Thursday, June 7, 2012

K19 - The Facts that "Satyamev Jayate" Missed - Part 2

Satyamev Jayate: Kidney Specialist to file a case on Aamir Khan

New Delhi: In the fourth episode of his widely-watched television show Satyamev Jayate, host, interlocutor and activist Aamir Khan spoke about healthcare services in India and the threat of rampant medical negligence. He called on 'victims' to share their trauma. One such victim of alleged medical malpractice was retired Army officer Major Pankaj Rai who lost his wife Seema to what he called a botched kidney transplantation operation.
Although Khan or his guest did not name anyone during the course of the show, but the doctor who was involved in the case, said his legal counsel and the hospital he worked for are preparing to send a legal notice to Khan and the show producers for tarnishing a reputation he had worked hard to build over 25 years of medical service. He accused Khan of lapses in research for the show and Rai of "falsely accusing him of medical negligence" that led to the death of his wife.
Nephrologist R Sreedhara, who worked at the Fortis Hospital in Bangalore, said during a telephone interview to IBNLive that ever since the episode of Satyamev Jayate was aired he has been inundated with calls. He was the consulting physician of Seema Rai when she first came to him in June, 2008 with kidney problems. He said his "harassment" started after her operation in May, 2010 when she went into a septic shock and died.

A still from Satyamev Jayate of Pankaj Rai
Dr Sreedhara has been fighting this battle in several medical bodies of arbitration for the past two years and said he has lost his mental peace due to "the falsehood propagated by Rai against him, his colleague and his hospital" for a high-risk surgery that went wrong due to added complications.
Rai alleged on the show that the doctors whisked his wife off to surgery without his consent and transplanted the pancreas of a cadaver donor, along with a kidney, that was not only an unnecessary medical procedure but one that risked his wife's life as well. But Dr Sreedhara said he had proof to show that Rai had suppressed much of the truth and even lied during the show and that it was him who was being hounded.
"I have posted feedback on the website of Satyamev Jayate, I have sent an email to Aamir khan, I have also posted an open letter to Aamir Khan. I don’t know if Aamir Khan has seen my reply or not, but I have attempted to send it to him. Meanwhile I have discussed with attorneys and the hospital and we are in the process of sending a legal notice to the show producers and Aamir Khan because he made a very serious allegation without bothering to do any research. The Karnataka Medical Council has clearly said there was absolutely no medical negligence involved and there was no monetary gain or personal gain to the doctors. How can Aamir Khan say there was medical negligence? Nobody has gotten back to me," Dr Sreedhara said.
Here's Sreedhara's account of the ill-fated surgery
"I am a Nephrologist. I am certified by an American board in internal medicine and nephrology. I worked and practiced in America for nearly 16 years and I came back to India in 2003. In the entire 16 years in America not a single patient had any complaint against me, regarding any negligence. My mental peace in the last two years has been destroyed due to constant harassment, for no fault of my mine. I become emotional when I talk about this. It's very very painful," Dr Sreedhara said.
"We have sent the medical case history to all doctors, to the All India Institute of Medical Sciences, to Madras, to Bombay, to America, everything was done properly. Some patients die in surgery due to unforeseen complications like what happened in our case. It is not because we tried to kill her, I mean what do we gain by killing a person?
"I work in the Fortis hospital in Bangalore. The patient, the wife of Mr Pankaj Rai, her name is Seema Rai, came to see me first about June 2008. She was suffering from diabetes and high blood pressure for more than 18-19 years at that time and she had kidney disease. We always discuss about future treatment like dialysis and transplantation. (In this also) we had discussed at length several times with the patient and her family," he said.
"About a year later, in 2009, she registered for cadaver kidney transplantation with a government body called Zonal Coordination Committee of Karnataka for Transplantation. She registered for that in April 2009, subsequently her kidney function worsened gradually and in November 2009 we started her on dialysis.
"After starting dialysis, she was doing well. On May 1, 2010, I got a call from the ZCCT, the agency that allocates cadaver kidney organs, that a potential cadaver had been identified and Mrs Rai was one of the potential recipients. On Saturday night she got admitted to Fortis hospital along with her husband and daughter. This was 8:45 at night on Saturday. I was out of town when I got the call from ZCCT and I came back to Bangalore and evaluated her. At that time the patient was also seen by the transplant surgeon we discussed again the cadaver transplantation procedure. The risks and the benefits were explained to the patient over a period of two years. She was a teacher at an international school, an intelligent person, and she understood," he said.
"The patient's husband gave us the consent"
