Orissa in Quagmire of AIDS; High Court Ruling and Minister’s Order Rot under Red Tapes!

Subhas Chandra Pattanayak
aids iconOrissa is in Quagmire of AIDS. The Government has not yet studied to what extent it has spread in the State. But the figure must be alarmingly high as the State has failed to stop supply of infected blood through the Blood Banks, despite specific direction of the High Court of Orissa, that had even punished the State Government with Rs.3 lakhs to be paid as compensation in a case where it was established beyond doubts that a boy of only 17 months of age had been infected with this dreaded disease consequent upon receiving transfusion of infected blood supplied by Government Blood Bank, BMC Hospital, Bhubaneswar, on an operation table. The Blood Bank had supplied screened blood; but the virus had escaped detection, as the ELISA method used for screening is not advanced enough to detect HIV in the grey zone or window period.

On elaborate study and research, the High Court of Orissa had ruled in W.P.(C) No.13441 of 2009 on 28 July 2011 that PCR NAT method be used in all the Blood Banks to stop supply of contaminated blood to patients, as had happened to the child in the instant case. Mandarins of Health Department, instead of implementing this Order, have kept this judgment subjected to their own judgment!
The following three articles, out of a lot earlier published in these pages, would be of help in understanding the sad phenomenon and to see how the Government of Orissa has criminally neglected the most calling cause of health in the State and how its Health Minister’s assurance to the Assembly to implement the remedial method – NAT, as directed by the High Court, has been rotting under the red tapes of bureaucracy.

The articles are:

1. Shocking Reality: AIDS Being Aided by Government of Orissa,
2. AIDS: A Coterie of Officers use Tricks of Subterfuge against the High Court Order and,
3. ORISSA MATTERS Exposed a Malady that reached a Remedy, thanks to Prasad Harichandan

On relying upon the Minister’s announcement in the Assembly, people had believed that they would soon be saved from threat of Transfusion Transmitted Infections like AIDS. But the Minister’s announcement stayed inconsequential because of political timidity.

Political Timidity

Prasad Harichandan of the Congress party was the mover of the adjournment motion, in reply to which Health Minister Dr. Damodar Raut had announced to adopt NAT for blood screening. Had the announcement been executed, the credit for its implementation might have also gone to the mover of the motion Mr. Harichandan. So it was abandoned. Health Minister Dr. Raut, who had given the assurance to the Assembly to implement the High Court order in phased manner, till his last day in the department, did not give the necessary thrust to implementation of his own announcement on NAT in the Assembly.

New Health Minister’s query

After Election-2014, a new Minister in Mr. Atanu Sabyasachi Nayak took over the charge of Health. A young, energetic, workaholic person, he immediately addressed himself to pending tasks. And, thus he located how the department has slept over the High Court Judgment as well as the assurance given by the Government to the Assembly for adoption of NAT to stop infected blood flowing into unsuspecting patients.

He sent the following “Note” to the Secretary.

ASNayak to S.H.Note Sheet
UOI No. 23/MSHFW, I&PR
Date 19.9.2014
This is regarding implementation of NAT screening method for blood in four centres catering to 6 major blood banks of the State.
The Hon’ble High Court in 2011 in one PIL case filed before it, had passed an order for earliest implementation of NAT. The then Hon’ble Minister, Health and Family Welfare, Odisha had assured on the floor of the house for implementation of NAT in phased manner while answering an adjournment motion on the subject on 01.09.2012. A technical committee constituted by the Government had visited two States i.e. Karnataka & Uttar Pradesh and inspected various centers where NAT was implemented and had given their report.
I am told that SBTC was directed to go ahead for implementation of the project. The major procedure involving financial & technical formalities are also over. The technical expert committee has also given its views on the request of proposals received.
It is a matter of concern why this important decision to implement the direction of Hon’ble High Court has not been operationalized till date.
A detail report in this regard is to be called for at the earliest. A meeting in this regard may also be convened at your level as early as possible to expedite the process.
Sd/-
Atanu
16.9.14
Minister of State (Ind), Health & F.W, I&PR, Odisha

In response to the Minister’s note, the Health Secretary informed him on 20 September 2014 that, “A meeting in this connection was scheduled to 15.09.2014 which could not be held due to sudden demise of the mother of the Director, State Blood Transfusion Council. The meeting has been rescheduled for 29.09.2014”.

