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Will the doctor fraternity recommend illegal transplantation surgeries?

In response to ‘A letter from Dr R Sreedhara to Aamir Khan’, Major (Retired) Pankaj Rai has written a rejoinder in which he has tried to present his version of the story involving the death of his wife Seema Rai who expired on May 6, 2010 after kidney-pancreas transplant surgery at Fortis Hospital, Bangalore. The incident was featured in the fourth episode, ‘Every Life is Precious’, of the TV programme Satyamev Jayate aired on May 27, 2012.

Rejoinder by Maj Pankaj Rai (Retd) to a doctor who insulted the oath of Hippocrates

Maj (Retd) Pankaj Rai

1. Background: My wife Seema Rai expired on 6 May 2010 after kidney-pancreas transplant surgery at Fortis Hospital. I complained to Karnataka Medical Council (KMC) and Appropriate Authority for Organ Transplantation (AA) of negligence and violation of Transplantation of Human Organs Act (THOA) by Fortis Hospital and its doctors.  AA accepted two of the three points in the complaint viz surgery without license and post-operative infection but not ‘informed consent’.

KMC exonerated doctors/hospital of violation of THOA. They issued a warning to Fortis Hospital for post-operative infection. Post-operative infection is a violation of the terms and conditions of the transplantation license and has not been challenged by the hospital. In Malay Kumar Ganguly Vs Dr Sukumar Mukherjee and Others (07.08.2009) Hon’ble Supreme Court had observed, “It is the duty of the doctors to prevent further spreading of infections. Hospitals or nursing homes where a patient is taken for better treatment should not be a place for getting infection”.

2. The doctors of Fortis — Dr Rajanna Sreedhara and Dr Ramcharan Thiagarajan — did not report the death of my wife within the stipulated period of seven days but after ten months. They did not suggest post-mortem even though she died on the sixth day of hospitalization. The cause of death described is ‘natural’ in the Form No 4 ‘Medical Certificate – Cause of Death’ of the hospital dated 7th May 2010 signed by Dr Ananda.

3. The misleading arguments of Dr Rajanna Sreedhara of Fortis Hospital are being refuted below:

4. High Court Orders: The quoted order of 23rd December 2011 has been superseded by the following: orders of the Division Bench of Karnataka High Court.

a) Order dated 19th March 2012: The Court observed that Fortis was trying to protract litigation since they got a stay order.

b) Order dated 17th April 2012: Fortis is restrained from doing any organ transplant surgery.

c) Order dated 30th May 2012: Stay to continue till the date of next hearing — 30th August 2012; Fortis cannot do organ transplant surgery.

5. Fortis’ Organ Transplant License: Registration is organ specific. No hospital can do transplant of any organ not specifically mentioned in their registration (Form 12). Violation is a criminal act. Fortis did not apply for pancreas transplant in the form prescribed (Form No 11), nor was it considered and permitted. The Inspection Team recommended kidney, liver and homograft only. The statement that Dr Ramesh told them that liver includes pancreas is untrue. This is confirmed from the replies by the Appropriate Authority for Organ Transplantation of Human Organs Act in March 2011, July 2011 and the orders of the Appellate Authority dated 24th November 2011. There is no ‘deemed provision’ in the Act. Hospitals which have license for pancreas transplant are:

  • Kamineni Hospitals, Hyderabad: Kidney/Heart/Liver/Pancreas
  • Global Hospitals, Hyderabad: Kidney/Liver/Pancreas/Small Intestines/Bone Marrow/Heart/Lung
  • Asian Institute of Gastroenterology, Hyderabad: Liver/Pancreas/Islet Cell Transplantation
  • Global Hospitals, Chennai: Liver/Pancreas (Regn No 19/2008 dt 14 May 2009)
  • BGS Global Hospitals, Bangalore: Kidney/Liver/Pancreas (MDM/20/07-08) dt 31 Oct 2008
  • Narayana Hrudayalaya: Pancreas (MDM/31/2007-08) dt 6 Sept 2008
  • Columbia Asia Hospital: Liver/Kidney/Pancreas (MDM/121/80-09) dt 3 Dec 2008
  • AIIMS New Delhi: Kidney/Liver/Heart/Cornea/Pancreas
  • Indraprastha Apollo Hospitals, New Delhi: Kidney/Heart/Liver/Pancreas

Fortis has committed an offence under Section 18 punishable with ten years imprisonment. The term ‘liver includes abdominal organs’ refers to Rule 9C and is not relevant to licensing/registration of hospitals as evidenced from the reply of DGHS (Directorate General of Health Services) and Bombay High Court ruling in 2011.

6. Informed Consent: This can only be given by the patient (Supreme Court ruling in Samira Kohli Vs Deepa Manchanda and Section 12). This was not done. The statement of Dr Sreedhara that risks were explained is untrue. He has himself stated that he did not recommend pancreatic transplantation. The stance has now changed. The question of pancreas transplant was raised only hours before the patient was taken for operation. The license conditions stipulate that a booklet containing risks/benefits have to be given to the patient 14 days prior to surgery. The patient has also to be evaluated by a psychiatric. This was not done.

Dr Sreedhara had in his notes dated 1 May 2010 had directed that the patient be evaluated by a cardiologist before evaluation. He admitted in his deposition at KMC that this was not done. Now, out of the blue a certificate from Dr Venkatesh is reported to have surfaced. This is another offence against the patient under Section 12 of the Act. The doctors misrepresented that they had a license for pancreas. This matter is the subject of a writ petition that I have filed before Hon’ble Court of Karnataka.

