RAIPUR India - The scene in the gloomy room where 83 women were sterilised last weekend is repeated routinely at makeshift contraception clinics across India: bloodstained sheets that aren't changed between patients, and hasty two-minute surgeries.
Only this time, something went tragically wrong.
More than a dozen of the mostly poor and illiterate villagers operated on by Dr. R.K. Gupta have since died, and scores remain sick in hospital, many of them in intensive care.
Interviews with police, doctors and government officials reveal that Gupta broke government guidelines by performing more than 30 surgeries in a day.
But his pace of 83 operations in 2 hours and 35 minutes was not unusual in a country that sterilised 4 million people last year, almost all of them women.
A police case against Gupta for causing death by negligence has been filed in the eastern Indian district of Bilaspur, 100 km north of Raipur, the capital of Chhattisgarh.
In comments to Indian media, he has denied committing any errors. Reuters calls to his telephone went unanswered.
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.
Rights groups call its sterilisation programme, which is run by state governments, coercive, because ill-educated women are often offered money and accept surgery by officials pressed to meet quotas without knowing the full risks.
Rural sterilisation camps are run in conditions that elsewhere in the world would be shocking: surgical equipment is often unsterilised, needles can be reused dozens of times and patients sometimes recover from operations on dirty floors.
"Unless there is a serious attitude and culture change then I can see this happening again," said Kerry McBroom, director of the Reproductive Rights Initiative at the Human Rights Law Network in New Delhi.