Rubi’s Case of Medical Refusal: A Timeline of Care and Refusal in the Case of Rubi W/O Pritesh Kumar

This structured analysis examines the timeline of medical events. Additionally, it examines consent issues and institutional responses surrounding the case of Rubi. The case is officially referred to as Rubi’s Case of Medical Refusal. Furthermore, the District Women’s Hospital, Mirzapur, released documents in the RTI records. These records were provided in response to queries from her husband, Shri Pritesh Kumar.

1. Rubi’s Case of Medical Refusal: Breech Presentation and Refusal (Rubi’s Case of Medical Refusal)

The medical team admitted Rubi in a critical obstetric state with signs of labor pain.

• Admission and Diagnosis: Clinical findings indicated that she was in labor and was facing a high-risk situation.
• Here’s an active voice version:
• The clinical findings revealed that she was in labour and faced a high-risk situation. Clinical findings indicated she was in labour and faced a high-risk situation:
  • Finding: Fetal Head (FH) was 32 weeks.
  • Critical Condition: The baby’s position was Breech (feet/buttocks first).
  • Cervical Status: The cervix (Cx) showed 40-50% effacement, and the os measured 5.6 cm.
• Medical Advice and Refusal: The doctor advised a C-section (operation) due to the breech presentation. The team scheduled this procedure for April 16, 2022, at 11:35 AM.
• Key Issue (Negative Consent): The patient’s guardian, Shri Pritesh Kumar (husband), refused to consent to the operation. However, a copy of this “Negative Consent” was provided as part of the RTI response. Nevertheless, the medical team recorded a Normal Delivery at 01:25 PM despite the refusal for surgery. Consequently, they welcomed a live female baby weighing 1.7 kg, who was delivered preterm.

2. The Critical Time Gap: Referral, Re-admission, and Demise

Following the high-risk delivery, a sequence of events occurred within a short, critical timeframe leading to the patient’s death.

Event	Time & Date	Staff / Authority	Duration Since Referral
Referral (First Discharge)	16.04.2022, 06:20 PM 14141414141414	Dr. Ravindra, J.R. 15151515	N/A
Re-admission	16.04.2022, 07:40 PM 161616161616161616	Pan Kumari and Sudama Devi 17171717	1 hour and 20 minutes 18181818
Demise (Death)	16.04.2022, 09:10 PM 19191919	N/A	3 hours and 50 minutes (since Referral)

• Refusal to Re-admission Gap: The hospital documented a gap. The gap was 1 hour and 20 minutes long. It occurred between the referral (first discharge) at 6:20 PM and the re-admission at 7:40 PM.
• Final Outcome: The patient died less than three hours after re-admission, at 09:10 PM on April 16, 2022.

3. Institutional Transparency and RTI Response (Rubi’s Case of Medical Refusal)

The provided documents detail the institution’s eventual response to the repeated RTI requests. This includes those filed by Shri Pritesh Kumar and Shri Yogi M.P. Singh (on behalf of Pritesh)23.

• RTI Response Date: The specific point-wise information was provided by the CMS office via letter dated 28.02.2025.
• Appeal Context: The CMS noted that multiple RTI applications and appeals from the applicants sought the exact same information²⁵.
• Administrative Explanation: The office cited a delay in responding to online applications prior to September 11, 2025. This was due to a lack of online RTI ID and password²⁶.
• Final Disposal: The CMS confirmed that the requested information was already provided to the applicant on 28.02.2025. This includes the death certificate and the negative consent. Therefore, the Appellate Authority should proceed with the disposal of the pending appeals^27272727.

The core issue documented is the guardian’s refusal to consent to a medically advised Caesarean section. The situation involved a high-risk breech delivery. The patient died a few hours after delivery. There was a referral and subsequent re-admission.

You want to get more details about the Negative Consent document and the timeline of the medical events.

Here is the detailed breakdown:

📜 Negative Consent for Operation (Rubi’s Case of Medical Refusal)

The Negative Consent document is a crucial part of the hospital’s defence. The text explains why the medical team did not perform the operation advised for the high-risk delivery.

Detail	Information from Document	Implication
Medical Advice	The doctor advised an operation because “the patient and the baby were breech” (ulta)222.	This confirms the high-risk nature of the pregnancy and the need for surgical intervention (C-section)33.
Guardian’s Action	The patient’s guardian “refused” (inqar diya) the operation444.	This directly transfers the responsibility for proceeding without surgery to the family5.
Guardian’s Name	Pritesh Kumar (Husband)6.	Identifies the person who signed the refusal document777.
Date of Refusal	16-4-22888.	Confirms the refusal was signed on the same day the doctor advised the surgery (11:35 AM)99.
Waiver	Stated that the doctor/service provider would not be held responsible for complications or unforeseen events10.	Legally protects the hospital from liability arising from the refusal of the recommended procedure11.