Fortis has also not said that their then legal counsel Dr Joga Rao who represented them at KMC/High Court was also a faculty at National School of Law from whom the Government sought an opinion on ‘informed consent’. National School of Law has said that they have not verified whether the patient herself signed and whether risks/benefits were explained in the manner specified in the license conditions. When the subject of pancreatic transplantation was first broached on 1st May 2010 because an organ was available and even though the patient had not registered for that, where is the question of explaining risks 14 days prior to surgery?

7. Testimony by other doctors: Dr Gokul Nath of St John’s Hospital did not represent St John’s Hospital but in his personal capacity sent his affidavit to KMC. I was not permitted to cross-examine him. His evidence therefore is inadmissible. None of the doctors who have testified on behalf of Dr Sreedhara have stated that a hospital can do illegal transplant pancreatic transplant surgery and without patient’s consent and violate patient rights.

8. Dr Sreedhara has referred to earlier enquiries (Dr Raju / Appropriate Authority) in December 2010 where they were exonerated. He has suppressed the fact that these enquiries are irrelevant in view of Hon’ble High Court of Karnataka orders in WP 6523/2011 which has reached its finality. All the arguments put forth by Dr Sreedhara were trashed by the Hon’ble High Court. On the contrary Dr Sreedhara and his hospital have shown disrespect for the Court by raking these arguments again.

It is also pointed out that KMC is not competent to investigate violations of Transplantation of Human Organs Act, but it is the Appropriate Authority constituted under Section 13 of the Act. Are people aware that elections have not been held in KMC for the past 17 years? It is also relevant to take note of the Hon’ble Lokayukta findings about Fortis and Dr Raju’s behavior which is under scrutiny at the office of Hon’ble Lokayukta. The orders of KMC have also been challenged at MCI.

9. Other violations of Transplantation of Human Organs Act:

a) Dr Ramcharan Thiagarajan (transplant surgeon) was also a part of the authorisation committee – ‘conflict of interest’ and violation of Rule 4A of Transplantation of Human Organ Rules. This by itself is an offence punishable under the Act.

b) Website: Fortis does not display details of transplant surgeries done as specified in Rule 6(F)(j). http://www.fortishospitals.com/

Summing Up: In our country we respect doctors next to God and rightly so. Here we are not talking about medical negligence but breach of trust by doing surgery without a valid license and without consent. Should a stage come where patients ask doctors/hospitals to show their licenses/registration? How different is this from quackery and deceit? Should more homes be destroyed? Should the license be used as a license to kill and should influential doctors/private hospitals use their clout to silence anyone who questions their wrongdoings? Is not the society at risk when merchants of death go around freely?

Related Story

The Seema Rai case in Satyamev Jayate: Time to bell the cat?

36 Comments

  1. abc abc Monday, February 11, 2013

    correctly said mr. rahul

  2. Maj Pankaj Rai Maj Pankaj Rai Monday, July 30, 2012

    Some doctors do actually harm patients and that is the reason why one gets justice by going to Courts of law.

  3. Maj Pankaj Rai Maj Pankaj Rai Monday, July 30, 2012

    Sir – the issue of informed consent is now being decided by the Hon’ble High Court of Karnataka where the doctors and the hospitals continue to contradict themselves.

  4. Maj Pankaj Rai Maj Pankaj Rai Monday, July 30, 2012

    Doctors are not above law and the number of cases where doctors deliberately harm patients are increasing. The unfortunate fact is that doctors do not practice self governance. Hence, the society will have to take up this onerous duty. Let us not forget that medical negligence is considered as one of the top ten killers in the world.

  5. ketan ketan Saturday, July 14, 2012

    i agree with u…………………………………………dear

  6. Some1 Some1 Friday, July 13, 2012

    Dear Maj Rai,
    I am unsure i get your message, Are you suggesting the Medicine Doc played with your wife’s life by *NOT* interfering with surgery and letting something happen which the medical literature suggests to be correct?

    “First of all why did Dr Rajanna Sreedhara play with the life of my wife by suggesting a pancreatic transplant a few hours before surgery merely because an organ was available without medical evluation? The doctor has himself admitted that he kept silent when pancreatic transplant was suggested?”

    From whatever i have read as yet, i can suspect the Hospital, even the Surgical team to some extent of errors, malafide acts.
    What I cannot really fathom is what omission, mistake, malafide intention are you suspecting of the Medicine guy?

    Lastly, “Why have the doctors not obtained informed consent which is mandated to protect patient rights and safety?”, I recall something of the nature said by Ms Aabha as well on the show… As in she only onlu mulling over signing for the tests and only later did she realise that actual surgery had already been performed?
    Would you let the forum on this site or SMJ site see, in case you do have the case papers, what was actually signed and by whom?

    Just a Guy…

  7. Maj Pankaj Rai Maj Pankaj Rai Wednesday, June 27, 2012

    Dear Sir,

    First of all why did Dr Rajanna Sreedhara play with the life of my wife by suggesting a pancreatic transplant a few hours before surgery merely because an organ was available without medical evluation? The doctor has himself admitted that he kept silent when pancreatic transplant was suggested? Why have the doctors not obtained informed consent which is mandated to protect patient rights and safety? Can a doctor’s intentions ever be good if he does an illegal transplant surgery? Why was post mortem not suggested? How was the death described as natural? Why did the doctors not report death within the stpulated period but after 10 months?

