Newborn's death during referral shows Govt's failure to enforce SOP

Death of a newborn in Kupwara district has put a question mark over the implementation of the standard operating procedure (SOP) framed by the Government at the beginning of this year to ensure safety of patients during referrals.

On Saturday, Fatima Begum, a pregnant woman from far flung area of Sarkoli, Kalaroos was brought by her family to primary health center (PHC) Kalaroos with some complications. She was referred to sub-district hospital Kupwara by the doctor on-duty.

While travelling in a hired vehicle, she delivered a baby on way to the hospital. The baby “died soon after birth” according to family. The death triggered a massive uproar in the area with people demanding action against the doctor who “refused” to provide an ambulance to the patient.

The subsequent inquiry by health depart has revealed that the doctor on duty “refused to provide ambulance” although “an ambulance was present in the premises of the hospital at that time”.

As a result, the family was “forced to hire a taxi” to ferry the patient to Kupwara for further management. A few kilometers ahead, a “dead baby” was delivered in the cab, as per the report compiled by the two member probe committee constituted by chief medical officer (CMO) Kupwara.

The incident is a reminder of the sequence of events in January this year, when a pregnant woman from Moori Kalaroos referred from Kupwara was “refused admission” at a Srinagar hospital, “forcing” her to deliver on road, and death of the newborn afterwards.

The incident had forced Government to frame SOPs to be implemented at levels of healthcare system and to ensure that patients reach the destination hospital  safely and are provided adequate care.

The recent incident, a senior doctor in Government Medical College (GMC) Srinagar said, illustrated the failure of two “guarantees”. First, as the GoI’s flagship scheme for pregnant and newborns Janani Shishu Suraksha Karyakram (JSSK) mandates, the patient was not provided an ambulance to ensure her smooth travel. Second, as the recent SOPs of State government for patient referrals demands, no healthcare provider accompanied the patient to ensure her safe transit to the destination hospital.

However, a doctor working in Kupwara district said that SoPs formulated by Government were mere “rhetoric” in absence of augmentation of human resource in peripheral hospitals. “Take the same Kalaroos hospital for example – there is only one healthcare provider at the hospital at a given time. Will she attend the admitted patients or accompany the referred patient?” he said.

In addition, the doctor said, in Kupwara district, despite claims of Government, no human resource has been added to augment maternity services. After 4 pm, a pregnant woman referred to Kupwara from any PHC of the district will inadvertently be sent to Lal Ded Hospital. “Maternity services continue to run on crutches in this far-flung district. So what are SOPs meant to achieve?” he asked.

Dr Bilal Ahmed, the accused doctor, said the ambulance was not provided to the patient as “she did not present with pregnancy” to the health center. “She was suffering from anaemia related edema and heart ailment and the family did not reveal her pregnancy status,” he said. He added that the family “did not ask” for ambulance. Asked about the status of ambulances at the health center, he said, “We have two ambulances, but only one driver is available at a given time.”

Commissioner Secretary health and medical education acknowledged that there were “some instances of lapses” in the implementation of SOPs on ground. “We need to set an example and the person found guilty of the lapse would be dealt with sternly,” he said.

Director health services, Dr Kunzes Dolma, did not answer repeated phone calls from Greater Kashmir.