Thursday, June 7, 2012

Reply from the doctor accused by Aamir Khan in Satya Meva Jayate

There was a lot of buzz on the site after the article about Aamir Khan and Satya Meva Jayate. Thanks for all your comments and insights. If there are so many people who think like this, I must recant my words of hopelessness. Change is possible if just a few good men and women begin it and work for it. Maybe we can stem the rot and rebuild the standing of our profession. Thanks again and do keep the ideas and comments coming.

In the programme that Sunday, there was a long segment on a gentleman who accused a nephrologist and transplant surgeon of a multitude of crimes which led to the death of his wife. At the time, I did feel that this level of malpractice could not happen in the strictly monitored field of transplant surgery and hence did not mention it in the previous post. Dr. Jeevan Kuruvilla, a dear friend who works in my old hospital in Jharkhand (whose excellent blog you can access here) forwarded me this letter which is supposedly from the nephrologist who was accused in the programme. And here is a news articles that substantiates what he has written in the letter with the concerned documents (see bottom of the article)

My e-mail to Aamir Khan is noted below:
Respected Aamir Khan Ji

I watched with shock and despair the Satyamev Jayate program 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.
Mr. Rai has been making false and fabricated allegations for the past 2
years. While talking to you, in addition to providing you with false
information, he also withheld crucial facts.Over the past 2 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 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 lier 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
(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 (1 May 2010). The patient and her
family were all informed about risks and benefits of transplantation for
more than 2 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 counseled 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 1 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 1 May itself and handed over 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 was not given on the night of 1 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 1 May, then a surgeon from another Hospital would have
proceeded to retrieve the cadaver organ on the night of 1 May. The surgeon
from our hospital would have gone home. The very fact that our surgeon
traveled on the midnight hours of Saturday to the donor Hospital and
brought back the cadaver organs by about 5.30 AM 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 1 May to seek help to arrange
for a special medicine (Simulect) that was to be given to the patient in
the Operating Theater 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 7.30 AM on 2 May (Sunday) and handed the same to the
Operating theater 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?

3. 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 30 May 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 liters of
blood.  She received 33 units of blood over 4 days which is about 13 liters
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 6 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 have clearly stated in their 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 the Hospital bill was not for the surgery
alone. Most of the cost was due 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 todate 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 program 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

-Dr. R. Sreedhara

Sunday, June 3, 2012

Aamir Khan lays bare medicine's deepest secrets

Last Sunday, we were on a holiday to the quaint little hill station of Kasauli. And since we were on holiday, a lot of time was spent in front of the idiot box to make up for all the time at home where this pleasure is not available to us! And thus it happened that I was able to watch the entire episode of 'Satya Meva Jayate' where Aamir Khan tore into the medical profession. For those of you who have not watched it, the link is here and the main points he talked about as far as I can remember are the following
- Surgeons have been caught performing unnecessary operations (I heard somewhere else that the main indication for a hysterectomy in some areas of our country was............. the presence of a uterus!!)
- Doctors take commissions of upto 50-60% to refer patients to their colleagues as well as to testing centres
- If a doctor pays huge amounts of money to get into medical college, it is likely that he will spend the rest of his life trying to earn that money back!
- The MCI (medical council of India) has no interest in taking action against the wrongdoers. While there have been 50-70 doctors debarred every year in the United Kingdom for malpractice, in the last 4 years, India has debarred none!
- The MCI itself is hugely corrupt especially in the area of accrediting medical colleges. We all know the story of Ketan Desai who has made us all ashamed to be called doctors considering the amounts of money that he was found taking and the number of scams he was involved in.
- There is a nexus between the drug companies and doctors. Doctors can prescribe whatever medication they want and patients have to buy the specific brand. More often than not, the brand prescribed is based upon the benefits that the company provides the doctor
- There are some innovative schemes like the generic drug scheme in Rajasthan and the insurance scheme of Narayana Hrudayalaya which are providing equitable health care.