Secretary acts a judge over the judgment

What happened on September 29? The meeting was held under chairmanship of the Secretary of Health. But it was nothing but an exercise of equivocations, and attempts to stymie the implementation. And, more intriguingly, it was a game of subjecting the judgment of the High Court to judgment of the Secretary. The Minister should take serious note of it.

Secretary doesn’t bother about Minister’s query

As would be seen from the Minister’s note sheet, he had asked, “Why this important decision to implement the direction of Hon’ble High Court has not been operationalized till date” And, he had called for “a detail report” on the delay and had directed to convey a meeting “as early as possible to expedite the process”.

But, instead of complying with the absolutely appropriate orders of the Minister, the mandarins invented tricks to delay the process.
I quote from the minutes:
After thorough discussion, the following decisions were taken:
i. The fact sheet on NAT needs be prepared and submitted;
ii. The letter may be issued to NAT technology user States to get feedback on NAT technology after implementation of NAT, such as performance of NAT system, transport logistics, review mechanism along with grievance redress mechanism during failure of equipment.

Playing over judicial wisdom

The “fact sheet on NAT” is already with the department, as otherwise, the decision could not have been taken to adopt NAT and call for Tenders. Why then this decision at Para- i? Moreover, the High Court has analyzed the essential necessity of NAT to stop supplying HIV infected blood to unsuspecting patients. The government has only one option; i.e. implementation of the High Court Order.

Where from the mandarins get the mandate to sit in judgment over the judgment of the High Court?

When the bureaucratic decision quoted above in Para- i is nothing but playing over the judicial wisdom of the High Court, the decision at Para- ii is indicative of how casually the mandarins are treating the issue of AIDS that they generate by supplying contaminated blood to the patients on operation tables or for serious diseases that require regular and frequent blood transfusion like Thalassemia, Sickle Cell etcetera.

Luxury of equivocations

The quoted decision at Para-ii above says, “Letter may be issued to NAT technology user States to get feedback on NAT technology after implementation of NAT”. They shall send letters to other States to get feedback on NAT! What a great design to waste time!

After the High Court judgment, the Secretary of the Health Department had deputed a high-level committee of experts to collect physical feedback from States where NAT is in use and the Expert Committee’s report, strongly recommending adoption of this advanced technology to ensure supply of safe blood, is very much in the records of the department. This has also been reflected in the Minister’s note quoted supra. So, why again the decision to send letters to the same States for feedback? Does replacement of a Secretary with a new incumbent renders earlier obtained feedback useless?

Moreover, why this, when the only option left to the Secretary is implementation of the ruling of the High Court in the 2009 case? And the only duty of the Secretary is to tell the Minister as to why the High Court Ruling has not been implemented.

The minutes of the September 29 meeting is more indicative of confusion the bureaucracy is creating. As for example, item b under Para iii wants the firm to give “Tax Details”. The tender notice issued by the department, to which firms have responded, itself has stipulated in its ‘Format’ that the “rate quoted should include all applicable taxes except Odisha VAT, which would be paid as applicable”.

When the respondents to this notice are bound by the ‘Format’ beyond which they cannot go, why this confusion is created in matter of ‘Tax details’? Obviously, the Secretary does not want implementation of the High Court Order and therefore, unnecessary hurdles are created in provision of funds for the scheme in supplementary budget.

To escape blame, a decision has been noted under Para-v, which states, “To roll out the NAT facility in whole State, the tentative budget requirement will be around Rs.23.7 crores. But as per decision, in first phase total budget, requirement was projected at Rs.9.48 crores (as per EFC decision). Thus provision in supplementary budget will have to be made based on requirements”.