"At that time the surgeon also explained to the patient that in cadaver transplant situation the simultaneous transplantation of kidney as well as pancreas was better in the long term, also the immediate post operative risks are higher in surgery. The patient and her family had a lot of questions which answered. They wanted to speak with their relative in New York so the doctors came out of the room. The patient's husband said 'Dr Saab we will proceed with simultaneous kidney and pancreas surgery.' This was around 1030 - 1045 in the night on Saturday. At that time the surgeon was present, the nurses were present. Mr Rai directly told me in person that 'we will proceed with simultaneous kidney and pancreas transplantation.' Even at that time I told the husband that 'Mr Rai your wife had registered only for kidney transplantation in the past one year, pancreas was only suggested to you today. Till the patient is taken to the operating room, you can change your decision and let us know. Kidney transplantation will be done and there are no additional charges for pancreas," Dr Sreedhara said.
What the Rais had to say on the show
"It's not as if people can't live with dialysis. They called us from the hospital to tell us that a donor was available. We had her admitted to the hospital on the doctors' advice. We were amazed that a day prior to surgery the doctors said we could transplant her pancreas as well. Have you heard of such a thing? They kept saying there's no risk. But Seema said she wasn't prepared for this," Rai told Khan during the May 27 episode of Satyamev Jayate. "The doctors said we could wait till the morning to get a cardiologist to take a look at her," he said.
Rai's daughter Abha said at around 5 AM a nurse came in and claimed she had to take her mother for a routine check up and asked her to sign a form. They insisted that the hospital authorities had not taken their permission prior to the surgery.
Post-operation complications
Rai said he was asked to arrange for blood as the doctors said his wife could die on the operating table. He said the doctors estimated that the blood loss would be 390 ml. According to Rai, the doctors transplanted 119 units or approximately 60 litres of blood during the three post-operative days.
What Dr Sreedhara had to say
According to Dr Sreedhara, in the three days post the operation, the patient developed a severe bleeding condition called Disseminated Intravascular Coagulation or DIC. "In DIC we give blood as well as blood products like plasma. We gave the patient 33 units of blood which roughly amounts to 13 litres of blood. Mr Rai is promoting this falsehood that platelet is also same as blood, 1 unit of platelet is about 50 ml not 500 ml as he has calculated so it's like comparing apples and oranges."
What went wrong?
Dr Sreedhara said that on the night of operation "the patient was stable throughout the night and she was evaluated by myself and transplant surgeon and the anaesthesia team for a preoperative evaluation she was stable and found fit for surgery. The transplantation started and the kidney transplantation was done first. I went to the OT just to see how she was doing. She was fine and the kidney as soon as it was transplanted started making urine. I came out of the OT and assured Mr Rai that the kidney transplantation was over and she was doing well and we were going ahead with the pancreas transplantation. He thanked me."
This contradicts with Rai's statement that he was not aware of the surgery being done on his wife and had not given consent for it.
"By post operative day three she was becoming awake and responsive and we were about to remove the ventilator. Unfortunately on the evening of day three she developed high fever and she went into septic shock on the fourth day. Patients with diabetes or kidney failure have a high risk of infection, plus when we give all these powerful immunosuppressive medicines, the risk of infections increase further. Plus she had received a lot of blood and blood products because of bleeding," he said.
"During the entire hospitalization Mr Rai was very thankful and in fact he told me several times, 'Dr Saab how much you are struggling to save my wife, how can I thank you?' After the patient passed away I called them several times to express my condolence. I also told the emergency room doctors to evaluate his daughter and give her some medication to calm her down. Next day again morning he called me and said 'Dr Saab please help us to get the body', I called the hospital administration and told them please resolve their bills immediately. After that I never heard from him. Before the surgery he used to be so friendly."
The legal battle
On May 30, 2010, Rai lodged a police complaint alleging murder. About a week after his wife passed away he filed a medical negligence complaint at the Karnataka Medical Council. Subsequently he complained to the Health Department, the Human Rights Commission, the National Accreditation Board for Hospitals and held press conferences.
"On Satyamev Jayate, Rai said he never gave consent. But when he lodged a complaint with the police and the Karnataka Medical Council, two to three weeks after the death of the patient, he never mentioned the issue of informed consent. If somebody has operated on a patient without consent, won't that be your first complaint? It's only in afterthought that he's saying that they didn’t give informed consent. The Karnataka Medical Association did a very thorough investigation over one year and conducted a lot of hearings," he said.
According to Sreedhara, the KMC completed their enquiry within one year and they came to the unanimous decision in June 2011 that there was no medical negligence on the part of the doctors. Rai appealed against the decision to the Medical Council of India and that appeal is still ongoing. He also complained to the Lokayukta against the Health Department.
Rai's complaint that the hospital did not have the facilities for multi-organ transplant was entirely baseless, Dr Sreedhara said.
An official spokesperson for the Satyamev Jayate team refused to comment on the matter.
Dr Sreedharan has accused Khan's team of not doing their homework by getting both sides of the story, as a result of which his integrity is under question. And Rai has lost his wife to what he termed gross negligence. The case is still being examined, which makes conclusions premature.