    Sir – in our country patients die but as expected doctors are absolved because the enquiries conclude that doctors can do no wrong and a patient’s family can never be right. If the law is not respected, illegal organ scams will start happening all over the country. Harvesting of organs cannot be done by a lay man.

    The system will only change if some people are determined that they will suffer pain but will not allow other families to be broken which is possible when a court of law awards exemplary punishment to such doctors. Life is precious and cannot be purchased by compensating a broken family. The law of the land should be respected by all and the black sheep in the medical fraternity who have no respect for the law should suffer the consequences.

  8. Maj Pankaj Rai Maj Pankaj Rai Wednesday, June 27, 2012

    Doctors are not above the law of the land. They do not have the right to do illegal transplant surgeries and without the consent of a patient. I appeal to the doctors to condemn the black sheep in their fraternity else the cadaver organ transplant programme in India can get derailed. Not having a license is not a mere irregularity but a cognisable offence punishable with imprisonment. I hope Malvinder Singh and Shivinder Singh are aware of the bad name to Fortis being brought about by Dr Rajanna Sreedhara and Dr Ramcharan Thiagarajan. It is unfortunate that some doctors become so greedy that they will go to the extent of taking a patient’s life without any remorse. This is not a case of medical negligence or error of judgment but the treacherous lies of an unscruplous doctor who destroyed a home and has no respect for the law of the country and citizens of India who trust doctors.

    It is also strange that Dr Rajanna Sreedhara has gone into hibernation after all his untruthful statments have been exposed. If the doctor(s) is not guilty, he should not think of jumping bail and fleeing the country and should put his version when trial commences.

  9. Suresh Suresh Saturday, June 23, 2012

    Don’t support illegal activity. Go and see your ethics then practice. These ethics are made by you peoples only. better go abroad and do your R&D on patients.. It seems that life is cheap in India.

  10. DR. RAMESH VARDHAN DR. RAMESH VARDHAN Tuesday, June 19, 2012

    no body is above the law , if right, no one can punish you , if wrong should not be speared. doctor or actor or director every one should fall in to line. let us allow law to take it’s course . we have to go long way to be on par with rest of the world . over the counter one can buy any thing with out any valid priscription . t i i = this is india. this country is flooded with quacks both qualified as wel as uneualified.

  11. NonMedico NonMedico Monday, June 18, 2012

    Dear Maj Pankaj, Ms Aabha,
    While the legality of the situation is something you are always and continously writing about and linking to the treatment of Mrs Rai, I would really like to understand from you both what were the surgical and medical mistakes/errors committed during treatment which has made you sue the Fortis.

    Reading through all the comments you guys have written, i can so far make out the situation is far too much complicated than simple story you shared on the SMJ or the Doc treating you shared in previous post.

    Perhaps i shall ask that Good Doc to clarify on the legality as well, while i request you to clarify on the medical aspects…

    Rgds,

  12. Maj Pankaj Rai Maj Pankaj Rai Thursday, June 14, 2012

    Sir – the patient did not consent. Secondly, even if that be so the community of doctors will always gang up to save another doctor. However, courts of law will never believe that consent is valid when the legality of the matter is itself illegal. Sir, please do not take me at face value but please read the law.

    There is no good faith here. Supreme Court’s judgment on infections hold Court. I suggest that instead of showing contempt for Supreme Court, please file a review petition and ask the Supreme Court to set it aside. Good luck in your venture!

    Sir – thank God I am able to prove my point in High Court. Had doctors have that right they would start jailing victims if they ever raise a voice against any other doctor. A doctor according to another can never be wrong. It is the victims who are always wrong because a doctor comes first and always.

  13. Maj Pankaj Rai Maj Pankaj Rai Thursday, June 14, 2012

    Sir – the doctor should use the arguments suggested in court rather than jumping bail. The first question is why did he do illegal transplant surgery? I am sure you are a good mind reader but probably judges in courts are not and thank God for that. They have to go by the law. If doctors show disrespect for the law in India they should be penalised. This is NOT a mistake but a cognisable, non-bailable crime against patient rights and humanity.

    Sir – an appeal to all learned doctors. If the citizens of India come to know that doctors support crimes committed by the black sheep in their fraternity the credibility of doctors will be eroded even further. Please do not destroy the trust of patients by doing that I appeal to you.

    Licensing is a serious business and do illegal transplant is NOT a mere mistake. The committee did not recommend pancreas. The law has been enacted with punitive measures so that kidney and organ scams hopefully are not perpetrated by scheming and cruel merchants of death.

    Doctor cannot play God and get away by saying that he did not have time to explain risks/benefits. This doctor had all the time to collect his fees. Too bad, this is prohibited and another violation of Transplantation of Huma Organs Act.

    I have not only questioned the competence of the surgeon but the mala fide intentions as well.

    It is high time that Medical Tribunals are formed in India and punitive action taken against the black sheep against of the medical profession. People go to High Court because MCI/State Medical Councils are a system of the doctors/by the doctors and of the doctors where all will unite and tell the victim that a doctor can do no wrong and the victim can never be right. Thank God, High Courts/Supreme Courts reverse such judgments.

