CAG Audit Reveals Critical Failures in Madhya Pradesh's Medical System Before Deadly Syrup Tragedy

A significant management crisis in Madhya Pradesh medicine stores was highlighted in a central audit report last year, preceding one of India's most devastating medicine tragedies that claimed at least 23 children's lives. These fatalities are connected to contaminated Coldrif cough syrup, bringing renewed attention to drug testing protocols and inspection frequency.

The Comptroller and Auditor General of India (CAG) report, presented to the assembly on December 18, revealed that no physical verification of stores occurred during 2018-22 at numerous hospitals, including Chhindwara Institute of Medical Sciences (CIMS), the epicenter of recent deaths. Bhopal's Hamidia Hospital and Sultania Zanana Hospital were also implicated. According to state regulations, all medical stores require annual physical verification.

The assessment of Madhya Pradesh's public health infrastructure and health services management identified irregularities during physical inspections of central medicine stores in the evaluated hospitals.

Furthermore, 263 drug varieties worth over Rs 1.08 crore expired between 2017-22 at Hamidia Hospital (Bhopal), Jaya Arogya Hospital (Gwalior), and CIMS, indicating inadequate drug stock management by hospital administrators.

The central drugstore at JAH, Gwalior, exceeding 100 years in age, was declared structurally unsafe by the Public Works Department in 2016.

Auditors discovered that pharmacies in test-checked facilities lacked labeled shelves, continuous temperature monitoring for cold storage areas, and proper freezer temperature maintenance records.

Drug cartons were found directly placed on floors at JAH Gwalior, Hamidia, and Sultania Zanana hospitals. Without physical verification, recorded stock positions couldn't be confirmed.

The CAG also identified a shortage of 22,845 health workers across healthcare facilities. This deficit stemmed from 182 posts not being sanctioned as required by Indian Public Health Standard Guidelines. Among sanctioned positions, 11,535 vacancies existed across 1,775 health institutions.

Doctor shortages ranged between 6-92% in district hospitals, 19-86% at community health centers (CHCs) and primary health centers (PHCs), and 27-81% at sub health centers (SHCs).

Additionally, medical colleges faced 27-43% staff shortages while the AYUSH department experienced 28-59% deficits.

Within the nursing workforce, shortages reached 3-69% in district hospitals, 4-73% in civil hospitals, and 2-51% in CHCs, PHCs, and SHCs compared to sanctioned positions. The AYUSH department specifically showed nursing shortages up to 27% in medical colleges and 59% in healthcare institutions.

A separate CAG performance audit for Tamil Nadu, presented December 10, 2024, identified deficiencies in meeting drug inspection targets and sample collection goals.

In 2016-17, Tamil Nadu's target was 100,800 inspections, but only 66,331 were completed, indicating a 34% shortfall. By 2020-21, this inspection deficit increased to 38%, with just 62,358 of the targeted 100,800 inspections conducted.

Between 2016 and 2021, the highest inspection shortfall reached 40% during 2019-20.

The CAG also highlighted significant gaps in drug inspectors collecting samples for testing, with deficits reaching 54% in both 2018-19 and 2020-21.