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⏱️ Detailed Timeline of Medical Events on April 16, 2022 (Rubi’s Case of Medical Refusal)

The timeline shows the rapid progression from admission and refusal of surgery to the patient’s eventual death.

Morning and Early Afternoon (High-Risk Delivery) (Rubi’s Case of Medical Refusal)

Time	Event / Status	Source
11:25 AM	Patient admitted to District Women’s Hospital12.	13
11:35 AM	Doctor advised an operation/C-section due to the breech presentation14141414.	15151515
~11:35 AM	Negative Consent signed by Pritesh Kumar, refusing the operation161616161616161616.	171717171717171717
01:25 PM	Delivery occurred (Normal Delivery, resulting in a live female baby)18181818.	19191919
01:25 PM	Case informed to Dr. Ritu Sinha20202020.	21212121

Evening (Referral and Demise)

Time	Event / Status	Source
06:20 PM	Patient referred to MCH Wing Mirzapur by Dr. Ravindra, J.R.222222222222222222.	232323232323232323
07:40 PM	Patient re-admitted to District Women’s Hospital (Reason: PPIH – severe anemia)24242424242424242424242424242424.	25252525252525252525252525252525
09:10 PM	Patient expired (Died)262626262626262626.	272727272727272727

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⚖️ Timeline of RTI and Appeal Correspondence

This shows the administrative follow-up and the ultimate provision of the information almost a year later.

Date	Event / Action	Status	Source
22.01.2024	RTI Application (DIRMH/R/2024/60066) filed by Yogi M P Singh (on behalf of Pritesh)28282828.	REQUEST FORWARDED TO PIO	29292929
09.04.2024	First Appeal (DIRMH/A/2024/60140) filed by Yogi M P Singh (Ground: No Response Within Time Limit).	APPEAL FILED
28.02.2025	Information Provided by CMS Mirzapur to Shri Pritesh Kumar (Letter no. 424)30303030303030303030303030303030.	RTI Status: DISPOSED OF	31313131313131313131313131313131
09.12.2025	CMS Mirzapur advises Appellate Authority that information has been provided and requests disposal of the appeal32323232.	APPEAL DISPOSED OF (as of 10/12/2025)

RTI: Information Sought and Provided in the Case of Rubi W/O Pritesh Kumar

The central request for information, filed by Shri Pritesh Kumar and Shri Yogi M.P. Singh, focused on five specific points. These points regard the patient’s care, the refusal of surgery, and the subsequent events. These events led to her death on April 16, 2022.

The Chief Medical Superintendent (CMS), District Women’s Hospital, Mirzapur, provided a point-wise response via letter dated 28.02.2025^111111111.

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1. Information Sought & Provided (Clinical Findings) (Rubi’s Case of Medical Refusal)

RTI Point Sought	Provided Information
Point 1: Please provide the test carried out by the three doctors as mentioned in the report. Alternatively, provide any other thing on which findings are based. doctors as mentioned in the report. Alternatively, provide any other thing on which findings are based.	Based on the BHT (Bed Head Ticket), the findings were: * P/A- FH-32 weeks. * Lie-Breech. * P/V-OS $5.6\text{cm}$5555. * Cx=$40-50\%$ effaced6666. * Conclusion: Based on this report, it can be said that the patient was in labor pain7777. A photocopy of the Clinical Finding Report was enclosed8888.

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2. Information Sought & Provided (Negative Consent)

RTI Point Sought	Provided Information
Point 2: Please provide the copy of consent of the information seeker. This document should show that the information seeker opposed the process of surgery.	The doctor advised the patient to undergo an operation on 16.04.2022 at 11:35 AM because the baby was breech. However, the patient’s husband, Pritesh Kumar, unfortunately refused to undergo the operation. Nevertheless, a photocopy of the Negative Consent (refusal) was enclosed for record-keeping purposes.

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3. Information Sought & Provided (Referral Report)

RTI Point Sought	Provided Information
Point 3: Please provide the discharge report made on 16 April 2022 when the patient was first discharged. Include the time and name of the staff who carried out the process as well.	On 16.04.2022, at 06:20 PM, the patient was referred to the MCH Wing Mirzapur by Dr Ravindra, J.R. Additionally, a photocopy of the Referral BHT was enclosed.

