Imphal Review of Arts and Politics


Death of a Young Pregnant Woman Brings Focus on Need for SOPs for Non-COVID Patients

An inquiry has begun into the atrocious case of Ms. Kanpatliu who died days back after being refused admission to five different hospitals in Imphal where she was taken for emergency natal treatment. An order issued on August 6 by the joint secretary, Health and Family Welfare, R, Rang Peter stated that a two-member enquiry committee consisting of Additional Director (Plg) of Medical Directorate Dr. H Babychand and Deputy Director (PH) of Medical Directorate Dr. Y Premchandra as the chairperson and member of the inquiry committee has been constituted to look into the incident leading to the death of Ms. Kanpatliu Kamei, wife of Roshan Balang, 20 years of age, from Puichi (Oktan) Village who died along with her unborn baby in the morning around 4 am at the Shija Hospital Casualty entrance on August 6. The order also instructed the committee to submit the enquiry report within a period of one week from August 6.

Speaking to FPSJ Review on August 8, Dr. Babychand said that they received the order on institution of an inquiry committee at about 4.30 pm on August 6. “The Inquiry Committee has already begun the process of enquiry by serving circulars to the authorities concerned of Senapati District Hospital, JNIMS, RIMS, Imphal Hospital, Raj Medicity and Shija Hospital and called on the medical superintendents and casualty in-charges of the said hospitals to give their statements on August 9. The committee will interview them one by one maintaining social distancing,” added Dr. Babychand.

She said the committee is confident it will be able to complete the enquiry report and submit it to the government within the stipulated one week. As the last day of the stipulated time falls on August 12 which happens to be a public holiday the report will be submitted on August 11, for consideration by the government. However, the enquiry is purely departmental and necessary actions will be taken up by the government after the report has been submitted, added Dr. Babychand.

The institution of inquiry committee has been taken up after news of the death of a very young pregnant woman and her unborn baby after she was allegedly refused admission in some hospitals both public and private in Imphal which went viral on social media, hit the front pages of the local dailies and was covered as headlines by local TV channels and appeared in national media.

It is very unfortunate and heart-rending that the 20-year old pregnant woman, Ms. Kanpatliu Kamei who also tested COVID-19 negative died when they reached Shija Hospitals at the casualty entrance in the wee hours of August 6 after running from one hospital to the other due to the denial of admission in five hospitals in Imphal.

This unfortunate incident has once again reminded us about the need of a policy and programme and Standard Operation Procedures (SOPs) for the hospitals in Manipur for treatment of non-COVID patients and medical ethics along with effective management of COVID care and prevention as highlighted in last week’s article.

Moreover, some pertinent questions crop up in the case of Kanpatliu’s death. Is Senapati District Hospital not able to handle delivery cases? What led to Kanpatliu’s death? Why did the hospitals refuse to provide medical service to her?

Remarkably after the incident of Kanpatliu’s death, Manipur Government’s Principal Secretary (Health & Family Welfare) V Vumlunmang has issued an order on August 6 that all government hospitals and private hospitals ensure that all patients who reach their facility are attended to promptly, especially emergency  and time-bound cases. The order further instructed that each hospital/health facility shall designate responsible staff to ensure there is no denial of service.

Meanwhile, in a press release issued on August 7 by Haulianlal Guite, IAS, Chief Executive Officer of State Health Agency of the Government of Manipur the government has established a 24X7 toll free helpline number, 1800-103-2015, to ensure there is no denial of service, wherein any person denied treatment by a hospital can immediately call.

On a query on how to avoid such incidences and treat non-Covid emergency patients, Dr. Sukham Thoibahenba, Prof and HOD of Anaesthesiology, JNIMS expressed to FPSJ Review, “Such a unfortunate case could have been avoided if Senapati District Hospital had contacted JNIMS either over phone or WhatsApp as is being practiced in most emergency cases amidst COVID-19 pandemic and even in normal time instead of just sending off the patient party.” Cooperation between hospitals and a policy are the need of the hour. We did an emergency operation on a woman on the night of August 4 without knowing COVID-19 status taking all the risks and luckily her life was saved, he added.

Further, JNIMS Medical Superintendent Dr. T Rajen said to FPSJ Review, ‘Enough Rapid Antigen Test kits and protection gears should be made available so that doctors and health care workers can attend to non-Covid patients assuming that they are COVID-19 positive.”

Regarding the problems being faced by the non-Covid patients and their party, doctors and health care workers, the rising number of documented or non-documented deaths of patients for want of medical treatment amidst the COVID-19 fight, RIMS Medical Superintendent, Dr. Ch Arunkumar said to FPSJ Review, “There should be a comprehensive and practical policy for the state for non-Covid patients. For RIMS a policy and Standard Operating Procedure for non-Covid patients is being prepared and will be ready soon.”

