Respected Aamir Khan Ji,
I watched with shock and despair the Satyamev Jayate programme of May 27, 2012. I am responding since you referred to me although you do not know me. I am the Nephrologist that you referred to while conversing with Mr Rai (Major Pankaj Rai). Mr Rai has been making false and fabricated allegations for the past two years. While talking to you, in addition to providing you with false information, he also withheld crucial facts.
Over the past two years, Mr Rai has been harassing the Transplant surgeon and myself (Nephrologist) and the Hospital by filing multiple and concurrent complaints at various fora whether or not they have any role on his complaints. With his manipulations, he has succeeded to a great extent in bringing to a standstill transplant surgeries at the Hospital which has caused a great deal of hardship to several patients. In addition, he has also caused immense damage to the noble field of cadaver transplantation in Karnataka state. Once you are aware of the actual facts, I have no doubt that you will express regret for having given platform to a sophisticated liar with immense theatrical and manipulative skills. Here are some facts that shed light on the truth.
1. Mr Rai never informed you that Mrs Seema Rai underwent cadaver donor transplantation and was registered for a cadaver transplantation more than one year prior to surgery. The phone call on the night of admission was made because a suitable cadaver donor had been identified by ZCCK (Zonal Coordination Committee of Karnataka for Transplantation, the government body that allocates cadaver organs) and not by the doctors or the Hospital. Cadaver transplantation has to be done emergently, otherwise the organ(s) will decay within hours and become useless. That is why the patient was admitted on Saturday night (May 1, 2010).
The patient and her family were all informed about risks and benefits of transplantation for more than two years (since June 2008). In fact, whenever the patient consulted me she was eager to get kidney transplant so that she could stop the misery of undergoing dialysis. You can ask any dialysis patient, they will inform that they do not want dialysis but prefer transplantation.
2. Mr Rai, Mrs Rai and Abha Rai all were again counselled for more than 1 hour on the night of admission about kidney and pancreas transplantation. Subsequently, they also discussed with their relative in New York. Then on the night of 1st May itself Mr Rai personally informed me and other doctors to proceed with kidney + pancreas transplantation. The Informed Consent form was signed on the night of 1st May itself and handed over to the ward doctor. These facts have been documented by the nurse as well as the ward resident doctor.
The State Medical Council as well as the National Law School of India have investigated the Informed Consent issue and clearly stated that Informed Consent was indeed taken prior to surgery. In fact, if the Informed Consent were not given on the night of 1st May, the cadaver organ would have been allocated to the next patient on the waiting list for cadaver transplantation who was also admitted to another Hospital on the same night for possible transplant surgery. (Whenever a cadaver donor is available, several patients on the waiting list such as Seema Rai are called and advised to get admitted so that the cadaver organ does not get wasted in case one or more patients are found to be unfit or do not want surgery.)
If Mrs Rai and her family had not consented for the surgery on the night of 1st May, then a surgeon from another Hospital would have proceeded to retrieve the cadaver organ on the night of 1st May. The surgeon from our hospital would have gone home. The very fact that our surgeon travelled on the midnight hours of Saturday to the donor Hospital and brought back the cadaver organs by about 5.30am on a Sunday morning suggests that the patient and family indeed had agreed for the surgery.
3. Mr Rai also concealed from you the fact that he had telephoned the Nephrologist several times on the night of 1st May to seek help to arrange for a special medicine (Simulect) that was to be given to the patient in the Operating Theatre before the transplant procedure. The Nephrologist had personally called the pharmaceutical company on Saturday night to help Mr Rai to procure the medicine. The Nephrologist had given personal surety to the company since Mr Rai told him that he did not have cash to purchase the medicine in the middle of the night. In fact, Mr Rai procured the medicine at about 7.30am on 2nd May (Sunday) and handed the same to the operating theatre staff. If the patient and Mr Rai had not consented for the surgery, why would he purchase the medicine and hand it over to the Hospital staff?
