Furious protesters took to the streets in Chhattisgarh on Wednesday as activists complained standard procedures and guidelines were not followed in the state's mass government-run sterilisation programme that left 13 women dead.
A team of doctors rushed to Bilaspur to investigate the deaths following the operations performed by a doctor accused of using rusty equipment in an operation theatre that had not been used for four months.
The cause of the deaths was not immediately clear, but officials said the victims showed signs of toxic shock, possibly because of dirty surgical equipment or contaminated medicines. The victims had suffered vomiting and a dramatic fall in blood pressure after undergoing laparoscopic sterilisation, a simple process in which the fallopian tubes are blocked.
"Preliminary examinations suggest septic shock may have caused the deaths," said local government official Amar Thakur. "It looks like the equipment that was used was probably infected. We are waiting for the report."
A total of 83 women, all villagers under the age of 32, had the operations on Saturday and were sent home that evening, but more than 50 became seriously ill later and had to be hospitalised.
The expert team from Delhi's All India Institute of Medical Sciences (AIIMS) reviewed the clinical details of the women who fell ill, but did not say what led to the deaths.
"All of us unanimously think that the cause of the illness can only be ascertained after all laboratory results and post-mortem findings are available," said Dr Anjan Tirkha, who headed the seven-member team.
Sources said the death may have been caused by drugs prescribed to the patients or internal malfunctioning resulting in renal failure, respiratory failure and liver infections.
The doctor has been accused of operating on more than 80 women in just a few hours with the help of two assistants in an abandoned private hospital, officials said.
Police have filed a case of causing death by negligence against the doctor, RK Gupta, Bilaspur IGP Pawan Dev told HT. The state government rewarded Gupta on January 26 for accomplishing his target of laproscopic tubectomies.
N Sarojini, founder and director, Sama Resource Group for Women and Health, said the Bilaspur surgeries violated Supreme Court orders saying that a medical team can conduct a maximum of 30 operations in a day with two separate laparoscopes.
"One doctor cannot do more than 10 sterilisations in one day, yet the surgeon in Chattisgarh did an astounding 83 surgeries in a short span of five to six hours… The scale of these deaths and critical morbidity clearly show that these operations were not done under standard protocols," she said.
"The only step that has been taken by the government till now is to announce Rs 4 lakh compensation for the families of the dead and suspension of some doctors. These steps are not adequate to ensure that such incidents do not happen again. The systemic failures that led to this incident need to be addressed."
Although the surgery is voluntary, rights groups say the target-driven nature of the programme has led to women being coerced into being sterilised. Women are given Rs 1,000 rupees and men Rs 2,000 as incentive to undergo the procedure.
Shiv Kumari Yadav, 26, and Parvati Bai, 25, said they would not have opted for the procedure had they known about the surgeries were carried out in an unhygienic operation theatre. "Two women were simultaneously handled on the two parallel beds by the doctors," said one of the patients.
The Chhattisgarh high court has issued notices to the union and state governments as well as the Medical Council of India seeking a detailed report within 10 days.
(With agency inputs)