Non-Oriya Health Secretary Sabotages the Minister: CM Ought to Know, His Party is spreading AIDS

Subhas Chandra Pattanayak

When on July 7, in presence of Panchayati Raj and Law Minister Mr. Arun Kumar Sahoo and Food Supplies and Consumer Welfare, Employment, Technical Education and Training Minister Mr. Sanjay Kumar Das Burma, the Minister of Health and Family Welfare, Information and Public Relations Mr. Atanu Sabyasachi Nayak told me on his own accord, in his Secretariat chamber, that, the issue I had raised has been ordered to be implemented immediately, I was very happy and was sure, Orissa shall be saved from a great disaster.

But I had no idea that his Secretary – a non-Oriya IAS officer – would sabotage him and continue infecting people of Orissa with AIDS through unsafe blood supplied by Red Cross Blood Banks without proper screening.

I had stumbled upon a case of AIDS caused to a 3 year old boy in 2012.

He was a victim of blood transfusion on operation table.

The blood he was given was infected with HIV.

He was a native of a village of Baramba adjoining my birthplace Tigiria. His father had given me the details of how the misfortune engulfed him and had requested me to take such steps that no child should be such a victim of medial mismanagement. His sobs and tears are still alive in my heart.

I investigated into it and found that in 2011 the Orissa High Court, on awarding a cash punishment to the State to the tune of Rs.3 lakhs, had directed that the Orissa Government must immediately adopt NAT method of blood screening as the prevailing method of ELISA was not competent enough to detect HIV in its “window Period”. The Government was sleeping over it.

I exposed the malady repeatedly with updated input. It attracted attention of Sri Prasad Harichandan, then the Opposition Chief Whip, who moved an adjournment motion on the topic. On September 1, 2012, the then health Minister Dr. Damodar Raut answered the motion with an emphatic YES to the NAT method and announced to adopt the method in all Blood Banks “in phased manner”, which would start with four major Blood Banks serving the 3 Government Medical Colleges and the Capital Hospital.

He could not see his announcement implemented because the health secretary and a few mandarins were interested in continuance of the ELISA method.

I continued to expose the apathy of administration in this particular matter, as a big population of transfusion dependent patients were sure to be affected by the dreaded virus. Taking the cue, almost all newspapers of Orissa used their spaces time and again in this mission; but the mandarins did not buzz.

After election 2014, the portfolio of Health came to the hands of the young dynamic Minister Atanu Sabyasach Nayak.

I raised the issue before him, cries of the unfortunate man of Baramba still vibrating in my heart.

He took two days to study the matter and sent the following “Note” (No.23, Dt.19.9.2014) to the Secretary:

“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 on one PIL case filed before it had passed an order for earliest implementation of NAT. The then Hon’ble Minister, Health and F.W., Odisha had assured on the floor of the House for implementation of NAT in phased manner while answering an adjournment motion in the subject on 01,09,2012. A Technical Committee constituted by the Government had visited two States i.e. Karnatak and Uttarpradesh and inspected various centres where NAT was implemented and had given their report.

I am told, the SBTC was directed to go ahead for implementation of the project. The major procedure involving Financial and Technical formalities are also over. The Technical Expert Committee has also given its views on the Request of Proposal received.

It is a matter of concern, why the 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.
A.S.Nayak,16.9.14

One year has passed away since then. Implementation is hanging under many pretenses.

This is a classic instance of how incompetent or ill-motivated mandarins in the Secretariat have been playing tricks upon the political Government.

It is an instance of how a non-Oriya IAS officer has continuously kept the Minister in dark, while pushing at least two Oriyas into AIDS everyday by forcing unsafe blood upon them.

Yesterday, the Chief Minister addressed a workshop of his party in matter of Jivan Sindhu, a project of BJD to make the party appear concerned for the people. It transpired from his speech that since commencement of this project six months ago, its collection of blood has reached 37,232 units.

Medico-scientific surveys have established, and the High Level Technical Committee held under the chairmanship of the Health Secretary on 17.10.2014 had held that, “NAT yield (ELISA Negative & NAT positives) is around 500: 1” which means, NAT method detects one case in every 500 units as HIV positive and ELISA detects none.

All the blood units in Orissa are being screened in ELISA method. This prompts us to suspect that out of the 37,232 units of blood collected and supplied by BJD during this six months under the banner of Jivan Sindhu under guidance of the Chief Minister, AIDS causing viruses have been pumped into at least 76 unsuspecting patients.

