KARACHI, Dec 28: A high-level committee looking into the death of a pregnant woman at the Civil Hospital Karachi earlier this month has recommended that every operation, whether routine or emergent, be undertaken by professionals of the rank of assistant professor or senior registrar or above.

The postgraduate trainees as well as RMOs should not handle the cases independently but rather under the strict supervision of the professors-in-charge or senior registrars. In view of their casual approach towards human life, the committee recommended strict punitive measures against seven medical staff, including an assistant professor and a Duty RMO.

The high-level committee recommended that these seven individuals be served with show-cause notices, duly signed by the provincial health secretary, Ashiq Hussain Memon. The committee which recommended these steps comprised Dr Shereen Narejo, deputy secretary (general), and S.M. Tayab, deputy secretary (administration-II).

They recommended the disciplinary steps after careful examination of the conditions under which Anisa Khatoon, wife of Abdul Jabbar, died on Dec 4, barely 15 minutes after undergoing a C-section surgery, according to the committee’s report, a copy of which has been obtained by Dawn.

The report says that Anisa Khatoon, a 30-year-old woman with her fifth pregnancy, was received at the Civil hospital’s gynaecology outpatient department at about 1.30pm on Dec 4. She was diagnosed as having a conjoined pair of children.

An assistant professor examined Mrs Khatoon and admitted her for emergency C-section because she was already in labour. She was sent for an operation at about 3pm.

The surgery was performed by a private postgraduate student who was assisted by an RMO. Anaesthesia was also handled by two postgraduate students. Initially the patient was given spinal anaesthesia which was not found to be effective. Later, general anaesthesia was administered.

Mrs Khatoon ultimately gave birth to a conjoined twins but the operation lasted well over an hour, one-and-a-half to be exact, says the committee’s report.

The patient was handed over to the RMOs at about 4.40pm by the anaesthetist after confirming her responses. She was received in the ward at about 5pm. She died at 5.15pm.

The report says that the assistant professor who examined Mrs Khatoon should have undertaken the surgery herself because she was the most senior doctor on duty. “Casual attitude on her part to handle an emergency led to such a precious loss of a young woman,” according to the report.

“It is also surprising that private postgraduate students, who are otherwise not eligible to perform such procedures independently, handled this affair independently to the extent that anaesthesia was also performed by PGs.”

The doctors on duty, including the RMO, should have consulted their seniors before the operation. “None of the officers, both senior and junior, felt responsibility to act in a coordinated and humane manner.”

Poor post-operative care was evident from the fact that the patient died within 15 minutes after leaving the operation theatre, says the report. It adds that in the opinion of an expert, Prof Khurshid J. Noorani of the Jinnah Postgraduate Medical Centre: “(T)his being an unusual case of conjoined twins which should have been performed by (a) senior obstetrician was handed over to a junior doctor under training... The presence of a senior doctor could have made the difference in the outcome.”

The committee’s report has recommended that the professor-in-charge of the ward in which Mrs Khatoon died be asked to explain her position.

The medical superintendent of the hospital may also be asked to furnish an explanation.