This note, juxtaposed with Para-iv that says, “Policy decision should be chalked out”, read with the mischief as discussed in context of Paras- i, ii and iii above, makes it clear that either the bureaucracy is infested with elements that need greasing of palms to make the matter move or the Secretary is too stubborn to yield to orders of the High Court and the Minister. Be it whatever, it is clear that the mandarins in Health Department are not paying attention to the urgency of stopping supply of AIDS generating contaminated blood from Blood Banks in the State.

Health Secretary makes a farce of EFC

The situation is horrific when the meetings taken by the Health Secretary do not bother about soundness of the minutes of the Expenditure Finance Committee (EFC) held as far back as on 13 December 2013.

“After going through the relevant documents of the Indian Council of Medical research (ICMR) Studies and other related studies papers & documents”, this authoritative body, in its decision No.1 had “approved” the “proposal submitted by the Health and Family welfare Department for implementation of NAT PCR testing method in Blood Banks in the State”. Further “It is decided to be implemented in the three Medical Colleges and Hospitals of the State”, said its 2nd resolution. The Health department has made a farce of this approval of the EFC.

Manners of the mandarins

The following events may help us understand how hazardous to human health are the manners of the mandarins in the Department of Health in Orissa –
1. The High Court of Orissa, shocked to see a 17 month old boy in AIDS by taking blood on the operation table supplied by a Blood Bank of Bhubaneswar, had issued mandatory direction on 28 July 2011 to the State Government to immediately adopt NAT method for blood screening, so as to eliminate every chance for HIV virus escaping detection within window period.

2. The Minister of Health, in replying an adjournment motion on 1 September 2012 on the issue of non-implementation of the High Court ruling, declared in the House that the Government would implement the Order in phased manner with utmost quickness.

3. Following the Minister’s announcement, an expert committee was sent to various States that use NAT method for field study and feedback and the said Committee submitted its report recommending NAT as the most efficient method for ensuring safe blood to the patients that led the Health Department to arrive at a decision to adopt NAT.

4. The Finance Department accorded necessary approval vide the EFC resolution on 13 December 2013.

5. Request of Proposal was issued through ads on 20 February 2014 and offers obtained and firms selected under stipulations laid down by the department.

6. Despite this when the High Court order of 28 July 2011 and the Minister’s announcement of 1 September 2013 were not implemented, despite EFC approval on 13 December 2013 till 15 September 2014, the new Health Minister, in his notes dated 16 September 2014 wanted to know from the Secretary the reasons thereof and asked the Secretary to call a meeting to ascertain who caused the delay and “as early as possible to expedite the process”.

But, instead of honoring the Minister, the Secretary has taken all steps to delay the process!

This is when the State is in the quagmire of AIDS.

Sad

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State in whirlpool of TTIs; Young Orissa stresses on implementation of Minister words to Assembly for safe blood from Blood Banks

YO Press meet

Orissa is in serious debacle due to spread of transmission transferable infections with deadly viruses like HIV/HBV/HCV escaping notice as outdated methods in vogue are not capable of perfect screening of blood in the blood banks, alleged Young Orissa in a Press conference on July 12 at Bhubaneswar.

Secretary of the organization, Debi Prasad Nayak presented various documents in support of his apprehension that the State of Orissa, due to nonchalance of administration, has fallen in a whirlpool of transfusion transmitted infections (TTIs). Three out of 1528 units of blood carry life killing viruses like HIV, HBV, HCV etc as the existing system of blood screening escape detection in blood banks, he said.

“According to ICMR, these viruses escape in 3 average cases of screening in1528 donated units of blood. Orissa is having 3,41,000 units of blood donations per annum in the average. This indicates that at least 669 unsuspecting patients are accepting infected blood transfusion in Orissa per year”, alleged Nayak.