This is a very serious situation.

Jivan Sindhu is a political program of the ruling party aimed at appearing pro-people as it is increasingly being viewed as a server of avaricious industries at the cost of indigenous population. The CM wants that, before the next election, its blood collection should exceed 5 lakh units.Vote bank politics can go to any extent.

If NAT is not immediately implemented, the said 5 lakh units would be forcing at least 1,000 Oriyas into AIDS by way of blood transfusion.

Health Minister Atanu babu should immediately wake up as the concerned Minister and foil the foul game of the non-Oriya IAS officer, who, as Commissioner-cum-Secretary has been presiding over the horrific delay in implementation of the already approved program, is playing; or if he is unable to administer his Secretary, the attention of this Chief Minister should immediately be drawn into this malicious conduct of the mandarins.

Human life is more precious than the lady IAS officer, whose negligence and incompetency is pushing unsuspecting Oriya patients into the pernicious grip of HIV.

Any further delay must not be allowed.

Nothing could be more Incongruous than Biju Janata Dal’s Blood Plan

Subhas Chandra Pattanayak

Orissa Chief Minister Naveen Patnaik has announced today that his party – Biju Janata Dal – would conduct blood collection camps all over the State with effect from March 5.

Nothing could be more incongruous than this, when his government has been spreading AIDS by keeping the blood banks bereft of necessary facilities to supply safe blood to patients.

If the BJD blood plan is not meretricious and nasty political ploy, it would be better for its members to educate their chief minister Naveen Patnaik to act honestly and to immediately implement the NAT decision for safe screening of blood, without waiting for bribe.

The following links may be studied by them to reach the crux and to educate their party chief -cum-chief minister on necessity of proper screening of blood, to stop spread of AIDS in absence of appropriate technology.

http://orissamatters.com/2015/02/19/aids-imperils-orissa-deliberate-delay-in-reaching-at-remedy-is-payola-the-purpose/

http://orissamatters.com/2014/10/20/orissa-in-quagmire-of-aids-high-court-ruling-and-ministers-order-rot-under-red-tapes/

http://orissamatters.com/2012/08/28/aids-a-coterie-of-officers-use-tricks-of-subterfuge-against-the-high-court-order/

http://orissamatters.com/2012/07/08/shocking-reality-aids-being-aided-by-government-of-orissa/

http://orissamatters.com/2012/09/02/orissa-matters-exposed-a-malady-that-reached-a-remedy-thanks-to-prasad-harichandan-and-the-new-health-minister/

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

Attempts to foil Health Minister’s assurance; only the rich to get safe blood!

Subhas Chandra Pattanayak

In reply to an adjournment motion moved by Opposition Chief Whip Prasad Harichandan on 1st September 2012, Health Minister Dr. Damodar Raut had assured that Orissa would adopt NAT PCR system to ensure appropriate screening of blood to avoid AIDS from transfusion.

A boy of only 17 months was found infected with AIDS by accepting transfusion of blood obtained from Muncipal Hospital Blood Bank, Bhubaneswar. The news was broke by orissamatters.com in 8 July 2012 and Sri Harichndan had very ably brought the matter to the attention of the Assembly.

Dr. Raut in his reply noted that people of Orissa have made monumental mark in blood donation and from 126076 units in 2000; blood collection has reached 307022 units in 2011. People’s eagerness to donate blood to save the lives of fellow citizens needs be equally honored by the government’s readiness to supply safe blood to needing patients through proper screening. Therefore, Dr. Raut said, in a meeting on 22 August 2012 the Government had consulted all the Blood Bank Directors and Officers in a conference and had taken a decision to jettison the rapid test method of screening and adopt ELISA method to screen out AIDS virus in the Blood Banks.

As Harichandan pointed out that ELISA is not the latest technology to screen AIDS virus, but NAT PCR is, the Minister had appreciated the position and had assured to adopt the latest method; for nothing is more valuable than human life and moreover, as patients’ confidence in blood banks would diminish if AIDS virus escapes the deficient screening. He however had declared that the method being costly, the State would start with four major blood banks: one each attached to the three Government Medical Colleges and the Capital Hospital Blood Bank. The facility would be extended to all the Blood Banks of Orissa in course of time, he had assured the Assembly.

The Budget of Health department placed in and awaiting approval of the Assembly has made a token provision for replacement of ELISA with NAT PCR in the aforesaid four Blood Banks.

