The doctor whose sterilisation of 83 women in less than three hours ended in at least a dozen deaths said on Thursday the express operations were his moral responsibility and blamed adulterated medicines for the tragedy.
Dr R.K. Gupta, who says he has conducted more than 50,000 such operations, denied that his equipment was rusty or dirty and said it was the government's duty to control the number of people that turned up at his family-planning "camp".
"It is up to the administration to decide how many women would be kept for operation," a visibly upset Gupta told Reuters from the police station where he is being held in custody. He faces charges of causing death by negligence.
"If they kept in that place 83 women, it is my moral responsibility to operate (on) all the women. If I decline to do that I would have faced public agitation," said Gupta, who was awarded a state honour 10 years ago for his sterilisation work.
India is the world's top steriliser of women, and efforts to rein in population growth have been described as the most draconian after China. Indian birth rates fell in recent decades, but population growth is among the world's fastest.
With more than 4 million Indians sterilised every year, a system of quotas encourages officials and doctors to cut corners, activists say.
Gupta said health workers gave the women ciprofloxacin, a commonly prescribed antibiotic, and ibuprofen, a pain killer, after the operations, which were conducted in a grimy room of an unused private hospital in a village called Pandari in Chhattisgarh.
At least 13 women have died so far, with scores more still hospitalized and some critically ill. Some of the sick women were operated on by a different doctor at a second camp on Monday. Gupta said this was evidence he was not to blame.
"I am not the culprit. I have been made scapegoat. It is the administration which is responsible for this incident," he said, speaking in a dimly lit police hostel room after being taken into custody from a friend's house on Wednesday night.
The government of Chhattisgarh, one of India's poorest states, banned five batches of drugs and a batch of surgical cotton wool on Wednesday pending further investigations. The banned medicines include Indian-made brands of ciprofloxacin and ibuprofen and were used in Gupta's sterilisation camp, a government statement said.
Rights groups say the sterilisation programme is coercive because ill-educated women are often offered money to accept surgery without knowing the full risks. State government officials who run the programme are pressed to meet quotas.
Protocols state that doctors should spend at least 15 minutes on each operation and perform a maximum of 30 in a day. Several doctors told Reuters it was common to perform up to 90 sterilisations a day, leaving little time to maintain hygiene.
Gupta said it was the responsibility of the government to clean the clinic, which police say was filthy, and to provide him with more instruments. Asked why he didn't complain, Gupta said the conditions were normal and he kept his equipment clean.
Gupta said he generally took between two and five minutes on each operation, and that this gave two assistants time to clean scalpels.
He said allegations by a senior government official that the tools were rusty were untrue and that he wore gloves and a gown.
"They are dipped in spirit after an operation and then reused. If I feel it is not working well I change it. I do about 10 operations with the same knife. Towel clips are also reused after being dipped in spirit," he said.
Police say the room used as an operating theatre was hung with cobwebs, and that the fast turnover of operations meant there was no time to change bloodied sheets. Activists say the rushed nature of the programme meant disaster was almost inevitable at some point.
"It's a mystery," Gupta said of the deaths. "I never came across any such complications in the past."