The Bengal government on Monday identified “serious negligence” and violation of the standard operating procedure by doctors as the prima facie cause for a young mother’s death and the serious illness of four more post-childbirth women at Midnapore Medical College and Hospital.

Senior doctors should have been present during the deliveries but the job was left entirely to “trainee doctors”, chief secretary Manoj Pant said.

Mamoni Ruidas, 30, of Garbeta in West Midnapore died at the hospital after delivering a boy on Friday. One of the four others who fell critically ill has improved while the other three were shifted to SSKM Hospital in Calcutta on Sunday night. Two of them are on ventilator support.

Pant, addressing a news conference at the state secretariat, promised to fix accountability at all levels once the inquiry by a 13-member team, appointed by the health department, was complete.

He said samples from the batch of Ringer’s lactate intravenous solution administered to these five women — the suspected reason for the deterioration in their health — had been sent for analysis.

“Prima facie, there is serious negligence on the part of the (doctors’) unit that was on duty. What happens is that this is done by senior doctors. Here it was handled by trainee doctors (postgraduate trainees), which is why we believe that the standard operating procedure and guidelines have been violated,” the chief secretary said.

“Still, we have ordered detailed investigations. Who were involved in the treatment, what was the negligence and the extent of the negligence can be determined after a detailed investigation. Strict action will be taken against those found guilty,” he added.

“Earlier too, we had instructed that trainees have to work under the supervision of senior doctors. A proper duty roster should be maintained. Prime facie, a violation of this too has been found.”

A health department official said the 13-member inquiry committee, which had visited the Midnapore hospital, had flagged “unsupervised C-section procedures performed in the absence of the senior doctors”.

“Also, the basic protocols of hygiene were not maintained, which could have ledto infections. This had happened because there was no senior doctor supervising and only junior doctors were performing the procedures,” he said.

“Between January 8 night and the early hours of January 9, the five deliveries were done. One delivery started at 10.20pm and another at 10.50pm. Officially bothwere (shown to have been) done by one senior doctor. It’s not possible for a lone senior doctor to perform or supervise two procedures simultaneously (since they would have overlapped in time) on two OT tables.”

The health official said many staff members at the Midnapore hospital had told the inquiry committee that no senior doctor was present. “There are three senior doctors in the unit and one of them was on duty (but not present),” he said.

He said that in case the solution had triggered a reaction, there should have been senior doctors present to treat the patient.

“We have come to know that when one of the five women was suffering rigors (violent shivering), junior doctors were managing it. Rigor is a serious condition and senior doctors should ideally manage it,” he said.

Members of the inquiry committee told The Telegraph they had collected material evidence from the Midnapore hospital and recorded their opinions in the preliminary report, submitted on Monday.

“Samples of the drugs that were used have been sent for analysis. It will take about 10 to 12 days for the results to arrive. The inquiry committee may meet again to draw up a final report after the results come,” a member said.

Chief minister Mamata Banerjee on Monday met 10 officials who head various branches of the health department and told them that procedural or administrative lapses would not be tolerated, Pant said.

The state government has also asked the CID to probe the case. “If the CID’s inquiry too finds negligence, it will help our probe and we will be able to take the correct actions,” Pant said.

CID sources said a team of senior officers would be formed and a case of medical negligence drawn up under criminal law.

The CID team will visit the Midnapore hospital. Among other things, it will get hold of the duty roster and identify those who were part of the unit.

The team will also record the batch and the production dates of the Ringer’s lactate solution that was allegedly administered to the five patients and get a copy of the SOP for institutional deliveries.

“If negligence is found at multiple levels, the investigation will identify them in detail. Let us begin the probe first,” a senior officer said.