But, the Finance department has planted a rider that the cost of NAT PCR screening should be collected from the patients. If the rider is not dropped, only the rich will benefit; because the poor patients cannot afford the screening cost.

The present Finance Minister was the Minister of Health when deficient screening through old method of ELISA had infested the seventeen months old child with AIDS and the Orissa High Court had punished the state Government with cash penalty of Rs.3 lakhs for supply of HIV infested blood to the boy without perfect screening. When he is the Finance minister, his department is asking the Health department to impose such a heavy cost on poor patients on accounts of NAT PCR that it will never be possible for them to get pure blood through perfect screening!

Should the poor people have no right to safe blood? Should the latest and the safest NAT PCR screening for which the government in the Health department has put budgetary provisions on the anvil of the Assembly be available only to the rich?

Should the Finance department be allowed to foil the most welcome welfare proposal of the Health department?

Should the Assembly allow its own anxiety for safe blood to patients be steered into benefit of the moneyed men alone?

AIDS: A Coterie of Officers use Tricks of Subterfuge against the High Court Order

Subhas Chandra Pattanayak

The National Blood Policy makes it a must for the State “ to provide safe and adequate quantity of blood, blood components and blood products” (Objective 1) and “to make latest technology available” (Objective 3) to the blood banks for correct screening so that patients needing urgent transfusion would get safe blood.

But the State government run by Naveen Patnaik has failed to adopt “latest technology” as a result of which AIDS is spreading through blood transfusion in Orissa. Dependents on frequent transfusion such as thalassemia patients are more vulnerable to Virus 1 (HIV-!), Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV).

After we exposed this phenomenon in these pages, various news media organizations have been harping on about the urgency of adoption of latest technology in screening of blood.

In a case of a 17 month old child who is infected with AIDS after taking blood transfusion, the Orissa High Court, a year ago, had not only awarded a cash compensation worth Rs. 3 lakhs to the infected boy, but also had made it a “must” for the Government to adopt advance technology, i.e. NAT PCR method in “all the Blood Banks” for blood screening, in order to ensure supply of “safe blood” to patients. Its mandate is in these words: “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”.

Steps to Implement the Court Order

This judgment had forced the State government to review its blood screening scenario in a high level committee constituted for the purpose under the chairmanship of Dr. Pramod Meherda, IAS, M.D., NRHM & Project Director, Orissa State AIDS Control Society.

The Professors & Heads of Departments of Microbiology in VSS Medical College, Burla Dr. Sudhir Kumar Ghosh, the Professors & Heads of Departments of Microbiology in MKCG Medical College, Berhampur Dr. Binojini Parida, the Associate Professors in Microbiology department of MKCG Medical College, Berhampur, the Associate Professors in Microbiology department of SCB Medical College, Cuttack Dr. Bimoch Prajna Pati, the Drug Controller of Orissa, Ex-Director of SBTC Dr. L.N.Hati, Dr. Mangala Pr. Mohanty, Hon. Secretary, IRCS-OSB, Director of Central Red Cross Blood Bank at Cuttack Dr. Benudhar Satpathy and seven other top functionaries were members in this committee.

Unanimous Recommendation for NAT

The Committee met on 25 Feb.2012 at the Conference hall of OSCAS. Its minutes disclose, “After thorough discussion on NAT PCR technology, the Committee unanimously recommended that the NAT PCR technology which is the latest testing facility need to be introduced for screening of the blood units to reduce the gray zone period of Transfusion Transmissible Infections like HIV-I, HIV-II, Hepatitis-B and HCV, as it is the latest and foremost technology available in India”.

The Sleeping State

Despite this “unanimous” recommendation submitted “after thorough discussion” by all the above noted illustrious microbiologists, serologists and other specialists in the Committee, the State Government did not wake up to the occasion.TTI continued to affect lives in Orissa.

We had to expose this monstrous negligence of the state to the most urgent need of the moment in these pages on 8 July 2012.

Shocking Mischief

Thereafter, on 24 July 2012, the Secretary of Health P.K.Mohapatra took a “meeting on implementation of NAT PCR in Blood Banks”.

