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Chhattisgarh sterilisation deaths not due to rat poison  #Vaw

Author(s): Jyotsna Singh 
Date:Apr 8, 2015 

Reports accessed by Down To Earth show no evidence of death due to poison. Experts say deaths occurred due to unhygienic conditions and medical practices at the camp

imageWomen, who underwent sterilisation surgeries at a government mass sterilisation camp, had to be admitted to the Chhattisgarh Institute of Medical Sciences hospital in Bilaspur for treatment (Photo courtesy: Reuters)

On November 10, news of 13 women dying and many others landing in hospital after mass sterilisations in Chhattisgarh made national and international headlines. Subsequent investigations, including by Down To Earth (“Operation Cover-Up”, 16-31 December, 2014), exposed state attempts to cover up the entire incident as well as deep flaws in India’s approach to family planning. Five months on, no justice seems to have been done. In fact, evidence points to the state government being responsible for the deaths.

The state government has repeatedly tried to shift the responsibility of deaths and illness among survivors to non-state agencies, saying that the drugs were contaminated with rat poison. But reports of the State Forensic Laboratory, Raipur, show that the deaths were not caused by rat poison. Viscera analyses of five of the 13 women who lost their lives at the sterilisation camp did not find poison in the body of the deceased, says a source who has a copy of the reports.

“Viscera report is the final word in forensic science in investigations of deaths. The State Forensic Laboratory reports suggest the deaths have not occurred due to any poison, let alone rat poison,” says B L Chaudhary, forensic expert at Lady Hardinge Medical College, Delhi. All postmortem reports suggest that the deaths occurred due to infection, caused by unhygienic conditions and medical practices at the camp, he adds.

Test results of drugs used at the camp -Ciprocin 500 (contains antibiotic ciprofloxacin) by Mahawar Paharma and Ibuprofen 400 mg (contains anti-inflammatory ibuprofen) by Technical Labs and Pharma – further expose the callous attitude of the state government.

The Central Drugs Laboratory, Kolkata, tested Ciprocin 500. It established that the antibiotic was sub-standard, with only 51.78% of the claimed medicine in each tablet. But it is silent on contamination by rat poison

Soon after the incident, drug samples from the spot were sent to four laboratoriesgovernment and private-to determine cause of deaths and illness. The list includes the Central Drugs Laboratory (CDL), Kolkata, the National Institute of Immunology, Delhi, Sriram Institute of Industrial Research (siir), Delhi, and Qualichem Laboratories, Nagpur. All four laboratories’ reports, which are with Down To Earth, state that the medicines used in the operations were substandard. “A tablet is defined as substandard when it contains less than 80 per cent of what is claimed,” explains an official with the Central Drugs Standard Control Organisation (cdsco), Delhi. Two reports indicate toxicity.

SIIR tested 50 tablets of Ciprocin 500. The results showed that each tablet contained only 295 mg, or 59 per cent, of ciprofloxacin. It also indicated toxicity. Four of the five mice who were administered with the tablets died within 24 hours. The laboratory conducted an additional test which showed the presence of “zinc/aluminum and phosphide” or rat poison. Its report, however, does not mention the amount, crucial to determine whether the deaths happened due to rat poison. siir’s test on Ibuprofane also shows that the tablets were substandard, with 219 mg of ibuprofane, and contaminated with rat poison.

Similarly, the report by the National Institute of Immunology, Delhi, shows that after administering very high dose of Ciprocin 500 (500 mg/rat) the animal suffered from acute toxic shock and died. The same dose of another standard medicine Ciplox by company Cipla, did not affect the rat adversely. A public health expert, on condition of anonymity, says such high doses can be fatal for animals. He points out that the women at camp did not consume such high doses. “Amount is the key to the mystery of deaths and illnesses,” he says.

The report by Qualichem Laboratories established that the medicines were substandard. It is silent on contamination.

The CDL report also shows that Ciprocin 500 contained only 258.88 mg, or 51.78 per cent,of ciprofloxacin claimed. CDL’s report, however, does not mention contamination with rat poison. “The Kolkata laboratory is not even equipped to test for contamination of zinc phosphide, or rat poison,” says the cdsco official. Why did the state administration send samples to a laboratory that cannot test for the probable cause of deaths espoused by the state itself?

Lack of seriousness
The CDL report points to the lousiness of the Bilaspur Food and Drug Administration, which had handed over samples to the laboratory. While CDL received 200 tablets (10×20 strips), the official communication put the count as 1,000 (1000x1x500mg). CDL report also claims that the expiry date of September 2016 mentioned on the strip did not match with the expiry date of September 2015 mentioned in the official communication. “Even though these details do not affect the test results, it shows that the authorities were not serious about the issue,” says Sulakshana Nandi of People’s Health Movement, who has been fighting for the rights of the victims.

Responding to Down To Earth’s queries, R Prasanna, who heads Health Department in Chhattisgarh, said, “We cannot reveal anything as the matter is pending before a judicial commission.”

State harassment
The only serious step taken by the state government so far is to set up a one-person Bilaspur District Sterilisation Camp Judicial Inquiry Commission headed by retired judge Anita Jha. But deposing before the commission has been an ordeal for victims and their families. They had to travel long distances at their own expense. Ramanuj Sahu, for instance, had to travel 50 km twice to submit affidavit on behalf of his wife. The commission did issue letters urging women to file affidavits, but that was on March 3, 2015, the last date of the submission. Of 134 cases, only 51 have submitted affidavits. Most of the victims could submit affidavits only after receiving guidance from the Centre for Social Justice, a non-profit in Bilaspur. Gayatri Suman Narang, who heads the non-profit, says, “The government did not put any effort in collecting affidavits. The room was found closed on several occasions.” To add to their troubles, the commission since March 27 has started to cross examine those who deposed.

The affidavits outline the way surgeries proceeded on the two days of the camps. In one affidavit, a woman recounts how she gave thumb print on a paper, but the contents were not read out to her. In another affidavit, husband of a deceased woman says that he has not received the postmortem report of his wife despite asking for it several times. He says the surgeon reached the venue only at 3.00 pm, leaving little time for proper sterilisation of 83 women in one day.

Apart from the judicial commission, the police is investigating the matter based on firs of the deaths. “The state government has also initiated a departmental inquiry into the matter, but it is biased as all the members are from the health department,” says Yogesh Jain, convenor of non-profit Jan Swasthya Sahyog. “This is the reason, we have been demanding a clinical inquiry since January.” A clinical inquiry is done by a team, that includes a forensic expert, epidemiologist, gynaecologist, toxicologist, microbiologist, public health expert and local activists, and is considered unbiased. “But the state government is yet to set up one,” he adds.

The courts have also intervened in the matter. The Chhattisgarh High Court took suo motu cognizance of the matter and has asked the state government to submit a response. A public interest petition filed by Human Rights Law Network, Delhi, is pending in the Supreme Court. The apex court, on March 21, blamed the government for being unprepared in the matter. The next date of hearing is April 17, 2015.

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