Have a look at how doctors have reacted with this matter aired on Satyamev Jayate TV show at here

Wednesday, May 30, 2012

K18 - The Facts that "Satyamev Jayate" Missed

Recently we all saw an episode of Satyamev Jayate on 27th May 2012 regarding the malpractices done by Doctors in India. Let check the fact which Dear Aamir Khan & his team forgot to clarify or mention.
Few comments i read on internet by different medical professional..........

1st Doctor
Dear Mr.Aamir Khan, I have been trying hard but cannot get over the fact that you can 'sell' ignorance with such ease and honor. Though I agree to 'parts' of your show , Lets first get the facts right.
1) You said patients on dialysis live upto 15-20 years. Fact - The 5 year survival rate of patients on dialysis is about 25-30 % ( less than many cancers). Renal transplant remains the best available treatment option for chronic kidney disease. (I hope you take responsibility for people who after watching your show plan to not go for kidney transplant and die in less than 5 years)
2) An overenthusiastic girl from the audience said that her father was forced for an emergency liver transplant '6-7 years' ago for gastroenteritis. Fact- Even today there are ' a handful' of hospitals in India offering liver transplants. To think that 6-7 years ago , just a gastroenteritis patient was offered liver transplant is not only improbable but technically impossible.
3) A diabetic patient blamed a doctor for losing a toe. Fact- Lacs of diabetic patients per year lose entire limbs due to diabetic foot (cellulitis and gangrene) . Doctors go about stepwise cutting off toes, then foot, even the leg upto above knee level in order to save as much limb as possible. The patient in your show might still be able to walk just because of the timely action taken by the surgeon.
Mr. Aamir Khan i am not getting back at you because i took your show personally. Yes , I agree that there are doctors indulging in shameful malpractices and even i know a few of them. But i can proudly say i am surrounded by more doctors who work day and night just to ensure that their patients get the best possible treatment..The' BAD' doctors should be punished and we all can come together to ensure we do not encourage such malpractices.
Secondly i would have appreciated if you would have thrown some light on the entrance examinations and the hard work , dedication and sacrifices a doctor needs to clear his MBBS, MD, DM etc examinations. I wish you had spent half a day in the emergency department and OPD of a Govt. Hospital and realized that the work timings, working conditions, lunch breaks, doctor : patient ratio, hours of sleep per week , living conditions in the hostel and the stipend is worse than a class 4 laborer. You would have also surprisingly realized that the 'DOCTORS' are the only 'FUNCTIONAL' part of a Govt. Hospital which still caters to thousands of patients in a day. When you compared statistics of U.K and India , why didn't you include the salaries, living standards and the doctor: patient ratio the doctors have in developed countries. Coming to generic drugs, Yes, a large amount of rural population should have access to cheap generic drugs. But one should not forget the pharma companies that charge more for the drugs are the ones that spend crores of rupees for research and development of new drugs. Had there not been drug trials no new drugs would have been invented and we would have mortality rates compared to stone age.Also i agree that most doctors endorse certain brands of drugs ( which i do not deny may be for some financial gains also ) because they have faith in the quality of the 'active drug' of certain companies.Yes many local companies manufacture generic products ( which is a copy of the original molecule discovered by the expensive company) which can be used for unaffordable patients. But you did not mention that many of these generic drugs are of substandard quality and are the reason of many uncalled for deaths due to drug reactions. Most doctors would not want to take responsibility of the quality of the 'generic' drugs. Lastly, What do you mean when you say ' People of high IQ and desire to earn money should not become doctors'. Why aren't doctors allowed to have an ambition ?? How can a person who earns 4 crores for an episode of a so called 'social' show decide on what should be an individual's ambition and financial status !! Why can there be no doctors who earn well for their professional skills and do not indulge in malpractices ?! It just reflects your hypocrisy. I would like to offer a few solutions to the problem.
a) ' BAD' doctors indulging in malpractices should be suspended for life. We need a strong regulatory authority to publish expected treatment 'protocols' and punish doctors found to be doing unethical practices.
b) Regulatory authorities should also keep a check on the quality of drugs being manufactured and at the same time 'sold' at the local chemist.
c) Govt. medical colleges and hospitals should multiply several folds, increasing the number of doctors in each department , improving the doctor: patient ratio. Doctor's salaries and living conditions should be looked after and should be comparable to other professionals.
d) Regular CME'S and licensing exams ( like other countries) every 5-10 years.
e) The Govt. should spend 6-8% of GDP ON HEALTHCARE and a part of which should also be committed to the research and development of newer drugs.
f) No politician should be allowed to be associated with any private medical colleges.
g) The general public should be educated well about common diseases and the 'acceptable' qualifications of the doctors.
These are just a few points i can think of at the moment. I am sure had you bothered to have a panel discussion and find solutions in a healthy way, We could come up with a lot more viable solutions. However you chose to sensationalize your show, by hiring 'few' people with 'fake' or 'amplified' problems and shed a few tears. Hope you understand that Your allegations like ' HAMARE DESH KE DOCTORS ITNE BIMAAR KYUN HAIN' and 'MAUT KE SAUDAGAR' are as serious as calling all actors 'Rapists' ( after the shiney ahuja incident ) and all Muslims 'Terrorists'. Knowing that you twisted not one but not many known medical 'facts' to strike a chord with the 'ignorant' 'naive' audience, How do you expect me to have faith in you and the stories you would project in the upcoming shows. You have betrayed a large segment of the 'classes' as well as 'masses'. All i can say is i feel sad for the death of the 'image' you created in our minds and hearts. An unbiased Aamir who strives for nothing but the truth and the betterment of the society was after all a MYTH.
Condolences, An honest Doctor