  14. Maj Pankaj Rai Maj Pankaj Rai Thursday, June 14, 2012

    Should doctors betray patients by suppressing the facts that about their hospital license? Should doctors recommend pancreas transplant to a patient when the patient has not registered for pancreatic transplant? Should doctors cover the cause of ‘death’ as ‘natural’? Why was the transplant surgeon be a part of the authorisation committee? Why should the surgeon do tranplant surgery when he does not have the expertise? Sir, I know that doctor’s registration is important because doctors have to pay a lot of money (donations) to get admission and at the end of the day and a few patients dying does not matter. Sir, why is it that doctors will also support doctors even when he is wrong? I also have a few doctor friends and I ws told that doctors are bound to expose the black sheep in their profession. Sadly, I dont see that happening. Why did the doctors not recommend post mortem? Is it because the merchants of death sold a few organs and made money? Can the organ transplant programme take off if doctors sabotage it? Why did the doctors misrepresent their qualifications? Why do doctors have scant respect for the Transplantation of Human Organs Act knowing that these are offences are punishable with ten years RI? Why has Dr Rajanna Sreedhara left Fortis? Was he asked to leave? Why is he trying to flee to US? Does he have a murky past because of which he came to India? Why did this doctor influence witneses to lie under oath to save him?

    Sir, will you take your kith and kin for an illegal transplant surgery? Probably not because doctors always come first. The Hippocrates oath is no longer valid since at that time doctors did not remove kidneys from patients. Poor Hippocrates!

  15. Rahul do Rahul do Wednesday, June 13, 2012

    Written by Subodh Singhhttps://www.facebook.com/subodh.k.singh.501
    for advocacy of patient body which supports aamir khan

    Wow! Necessity is the mother of invention! Congratulations Dr Kunal Saha for running this organization- much needed today.

    There is no denying that the medical profession today is also afflicted with the same problems by which all other professions are affected today in India. The doctors are part of the same society. But the corrupt practices in this profession affects people’s health and lives and also hurts their sentiments for this has been considered and is a humane profession. There is a sacred relation between the patients and his doctor. The stories of breach of trust affect people the same way when they read the stories of father raping his own daughter. It hurts. But would you take away the trust between a father and his daughter?

    If you investigate you would find that the most of the stories which are run by media, both print and electronic, about the medical negligence are over-exaggerated, one sided and use bad language against doctors and they essentially do not present doctors or hospital’s views. They are biased. I agree that many stories of actual negligence may not actually surface.

    I agree , our health system is in a very sorry state today and doctors are part of that system. But that does not make the doctors only and solely responsible that. It is policy makers and administration who are responsible for it. If a ventilator, Dialysis machine or CT scan does not work in a hospital you can not thrash the doctors.

    The government needs to provide all the working infrastructure and good working conditions in all the government hospitals so that every Indian could be treated adequately in every part of the country. Why should a poor person be forced to go to an expensive private hospital in an emergency? He should get a world class treatment in a government hospital.

    Only those people who are willing to pay and have enough money should go to the private hospitals. All government employees, beaurocrates, political leaders and ministers should be essentially treated in government hospital. Why should tax payers money be spent on beaurocrates and ministers taking expensive treatment in private hospitals? Such a legislation will essentially improve the conditions of the government hospitals and common man will benefit from it. People and you should press this demand.

    Let private doctors and hospitals charge according to their abilities and market forces like any other professional does. To remain in competition they will have keep their charges justified. Let me assure you the expense of the government (and the patients’ together) on the treatment of patients in government hospitals is much more than the expense per patients in the private hospitals. It is extremely poor management (administrative) in the government hospitals which is the cause of such a sorry state of affairs.

    Allegations of not writing generic medicines is really laughable and underscores the clear lack of understanding of Amir’s research team of the situations in India. Can Aamir promise that hence forth everybody in his family will only take generic medicines manufactured and sold in India for any illness? Can lawmakers and beaurocrates take the similar oath? Can you, Dr Saha? If you can do it today , I assure you I will spend rest of my life , convincing doctors in India to prescribe only generic medicines. No doctors Saha, I will not take these medicines and none of my family members will do? And , I am sure , you know the reasons.

    There is absolutely no quality control on medicines in India. Even the branded medicines vary greatly in their quantity and efficacy. Why doesn’t a government and private agency essentially provides the doctors the study of the quality of every batch of medicines produces and marketed by the Indian pharmaceutical companies every month? I assure you if Indian doctors are assured the generic medicines costing Rs 2/- has the same efficacy that branded medicine costing Rs.200/- has, they will write the generic medicines only and the prices of branded medicines will drop sharply.

    Do you think doctors will do that test and provide that information? This was simple, why has it not be done so far in India? Again, let all government hospitals use only generic medicines and all government employees, beaurocrates and lawmakers and media persons be forced to use only generic medicines , their quality will improve immediately. But do you think it will ever happen in India?

    All that these political leaders, beaurocrates, media and film makers can do, is to bash the doctors for all ills and that is all. They are not serious about improving things for the poor people of this country.

    One more example, now the whole country believes that it is only the doctors who are responsible for poor sex ratio in the country and female infanticide and nothing else. Ultrasound came in 80’s and since then there is a progressive improvement in the sex ration in India. It was worse before. But who is bothering to see the census reports?

  16. Rahul do Rahul do Wednesday, June 13, 2012

    I don’t justify illegal transplant, but i respect the intention which doctor has for his patient which you see as illegal. Best Healthcare professionals,even here have suggested it scientifically , further it depends on outcome.