Mr Rai never asked the doctors or any other Hospital staff not to proceed with the surgery at any time. He was plainly lying when he made a statement to that effect to you. If in fact, the patient and her family had not consented for the surgery that would have been Mr Rai’s first and major complaint when he filed an FIR with the police on May 30, 2010 accusing the doctors of murder. In his initial complaint to the police as well as to the State Medical Council, Mr Rai never complained that he or the patient had not consented for the surgery. This fabricated allegation is clearly an afterthought on Mr Rai’s part.
4. The patient did not receive 119 units of blood, i.e., 60 litres of blood. She received 33 units of blood over 4 days which is about 13 litres of blood since she had developed a massive bleeding condition called Disseminated Intravascular Coagulation (DIC). She also received platelets, FFP and other blood products to correct DIC. The doctors never told Mr Rai and his family that 390 cc of blood would be required. No doctor can predict the exact amount of blood loss in a given patient who undergoes surgery. Besides, the large requirement of blood in this patient was due to the fact she developed a medical complication called DIC, which can happen after any major surgery or major trauma. Normally in transplant surgeries, we do not transfuse any blood at all.
5. The transplant surgeon is highly qualified to conduct pancreatic transplantation as well as kidney transplantation. He is trained at well-known Hospitals in the United States where he had conducted numerous multi-organ transplantation surgeries. All relevant documents were reviewed by the Health Department before the Hospital was granted registration for multi-organ transplant surgeries in March 2010.
6. Mr Rai was again lying when he stated that the doctors had switched off their phone on 6th May after the patient’s death. In fact, Mr Rai spoke to the doctors several times after the patient’s death. This can be easily verified by looking at Mr Rai’s phone records.
7. The Hospital was registered for multi-organ transplantation. There was a clerical error in the certificate, which was acknowledged by the Health Department. The Health Department has clearly stated in its report that registration for liver includes pancreas as well (since the skill required for transplantation of both these organs is one and the same).
8. Mr Rai also withheld from you that the Karnataka Medical Council has thoroughly investigated the case and found no evidence of any negligence on the part of the doctors.
9. Mr Rai also withheld the fact that the Hospital bill was not for the surgery alone. Most of the cost was due to the use of blood and blood products and other medicines, which was necessitated by the development of DIC and infection. If the patient had not developed DIC, the bill for a transplant surgery would have been about Rs 3.5 lakhs. In fact, there was no additional charge for pancreas at all. Whether the patient received cadaver kidney or cadaver kidney + pancreas, the bill would have been the same. There was absolutely no financial motive in recommending the combined surgery.
The surgeon recommended combined surgery because diabetic kidney failure patients do much better with combined cadaver kidney + pancreas surgery than cadaver kidney transplant alone. This has been well established in the medical literature. The surgeon made the recommendation with the best interest of the patient in mind. Even to date Mr Rai has not produced any scientific evidence or professional opinion to contradict the recommendation of the transplant surgeon. All transplant specialists who have reviewed the case (from AIIMS-New Delhi, PGI-Chandigarh, Chennai, Bangalore, and USA) have unanimously opined that the patient received the best possible treatment and that her death, although very unfortunate, was not due to any negligence on the part of the doctors or the Hospital.
10. Mr Rai also did not inform you on the Air that he has filed a complaint with the Consumer Forum seeking compensation of Rs 84,55,933. I am sure Mr Rai has used his theatrical skills to convince you and your team about his false allegations. I am also confident that you will realize the lapse your research team has done once all the facts become apparent. I am enclosing a detailed Medical History as well and other documents that shed light on true facts.
After my medical college, I studied and then worked in the United States for nearly 16 years. I came back with a dream to serve my countrymen. However, now after going through the mental trauma caused by a reckless individual who is inadvertently abetted by a corrupt officialdom and a thoughtless media, I am beginning to wonder if I made a mistake in returning to India. Perhaps, I should also go back to the United States like the doctor that you showed in the opening sequence of your programme who returned to the UK because of the corrupt system in India.
I invite you and your team to visit the Hospital, meet other patients who have undergone/undergoing dialysis, patients who have had transplant surgery, and meet the Transplant surgeon so that you can clarify all the facts for yourself. Please do not hesitate to contact me if you need any clarifications.
Dr R Sreedhara