A tragic maternal death in Chennai, linked to congenital heart disease complications, has ignited a major dispute in Tamil Nadu's Erode district. The conflict involves the district collector, public health officials, and the Indian Medical Association (IMA) over who should perform critical cardiac screenings for pregnant women.
The Directive That Sparked the Controversy
Following a detailed maternal death audit and a comprehensive emergency obstetric and newborn care (CeMonc) meeting, Erode District Collector S. Kandasamy issued a significant directive to private hospitals. The order was prompted by identified discrepancies in ECHO reports from private facilities, which allegedly delayed crucial treatment.
The collector's instruction was clear: "ECHO tests for antenatal and postnatal mothers must be done only by cardiologists to ensure accurate cardiac status and prompt intervention." Additionally, fetal anomaly scans were restricted to be performed solely by radiologists.
Kandasamy clarified to the Times of India that these decisions were based on expert opinions from a medical team. A senior health official involved stated that the maternal death audit confirmed a lapse in care. "The instruction was not a result of one case. We saw discrepancies in ECHO reports by private hospitals. These tests are done by technicians who may fail to spot problems. This endangers the life of pregnant women," the official explained.
IMA's Strong Opposition and Concerns
The IMA has vehemently opposed the collector's orders, labeling them as a "knee-jerk overreach" that could have severe unintended consequences. The association argues that the mandate will lead to dangerous delays in care and significantly increase costs for patients.
Dr. C. N. Raja, IMA national past vice-president, defended the current system. "ECHOs are performed by trained technicians. State medical colleges offer these courses, and the candidates are certified by the state medical university," he said. He highlighted a critical infrastructure gap: "We do not have the luxury of referring all ECHO reports to cardiologists in tier 2 cities and rural areas. When there are abnormalities, cardiologists are consulted."
The IMA has also formally written to the collector, urging him to reconsider the restriction on fetal anomaly scans. Doctors point out that the PCPNDT Act permits radiologists, sonologists, and gynaecologists to conduct these scans. The association emphasized that many obstetricians possess specialized training in advanced ultrasound, and these services, once limited to Chennai, are now locally available in Erode.
Balancing Safety, Access, and Expertise
This dispute underscores a fundamental tension in India's healthcare landscape: the need for highly specialized care versus the practical realities of access and resource distribution in non-metro areas. While the district administration's goal is to prevent tragic outcomes by ensuring the highest expertise, medical practitioners warn that rigid mandates could disrupt existing care pathways.
The core of the debate lies in finding a sustainable model that ensures accurate diagnosis for pregnant women without creating systemic bottlenecks or making healthcare prohibitively expensive. The outcome in Erode could set a precedent for how other districts in Tamil Nadu and beyond manage specialized maternal care protocols.
