No Country for Radiologists

IN FEBRUARY THIS YEAR, Dr Ashutosh Jape, a radiologist in Pune, detected something amiss in a foetus. Twenty weeks and five days old, the foetus, according to Dr Jape, was suffering from meningocele, a type of brain abnormality. The woman, the wife of a two-wheeler mechanic, had undergone an ultrasound the previous day with another radiologist, who had been unable to detect the problem.

Dr Jape informed the patient and her husband of the condition, and, asking them to tell their gynaecologist, advised them to return to him later during her pregnancy. He went on to fill in Form F (Form for Maintenance of Record in Case of Prenatal Diagnostic Test) as required by the PCNPDT or Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act. The Form demands, apart from the contact details of the patient, radiologist and the doctor, details like the number of weeks of pregnancy, and a declaration that the patient does not want to know the gender of the foetus.

About a month later, his clinic was being turned upside down. An investigation went on from late at night for over five hours and concluded at around 2 am. His three ultrasound machines were confiscated. And he was informed that he was going to be tried for sex determination of a foetus.

The woman had, unknown to Dr Jape, undergone an abortion. The foetus had turned out to be female. Working backwards, Dr Jape claims, the authorities decided that the radiologist must have revealed the foetus’ gender. “But I had done no such thing,” Dr Jape says. “All I had told the woman was what her foetus was suffering from meningocele.”

The authorities argue that Dr Jape hadn’t mentioned the foetus was ‘abnormal’ or that it was suffering from meningocele in Form F. But Dr Jape argues the form does not specify the need to fill in the diagnosis of any abnormality and that the space provided in the form is anyway so small that all he can fill is that an ultrasound was conducted. “There was no need to mention meningocele,” he says. “I had clearly stated what the foetus was suffering from in the report of the ultrasound. I was not hiding anything. But nobody was willing to listen to me.”

The case galvanised radiologists across Maharashtra, who have, over the years been complaining about harassment over the stringent application of PCNPDT Act, a law enacted to check declining sex ratios. Strikes by radiologists were held across Pune and other cities. An indefinite strike across Maharashtra was proposed recently, but called off after the Chief Minister assured them he’d look into the matter.

But radiologists continue to complain that since the 2011 census, in their zeal to improve sex ratio numbers, NGOs and authorities have begun to unnecessarily target them. “It holds the medical community responsible for a problem which is societal,” says Dr Jignesh Thakker, the coordinator of the Indian Radiological and Imaging Association (IRIA). “The focus has fallen upon us, when it is parents who are causing the problem.” Unsurprisingly, when the BJP’s Maneka Gandhi made the radical suggestion of compulsorily registering the gender of the foetus earlier this year, a proposal that would have shifted the focus of preventing female foeticide to parents, it was supported by the IRIA and Indian Medical Association.

Radiologists in Maharashtra claim that by focusing on the medical community to check declining sex ratios, it has created a situation where there is an obsession over form-filling. “Radiologists are being tried for sex determination under the PCPNDT Act for the smallest errors,” Dr Thakker says. “What has really happened is that the government has held radiologists responsible for low sex ratios and has given officials targets of how many ultrasound machines they have to seal.”

Last year, two radiologists were tried under the PCPNDT Act for irregularities in records maintained of those forms. The Bombay High Court, however, absolved them of the charges, ruling that the filling of forms is a clerical job which needs to be done by the clinic. Dr Jape says that for every pregnancy ultrasound, a radiologist has to fill a total of six pages of forms: these include four pages of Form F, apart from a reference sheet and a report of the diagnosis. “A radiologist will at least do a minimum of 300 such ultrasounds every month, which means a total of 1,800 pages. Now, there is every possibility that a small clerical error will slip in occasionally,” he says.

The issue gets further complicated, according to Mumbai radiologists, when it comes to small radiology centres in rural areas, where connectivity is poor (Form F needs to be filled online). “The truth is, nothing is being done to check female foeticide,” Thakker says.

It has been almost three months since Dr Jape’s machines have been confiscated. A local politician who had once nudged Dr Jape to reveal the sex of a baby in his family several years ago, and whom the radiologist had refused, has begun to harass him. “He keeps asking sarcastically if I need his help. I’m being mocked, when all I have done is follow the law,” he says.

censusdoctorsmedical ethicspre-natal sex determination test