I wish these accusations were figments of Aamir's imagination, but sadly they are all valid allegations and are happening with increasing regularity throughout our country, even in our most reputed institutions. I have found many links to stories about corrupt doctors from the top 5 medical colleges of our country, but will not post them here to save face - search for them and you will find them!!

Now over the past week, I have heard a vast variety of views on the subject. Most of them have been uncomplimentary, and criticisms have ranged from 'there are only a few doctors who do these things' to 'who is he to lecture us - what about Bollywood!!' My own feeling is that there was a sincere attempt to highlight some of the issues that most of us in the profession know about but try to ignore and most of the public are completely unaware of. Agreed there were some unnecessary theatrics, but then, what more can you expect  from an actor! And for that matter, it was rather kind of him not to go into too many details - had he done so, we may have been more embarrassed!! (Especially the present head of the MCI, Dr. KK Talwar who was squirming in his seat throughout the programme, not just when he was grilled by Aamir!!)

After I watched the programme I was filled was a growing sense of helplessness. We all know how deep the rot runs in our profession. There is no use in covering it up. I have seen with my own eyes or heard first hand reports of every one of these allegations occurring in medical practice. Just because the medical profession is so closed to the outside world, we have got away with our 'playing-God' attitude till now. But with the internet and the spread of education, the world is waking up to the fact that doctors are also just ordinary human beings who make mistakes, work for money and are always looking out for 'number one'. I think there are very few doctors who can honestly claim to be practising medicine solely to help people. We are actually just helping ourselves. By being doctors we find ourselves at the top of the social ladder, given respect and privileges in nearly all aspects of life. By being really good doctors, we can make a lot more money, do much better research (which gives us glory among our peers) or get more professional satisfaction (either with patient numbers or with specialisation). There are still a few centres and individuals for whom service is the core ideal, but lets face the facts - these are few and far between.

The chance of anything changing is very bleak, however much Aamir may shout about it. Many of the responses to the programme were on the lines of 'even doctors have to make money' or 'we need to make a lot of money given that we have worked so hard'. One body of doctors went on record asking for an apology. There was little or no introspection into what Aamir Khan insisted was the crux of the discussion - what is our attitude to our profession and to the patients who put their lives and faith in our hands.

I think it's time to stop berating the doctors. The age of the sacrificial and respected community doctor who gives his life to helping people is over. Now it is merely an industry just like any other. Even medical students who join their course planning to 'serve humanity' are lost along the wayside thanks to the overwhelming peer pressure and lack of inspiring examples. So let's stop hoping for an Utopia where young people join the profession to 'save humanity' and continue doing so throughout their lives. Let's treat doctors like we treat all people in other forms of business. They are after all humans and will work selfishly for their own interests just like all other humans. But at the same time, let us take them down from the pedestal that society has placed them on. They are only humans and therefore must be treated just like any service provider. If you go to a shop and find that the shopkeeper is rude, his goods are bad and his prices are high, it is unlikely you will ever go there again. So let it be the same way with doctors. Take 3 or 4 opinions for everything. Treat us all with distrust. If we are rude, go somewhere else. Demand to see our accreditation and experience certification. Don't get carried away by the big words we speak. Ask as many questions as you need till you completely understand what we are talking about. Then go home and google it. Then go to another doctor and see if he says the same thing. It is a sad state of affairs, but then this is obviously what we want! And in this way, the standard of doctors may go up and the rate of malpractice go down.

The day after the programme I saw a patient in the OPD with metastatic stomach cancer (which means that the cancer has spread and as such is inoperable and probably fatal within a few months). It had spread throughout his abdomen, but he was neither bleeding nor obstructed which are the usual indications for any intervention. He was told in one of the top surgical centres in Ludhiana to be admitted for an operation. Now what the doctors were planning to do, neither the patient nor his relatives knew. They were only told that he would be cured...... And that it would cost him about 2-3 lakh rupees...... Not only would the doctors reduce his quality of life, but they would also bankrupt his family in the process. With nothing to show for it...... We doctors do this everyday......... And justice weeps.......

UPDATE: Follow up article here.