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Why Don’t They Introduce Permanent Confidential Auditing And Enquiery Committees On Maternal Deaths?
P. S. Remesh Chandran
Editor, Sahyadri Books & Bloom Books, Trivandrum
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The terror of being mentioned in a confidential audit enquiry report automatically brings down the number of maternal deaths.
Most advanced countries in the world have permanent committees or institutions to conduct periodical confidential enquiries into maternal deaths. They conduct regular mandatory audits and confidential enquiries on the death of mothers and babies with funds and staff provided by government. The objectives of these committees are more preventive than punishing. Remarkably, India has no such committee or institution like most other developing or under-developed countries. If something such existed, their annual or biannual reports would have been a dread to the medical professionals and public health bureaucrats in this country. Such committees or institutions can lessen though not take away the high risk of mothers and babies dying in hospitals. The world model is these committees, instituted in some countries as permanent disease detection, investigation and control centres like the Diseases Control Centre in Atlanta, concerning themselves with publishing regular periodical reports on specific subjects like maternal hemorrhage, hepatitis, sepsis, anemia and infections, which is more functional as a preventive warning to those professionals engaged in these specific fields. The terror created by these permanent confidential enquiries and reports have known to have brought down maternal morbidity by ninety percent! Still India declines to set up a permanent committee on maternal morbidity!!
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In some countries these reports would be released every ten years or even five years for a start as the incidents they have to enquire becomes fewer in numbers with the clearing of backlog cases. In England such reports were published every three years first and then yearly. In India it is estimated that even the first report of such a committee formed would take a hundred years for releasing because millions of such cases with records still available are pending investigating. If that committee functions in a rocket-docket manner and thousands of staff and billions of funds are provided, after some fifty years later perhaps they may be able to release reports every fifteen years first and every ten years later. That number of maternal and infant death cases is pending investigation in hospitals throughout the country.
The death of pregnant women during hospital care in treatment facilities, their death within six weeks of medical termination of pregnancy (MTP) done inside or outside institutions, their deaths between six weeks and one year after the end of pregnancy period- all are subject to review and assessment by permanent confidential investigation committees. Not a few of these cases have every chance of being proved homicides in legal terms in the end, warranting arrest, prosecution and imprisonment of attending personnel. There is also the question of payment of compensation to the dependants or relatives of victims at international rates. For this purpose, and also to ensure transparency, all or parts of these reports cannot be kept confidential. Therefore, in addition to the most confidential parts of the reports being sealed and handed over law courts, executive summaries of the reports will also have to be released for public attention anyway. Some countries footed on nothing-to-hide policies even publish the full reports online.
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India was not willing to copy the permanent confidential enquiry system on maternal deaths from Britain.
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Even as early as 1910 there have been authorized confidential enquiries into maternal deaths in the United Kingdom, with most of these enquiries centering on the social, educational and economic backgrounds of poor women who were the most to die in those times an association with pregnancy and child birth. Lack of hygiene in clinical as well as non-clinical settings was noted in these earlier reports and the importance of training hospital and non-hospital help on the proper use of forceps and later on the safe use of antibiotics were emphasized. Recommendations on ways to reduce complications during pregnancy, child birth and post-child birth periods were made. Because these confidential reports were a new introduction into the medical field, the earliest reports had to cover thirty to forty plus years to accommodate all pending cases- pending cases meaning those for which records were available in hospitals and clinics. Countries which introduced these permanent confidential enquiries the earliest could now release compiled reports every three or two years because their workload was now less, for most of the pending cases had been covered and only the current ones remained to be covered, not to mention the fright these permanent enquiry systems created among health professionals already bringing down the number of maternal deaths and cases to be enquired significantly.
In the U. K. Reports, maternal deaths in England, Ireland, Scotland and Wales were covered. Today they are up-to-date. They only have to enquire what is yet to happen. As such, the example set by the United Kingdom is one of the best to follow in enquiring into maternal deaths, especially by their former colonies like India which even followed their language and their parliamentary, administrative and judicial systems. Remember that this permanent confidential enquiry system had been in full roll in England when India gained independence from Britain in 1947. India which was quick to copy its parliamentary, administrative and judicial systems from England upon gaining independence was not willing to copy this permanent confidential enquiry system from Britain to ensure accountability in the health care sector.
What are confidential in a permanent confidential enquiry committee’s or institution’s report on maternal deaths are the particulars of the victims, hospitals and treatment facilitators will not be revealed. Their names will be there in the reports but will not be reveled to the public and the press. This non-disclosure of names is expected to serve as the real deterrent to crimes of maternal death. One professional will not know whether his or her name is in there or not. These committees will enquire not only hospital records but anonymous complaints also. That is a great difference. Usually a hospital employee will not betray another hospital employee however bad or mischievous he or she is. Anonymous complaints can convey most often what absolute truth is there. Where pompous worthless departmental enquiry committees are adamant in not entertaining anonymous complaints (to save their professional brethren), permanent confidential enquiry committees on maternal deaths encourage anonymous complaints to get quickly and thoroughly to what actually happened and where. Anonymous complaints may even lead to maternal deaths that went unreported.
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Anyway, a permanent confidential enquiry committee assesses every data available to them through official channels and others fetched by them by various methods without authorities’ knowledge. They will have enlisted professionals from every faculty in medicine who are paid no salaries, no allowances, no sitting fees, no remunerations and no rewards. They are expected to be a dedicated committed daring lot. Each case will be reviewed by a dozen expert assessors in the concerned specialties- not below ten anyway- and other expert teams will prepare written reports based on the assessors’ notes. That is those who assess the case and those who write the report will always be different. These data, reviews, assessments and writings will not only remain in the yearly reports but also in the specialty reports compiled occasionally.
Instituting these permanent investigation committees on maternal deaths, when it is going to happen in India, is not to be done following the same methods followed to institute those constitutional bodies like the National Human Rights Commission of India and the National Women’s Commission of India because even while these great bodies were in existence the number of maternal deaths in India has not declined all these years nor have we ever heard about any compensation paid to any victims’ families. When a pregnant woman dies a child also dies with her or is left alone to the harsh treatment of the world to live like an orphan for at least a few years. So the death of a pregnant woman before, during or after delivery due to negligence or ignorance of medical professionals is a double crime which is not to be viewed lightly under any circumstance. Therefore unprecedented legislation will have to be needed to make this kind of permanent committees to come into force in India. Perhaps holding national referendums and collecting people’s opinions online before constituting these committees will become inevitable.
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Images Courtesy: Pixabay.
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https://www.amazon.com/dp/B087D34RVM
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About the Author P. S. Remesh Chandran:
Author Profile Of P S Remesh Chandran By Sahyadri Archives.
Editor
of Sahyadri Books & Bloom Books, Trivandrum. Author of several
books in English and in Malayalam. And also author of Swan: The
Intelligent Picture Book. Born and brought up in the beautiful village
of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala.
Father British Council trained English teacher and Mother University
educated. Matriculation with distinction and Pre Degree Studies in
Science with National Merit Scholarship. Discontinued Diploma studies in
Electronics and entered politics. Unmarried and single.
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P. S. Remesh Chandran, Editor, Sahyadri Books, Trivandrum, Padmalayam,
Nanniyode, Pacha Post, Trivandrum- 695562, Kerala State, South India.
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