Madam Speaker, I wish at the outset to convey my deepest condolences to the family of the deceased patient. Madam Speaker, with your permission, I will reply to question B/881 and B/902 together as they relate to the same subject matter. Madam Speaker, I am informed that on 18 May 2026, late patient B.M., a 21-year-old pregnant woman, attended the Accident and Emergency Department of Sir Seewoosagur Ramgoolam National Hospital at 23.48 hours, complaining of low abdominal pain. The doctor diagnosed the patient with 23 weeks pregnancy with low abdominal pain. The doctor recommended immediate admission, but the patient refused and signed Discharge against Medical Advice. It was noted that the patient had no antenatal follow-up. According to established protocol, a pregnant woman should attend antenatal follow-up at the hospital or any health centre to be seen by a gynaecologist for a full assessment, including an ultrasound. According to information available, unfortunately, the patient did not follow antenatal care as recommended in our service. Madam Speaker, about three hours later, that is, on 19 May 2026 at 3.00 a.m., the patient returned to Sir Seewoosagur Ramgoolam National Hospital, still complaining of abdominal pain and having minimal bleeding. On examination it was observed, that the patient was in labour. The foetal heart was absent. The doctor on duty informed the Specialist on call who advised to admit the patient in the Labour Ward to enable the delivery to progress naturally. Madam Speaker, on 19 May 2026 at 6.40 a.m., that is three hours later, the patient started to bleed profusely due to placental abruption, that is, detachment. The Specialist on call was informed of the case. He advised to transfer the patient to the operation theatre for surgery according to our established clinical guidelines. The Specialist on call performed the necessary intervention at 7.00 a.m. The patient was thereafter transferred to Gynae Ward at 9.00 a.m. since she was stable following the surgery. At 11.50 a.m., the patient collapsed in ward. She was attended by the Specialist on call and sent to the operation theatre for immediate intervention. Madam Speaker, in the operation theatre, the patient was seen by the treating Specialist and the Consultant in charge who proceeded with a hysterectomy, that is, uterus was surgically removed. The patient was thereafter transferred to Intensive Care Unit for post- operative management. Madam Speaker, on 21 May 2026 at 9.05 a.m., it was noted that her abdomen was distended and exploratory laparotomy – that is the abdomen was reopened to assess the bleeding – was performed and patient was kept in ICU. On 22 May 2026, the patient was still in ICU and was seen by a multidisciplinary team comprising a physician, nephrologist, anaesthetist, surgeon, gynaecologist, but her condition continued to deteriorate. In spite of further management, the patient developed several complications and, unfortunately, passed away on 23 May, at 8.40 a.m. Madam Speaker, I am further informed that the body was sent to the Police Medical Officer for post-mortem, which was refused by the relatives. For all road traffic accident, post-mortem examination is mandatory. For ordinary cases, same is at the discretion of the Police Medical Officer. Madam Speaker, given that this is a case of maternal death, a preliminary enquiry was chaired by the Acting Regional Health Director, and he recommended for an in-depth inquiry into the matter. Based on the recommendations of the preliminary enquiry, my Ministry has, on 26 May 2026, set up an independent enquiry committee on the matter. The independent enquiry was conducted on 28 May 2026 at SSRN Hospital. The enquiry team comprised an Acting Regional Health Director from Dr. Jeetoo Hospital, and two Consultants-in-Charge in Obstetrics and Gynaecology from Victoria Hospital and Jawaharlal Nehru Hospital, respectively. Madam Speaker, the independent enquiry report was submitted to my Ministry on 01 June 2026. The report of the enquiry panel concludes that a catastrophic medical outcome was heavily driven by a combination of suspected regular cannabis use, of high-risk obstetric conditions and severe patient-side delays. The lack of routine antenatal surveillance has severely predisposed the patient to placental abruption and acute disseminated intravascular coagulation (DIC). I wish to inform the House that a large 2024 cohort study found that cannabis use during pregnancy was associated with a higher risk of gestational hypertension, pre- eclampsia, abnormal pregnancy weight gain and placental abruption. The initial refusal of inpatient management by a discharge against medical advice directly delayed critical early intervention. Once re-admitted, the medical team executed all standard emergency, surgical and intensive care protocols without delay or shortcoming. Despite maximum blood component therapy to reverse the bleeding, the sheer severity of the fulminating DIC culminated in fatal multiple organ failure and transfusion-related acute lung injury (TRALI). Madam Speaker, despite the conclusion of the independent enquiry committee, in the interest of justice and transparency, my Ministry will refer the case to the Medical Council of Mauritius for an in-depth investigation and appropriate actions.

Okay, one to start with.

Thank you, Madam Speaker. Will the hon. Minister inform the House whether no gynaecologist was present at 3.00 a.m. on that date, and the problem comes with the recent ruling of the Employment Relations Tribunal on the work of specialists on a 24/7 basis? What is being done to this effect? Thank you.