To our surprise and shock, we found that all the super-specialists, serologists and microbiology Professors who, “after thorough discussion” in the previous meeting of 25 February 2012 had “unanimously” recommended that “the NAT PCR technology which is the latest testing facility need to be introduced for screening of the blood units to reduce the gray zone period of Transfusion Transmissible Infections” were kept out of this meeting and a Director of Medical Education and Training (DMET) having no role under the rules of business in the concerned matter, who was to retire from service the same month, was encouraged to lobby for the old ELISA method and to raise a bogus allegation that the High Court had delivered its verdict directing for adoption of NAT PCR for blood screening without being “apprised properly on the issue under reference”. And, it seems, such aspersions against the High Court was approved in the meeting, as is evidenced in its 1st resolution that reads, “ Special Secretary (Technical) H&FW Department, Govt. of Orissa will move file for filing a review petition against the judgement”.

New Tricks of subterfuge

It is seen from the meeting taken by the Health Secretary, that ,the Special Secretary of the Department who hails from the pool of Doctors, collaborated with the said DMET in confusing the issue with a downloaded document of Canadian Blood Banking Association “where it is mentioned that the HIV positive scenario is 1 in 2.7 million than ELISA”. The quoted observation is a conundrum and the Health secretary, before signing the minutes, has failed to notice this confusing expression. However, one is at a loss to understand when the Special Secretary with a downloaded version of Canadian Blood Banking Association was allowed to mislead the meeting, why had the Health secretary not wanted to know how the scenario is seen by Indian authorities on blood screening by NAT, specifically as India has a high prevalence of the killing viruses when Canada is almost free of these killers.

The Chilling Scenario in India

A research reported in Indian Journal of Medical Research (127, February 2008, pp 140-147) is captioned “Multicenter evaluation of individual donor nucleic acid testing (NAT) for simultaneous detection of human immunodeficiency virus-I & hepatitis B & C viruses in Indian blood donors”.

The research was based on the ground that “India has a high prevalence of HIV-I, hapatitis C & B viruses (HCV and HVB) in the blood donors but has yet to implement nucleic acid testing (NAT) in blood screening”. It had tested 12,224 samples along with their serological results obtained from representative eight blood banks in India and had submitted its findings to the Journal on 26 September 2006.

Luminaries in the field namely R.N.Makroo, N. Choudhury, L. Jagannathan, M. Parihar-Malhotra, V. Raina, R. K. Chaudhary, N. Marwaha, N. K. Bhatia, and A. K. Ganguli had conducted the research that the Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, had patronized.

They reported, “Data from our study suggested that the NAT yield for all three viruses (HIV, HCV and HVB) in India could be 29 times higher than that observed in Japan, and higher for HIV-I alone. Our observed HIV-I yield was over 515 times that observed in the US and Canada, 89 times that observed in Italy”.

So, citing a report of Canada where the prevalence of HIV-I is 515 times less than India, to frustrate the “unanimous recommendation” of the earlier committee, is not only low on merit but also is a mischievous attempt to mislead the Government.

The study cited above has concluded that its “observed NAT yield for all three viruses was 1 in 1528. This study was conducted in 2006. Now the 1 has become 3 inasmuch as every blood unit is becoming 3 units of blood products viz. platelet, plasma and pack cell. This means, if the virus was escaping EISA test in one out of 1528 samples, it would be read as three escapes in 1528 samples. This estimation relates to 2006 when HIV-I was not as wide spread as it is today. So, in every 1528 cases, it can be safely said that multiples of three cases of HIV-I infection are not being detected through screening in ELISA method.

In Orissa, blood collection has reached 3 lakh units per year. Divided into the three categories, i.e. platelet, plasma and pack cell, the total collection becomes 9 lakh units. If the 2006 study is applied to this volume of 9 lakh units, at least 1767 transfusion takers are possibly getting AIDS infected with the virus escaping detection, as ELISA is not efficient to detect the virus during the “window period”.

Orissa has 81 blood banks out of which 56 are running under joint banner of the state government and Red Cross whereas only one blood bank functions directly under the Government. rest are privately managed. Out of all these 81 blood banks the ELISA facility is also not available in 23 blood banks. After we exposed the malady, the government has ascertained through review that these blood banks having no ELISA facility are using rapid test kits to detect AIDS virus! The meeting held on 24 July under chairmanship of the Health Secretary (where he was in fact not even present) has noted this in its resolution No.2 and suggested that “No blood bank should procure any rapid test kit for hepatitis B & hepatitis C and HIV at their level”. The rapid test is a method through which the viruses escape detection. Taken into consideration, this makes it clear that non-detection of AIDS virus is alarmingly rampant in Orissa.

Yet, the mandarines in the health department have kept the High Court oder for adoption of NAT PCR method inoperative and are conniving to go in litigation against the said order.