According to family sources of the deceased, Ms. Kanpatliu Kamei, wife of Roshan Balang of Oktan village of Noney district died carrying an unborn baby at the casualty entrance of Shija Hospital in the wee hours of August 6. They had brought her up to Senapati District Hospital at about 2 pm from Makuilongdi village in Senapati district, her maternal home. Kanpatliu was staying at her maternal home in Makuilongdi with her husband, sources close to the family said. The doctors at the district hospital kept her under observation for several hours and later referred her to the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Imphal around 10 pm.

However, when FPSJ Review contacted Dr. Allen Chiru, a senior medical officer of the Senapati District Hospital, who attended to the woman after his OPD duty, said that the patient was admitted in the hospital around 4 pm in the evening and it was learnt that they had earlier tried to deliver the baby at home with the help ASHA workers before coming to the hospital. It was also told that Kanpatliu was brought to Senapati District Hospital only after she complained that she could not feel any movement of the baby but had abdominal pain.

Dr. Allen further said that after having been admitted he did an ultrasound at the Casualty and found that there was no fetal heart rate. He said the same was explained to her husband and patient’s attendants. Moreover, the patient party was also informed about her pelvic examination result and told them it was borderline pelvis and she will be observed for some time for progress of labour as she had some labour pain. However after enough observation there was no good progress of labour. Then, her husband and the patient party were informed of the situation that it would not be possible to have a normal delivery, added Dr. Allen.

Dr. Allen further told FPSJ Review that the patient’s husband also requested to be referred to some other hospital without delay if that was required. Therefore, the patient on the request of her husband and relatives was referred at about 9.30 pm to another hospital with better facilities.

Moreover, Medical Superintendent of Senapati District Hospital, Dr. Thao Barou on a query by FPSJ Review whether there was any lapse or negligence on the part of the district hospital in the treatment, responded that they did their best.  Dr. Thao further said that the patient was admitted to the hospital around 4 in the evening and it was learnt that they had earlier attempted to deliver the baby at home with the help of some ASHA workers the previous night (August 4) before bringing her to the hospital.

However, despite Kanpatliu’s complaints of pain in the abdomen it was observed that her condition was stable with BP 110/70mmhg, PR 80/min Intravenous fluid and required antibiotics were given. But she was not developing any contraction i.e. a shortening of the uterus muscles occurring at intervals before and during childbirth, Dr. Thao added.

As such she was taken inside the labour room and kept under observation. At 7.30 pm, the patient was re-examined and there was not much progress and again at 9 pm she was rechecked and there was no progress, Dr. Thao said.

When the casualty doctor did ultrasound, they found that no fetal heart rate of the baby was detected, which suggests that it was a case of intrauterine fetal death (IUFD), she further said. Concerned about the mother’s health, the doctor asked the patient to wait so that the delivery process could take place even if the baby had died. The patient’s condition was explained to the husband and relatives, she further said adding they insisted that they wanted to go to Imphal for further treatment.

Dr. Thao Barou said, “The patient’s vitals from the time of admission till the time of referral was stable.”

On a further query whether the Senapati District Hospital cannot handle such delivery cases of cesarean section operation even if it is IUFD, Dr. Thao told the FPSJ Review that the Senapati District Hospital has gynecologists and other infrastructures except blood bank. In case excessive bleeding occurred as Kanpatliu’s case was her first child, it would have been beyond their capacity.

Subsequently, the patient party hired a private vehicle and reached JNIMS around 12.30 am but the patient was deprived of treatment at JNIMS. A relative of the deceased woman who accompanied her to Imphal, said the deceased was refused to be treated at JNIMS on the pretext that a patient had tested positive at the Obstetrics and Gynaecology ward of the hospital.

However, Medical Superintendent of JNIMS, Dr. T Rajen on August 7 told FPSJ Review that there was no evidence of the patient being brought up to JNIMS for delivery. “We don’t deny any emergency patients amidst COVID-19 pandemic. Even at midnight of August 4, we did an operation and saved a woman,” added Dr. Rajen.

They were informed that JNIMS no longer admits new patients due to the positive cases in the department and haplessly wandered from one hospital to the other, though they possessed a COVID-19 negative test result, the patient party said.

Further, Pouchulung Kamei, cousin of the deceased said that after she was refused at JNIMS they sought the help of a man who was working in a pharmacy near JNIMS, as they were strangers to Imphal, to take them to other hospitals including RIMS. However, RIMS also refused to admit her.

Notably, on a query regarding the alleged refusal of providing medical treatment to Kanpatliu by gynaecology department, Medical Superintendent, Dr. Ch Arunkumar told FPSJ Review on August 7 that an enquiry is underway to examine if there was any negligence by the concerned wards or departments.

Family members further said that since RIMS also refused, they tried Imphal Hospital, Raj Medicity and a private hospital among others but in vain.

“At last we reached Shija Hospital at about 3.30 am and while our people were talking to the hospital staff for admission waiting at the Casualty entrance for about three-four minutes the patient with her unborn baby breathed her last,” said Kanpatliu’s husband Roshan Balang.

“I would have been satisfied if she was attended to by doctors in the government or private hospitals in Imphal,” Roshan complained to FPSJ Review.

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