I thank the hon. Member. She appears to be very well-informed about this. Pursuant to government policy aimed at reducing maternal and under five mortalities, the PRB Report of 2008 expressly provided for officers of the grade of Consultant-in-Charge and Specialists in the field of Obstetrics and Gynaecology, Paediatrics and Anaesthetists to be physically present, at all times, to ensure coverage at night in the regional hospitals. Unfortunately, in August 2022, the then government proceeded with the implementation of 24/7 specialised services in the three above-mentioned fields without ensuring an adequate number of Specialists were available in these fields. They acted very fast, and unfortunately, following a labour dispute between the Government Medical and Dental Association and the Government, regarding 24/7 specialised services, the Employment Relations Tribunal concluded that 24/7 specialised services constitute an imposition of a unilateral change in terms and conditions of service. The ERT, therefore, recommended that the Ministry has to review the situation. That is, the doctors will no longer be asked to compulsorily be present 24/7. Only when they are called, they will have to be present. When that award was out, on the same day – I remember because we had decided that we have to discuss with the syndicats, the unions –, but unfortunately, the Government Medical and Dental Officers Association, the Secretary wrote a letter to all those who are concerned, stating that the 24/7 working system, illegally imposed upon the Obstetricians, Gynaecologists, Paediatricians and Anaesthetists, shall stop with immediate effect. So, what they did is that they stopped it, though we were still discussing with them to find ways and means on how they will be present. They stopped it and, therefore, they were on call. It is a fact that the gynaecologist was not present at that time. If I am not mistaken, he was giving instructions, but he came around 6.00 in the morning. I can inform the House that because of this we will be very strict about it. We are definitely going to have a protocol, a very severe protocol and serious one – we are working on it –, to see to it that when any life is in danger, any patient is in danger, not only the doctor responsible for that discipline, but all those directly or indirectly associated with it should be compulsorily present because it is not a matter of money only, it is a matter of life and death. Unfortunately, I am very, very sorry to say that – I am not going to blame all –, but there has been a handful of them who are making abuse of this award which has come out.

Okay. Chief Whip! Because she had a question you replied to.

Je vous remercie, Madame la présidente. Je présente également mes sympathies à la famille endeuillée. Can the Minister inform the House whether une assistance psychologique will be provided à la famille endeuillée? Je vous remercie, Madame la présidente.

Upon request, definitely, I will look into it favourably.

Yes, your second question!

Thank you, Madam Speaker. Par rapport à ma question supplémentaire, the Minister made it clear that there is going to be a 24/7 presence of Specialists such as Gynaecologists. He already answered. Can the Minister inform the House who asked the doctors to stop working 24/7, and what is the outcome of the report of the high-powered committee in this matter? Thank you.

There is no high-powered committee as such. As I just said, it was about the Government Medical and Dental Association as well as the Employment Relations Tribunal, that is, the ruling of the Tribunal. But I had just mentioned that once the ruling was out, on the same day, without waiting a single day, a single minute, instructions came from the union that it has to be stopped immediately. Everybody knows that these are very rare fields, scarcity areas. We have a lack of such experts and specialists in our in our hospitals, and it was extremely difficult for us to, immediately, rush and to take a decision. But we have maintained that the doctors have to be present on call. They should be present. The doctor was present, but was present early in the morning. He gave instructions and then after that he came. That is why I said we are referring the matter to the Medical Council. It is up to the Medical Council to go through all the reports and to take the necessary action.

Yes, Dr. Aumeer!

Thank you, Madam Speaker.

That will be the last question!

First, I extend my deepest sympathy to the bereaved family. The hon. Minister, in his answer, mentioned that he has been made aware of the report. He clearly mentioned that disseminated intravascular coagulation (DIC) is the main cause of death in this particular case, and it is usually the main causes of death in maternal deaths. May I ask the hon. Minister whether it is not high time that all our public hospitals have a consultant haematologist, who is a specialist in DIC, to avoid such tragedies? Thank you.

Definitely, I will consider it favourable, except that the only problem is that it is a scarcity area. We will try to find out if we can get the support from our partners, particularly the WHO because we keep on getting advice from them and even from experts.

Thank you. Hon. Members, now, I am informing you that the Table has been advised that the following PQs have been withdrawn: B/882, B/897, B/903, B/907, and B/909. Thank you. I will now raise for one and a half hour. Thank you very much. At 1.00 p.m., the Sitting was suspended. On resuming at 2.33 p.m., with the Deputy Speaker in the Chair.

Please be seated! The hon. First Member for Vacoas and Floréal! FOND DU SAC GOVERNMENT SCHOOL - PRE-PRIMARY UNIT - UPGRADING WORKS