Just imagine, how unsafe is Orissa .

THE ISSUE IS AIDS: LET THE VERDICTS BE NOT MERE WORDY ACROBATICS

Subhas Chandra Pattanayak

When a welfare verdict by higher judiciary goes barren, and the fellows responsible for rendering it barren go unpunished, the verdict looks like mere wordy acrobatics.

Sadly, welfare verdicts of Orissa High Court are going barren and the Court has no monitoring mechanism to stop it.

This serious syndrome needs cogitation; because, increase in number of barren verdicts may diminish the revered authority of judiciary in eyes of the public.

Instantly, cognizance on a case of HIV infection through transfusion of infected blood, despite the Court’s order in a similar case lying barren, attracts our attention.

In these pages, on 8 July 2012, we have discussed the earlier case and showed how the High Court’s direction issued on 28 July 2011 in W.P.(C) No.13441 of 2009 to ensure supply of safe blood to patients under treatment has not been implemented despite lapse of a year.

Now a Public Interest Litigation (PIL) has been filed by Advocate Prabir Das in the Orissa High Court seeking compensation for a woman allegedly infected with AIDS after receiving HIV positive blood obtained from an official blood bank.

Blood Banks: the breeding centers of AIDS

There are presently 57 official Blood Banks in Orissa, manned and managed by the State Government under the banner of the Red Cross.

The transaction of blood through these blood banks comes around 2.8 lakh units per annum.

Screening of blood to determine if the donor is AIDS affected is being conducted in the old method of Rapid and ELISA. When no lab records are auto-generated for verification and reference in the Rapid method, ELISA testing generates the records which at least can be verified. But, in as many as 20 of the 57 government blood banks, there is no ELISA machine and Rapid is the only method in practice there, leaving the screening to assumption only.

But the ELISA test is also not competent to detect dreaded viruses of HIV, as discussed in the earlier article, during the window period.

Not only HIV, but also other dreaded viruses like Hepatitis B and C are also transmitted through blood.

These three most dreaded viruses escape detection in ELISA and Rapid tests during window period. The latest method therefore is PCR/NAT. Orissa has not woken up to this. Hence, blood banks have become breeding centers of AIDS and Hepatitis.

Concern of the Court

Expressing serious concern over a 17 month boy getting infected with AIDS by receiving HIV positive blood, the High Court of Orissa, in its order referred to above, had issued clear orders for immediate adoption of PCR/NAT method for blood screening exactly one year ago.

But the State Government is a habitual offender of Court orders, if, specifically, they are welfare orders, meant to give benefits to all and everybody including and beyond the partyline of the case. It rendered the order barren.

Yet, the same barren order and discussion thereon in these pages has inspired the present PIL.

Taking cognizance of the PIL, the Court has issued notice on Thursday to the State Government through authorities named in the petition asking them to respond within two weeks.

And, if the case is true that the infection has come to the woman through transfusion of infected blood, the order is expected to the same as the earlier order that has remained a barren order till date.

At this stage, we deem it proper to insist that the Court should not issue any more barren orders.

The order in W.P.(C) No.13441 of 2009 is one year old. Had it been implemented, we are sure, spread of AIDS through HIV infected blood, transfused as safe blood within the window period, could have stopped and most probably, the present case would not have arisen.

Let verdicts be not wordy acrobatics

So, we insist that the High Court, while delivering the judgment in the instant PIL, should take steps to eliminate every possibility of its oder being rendered barren.

It should fortify its order with specific punishment against the Minister concerned – because under Rules of Business a Minister is the chief executive of the department under his control – for non-implementation of the order while having stipulated specific time for its implementation in contravention of which the punishment should automatically be enforced.

And, simultaneously, as the present PIL is bound to rely upon the earlier order in W.P.(C) No.13441 of 2009, we insist that the court should restore the same case to file to pronounce appropriate punishment against rendering of the order therein barren and pending decision in the present PIL, issue a mandamus for instant adoption of PCR/NAT technology in all the blood banks – public and private – for screening of blood to save human lives.

Our suggestion

The High Court may please constitute a permanent body of its own, comprising one of its own Registrars, or, if paucity of hands becomes the barrier, a small combine of lawyers and accredited scribes, with powers to monitor the implementation of its welfare orders or mandamuses like the one in the Writ case referred to above and to keep the Court apprised of every stage of implementation thereof for its further action.

Otherwise, welfare verdicts may look like wordy acrobatics and nothing else.