Dr Archana Sharma was a 42-year-old M D in Obstetrics and Gynaecology, at the Anand Hospital, Lalsot, Rajasthan. She was a gold medalist, and awarded the best orator at a national conference of Obstetrics and Gynaecology. Before joining her husband at the Anand Hospital, Dr Sharma worked as the associate professor and unit head at the Gandhinagar Medical College, Gujarat. In March 2022, she attended to the delivery of 22-year-old Asha Bairwa, for the latter’s third pregnancy, and after three girls. The surgery was carried out and the baby delivered successfully. However, following delivery, the patient developed PPH (Post-Partum Hemorrhage), a complication known to be the most important contributor to maternal mortality, accounting for 24% of cases. Notwithstanding the general decline in maternal mortality nationally, Rajasthan still has the 4th highest rates across States.
In spite of blood transfusions and standard resuscitative measures, the patient expired. The family initially acknowledged the efforts of the hospital and the doctors, and took the body home for cremation. At this stage, a local goon and BJP stalwart Shiv Shankar Balya Joshi intervened, along with Rakesh Matlana and Jitender Gothwal. They persuaded the husband to file an FIR, brought the body back to the hospital, laid it at the entrance and having collected a hundred or so henchmen created a scene. It is alleged that a huge sum of money (Rs 50 lakh) was demanded to “settle” the case. This individual is well known for running extortion rackets in the area in non-election seasons. Mahesh Bihari, a journalist, was roped in to publish a cooked-up narrative. Interestingly, the patient’s husband now states he is illiterate and was made to sign a blank piece of paper. The police were pressurised to charge the doctor with section 302 which they later altered to 304.
For section 302, motive, intention, medical evidence, eyewitnesses to the particular case are extremely crucial. “Mens rea”, the intention to commit murder, is to be established, as well as prior knowledge and awareness of the consequences of the act. In 304, there has to be (i) intention to cause death or bodily injury likely to cause death and (ii) knowledge that the act is likely to cause death. Do the police seriously believe that the doctor intended to cause the patient’s death? This is preposterous and baseless. The SC has clearly ruled in major landmark judgements, (Jacob Mathews vs State of Punjab 2005; Martin D'Souza vs Mohd. Ishfaq; Lalita Kumari vs Govt of UP) that no doctor can be arrested for medical negligence unless the case has been referred to a board of experts specialised in the field relating to the allegation of negligence, for assessment. Proceedings may be initiated if, and only if, the committee finds the doctor negligent. The judgements also urged the Centre and States to make provisions for appointing such committees. Till date no such effort has been initiated. In this particular case there were a number of factors which increased the risk of PPH. Prolonged second stage of labour, two previous cesarean sections (the second, one year prior, for twins) and multigravida. This patient had gone for delivery at Lalsot from where she was referred to the hospital at Dausa. From there she was referred to Government hospital in Jaipur, Rajasthan, where the doctors insisted on a tubal ligation because of the two previous caesareans. The relatives refused, apprehending a fourth daughter and eliminating chances of a male child. They decided to shift the patient back to Lalsot, which is 140 kms from Jaipur and the time taken for travel to and fro, in her condition surely aggravated the risks. Society wants male children, and the Government, which does not provide adequate infrastructure, insists on policies of tubectomy after 2 deliveries. Clearly there is a conflict of interest.
Unable to withstand the pressure, Dr Sharma hanged herself leaving behind a husband and two young children. Her suicide note stated, “I love my husband and children a lot. Please do not harass them after my death. I did not commit any mistake. I did not kill anyone. Stop harassing doctors so much for this. My death may prove my innocence. Don’t let my kids feel the absence of their mother.” Medical professionals do have higher rates of suicide than the normal population; however, none of the factors accounting for these increased rates were operative here. She died purely because of police harassment.
The incident has understandably outraged the medical fraternity. At least two medico-legal bodies are filing PILs against the police. In spite of SC judgements, in spite of nearly all States having legislation to prevent assaults on doctors, the police feign ignorance of procedure and continue to arrest doctors on flimsy, trumped up, imaginary allegations of criminal negligence. A myopic home minister has declared that there is no need to modify/review legislation to prevent such incidents. The government and society simply have to change its attitudes and views. Without this, the health system in this country is headed for disaster. A number of issues need immediate redressal. Section 302 should have never been imposed; and worse still changing it later to section 304 reeks of gross criminal negligence on part of the police. Severe disciplinary action is called for. The police must be made aware of the SC judgements urgently; because ignoring the provisions of these judgements amounts to contempt of court.
I am disheartened and disappointed to see the dismal lack of interest of the media, in this incident. Joseph de Maistre was the first to state in 1811, "Every nation gets the government it deserves." I can’t help feeling this can be borrowed to state: - “Every society gets the healthcare it deserves.”
(The writer is a founder member of VHAG)