Citing official statistics, he said, “there are 12,000 thalassemia patients in Orissa who thrive on blood transfusion taken at least once or twice every month. They use about 25% of the total blood received through donations. So, at least 167 thalassemia patients are suspected to be receiving blood infected with HIV/HBV/HCV viruses without them knowing of the danger. This is more serious a syndrome when there is possibility of three fold more infections as an unit of blood is now being separated into three component like platelet, plasma and pack-cell under NACO guidelines for better, larger and specific use of the life-saver. This is stark treachery against the unsuspecting patients’ he said.

Narrating how an unsuspecting patient of only 3 years, who for surgery had accepted transfusion of blood obtained from BMC hospital Blood Bank, was found infected with HIV”, he informed that the “Orissa High Court considering his complaint, had directed the State Government to pay him Rs 3 lakhs as compensation with a further directive to adopt NAT method for dependable screening of blood as the Government is basically responsible to supply safe blood to patients”.

This judicial direction was given in W.P.( C ) No.13441 of 2009 disposed of on 28.07.2011. But the State Government, as is its wont, did not pay any heed to the High Court directive.

Worried over the administrative negligence to such a serious hazard, the Opposition Chief Whip Sri Prasad Harichandan moved an adjournment motion on the issue on September 01, 2012. Nayak said, “Honʼble Minister of Health Dr. Damodar Raut, in his reply announced that the Govt. will use NAT method in all Blood Banks in phased manner and will start Nat Screening with immediate effect in the four most major Blood Banks in the three Medical College Hospitals and Capital Hospital. But, we regret to note, the Ministerʼs announcement has gone barren and resultantly AIDS is rising along with other TTIs in Orissa” cried the Young Orissa Secretary while informing that a “recent case of HIV infection located in the capital city is caused by unsafe blood transfusion”.

“We demand immediate implementation of the Ministerʼs announcement in the Assembly on September 01, 2012 by replacing the ELISA screening with NAT PCR Screening in the Blood Banks attached to Capital Hospital and the Hospitals of the three Government Medical Colleges at Berhampur, Cuttack and Burla and adoption of the said method in all the Blood Banks of Orissa without monetary pressure on the patients” , said Sri Nayak.

Young Orissa office bearers, Priya Pritam Mohanty, Pranab Kumar Bal, and Arobinda Mishra were present in the conference along with Nayak.

Shocking Reality: AIDS Being Aided By Government of Orissa

Subhas Chandra Pattanayak

It is shocking. But it is the reality. The Government of Orissa is contributing to spread of AIDS by sleeping over evidences of transfusions of HIV positive blood in hospitals in the State, in absence of facilities for proper screening.

The reality has come to light through a very poor person of Baramba Tahsil, Pratap Kumar Nayak, whose son of only 17 months of age is infected with the dreaded disease due to presence of the virus in the blood he was transfused with during an operation.

In a chilling case before the Orissa High Court (W.P.(C) No.13441 of 2009) Nayak narrated that his son Adarsh was born on 21 Oct.2007 in a Public Health Center (PHC) in Nayagarh district by way of normal delivery. But a day thereafter it was found that the baby had no anal canal. On contact, the PHC, not equipped with a pediatric specialist as it is, advised Nayak to consult Khurda hospital, where, a Dr. Jayaram Patra diverted him to a Dr. Subrat Mohanty, pediatrician, who again diverted Nayak to a private hospital of Bhubaneswar, The Neelachal Hospital. Nayak admitted his 3 days old son in this hospital on 24 Oct. 2007. The next day, Dr. Mohanty conducted the operation and claimed that it was successful. The baby was given transfusion of a bottle of blood, obtained from Red-Cross Blood Bank, Municipal Hospital, Bhubaneswar on requisition by the surgeon and against payment of its cost, in course of the operation. At the time of discharge, he was advised for a second operation after 10 moths for which Nayak admitted his son to the same Neelachal Hospital on 18 August 2008. As transfusion of blood was made a prerequisite to operation, on requisition of the hospital, a bottle of blood was also procured from the said Red Cross Blood Bank, Municipal Hospital, Bhubaneswar on 19.8.2008 against payment of its cost and the baby was operated on that day. The second operation was also claimed to have been successful like the earlier one and the baby was discharged after ten days of the operation. As advised by the Doctor, the baby was again admitted in Neelachal Hospital on 25.2.2009 for final surgery.

