By Mohuya Chaudhuri *
In February, prominent filmmaker Nirad Mahapatra, known for his national award-winning film, Maya Miriga, passed away suddenly because of medical negligence at Fortis Hiranandani hospital in Navi Mumbai. He had been ailing for a while and had his check up done at the Apollo hospital in Bhubaneshwar in December last year, where several tests confirmed that he had an ulcer in his bile duct, which was treated through endoscopic procedure.
On his follow-up visit, a biopsy was conducted through endoscopy again, along with a CT scan, which confirmed there was a malignancy in his intestine. Based on the diagnosis, he was advised to undergo a surgery to remove the tumor.
For further diagnosis and treatment, Nirad Mahapatra went to Fortis Hiranandani hospital in Vashi in Navi Mumbai, where he consulted the head Oncology Surgeon, Dr Shishir Shetty. Despite the family’s request to get a PET Scan done to reconfirm malignancy, no additional tests were conducted to corroborate Apollo’s report about malignancy. Dr Shetty advised that he should undergo a supra major surgery called Whipple’s surgery, which is done to remove malignant tumors in the bile duct. On 13th of January, Mr Mahapatra was operated.
But the family members sensed that there was some serious negligence in the way he was being treated at the hospital.
When he was removed from the recovery room immediately after the surgery to the ICU, surprisingly neither the doctor nor his assistant was there to oversee the patient. Soon after the transfer, the anesthesia wore off and the patient began to complain of intense pain. When questioned, the doctor maintained that epidural had already been administered which would take half an hour to work and would alleviate the pain.
However, family members found that the doctors had forgotten to administer epidural after the surgery. For an hour and a half, he suffered intense pain. At the ICU, Mahapatra’s son Sandeep says, the doctors were unaware of the patient’s medical history or post surgery condition apparently because neither Dr Shetty nor his assistant had done proper handover from OT to ICU to the attending doctor.
The negligence didn’t end there. Post surgery, it was found that he had fluid discharge from his incision area and this was shared with Dr Shishir Shetty’s assistant Dr Nikhil Rane since Dr Shetty had left the country for five days. In his absence, Dr Rane was handed the responsibility of overseeing Mr Mahapatra. Unfortunately, he misdiagnosed the condition, assuming that it was simply body fat or seroma and did not bother to conduct blood tests or even pus swab culture to determine the cause of the infection. After a supra major surgery like Whipple, it is mandatory to do blood tests daily but Dr Rane ignored it. In 3 to 4 days, the situation became grave since the discharge continued to increase rapidly.
It was only after Dr Farah Ingle, in charge of internal medicine, did blood tests that it was found that his white blood cell (WBC) count was in excess of 31000, indicating a very high level of infection. She suspected he had sepsis and tests confirmed that he had klebsiella pneumoniae, which is hospital inflicted bacterial infection. It is life threatening and commonly occurs in patients who are being treated and are on ventilators or intravenous catheters.
In ICUs, health personnel treat multiple patients and can easily pass on the infection through touch. Clearly, the staff had not taken precautions exposing him to the infection.
Meanwhile, the delay in diagnosing the reason for the infection had already put him at high risk. Once again, he was shifted to the ICU and this time administered heavy doses of antibiotics. The wound was kept open for surgical cleaning everyday. In the second round too, the wound was kept open, which led to continuous discharge of pancreatic fluid and excessive bleeding. His haemoglobin level by then had dropped dangerously low to 5.9. He also continued to suffer from excruciating pain and trauma.
Dr Shetty, who had returned by then, during examination found that the reconstructed parts of the first surgery had not healed causing pancreatic fluid to leak.
Mr Mahapatra was made to undergo a second surgery although it was not clear why it was being done. The family remained completely in the dark.
Unfortunately due to gross negligence on the part of doctors, lack of adequate post-operative care and monitoring and absence of follow ups to ensure the patient’s recovery, Mr Mahapatra breathed his last on 19th February.
In this case of medical negligence, several issues come to the forefront about the quality of healthcare services and delivery in the private sector. What stands out in Mr Mahapatra’s case is the fact that the biopsy report following the first surgery showed that he did not have any malignancy. The question that arises is why did the doctor make him undergo surgery without conducting any tests prior to the operation? Sandeep has a host of questions about the way the hospital went about it, but no answers are forthcoming. Why did both Apollo hospital and Fortis wrongly diagnose the patient’s condition? Why there were no proper follow-ups with the patient prior to operating him? Why was the whole procedure done in such a sloppy manner? Why was no monitoring done after he was moved to the ward after the second surgery, which led to his death?
The family is devastated that doctors, who take the Hippocratic Oath to save lives, provide ideal care and are meant to be compassionate towards patients, are today irresponsible and indifferent towards them and are engaged in unethical practices because they are driven by commerce. In Mr Mahapatra’s case, limited attention was paid to assess and identify his medical condition. If the doctor had been more focused, he could have saved his life. However, according to his son Sandeep, the cost of the treatment is an indicator why doctors prefer to retain patients in the hospital. While the original cost was 2.75 lakhs for four days in the ICU and 6 days in the ward, it rose to 18.5 lakhs because he had to remain hospitalised for a longer duration due to the negligent behaviour by the doctor and the medical staff. Clearly, the interest lies not in the patient’s safety and speedy recovery but the monetary gain.