    Due to short time* circumstances* of having a donor available , if a doctor went ahead and not spent time explaining procedure to patients family , it is acceptable to me .
    Its case of ethics and not more then that, not of illegality . Standards at fortis, post op infection rate are everything suboptimal in india, why didn’t you question for care abroad.
    Liver and pancreas not having similar license is more of paperwork n mistake may be but competency should not be questioned.

    Would you have got a cadaveric transpant here in the period of time. I learnt under nephrologist in india and now am here under nephrologist in USA and i can easily point out deficiency in system of india but rather than doing so , i am okay with way healthcare is able to take care and way doctors carry out their functioning.

    Not that it’s justified but , I on my part will provide best care for individual patient.

    Respected Major, you are not a doctor in India ..take time to look around in any hospital .Spend time of atleast a month in any hospital in india, before you reply further

    These mistake laden envoirment and bypassing ethics make us see the number of patients a doctor has to see in Out Patient Department(OPD), if not patients die due to diarrhea and dehydration, ethics belong differently to each and every individual differently just like doctors, same like majors of army and same to any other person in any proffesion..

    there are few people in army who made army be in shame, so do few doctors, but the one in question …based on what he did..should not be seen in same light as you mention.period

    I hope you are not referring me as criminal bent mindset, i am not big of person to let u away with such snorty comment, Who are you to talk to me like that, i have different thinking , u have different , let’s honor difference of opinion.

    However due to your loss and anger this is perfectly acceptable and i am sorry for burst of anger above.

    I am in US, and the doctor colleague you were consulting before making decisions will agree the practice of defensive medicine here…just playing ethically and leading to more harm then good .

    Your intention in same way are good but they are doing more harm than good . If no citizen has trust in his army and army men, chaos in our population can be seen.

    I would rather be where , my competence can be respected rather then ridiculed, wont you Major.

    again i repeat
    Not that it’s justified but , I on my part will provide best care for individual patient.
    Respected Major, you are not a doctor in India ..take time to look around in any hospital.It’s not doctors fault but way doctors work according to law of land . Spend time of atleast a month in any hospital in india, before you reply further.
    I stand against malpraxis but the gray line can only be seen if you spend month in any hospital.

  17. Saikumar G Saikumar G Tuesday, June 12, 2012

    I am amused by the argument of Major Pankaj Rai that informed consent was not taken for his wife before surgery.No doctor will ever attempt to do renal transplantation without propred explanation or consulting the close relatives.Nobody can do a pancreatic transplantation without taking extra risk. The attending surgeon could have done kidney transplantation alone and got away with money due for him.Because,he wanted more benefit to the patient,he did that.What major Pankaj Rai should know is that in any standard informed consent form,the word authorizing the doctors to carryout biopsy or other required techniques for diagnostic or therapeutic purpose.Eg.Biopsy of a lesion which was clinically unexpected within the lumen of bronchio during routine bronchoscopy. Because of adverse outcome, Major Pankaj Rai is trying to do everything to downgrade medical profession.Every standard death certificate will have a column stating that whether postmortem was done or not.If not the reason will have to written in the form or in the case sheat. Post operative infection is a man made problem. If post operative ward is not kept sterile, the responsibility will be on the management.If there are more attendants going inside the ICU,there are more chances of hospital acquired infection and that too when the patient is on drugs suppressing the immunity to avoid graft rejection.It is almost impossible to stop entering them inside the ICU if the patient happens to be a VIP.There were instances where the ICU staff were were beaten up for objecting the entry of attendants.A doctor can act in good faith to save the life of the patient and when there was no mutual trust why surgery was allowed to be done in that hospital. Major Pankaj Rai should not think that his wife would have lived safely for many more years after renal transplantation.I had seen many post renal transplant deaths after few months of surgery because of infections outside.The truth is bitter and above sentiments and feelings.Learned people say that Law is nothing but logic.Whatever Pankaj Rai is doing now will not stand before truth and same can not be predicted before law.

  18. Dr Deepak Goyle Dr Deepak Goyle Tuesday, June 12, 2012

    Dear All,
    From some of the comments perused above one statement could be a trigger point for the litigious situation – cause of death being recorded as “natural” causes; apart from other triggers. Having previously read the detailed sketch of the treating physician on the events as unfolded this does not seem to be correct.
    Doctors are definitely not God, but they are placed on a pedestal for the unique position on account of their acquired ability to accord “relief” – physical, psychological and many a times social – and as a consequence our patients expect the conduct of Doctors to be worthy of being placed on a pedestal.
    And this is the point I stress – correct, timely and truthful communication is one of the fountainheads for development and continual affirmation of trust.
    Errors like the above stated “cause of death” leads to a situation of lessening of the trust placed in the practitioners of this profession.
    I definitely do not agree that incidents like these would have only a deleterious impact on rational decisions taken by expatriate doctors from returning back to India. From what I understand USA has one of the highest rates of medical litigation. I can only hope that the doctors coming back from the western worlds bring back merits of those systems and work towards adapting them to the requirements of this region and do not consider that the population here will not question their conduct.
    Mistakes while practicing this profession have been made in the past and are likely to continue too. However what is not acceptable are errors of mis-communication(s).
    I am sure no person / institution / law would penalize for an error of judgement and these can become very evident from the chronology of events as they unfold and can be made out from the medical records.
    In the end we must also understand that all are wiser in hindsight! Let us join hands in developing systems such that situations like these do not repeat and incidents like these serve as examples not to emulate.
    I am happy that an incident like this this has been openly discussed, there are many lessons evident although at the unfortunate expense of some of the “actors” of this situation and hope that mankind and the profession is able to benefit from the exposition of this situation.

