and needs regular treatment. She runs away from home and has regular fits. Dr. Dev Kumar Neupane, who was involved in Thapa’s treatment, says, “When she was brought in, her brain had been inflamed due to bacterial infection and she was unconscious.”
Two other women, Sushila Sharma, 28, and Binda Ghimire, 19, were also referred to the same hospital in critical condition. Luckily, they were able to return home following extensive treatment but still have to visit the doctors regularly.
Sapana Parajuli, 24, was also referred to KMC where she was treated for a week while Diya Shrestha, 21, and Chandra Kumari Kafle, 37, were referred to Star Hospital at Sanepa. Both still complain of severe pain in the spine where the doctors had administered spinal anesthesia, and have to go for regular checkups.
“She used to get out of control and doctors had to tie her hands and legs,” says Arjun Kafle, Chandra Kumari’s husband.
Bhagwati Amatya, 20, from Makwanpur lost her baby after her health deteriorated within a few hours of the operation on September 10 at Prasuti Griha and she had to be referred to Star hospital. The hospital authorities didn’t tell her what caused the baby’s death but she blames the hospital for not taking proper care of her healthy newborn.
26-years-old Deepa Shrestha was also referred to the Blue Cross Hospital at Tripureshwor and returned home after a week of treatment. But her newborn who became ill on the fifth day of birth died on October 29, 2012.
Negligent, or corrupt administration?
After the families of the victims raised the issue of negligence, the hospital administration formed a probe committee led by Dr. Amir Babu Shrestha, which included family members of the victims. The committee sent 11 samples of different medicines used in the treatment for laboratory tests at the National Medicine Laboratory via the Department of Drug Administration (DDA).
The laboratory tests confirmed that that two injections administered during the delivery were contaminated and there was presence of bacteria.
“We spent two weeks testing and retesting those medicines. The tests have confirmed that two medicines, Ranitidine (Emtec) injection (manufactured by Sanjivani Parental India Limited) and Oxytocine 1 ml injection (manufactured by Hindustan Pharmaceuticals India), were contaminated with bacteria and fungus and weren’t sterile, either,” says the head of laboratory, Mohan Prasad Amatya.
Chandra Kumari Kafle-37 undertaking treatment at Star hospital
Anesthesiologist Dr. Chhatra Krishna Shrestha at the Prasuti Griha admitted to administering both injections on all the nine patients.
Ranitidine injection is given to prevent gastritis generated by the side effects of the antibiotic given during delivery, while oxytocine injection is given to stop excessive uterine bleeding.
It was obvious that contaminated medicine was the probable cause of death of those women at Prasuti Griha. But the hospital authorities spread the rumor of infection to conceal that fact. The director of Prasuti Griha, Dr. Shila Verma, refused to comment on the incident, while the chairperson of the Hospital Development Committee, Dr. Shyam Sundar Misra, said that he was unaware of the incident.
The committee submitted its investigation report to the Prasuti Griha Administration on November 18, 2012 which concludes that the hospital administration has been procuring low-quality medicines against the prescribed guidelines for procurement but it doesn’t recommend action against the guilty officials.
Meanwhile, the Department of Drug Administration has issued directives to the injection importers to withdraw the entire batch of the harmful injections from the market.
“We’ve already withdrawn the entire batch of Ranitidine injection (batch no. SRA 113) from the market, as per the DDA directives,” says Shes Kant Subedi, Chairman of Injection Nepal, the importer of Ranitidine injection in the Nepali market.
Similarly, Chhetrapati-based Minko Pharmaceuticals is the importer of Oxytocine injection which was found to have been harmful. The proprietor of Minko, Mrigendra Shrestha said that the company has already withdrawn the remaining 800 ampoules of Oxytocine injections (Batch# 402) from the market, following the DDA’s directives.
Besides the above mentioned injections, the patients were also given Bupivacine, called Bupitroy, an anesthesia injected directly into the spinal cord. The hospital had bought 25 ampoules of Bupitroy, Batch No. 15152, manufactured by Triokaa Pharmaceuticals India, on September 11, 2012.
Dr. Amir Babu Shrestha, who was involved in the delivery of Lata Gurung, admits that she was given Bupitroy injection of Troikaa Pharmaceuticals Batch No. 15152 through the spine, after which she developed complications.
“After we had discovered similar symptoms in other patients, we changed all the brands of medicines, including Bupitroy used in the delivery, after which we didn’t have any problem.”
On September 16, another woman at KMC developed similar symptoms immediately after a few hours of delivery operation. The attending doctors instantly conducted lumber puncture test to detect whether the patient had meningitis and found that she had bacterial meningitis. The patient had been administered Bupitroy injection of Troikaa Pharmaceuticals Batch No. 15152 through her spine, the same that was administered to those at Prasuti Griha.
