ORISSA UNDER THE GRIP OF AIDS: DMET TRIES TO FOIL THE HIGH COURT ORDERS

Subhas Chandra Pattanayak

“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 Antigen 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”.

Thus said the High Court of Orissa a year ago on 28 July 2011 in W.P. (C) No.133441 of 2009 while asking the State Government to pay the writ petitioner Rs.3 lakhs as cash compensation against deficient screening of blood without using the NAT PCR method, as a result of which, the 17 months old child of the petitioner was infected with AIDS.

By saying, “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”, the High Court has made it an unavoidable must for the Government to use the NAT PCR screening method in all the Blood Banks in Orissa.

It is a blatant contempt of Court to delay implementation of this mandamus.

The Orissa Government, therefore, had taken up the matter in a specifically held “Meeting on Implementation of NAT PCR in Blood Banks” under Chairmanship of Dr. Pramod Meherda, IAS, MD, National Rural Health Mission and Project Director of Orissa State AIDS Control Society.

Members present in meeting were: Dr. Mangala Prasad Mohanty (Honorary Secretary of Indian Red Cross Society – Orissa State branch), Kamalakanta Dash (FA, OSACS), Dr. P. K. Acharya (Additional Project Director, OSACS), Dr. Sudhir Kumar Ghosh (Professor and HoD, Microbiology Dept, VSS Medical College, Burla), Dr. Banojini Parida (Professor and HoD, Microbiology Dept, MKCG Medical College, Berhampur), Dr. Pritilata Panda (Associate Professor, Microbiology Dept, MKCG Medical College, Berhampur), Hrushikesh Mohapatra (Drugs Controller, Orissa), Dr. Bijay Kumar Swain (Joint Director, Health Services (T.B.Cell) Orissa), Dr. Jyotsna Patnaik (D.D., STI and JD, BS), Dr. Bimocha Pragna Pati (Associate Professor, Microbiology Dept, SCB Medical College, Cuttack), Dr. L. N. Hati (Ex-Director, State Blood Transfusion Council, Orissa), Dr. Chhanda Charan Sahu (Blood Bank Officer, BCSU, Anugul), Dr. Debashish Mishra (Director, Model Blood Bank, Capital Hospital, Bhubaneswar) and Dr. Benudhar Satapathy (Director, Central Red Cross Blood Bank, Cuttack).

This special meeting for the specific purpose of implementation of the High Court orders was held in the conference hall of OSACS on 25 February 2012 after collection of various documents and medical literature. The minutes thereof records, “the matter was placed before the committee with all the supporting documents like Hon’ble High Court’s judgment, correspondence letter to NACO, Transfusion Medicines Technical Manual, Screening of donated blood for Transfusion, Recommendation of WHO on Transmissible Infection, Proceedings of Karnataka Government on NAT PCR and supply order along with purchase of All India Institute of Medical Sciences, New Delhi”.

This specific meeting, actively participated by subject matter specialist noted supra, unanimously decided to implement the High Court order as that was the most unavoidable and appropriate way to save the people from the transfusion-transmissible-infections(TTIs).

Its resolution said,

“All the Committee members went through the documents and also verified the possible grey zone documents of each individual disease (TTIs) and also went through the document from the website i.e. Journal of Association of Microbiologists, USA. 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 blood units to reduce the grey zone period of transfusion- transmissible-infections like HIV-I, II, Hepatitis B and HCV, as it is the latest and foremost technology available in India”.

But, despite this recommendation, the State Government failed to appreciate the urgency of its implementation. We exposed this menacing lack of concern for human life in these pages on 8 July 2012; and then a new case, seeking redressal in TTIs, gained cognizance of the High Court. This prompted the Government to remember the February meeting.

When the February meeting had unanimously recommended for adoption of NAT PCR method for screening of blood to eliminate the possibility of TTIs like HIV-I, II, Hepatitis B and HCV, it had constituted a sub-committee under chairmanship of the Special Secretary of Health to determine the manner of its execution. That sub-committee, after lapse of long five months, met on July 24.

But surprisingly, the D.M.E.T., Orissa, though not a member of that sub-committee, attended the meeting and tried to foil the High Court order with misleading emphasis on continuance of the outdated and deficient methods of blood screening presently in vogue in Orissa.

Our sources say, the meeting ended with no decision, notwithstanding how harmful be that to health of the people.

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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.

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?