  19. atul jain atul jain Tuesday, June 12, 2012

    Maj Rai aap baal ki khal nikal rahe ho.Duniya me koi bhi marta nahi agar sab kuch Doct.ke haath me hota .Aaj ki tarikh me swayam bhagwan bhi aa kar treat. de to unpar bhi log shaq karenge.kaash aap ki beti ya beta docter hota .plz apne bachcho ko dr banaiye taki wo doct. biradari ki buraieyo ko dur kar de.
    Lets see aap apni wife ke jane se kitne dukhi he

  20. dr abhishekgupta dr abhishekgupta Monday, June 11, 2012

    dear major rai, it is unfortunate that you had to undergo the trauma of your wife’s death but please don’t sabotage the doctor patient relationship off it. legalities are important but it smells greed and ego (apologise if i am wrong or rather too straightforward on this one) in this case. sounds like your ‘trust’ on your doctor was synonymous to ‘successful outcome’ of the surgery. siddharths comments esp the last paragraph is really touching and true. may god almighty and your dear wife in heavens above give you the conscience. may the truth and humanity win… ‘satyamevjayte’!!

  21. DR.Raj Manas DR.Raj Manas Monday, June 11, 2012

    nicely concluded sir…!!!

  22. Ramandeep Ramandeep Monday, June 11, 2012

    I agree with Siddharth above….infection control many times is not in our hands, have seen patient slipping even with best treatment….I think Indian hospitals should also have counsellors like in the west, when you loose a loved one we do need to learn to handle the loss….battles like these never end! Its a rut…and a bitter rut.
    Many times clinical decisions have to be taken in the spur of the moment, believe me no doctor likes a patient dying on him….it’s the worst feeling.

  23. Siddharth Siddharth Monday, June 11, 2012

    Dear Maj Rai,

    I sincerely feel for your loss and pray to the Almighty to give eternal peace to the departed soul. Please let me start by saying that I also lost a loved one to the side effects of modern day chemotherapy.. In this particular case, it was a high grade infection which only occurs when the immune system is suppressed by the chemotherapy drugs. It is a well known, though rare complication. Had the treating team warned me of this? They did tell me the risks in general, but i guess they left out ‘fulminant Pseudomonal infection’. Does it mean that we were not ‘informed’? I guess not.
    There are probably scores of things that COULD go wrong with any line of medical treatment. Some complications are expected, others unexpected and yet others that may occur for the first time and be reported in the literature as ‘case reports’. Does that mean that rare complications should be viewed as criminal actions on part of the treating doctor? Absolutely not.
    I have full faith in our judicial system, but I find it equally ridiculous for the courts to pass directives like the one you have pointed out (Malay Kumar Ganguly Vs Dr Sukumar Mukherjee and Others (07.08.2009) Hon’ble Supreme Court had observed, “It is the duty of the doctors to prevent further spreading of infections. Hospitals or nursing homes where a patient is taken for better treatment should not be a place for getting infection”.)

    Do you believe that any doctor would willingly try NOT to control the spread of infection. This whole premise (of ‘duty’ of doctors to prevent further spread of infection) smacks of ignorance and bias. Do you think it is always possible to control the spread of infection. The answer sir, is no, not even with the best of antibiotics and other measures and not even in the best of the hospitals in the world. What is the ‘appropriate’ line of treatment to control infection should probably be decided by a panel of experts (doctors) and not lawyers and judges.

    As far as the license issue is concerned, it is more of an administrative problem with the Fortis authorities rather than the doctors themselves. The transplant surgeon performed simultaneous pancreas transplant in the best interests of the patient. There is a huge bundle of medical literature to prove the benefit of this procedure. I’m sure you would not have sued for this clause if the surgery had gone forth smoothly, like it does most of the times. In fact, you would not have even bothered with the details of the license then.

    It really is unfortunate that the doctors intention to treat is being mis represented as ‘criminal’. Mob mentality always ensues in India. People don’t even try to get the facts straight. It’s just ‘maaro’ ‘maaro’…join the others to kick innocent people.

    More and more people are saying that those who are trying to ‘defend the criminals’ are ‘criminals themselves’. This is utter nonsense. When did we stopped listening to the voice of reason? Why is the mob trying to drown out the sane voices of professionals, who are not opposing Amir Khan, rather his one sided portrayal of the medical profession. What kind of one sided ‘justice’ is this where you alone sit in front of millions of viewers and the other party is not even allowed to express themselves?

    Enough is enough. This insanity has to stop. We have to view things in the correct perspective. If this is the kind of treatment that doctors can expect from the public, I have no hesitation in saying that every doctor will resort to ‘defensive’ practices to stay out of such problems. Maybe every patient should receive a list of 100 complications common and rare before every surgery. Maybe doctors should stop doing things in good faith altogether. Let the medical procedures be dictated by the law and not the medical principles.