“We immediately barred the respective batch and other injections manufactured by Troikaa Pharmaceuticals,” says Dr. Chanda Karki, head of Gynecology Unit at KMC.
The importer of the Bupitroy injection told us that they have already withdrawn the respective batch of injection from the market, following the complaints.
The Bupitroy injection of Troikaa Pharmaceuticals batch No. 15152 at the Prasuti Griha was supplied by Chhetrapati-based Shanghai Pharmaceuticals Pvt. Ltd. The hospital management has been procuring medicines under the Safe Motherhood program.
Another death from Bupivacine injection
Last week, on February 16, Rita Adhikari of Dhapakhel in Lalitpur was admitted for delivery at Patan Hospital. On the following day, immediately after administering Bupivacine injection, she developed suspicious symptoms and then lost consciousness. Her attending doctors administered antibiotics but her condition deteriorated and she had multi-organ failure. On the fourth day of getting admitted to the hospital, she had a miscarriage. The doctors then operated on her to remove the dead infant. On February 21, the fifth day, she also died in the Intensive Care Unit (ICU) of the hospital.
The director of Patan Hospital, Dr. Pawan Kumar Sharma, said, “She died of Bupivacine injection.” She was administered the said injection produced by the Indian pharmaceuticals, Claris Life-Science Limited, Batch No. A010747.
Ill-equipped laboratories
The discharge sheets of patients who were referred to and treated at different private hospitals clearly mention that they had suffered from Meningiusmus, the first stage of meningitis which causes inflammation in the protective membranes of the brain. The medical records state that the women were healthy prior to delivery and went into medical relapse after they were given Bupivacine.
“Everything indicates that whatever caused the inflammation, it entered directly into the brain through the spine,” says Dr. Yubaraj Sharma, a senior doctor at Kantipur Hospital, who attended to Lata Gurung, Shusila Sharma and Binda Ghimire.
Dr. Anil Pokharel of Star Hospital and Neurologist Dr. Dinesh Bikram Shah at Blue Cross Hospital agree with Sharma.
Public health expert Dr. Sarad Raj Onta also opines that the symptoms developed in the patients in such a short time indicates bacterial infection entering directly into the brain through the spine.
After confirming contamination, on November 20, the National Medicine Laboratory sent its lab report to the Prasuti Griha instructing the hospital not to use the injections Ranitidine (Batch No. SRA113) and Oxytocine (Batch No. 402). However, the laboratory chief Mohan Prasad Amatya says that the laboratory doesn’t have the technology to detect whether the medicine contained chemicals that caused meningitis.
After senior doctors suspected Bupitroy injection of causing meningitis, the sample of the injection was also sent to Nepal Academy of Science and Technology laboratory but the laboratory lack technology to test the chemicals in the injection.
Director of DDA, Radha Raman Prasad says, “We’re supposed to grant permission to pharmaceutical companies to import their product only after our laboratory tests confirm safety and efficacy of the medicine. But we don’t conduct tests of each batch of the medicines.”
“It’s a glaring proof of an utter disregard that concerned authorities show towards public health and wellbeing,” says Ram Chandra Simkhada, advocate and Secretary of Kathmandu Committee of Consumers Rights Protection Forum, stating that nowhere in the world the government grants permission to pharmaceutical companies to import medicines without obtaining tested approval from laboratory for each batch of medicines.
The Essential Service Operation Act (ESOA) 1957 requires every single batch of medicines to be approved by the laboratory.
Irresponsibility and impunity
There is no dearth of stringent laws to protect consumer rights and health if only the provisions of Muluki Ain-2020 BS and ESOA Act-1957 are implemented effectively. Drugs manufacturers, importers, suppliers and the concerned authority responsible for granting permission, as well as health providers and hospital management who put public health at risk, can be fined upto Rs 500,000 and face jail term upto 14-years, according to the severity of incidents and involvement. The law also stipulates life imprisonment with seizure of all property in case of deaths of mothers and babies resulting from negligence of the involved.
There is little doubt that the deaths and sufferings of women and children in the Prasuti Griha were the direct result of negligence of the hospital authorities and it reeks of corrupt practices in Nepal’s health sector. But neither government attorneys who have jurisdiction of filing cases against the culprits nor the consumer rights group or other organizations working in the field have shown interest in securing justice for the victims and setting strong precedence. They have conveniently turned a blind eye on the plights of innocent women who were victims of Nepal’s unhealthy health system.
Sunuwar is an investigative journalist associated with the Centre for Investi
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