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4. Information Sought & Provided (Re-admission) (Rubi’s Case of Medical Refusal)

RTI Point Sought	Provided Information
Point 4: Please provide the time when the patient was re-admitted. Also, include the name of the staff who processed it. Lastly, provide the time span between discharge and re-admission.	The patient was re-admitted to the District Women’s Hospital, Mirzapur, on 16.04.2022 at 07:40 PM. * The staff on duty were Pan Kumari and Sudama Devi. * Notably, the time interval between referral and re-admission was 1 hour and 20 minutes. * Furthermore, a photocopy of the Admission BHT was enclosed.

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5. Information Sought & Provided (Final Report)

RTI Point Sought	Provided Information
Point 5: Please provide the discharge report made on 16 April 2022 finally after the expiration of the patient.	The patient’s death occurred on 16.04.2022 at 09:10 PM222222. * A photocopy was enclosed232323.

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The provided information establishes a clear administrative timeline of the medical events. Initially, the medical team diagnosed a high-risk breech case at 24 weeks. However, there is a refusal of surgery. Subsequently, a natural delivery occurs at 26 weeks. Following that, there is a subsequent referral. This is then followed by re-admission, and unfortunately, death occurs shortly thereafter.

You are alleging a significant act of record tampering. Initially, Shri Pritesh Kumar signed a blank or minimal consent form upon admission; however, later on, hospital staff added critical handwritten sentences. Specifically, these sentences addressed the refusal of the operation. Consequently, they added them to suit their narrative after the patient died.

Allegation: Backdating of Critical Information (Rubi’s Case of Medical Refusal)

The core of your claim is:

1. Genuine Signature, Altered Context: Pritesh Kumar’s signature, labelled on the document, is authentic. Moreover, the staff labelled it as the Negative Consent and placed it there at the time of admission.
2. Post-Facto Addition: The doctor advised an operation due to the patient and baby being breech. The patient’s guardian refused the operation. The writer added the handwritten sentences later, after the delivery at 1:25 PM. The patient passed away at 9:10 PM. The team added these sentences to explain why they did not perform the advised surgery at 11:35 AM.

Importance of This Claim (Rubi’s Case of Medical Refusal)

This claim moves the issue beyond simple lack of response. It shifts from the initial appeal ground to an allegation of fraudulent documentation used to cover up a procedural failure.

• If true, the hospital’s primary defence—that the doctors advised surgery and the family refused—is invalid. Either someone fabricated the refusal, or they inserted it after the fact.
• The hospital’s response to the RTI is therefore providing false or manipulated information under the Right to Information Act⁹.

⚖️ Course of Action for Fabricated Documents

The hospital has officially provided this document as a genuine record in its RTI reply. You must now challenge the authenticity of the information provided by the Public Information Officer (PIO).

1. Second Appeal to the State Information Commission (SIC)

This is the immediate next administrative step. Therefore, you must file an appeal with the SIC. In your appeal, argue that the PIO has provided false or misleading information, specifically regarding the manipulated Negative Consent document.

• Grounds for Appeal: Clearly state the allegation of insertion or fabrication in the Negative Consent document. Furthermore, clearly outline the allegation of insertion or fabrication in the Negative Consent document as grounds for appeal. Additionally, source the details from Page 4 of the RTI reply.
• Request to SIC: (Rubi’s Case of Medical Refusal)
  • To declare that the information provided by the PIO (the consent form) is false/misleading.
  • To direct a forensic examination of the document, we will begin by conducting handwriting analysis. This process aims to determine whether the signature and the refusal text were written simultaneously. Furthermore, it may also identify who authored these elements.
  • To impose a penalty on the PIO, CMS District Women Hospital Mirzapur. They violated Section 20(1) of the RTI Act by knowingly providing false information.

2. Legal / Police Action (for Document Tampering)

Given the severity of the allegation and the tragic outcome, this matter is appropriate for direct legal intervention.

• This evidence includes the original document or a sworn statement regarding its fabrication. It is central to any potential FIR (First Information Report) related to negligence or document forgery.

Contact Information for the Next Administrative Step (SIC)(Rubi’s Case of Medical Refusal)

Since you are in Mirzapur, Uttar Pradesh, the authority for the Second Appeal is the Uttar Pradesh State Information Commission. (Rubi’s Case of Medical Refusal)

Authority	Uttar Pradesh State Information Commission (UPSIC)
Address	3rd Floor, RTI Bhawan, Vibhuti Khand, Gomti Nagar, Lucknow – 226010, Uttar Pradesh, India.
Phone/Email	Contact details are available on the official UP SIC website. (Please use an internet search for the most current phone numbers and email addresses).