    I will end by replying to your original points in the concluding para.
    Yes, it is the right and responsibility of every patient to check the license of the doctor and the hospital. By doing so, you are not ‘maligning’ anyone and no doctor will mind that ever, if they do, don’t go to them. You talk of quacks, can a quack ever show you his license? I will proudly show you my degrees and licenses if you ask for them. A case of procedure done in good faith gone wrong does not make such doctors ‘merchants of death’. And finally, it is my humble request to you and the society at large to stop placing doctors ‘next to God’. We never asked for it and never will. No doctor can ever treat any patient without the will of God himself. We are as human as the person on the street and we deserve to be treated that way. Stop portraying us as ‘next to God’ in one moment and ‘as ‘merchants of death’ in the next.

    Amen

  24. Maj Pankaj Rai Maj Pankaj Rai Monday, June 11, 2012

    The point being missed is that the doctors had ulterior motives. The matter has legal implications which are very serious and should be deliberated having regard to the law of the land. Specifically:

    1. The patient was registered for kidney only. Why did the doctors not advise her to register for pancreas also?
    2. Is it normal for doctors to suggest pancreas transplant a few hours before surgery just because an organ was available?
    3. Why was the transplant surgeon also a part of the authorisation committee?
    4. Why did the doctor suggest an illegal transplant surgery knowing fully well that the hospital does not have a pancreas transplant surgery?
    5. Why did the doctors not suggest a post mortem and chose to describe the cause of death as ‘natural’?
    6. Why was the matter not reported to the government in 7 days but after 10 months?
    7. How does one know (other than the statements of the two doctors) that they have not illegally removed the organs and sold them off? Can kidney rackets be done by laymen? It is only the doctors who can do all this.
    8. Does the Constitution treat doctors above the law of the land?
    9. Are these matters not serious else the license of Fortis would not have been cancelled and the law prescribes imprisonment of 10 years? This is not unintentional medical negligence but deliberate criminal acts which the law considers as cognisable and non-bailable?
    10. Would any of the doctors who support Dr Rajanna Sreedhara recommend illegal transplant surgeries to their wives/children? I do realise that patients are ‘dirt’ for a doctor so long that a doctor’s registration is not suspended even though the homes of patients are broken? Doctors should come first – the interest of the citizens of India are irrelevant.

    These debates prove that governance of doctors is a serious matter and society should decide such things. I do not beleive that doctors can get away with illegal transplant surgeries anywhere else. Why is it that the doctors are on anticpatory bail? Do they want to go overseas to escape prosecution and imprisonment?

    Experts cannot decide violation of law. It is best decided by courts where one should go by evidence and law of the land else patients will lose their lives and doctors will get away scot free.

  25. Ramandeep Ramandeep Monday, June 11, 2012

    I agree the best way out is to form a panel of experts and let them decide…….as far as infection is concerned thats a complication we all are scared of and many times for reasons unknown it will still happen…the doctor is to blame if he/she did not take steps that normally would have been taken to prevent infection, like I said even in our medical books and literature infection is mentioned as a complication for all procedures and even in the best setting and in best hands it will still occur.

    Another question for the Rais…..had their patient been enrolled for a transplant? I presume they must have enrolled the patient, Abha Rais comment above that
    “Well, in this particular case a surgery was done without any consent and also without a need to do it. If the intent here was to save the patient; then why was such a surgery even done?’ Is a bit confusing…maybe they can elaborate…..because if surgery was not needed then the patient would not have been enrolled….if the patient was enrolled that means surgery was needed????
    Im just asking from a neutral point of view…..because the full facts are not with us…..if one reads the doctors account he seems right and if one reads the Rais account it seems they have a valid point!!

  26. DR. RAMESH VARDHAN DR. RAMESH VARDHAN Monday, June 11, 2012

    to the best of my knowladge the organs for transplants are given free( donated) , let the transplantttion be done in a govt. hospitals \ teaching medical colleges at a free of cost. let our forgein returned doctors sever the needy . insted of working for so called corporate hospitals ( every one knows about these hospitals & their way of functioning) .let the govt.decide about priceing & planning . there is no meaning performing a surgery on daying patient . can it improve the quality of life of a patient. ( is there any hospital ready to adopt such a suffering patients. the moment they sence the difficulty in pay ment they extubate patient , is there any hospital gone for bankcruptcy ( unlike air line & other businesses). more than 75% insurence money goes to so called corporate hospitals. when it comes payment to smaller hospitals run by the doctors , the same insurence companies put n number of queires . i think there is big scandle going on un noticed by law enforcing agencies .( like in real estate business , there is unseen evil forces involved in health care busniness too. ) . the living proof in working style new mediscl colleges.

  27. Abha Rai Abha Rai Monday, June 11, 2012

    Well, in this particular case a surgery was done without any consent and also without a need to do it. If the intent here was to save the patient; then why was such a surgery even done?

  28. Abha Rai Abha Rai Monday, June 11, 2012

    Before writing things which cannot be backed up people should not write it. So what if we were consulting the doctor? Does this give him the opportunity to kill my mother? Do a surgery without consent? Dr.Shreedhara’s name was not taken on the show but he himself starting posting false statements on social networking sites etc. He was the one who wanted to come out in public. He must instead feel sorry for his misdeeds. Why does he still continue to lie to everyone about the medical records if he is so honest? These are some things which need to be looked into before putting up random comments.