2nd Doctor

Dear Mr. Amir Khan,
I have been a big fan or your work, life and principles. I am also a fan of‘Satyamev Jayate. But I was shocked to see the episode on 27th May, 2012. You are an Icon. You should have thought well and done the homework before doing such a biased show. There are only two people in the film industry that are being taken seriously by the thinking class of society, You and Amitabh Bacchhan. So, when you give such a biased and one sided version of a story, it hurts. Speaking about such a thing on a “commercial” TV show is bad. (I am sure you have taken a big amount, only doctor are supposed to do charity and social work, not actors!!! Right!) I want to highlight few important points here. And yes I am qualified to make observations as I am a medical student.
1. Your guests and audience (the words were almost put in their mouth) said that private colleges charge a capitation fee of 40 – 50 Lacs for MBBS, you should have also produced some evidence of such practice. Like you call a victim in all your episodes, why not here? And do the same story Engineering, Architecture, Law and MBA colleges, do you think they are clean? Why target doctors alone?
2. You said Since 2001, government opened 31 medical colleges and 106 private institutes were opened.
– Please note that today in India, there are a total of 181 Private and 152 Govt Medical colleges. So the
number is not as bad as you projected. Don’t project only the time period which suits your story. Either give a complete picture or do not give a picture at all! And also, please find out how many of these private colleges are owned by politicians? 95% of Private colleges in India are owned and run by politicians. It is a bloody nexus between politicians and MCI. The corruption by politicians is to blamed for the mess, not doctors!!!
3. One of your guest (Dr.Gulhati) said that doctors ask for 30% commission from Pharma companies to
write their drugs. That is baseless, over-the-roof and sensationalizing the matter. That is as true as “Most
Leading actors ask newcomers to sleep with them” or “Lawyers take money from both the sides in a legal battle” or “Most chartered accountants teach their clients how to save tax and also pass info to taxman on where his client saved tax”. I know all of you will shout “Where is the proof?”. So are doctors!!! I am not trying to sensationalize things as you did on your show by shading those fake tears, but just trying to project that allegations are easy to make. I know you will say that this was the opinion of our guest, and not yours. But you provided a platform for these fake allegations.
4. You compared the numbers of Licenses cancelled in England and in India. I must say your team is quite resourceful and please collect and compare following details also –
a.Number of doctors beaten on duty by goons from various political outfits in government hospitals in UK
and India in last 10 years, and also the number of people convicted for such crime.
b.The Stipend (Salary a post-graduate trainee doctor/intern gets) or Salary and accommodation facilities
provided to the doctors of the two countries.
c.The duty hours and working conditions of the doctors of the two countries.
d.The academic and research infrastructure being provided to the medical students.