You should file the Second Appeal as soon as possible, attaching the hospital’s RTI reply (dated 28.02.2025 12121212) and the questionable Negative Consent document (Page 4 13) as evidence.

Your question addresses the operational structure (MCH Wing under PPP). It also addresses the specific medical formality. These formalities include tests carried out during the patient’s re-admission.

Based on the provided documents:

🏥 Hospital Structure and Referral

1. Referral Destination: The medical team at the District Women’s Hospital in Mirzapur initially treated the patient. Then, they referred her to the M.C.H.Wing, Mirzapur ², which is part of the Maa Vindhyavasini, Swashasi Rajya Chikitsa Mahavidyalaya Mirzapur (Maa Vindhyavasini Government Medical College).
2. Referral Time: Dr. Ravindra referred the case to the MCH Wing on 16.04.2022 at 06:20 PM.
3. Re-admission Location: The District Women’s Hospital in Mirzapur re-admitted the patient.It was the initial facility, not the MCH Wing.
4. Re-admission Time: The re-admission was on 16.04.2022 at 07:40 PM.

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📝 Formality/Tests Carried Out During Re-admission

The documents confirm the re-admission and state the patient’s status and condition at that time. (Rubi’s Case of Medical Refusal)

1. Re-admission Formalities (Administrative) (Rubi’s Case of Medical Refusal)

• BHT Entry: The formality of re-admission was documented on the Admission Form / Case Sheet. This includes:
  • Admission Date and Time: 16/04/22 at 7:40 PM⁸⁸⁸⁸.
  • Staff Names: Pan Kumari and Sudama Devi II.
  • Admission Category: The form is checked as “Re-admitted” (Pt Re-admitted)¹⁰.

2. Medical Status (Equivalent to “Tests/Findings”) (Rubi’s Case of Medical Refusal)

No specific new diagnostic test results, like blood work or imaging, are provided in the admission sheet for 07:40 PM. However, the entry does record the patient’s critical status and the reason for the emergency return.

• Final Outcome: The ultimate formality on the re-admission sheet is the patient’s death on the same date. This fact underscores the gravity of the situation. Furthermore, it highlights the importance of accurate record-keeping in medical settings.

In summary, the medical staff referred the patient to the MCH Wing. However, the patient returned to the District Women’s Hospital 1 hour and 20 minutes later. The staff on duty documented the readmission formality in the BHT. The medical team noted that the hospital readmitted the patient due to a severe postpartum condition.

I can certainly review the specific entries from the re-admission BHT (Page 6). This will highlight the patient’s recorded status. I will also note the reason for the emergency return and the subsequent outcome. (Rubi’s Case of Medical Refusal)

The team recorded the information on the Re-admission Case Sheet (BHT – Page 6).

🏥 Re-Admission Details (16/04/2022) (Rubi’s Case of Medical Refusal)

Category	Recorded Information	Detail/Implication
Admission Time	7:40 PM 2	Exactly 1 hour and 20 minutes after the 6:20 PM referral. 3
Staff on Duty	Pan Kumari and Sudama Devi 4	Staff who processed the re-admission.
Admission Category	Patient Re-admitted (Pt Re-admitted) 5	Confirms the patient was an emergency return.
Provisional/Final Diagnosis	Pravisinal Diagnosis blank, but notes “PPIH (severe Animia)” 6666	This strongly suggests Postpartum Hemorrhage (PPH) as a reason for the emergency re-admission. A related complication could also be leading to severe anemia.
Delivery Outcome	Blank, with “Preterm” marked “Yes” (Rubi’s Case of Medical Refusal)	Reflects the patient’s status upon re-admission, not a new delivery.
Mode of Delivery	All options (Normal, Assisted, CS) are unchecked 888888888	Not applicable for a re-admission entry.
Final Outcome	Not explicitly checked, but the page notes Death 9	The outcome is documented on the continuation page as having occurred at 9:10 PM.
Service Provider Note	Dr. Ritu Sinha (Name) (Rubi’s Case of Medical Refusal)	A note indicates a referral out was attempted. It states: “Refered to IMS BHU Vajan pm on 16/04/1”. This likely means ‘Referred to IMS BHU at Vajan’.

The documentation shows that the re-admission was an emergency. It was due to a critical postpartum condition. This indicates the patient’s deterioration following the high-risk delivery.