A surgeon and four other healthcare professionals at the government-run Medinirai Medical College and Hospital (MMCH) in Daltonganj have been placed on post-exposure prophylaxis (PEP) after they performed a cesarean section on a woman who allegedly concealed her HIV infection. This incident has raised concerns about patient disclosure and hospital safety protocols.
Details of the Incident
The woman, in her mid-twenties, gave birth to a healthy baby girl on June 6. Prior to the surgery, she had tested negative in a rapid HIV test. However, on Sunday, hospital staff became suspicious after noticing an anti-retroviral (ART) card belonging to the patient. When questioned, her husband admitted that they had not disclosed her HIV status initially but eventually produced the card. Following this revelation, the labor room was sanitized, and the couple underwent counseling. This was the couple's second child.
An ART card is a medical record used to track a patient's HIV diagnosis, treatment progress, and clinical visits. Its presence indicated that the woman was already undergoing treatment for HIV.
Hospital Response and PEP Administration
Upon learning of the situation, Palamu civil surgeon Dr. Anil Kumar Sriwastwa requested a report from MMCH medical superintendent Dr. Ajay Kumar. The five-member medical team involved in the surgery was subsequently segregated and will be under constant medical observation for 28 days as part of the PEP protocol. Dr. Sriwastwa described this as an accidental exposure to an HIV-positive person, emphasizing that the couple had lied and failed to inform the labor room team about the woman's HIV status. He stated, “The woman and her husband lied. Neither of the two told the labour room team the woman was an HIV-positive person. She underwent C-section as per the medical expediency.”
Explanation of False Negative Test
When asked whether an HIV test was performed before surgery, Dr. Sriwastwa explained that a rapid test had returned negative. He noted, “It does happen. When the viral load is low, an HIV person may test negative.” He further clarified, “Even if an HIV test returns negative and the person is on ART, the individual has HIV without a doubt.” This highlights the limitations of rapid tests in detecting HIV when viral loads are suppressed by antiretroviral therapy.
Legal and Ethical Considerations
Dr. Sriwastwa also referenced the HIV and AIDS (Prevention and Control) Act of 2017, which mandates that no doctor or hospital can delay or deny surgery to a person with HIV. This law aims to prevent discrimination against HIV-positive individuals in healthcare settings.
Patient Allegations
Meanwhile, the couple alleged that they were neglected after the disclosure, moved to a separate room with used bedsheets, and faced difficulties arranging one unit of blood. In response, Dr. Sriwastwa claimed that MMCH is providing all necessary care within available resources. The hospital administration is expected to address these allegations to ensure proper patient care and nondiscrimination.
This incident underscores the importance of transparent communication between patients and healthcare providers, as well as the need for robust protocols to protect medical staff from accidental exposures. The five healthcare workers will continue to be monitored, and the couple has been counseled on their responsibilities regarding disclosure of infectious diseases.