As usual, before operation, the blood of the baby was tested. Shockingly, the report indicated HIV positive. Dr. Mohanty withheld operation and advised Nayak and his wife to go to ICTC Centre for testing of their blood on 2.3.2009. On testing their blood it was found to be negative and the blood of the child was found to be HIV positive. Thereafter the baby was taken to S.C.B. Medical College & Hospital, Cuttack for collection of blood sample and the same was sent to M.K.C.G. Medical College, Berhampur for testing and also for CD 4 counting and the count was 1139 cells per M.M. on 17.3.2009. On 26.8.2009 Dr. Mohanty refused to operate the baby on the ground that there is no facility in Neelachal Hospital for operation of HIV positive patient.

As the parents’ blood test proved that they had no HIV infection, it was proved that the baby was infected with AIDS because of the blood transfused to him on being procured from the blood bank.

But, before the High Court, the State Government asserted that the blood supplied by the Blood Bank was screened for infectious diseases, specifically AIDS and was found negative. Where from the infection then came to the baby born to parents not at all infected with HIV positive?

The infection comes through (i) Unsafe sex, (ii) child born through HIV affected persons, (iii) through needles, and (iv) through blood transfusion.

The High Court determined that the baby being hardly 17 months old, he had no scope of infection from unsafe sex. His parents were not infected; hence infection through parents was ruled out. There was no possibility of infection through needles, as the hospital used only disposable needles to which the parents of the baby were witnesses. Thus the only cause of infection was the transfusion of infected blood.

How could then the HIV virus was not detected during screening of the blood? It was found that, blood screening in Orissa is not being done in Nuclear Antizen Test (NAT) or Polymer Chain Reaction (PCR) method, as a result of which, HIV virus is escaping detection.

As per medical science, the length of time following the infection of an individual to develop detectable antibodies is about three months after the infection. This is called the “Window Period”. The blood that Nayak received was certainly collected in this “Wndow Period”. NAT/PCR method could have detected the infection during the “Window Period”, but, as these methods are not in use in Orissa, the poor baby, for no fault of his own or of his parents, developed HIV positive.

“There is no provision in the State to identify virus during the Window Period. Unless special test known as Antizen Test is conducted through Polymer Chain Reaction (PCR) method, the virus cannot be identified during the Window Period i.e. during three months of infection. Therefore, the receipt given by the blood bank stating therein that the blood units are tested against HIV seems to be a myth” claimed Ms. Sujata Jena, Nayak’s lawyer in the High Court.

The Court has agreed with her and awarded cash compensation to the infected child, by making the following direction a must for the Government:

Needless to say that blood donated by one saves life of another. Donation of blood is a noble work. In order to achieve this avowed objective all necessary safeguards must be taken while collecting, testing, storing and supplying blood. Otherwise, instead of saving the life, the contaminated blood would take the life. It is not disputed that during window period, unless the special test known as Antizen test is conducted through Polymer Chain Reaction (PCR) method, the virus cannot be identified. Therefore, the Government must ensure that in all blood Banks the Polymer Chain Reaction (PCR) method is available to identify the virus of HIV during window period. We, further direct opposite party no.1-State to provide free medical treatment to the baby of the petitioner who is a HIV patient.

The judgment was delivered on 28 July 2011.

A year has elapsed. The State Government has not honored the judgment.

Infected blood is going on being transfused sans any check.

AIDS is admittedly menacingly spreading in the State.

Innumerable Nayaks are perishing.

The Government of Naveen Patnaik is so very busy in serving POSCO and the likes, that there is perhaps no time for it to read the High Court verdict even.

Any blood collected in camps and through campaigns such as of Ama Odisha may be HIV infected blood in “window Period”.

Everyone getting a transfusion is vulnerable to AIDS as recalcitrance of the government as discussed above is aiding to its spreading.

Will the High Court please take a note of it?