  29. DR.Raj Manas DR.Raj Manas Monday, June 11, 2012

    U know Maj, Rai- Just the person like u, many patients die n complicates their disease… in last few years,we have lost sm of the patients of electric burn with necrosed limb,just because they didnt give the consent of amputation of their limb even after explaining them the prognosis. and because of ur medico-legal issue,we didnt perform surgery..n pt died of complications of septicemia..
    We too loose our relatives( blv me- we too have parents,children n relatives) in hospital,but knowing about the uncertainty of any disease( even a minor fever),we try to convince our non-medico relatives n attendent and smtimes to OURSELF.
    apke jaise kitne log aate hai- “jab thik ho gaye to doctor bhagwan, jab complications hua to doctor beimaan”..still we work,because “its someone’s thankful wishes are more satisfying than someone critic n bad intention ”
    In ur own words- “Doctors are not above law”.By law,u can ask smone to do ur duty,but u cant force someone to serve the humanity….and blv me…none of the doctors want their patient die..so instead of spreading negativity about doctors, do some positive work.
    and,still if u are not satisfied,i can say-keep reading ur law books n next time,when u have some ailments,find one of the medicine from those books or get operate by urself with the help of law,but nt by medicine n kindness.
    thanks n regards,
    Dr.Raj Manas,
    Patna

  30. Dr Sudhir Dr Sudhir Monday, June 11, 2012

    Dear Major Rai,

    I take this opportunity to express my condolences on the sad loss of your wife.
    Every untimely death is unfortunate and being a surgeon myself I can only say that any death during surgery or during post-operative period is shattering for treating doctor as well. I want to say that we operate with an intention to cure and not to kill.

    From your submission it seems that your complaint is against the procedures followed rather than against the standard of care provided. However the impression which has been created on satyamave jayate is as if doctors have comitted a murder in broad daylight which is rather unfortunae

  31. Maj Pankaj Rai Maj Pankaj Rai Monday, June 11, 2012

    You justify a doctor doing illegal transplant surgeries without license? I hope you tell your patients in advance before performing illegal surgeries. Such doctors with a criminal bent of mine and better off outside India. Doctors are not above law and if they break laws they should suffer the consequences.

  32. Maj Pankaj Rai Maj Pankaj Rai Monday, June 11, 2012

    Patients dont want doctors doing illegal transplant surgeries and organ trafficing do wash their hands with their blood. Let us hope the court agrees wit your arguments grants special immunity to such doctors. Unfortunate that some doctors support criminals in their fraternity.

  33. dr manish agrawal dr manish agrawal Monday, June 11, 2012

    i am a practicing doctor in udaipur,rajasthan…i would like to bring few points:-

    1) Ours is a society, where there is lot of unawareness about medical conditions, illnesses and their treatment in society, even amongst educated people. So people, in general, have a lot of mis-conceptions ( and i am not talking about rural and illiterate people, but literate masses), and they don’t follow doctors advises. Eg, many people avoid necessary surgeries due to non-awareness, and pay the price for that. Showing such one sided and biased show by a big celebrity only enhances these problems, and reduces trust of people in medical profession, where majority of doctors are still involved in right practices favorable to patients. People in India, still trust a quack more than a qualified doctor. Such a representation of the noble profession, would only increase confusion in an already confused society.

    2) There are so many non-qualified ” jhola-chap” people practicing in my vicinity, in rural and peripheral areas. People having some bogus degrees from West Bengal, people who have been ward boys and nursing staffs in some hospitals, and even medical store owners and chemists are practicing medicine. They are not even prescribing medicines, but even giving injectables and admitting patients under them, which is very dangerous. There is a “bone-setter” practicing in “Lohira” area of my city, Udaipur, practicing complicated branch like orthopaedics without any qualification, and I see so many of his complications daily ( I am an Orhtopaedician), Why can’t government do any thing against such mal-practitioners? Why does administration and media close their eyes in this field.

  34. Bunty Bunty Monday, June 11, 2012

    No doctor in this earth even in his dreams would like his/her patient should die. They would do their best to save/cure patients illness. Dr.Sreedhara must have done lot of successful transplants and that must have been the reason for choosing him as the transplant surgeon in your case. You must have done lot of homework before choosing Fortis as the hospital for transplant. You yourself state that your wife did not die due to medical negligience. You have problems related with licensing issues. You look at all the facts and just do not do the things just for sake of it. This would destroy all the goodworks the doctors have done. Just because an unfortunate things have happened in your case because of circumstances beyond anybody control, do not further destroy the relationship of the medical profession wih the patients.

  35. Rahul do Rahul do Monday, June 11, 2012

    Let doctor do his job , it was scientifically supported procedure , it’s more of grief on part of major .

    Potraying mistakes if any , made by doctor as intention of doctors in current scenario is made , illetrate common man will question cancer investigation as dubious and can already be seen as doctors being thrashed on performing a CPR on a girl

    If patients are better judge. Let be known .google your symptoms and die peacefully and not litigate doctor who is coming after 16 yrs of flourishing practise in USA to serve their countrymen

    It takes lot to become one and starting as doctor in few months after my painful 6 years in learning only to be seen as evil person and earn thrifty 9000 per month is not acceptable to me . I would like to move out

    Then too , Rule to bond us here …against will and not by choice .
    Sad by state here in India n government on healthcare , that’s why no one wants to be a doctor . And those who do culminate into path of corruption for wanting better life for their children .

  36. Balaji Balaji Monday, June 11, 2012

    Nice article, Major Pankaj Rai. Satyamev Jayate!

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