However, despite all evidence pointing to negligence, the hospital authorities deny that there has been any negligence in his treatment. Responding to queries raised by Mr Mahapatra’s family, Dr Bipin Chevale, facility director at Fortis Hiranandan, claims that none of the procedures were faulty.
The patient was given analgesics after the surgery to relieve pain. But it is not clear why despite its administration, the patient continued to suffer severe pain.
There are, however, conflicting elements in the hospital’s statement, which attempts to defend the procedures and denies any wrongful action. While it admits that no biopsy was done to investigate whether there was malignancy or not, which in itself points to indifference on the part of the hospital, it also mentions the fact that there was no evidence that the patient had cancer. To carry out a surgery based on medical report from a referred hospital without assessing the patient’s condition is a serious breach of conduct.
Another case of poor medical ethics and dilution of moral principles took the life of Nagaraju Koppula, a talented young journalist working for the Indian Express newspaper in Hyderabad, who died at the age of 34 on April 12th, because he was misdiagnosed.
He had been battling lung cancer for over four years, but doctors at the government Chest hospital in Hyderabad where he went to get tested on October 2012, diagnosed his condition as tuberculosis.
Although lung cancer and TB can mimic each other, regular tests can detect cancer. However, despite monthly reviews, multiple doctors who took turns to see him were not able to either observe or diagnose cancer in Nagaraju’s lung. In March 2013, he was told he had second stage of TB. By then he had lost faith in the doctors and got a scan done at a private clinic and a nodule was identified in his collar-bone, which made it clear that he had cancer. His friends and colleagues got together and got him treated at the Indo American Cancer Research & Institute Hyderabad. In April, 2013, he got his biopsy done after a minor surgery was done to remove the lymph node.
The results were intimidating. The cancer had entered phase four and the chance of his survival was poor. He struggled for a year and half. Late detection, poor medical attention and care along with inadequate follow-up took his life.
Cases of death due to medical negligence in hospitals are rising rapidly across the country.
However, no appropriate action has been taken to redress such malpractices, which are a complete breach of the ethical principles of medical practice. Regulatory bodies like Medical Council of India (MCI) and Indian Medical Association (IMA) remain indifferent and have not taken any steps to regulate such irregular conduct.
Even public hospitals have begun to face the brunt of malpractices in the private sector. Dr M C Misra, director of All India Institute of Medical Sciences (AIIMS), says private hospitals often refer patients who are on the verge of death to government hospitals after having fleeced their families because they do not want to take the rap of botching up cases. It was found that many patients die while being shifted or by the time they reach the casualty department of government hospitals.
Citing the case of a private hospital in Noida, from where three patients were sent to AIIMs on the same day, Dr Misra says all three had been intubated to make it appear they were critical. But when doctors checked them, they were dead. The tertiary care hospital receives at least 8 to 10 such patients every week. These transfers were done not because of medical indication but on purely commercial considerations. Since many patients have low-income background and cannot afford the cost of treatment in private sector hospitals, they are sent away, which is highly unethical.
Dr Misra says there is an urgent need to formulate referral and transfer policy for inter-hospital transfers. Every hospital has to be bound by this. It should not happen that the hospital drives patients out from their facility without ensuring that bed and other medical services are available at the hospital where the patient is being transferred. For instance, AIIMS is currently overwhelmed by the number of patients and is often not able to admit referred cases. Therefore, there needs to be better coordination between both private and public hospitals. Without prior clearance, patients should not be shifted arbitrarily, he says.
It is imperative that every hospital must be responsible, whether the transfer is from government to government hospital or government to private hospital. No transfer should be made without prior discussion with the other hospital where the patients will be sent so that the patient is not denied treatment simply because of non availability of beds, ventilators, ICU care or other facilities like angiogram and embolization needed to treat the patient.
Only after the hospital confirms the availability of these facilities based on the needs of the patient, should the patient be transferred. It is the responsibility of every hospital to cater to such patients even if they don’t have the resources to pay for their treatment.
In case of unethical practices and medical negligence by doctors and other health personnel, strict action should be taken against those who are supposed to ensure that patients are diagnosed correctly and treated appropriately.
Commerce should not drive medical care or else many more lives will be put at risk because of negligence on the part of practitioners.
The Indian Penal Code, 1860 prescribes severe punishment for death due to rash or negligent conduct of a person. Under this section, there is a provision to file legal suits against doctors or other medical practitioners responsible for medical negligence. Unfortunately, only a few cases are filed against doctors allowing most of them to go scot-free.
As public distrust builds against the medical community, it is critical that urgent steps are taken to ensure that healthcare is run in an ethical manner, keeping the patient’s needs at the forefront. As cases of deaths due to medical negligence rise, it is a wake up call for the medical fraternity and the government. They must realise that there is a need for strict implementation and enforcement of regulations and ethical guidelines in order to prevent such medical malpractices.