5. You said that the most brilliant students who take up medicine, should take it only for service to mankind, they should go to other fields if they want to earn. Why? Are we living in imperialism? Are doctors not allowed to earn and spend a good life? You were asking Dr. Devi Shetty whether he can do humanitarian work and Earn at same time? This is like asking Amirkhan or Shahrukh-khan their income and generalizing it for every actor in the industry (Even junior artists). Sir, just as there are only few Khans and Kapoors, There are even fewer Devi Shetty and Naresh Trehan who run their chain of Multi-specialty hospitals spread all over the country. See what it takes to become a doctor and then give such “Geeta-Gyan”.
a. 5 and half year of MBBS training and 1 more year of Compulsory Rural Internship at Rs. 15000 - 20000 per month. (Any other field eg. Engineering, Management, a person would become Postgraduate in this much time and start earning double the amount.) If one doesn’t study further, the pay at this step is 22,000 per month.
b. After above 6 and half years of Graduation, 3 more years of Postgraduation, followed again by compulsory rural / Government job for 1 year or pay Rs. 25Lac bond. If one doesn’t study further, the pay at this step is 40,000 per month.
c. After this above 10 and half years, 3 more years of Superspeciality, followed by 1 year of Govt job or a Bond of Rs. 2 Crore. And the seats are so few with tough competition, there tends to be a gap of a year or two in preparing for various entrance exams.
6. Why only Doctors are being forced to work in rural and government hospitals after their study? Why only we should pay government if we don’t want to do it? The rural/Govt sector needs help of Engineers, Lawyers, Chartered Accountants and MBAs also. Why aren’t the Engineers sent to rural areas to design and monitor roads and industrials development? Why aren’t the Lawyers forced to work as Public prosecutors before they can join some big foreign corporate firm? Why aren’t the CAs asked to work in CAG office and various other government financial sectors before joining Multinational Giants? Now government wants that doctors should not immigrate to other countries without asking them. Why? Are the IIT/IIM students stopped before they flee to foreign countries for big fat salaries? So, why us? What is it that government of society has done for doctors that they should repay? They bloody can’t even protect them from goons while on duty.
7. You say that doctors are writing unnecessary and costly medications. Do we decide the price of a drug? Do we manufacture or give license to drug manufacturers? Controlling the price of essential drugs is a government job. We are helpless. Sir, its easy to point fingers. We don’t say that all is well. But all is not well anywhere. Its a different thing creating awareness about dowry or female foeticide. But its entirely different to comment on such a technical and complicated issue without getting into the details of it. You have maligned the entire medical fraternity. For every 10 doctors who are doing wrong, there are more than 1000 healers. You owe us an apology!!! This issue is not as simple as you think it is! Please show stories which are unbiased and straight-forward. You cannot do justice to such an issue, especially after charging a whooping amount for creating awareness!!!
(We hear that Amir has charged 3 crores for episode of satyamev jayate in which he spreads the message to doctors that they should not make money and do social service!!! How sacred!!! I don’t know if its true, but well, it’s the season of allegations!)
“We Doctors may be doing little social service, But at least we are not charging for it!” - Doctor..

To view the Case related to Mrs Seema Rai Kidney + Pancreas Transplantation, Visit here