Tamil Nadu: Newborn dies of medical negligence in Dharmapuri primary health care centre

The parents of the child alleged that the nurse was not available at the appropriate time to attend to the baby and this led to the child's death.
Image used for representational purposes only. (Express Illustrations)
Image used for representational purposes only. (Express Illustrations)

A woman lost her newborn child two days after delivery due to medical negligence at the Palayamputhur Primary Healthcare Centre in Dharmapuri.

Ananthi, wife of Vijaya Kumar, a farm worker, delivered the child at the healthcare centre on June 28. The staff asked her to stay back at the centre for post-natal care.

The duty nurse administered the newborn a vaccine for jaundice at noon on June 29. Later, the child developed a fever and died around 3.30 am on June 30.

The parents of the child alleged that the duty nurse was not available at the crucial moment to attend to the baby. This led to the death of the child.

The district health department launched a probe after the local media uncovered the tragedy. The investigation concluded that there was medical negligence. 

"The staff nurse, who was on duty, will face departmental action," a top official in the district told The New Indian Express Online on condition of anonymity.

The official explained that the incident happened at an additional Primary Health Centre (PHC). "Only upgraded PHCs - UG PHCs have doctors round the clock, while additional PHCs get only 'on-call' doctors," the official noted.   

Block Medical Officer Vasudevan, while explaining the sequence of events, said that the mother was feeding the baby when it suffered asphyxiation. Immediately, the child's father along with a kin went to the duty nurse's room seeking help. But the door to the duty nurse's room was locked. There was a delay on the part of the nurse to open the door.

However, he hastened to add, "We can’t call it medical negligence. It is a case of asphyxiation. It is true that the staff nurse and the helper stayed inside the room after locking it. But the staff nurse had given the newborn medicines for fever in the evening. And shortly after the father called for help, the nurse though not immediately available, did come to help. The staff nurse even performed Cardiopulmonary resuscitation (CPR) but in vain."

"We are done talking to the media. It's acceptable to us whatever action the government takes,” said Maruthamani, a relative of Vijay Kumar and Ananthi, who identified himself to be a DMK representative. 

In this case, the lethargy of the staff nurse and the helper induces vexation in one. But one also realizes that it was a matter of minutes which proved to be costly for the couple. It also speaks volumes about the health of primary healthcare in the country.

Meanwhile, a medical professional gave some clarity on the workings of the primary health centres.

How is a health unit district (HUD) divided? 

All districts don’t correspond to the same health district. A revenue district with larger geography might be split into two health unit districts. A HUD, based on population, is divided into individual health blocks. Each block will have a number of PHCs, which will function under a head or block PHC. 

Upgraded PHCs (which may or may not include Block PHVs) have 24-hour services, where doctors and nurses will work on three shifts. 

Additional PHCs will have doctors on duty from 9 AM to 4 PM, and stuff nurses staff around the clock.

Do additional PHCs conduct deliveries? 

Deliveries can be conducted in additional PHCs from 9 am to 4 pm. But, if there are any complications in the cases, doctors will refer them to other hospitals. After 4 pm, deliveries are not conducted in additional PHCs. But if the case is such that the pregnant woman will go into labour before she reaches another hospital, deliveries will be conducted at additional PHCs after 4 PM by trained staff nurses on an emergency basis and referred to higher treatment centres and the in-charge medico. 

The duty doctor, on the next day, will examine the baby and the mother. If they are in good health, they will be advised to stay there. If any issues are found during the monitoring, then the mother and baby will be shifted to a higher centre for further care. 

Are all PHCs locked up in the night? 

Usually, PHCs do not have security staff. Staff nurses have faced issues with harassment by unruly patients and/or attenders, so, they stay in the hospital premises in their rooms, away from the wards. But, usually, when patients knock on the door, they will attend to the patients. 

How is the staff shortage managed and what are the shift timings like for doctors? 

In case of shortage, doctors will be deputed from nearby PHC for shifts, or cover additional shifts. If there's a severe shortage, two doctors might be asked to cover the 8 AM to 8 PM shift, while a medical officer residing nearby would be asked to be available on-call.

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