VOX POPULI


Disastrous ‘electro-magneto-homeo therapy’ (1)

A pregnant woman was killed during an abortion in a make-shift clinic in Okhla’s Harkesh Nagar in mid-May. Dr. Yashwant Kumar Jha, who runs Jagdamba Clinic in the colony, was arrested and released on bail by a city court. The ‘doctor’ holds a bachelor’s degree in a quaint stream of medicine called electro-magneto-homeo-therapy in addition to being a Registered Medical Practitioner and BMS.

This is the third such reported case in recent months where innocent patients have fallen victims to quacks in various localities. In earlier cases the womb of a woman was pulled out along with the placenta at Khera Khud village in north-west Delhi. In another case the intestines were removed during operation.

The latest victim is 35-year-old Gayatri Devi. She consulted the ‘doctor’ on May 13 to get rid of her unwanted one-and-a-half month old pregnancy, saying that she already had three children and could not afford to feed another mouth. The ‘doctor’ called her at 12 p.m. the next day, assuring her that she would be discharged immediately after the operation. Instead, her body was discovered in the clinic at around 1 p. m. The operation was yet to be performed. She died apparently due to the administration of a wrong medicine as fresh injection marks and blood spots were seen on both arms of the victim. The initial autopsy report indicated that she had died of shock.

Striving officiously to keep alive (2)

Gillon comments on the case of Thomas Creedon, aged three, severely brain damaged, who was kept alive by artificial feeding and hydration even after his parents had argued the prolongation of his life was not in his best interest. Thomas died in February before the parents could seek legal intervention.

Gillon points out that it is universally accepted there is no moral obligation for doctors to initiate cardio-pulmonary resuscitation, respirators and antibiotics when these are not in the best interests of patients such as Thomas. In the 1950s, Pope Pius XII explained to anaesthetists that artificial oxygenation by respirator was not morally obligatory merely to prolong life and that respirators could be morally withdrawn knowing that the patient would die if the prolongation of life did not achieve a higher good and was unduly burdensome to the patient.

Gillon argues that feeding through an intra-gastric tube and other medical means for maintaining the hydration and nutrition of suck patients – as, indeed, is the provision of air or oxygen – cannot be part of a duty of care to the patient if it cannot benefit the patient, let alone where it is likely to cause more harm than good.

Gillon cautions against considering such inaction as ‘starving the patient to death’ just as it is incorrect to consider the Pope’s recommendation as one to suffocate the patient to death. Almost all patients where prolongation of life is deemed to be not in the patient’s interest are comatose or are sedated before the respirator or nutrition is withdrawn.

The ability to prolong people’s lives for their benefit is a wonderful and ever-increasing capacity of medicine. To use it to keep people alive when it does not benefit them, but harms them or others, is in my view to undermine the core of medical morality ‘

Doctors abetting artful dodgers (3)

A cursory glance at the official records of the State Legislative Council and proceedings and verdicts of the courts in Bombay leads one to the conclusion that the Director of Medical Education and Research (DMER), Vishwanath S. Yemul, has made wrong submissions to Health Minister Daulatrao Aher by saying that no one is guilty of doctor-criminal nexus in the JJ Group of Hospitals.

The official records of the JJ Hospital show at least half a dozen cases where criminals admitted to the hospital were either discharged or ran away on the day they were granted bail. Asraf Gulam Rasool Patel, under trial for criminal offense, was admitted to JJ Hospital on July 24, 1995 and transferred to the cardiology department on August 1. He was discharged on August 22 after being granted bail. Wasulal Narayan Lakhi was admitted in the department of orthopaedics on April 11, 1994. He was then transferred to the department of cardiology on June 2. He was discharged against medical advice after being granted bail. Kapil Dev Singh, booked by the Bhandup police, was certified by Dr. Lekha Pathak, Professor and Head, Department of Cardiology, as suffering from ischaemic heart disease.The court asked Dr. Anil Kumar in the same department to opine. Dr. Kumar submitted that Singh was not suffering from the ailment. (Some more cases are also referred to in the report.)

Senior professors attached to JJ Group of Hospitals remarked that unless there was a nexus between a section of doctors and criminals such criminals could never have been admitted without valid reasons. In several cases it was confirmed that patients developed ‘convenient illness’ to avoid arrest.

The inquiry ordered by the Maharashtra Medical Council (MMC) into the nexus between doctors and criminals has not made any progress. When the MMC asked the Dean of the JJ Group of Hospitals to submit the case papers to the Council, the Dean sought the permission of the DMER. The DMER, ex-officio member of the MMC, was expected to attend the meeting with the relevant papers. He failed to make an appearance.

Doctors abetting artful dodgers(continued) (4)

The Chief Metropolitan Magistrate of Delhi rejected the report of the doctor in Tihar Jail Hospital about the illness of the self-styled godman Chandraswami and ordered constitution of a medical board to examine him. Magistrate Prem Kumar described the report submitted by the medical officer in the jail as a ‘procured’ report. Passing a severe stricture against the medical officer, Mr. Kumar said, “On careful perusal of the report it seems that this may be a case of ‘fixing’ the jail doctor and thereby securing or procuring from him the desired medical report to make medical unfitness a ground for the prisoner not to attend the court and thus obstruct the progress of a smooth trial. The doctor has given quite a vague report and the diagnosis has not been clearly mentioned. It did not mention the perusal of any old record of the disease or any new investigations.”

Doctors abetting artful dodgers (continued) (5)

Rejecting the medical report by the Tihar Jail medical officer, Chief Metropolitan Magistrate Prem Kumar said, ‘It seems like a made-up report, for obvious reasons.’ He refused to believe defence lawyer Ashok Arora’s contention that Chandraswami was not getting any attention in jail and that he was informed twice about his being in a state of coma. Mr. Prem Kumar expressed surprise on the medical officer’s conclusion on the basis of plain X-rays that Chandraswami was likely to suffer irreparable damage to his nerves and pointed out that there was no expert opinion such as from an orthopaedic surgeon nor was a test such as computerised tomographic scan or magnetic resonance scan carried out.

(Since the publication of this report, the Chief Metropolitan Magistrate obtained the opinion of experts at the All India Institute of Medical Sciences, who have agreed with the medical officer at Tihar Jail. The latter has now been asked to justify his stand, especially in the light of the expert opinion.)

Physician-assisted suicide-tormenting questions (6)

In an early response to the lifting of bans on physician-assisted suicide by two federal appeals courts in USA, the New York Times posed a question that tor-ments doctors: ‘Will the right to die become the duty to die?

Is it likely that pressure will now be brought on the sick and disabled – self-imposed or from relatives – into choosing suicide over prolonged, futile and expensive therapy. Doctors, poorly trained in the treatment of pain and pressed by managed-care companies eager to cut costs, may put implicit pressure on their patients to choose suicide by not offering them acceptable alternatives.

Since existing law confers upon surrogates the right to withhold life support from mentally incompetent patients, will it also allow surrogates to decide that terminally ill patient should be given lethal drug?

Will the right to assisted suicide lead to euthanasia?

Maharashtra Medical Council (7)

I think it is useless to expect justice from the medical council. In medical councils, professional sympathy and professional contacts play an important role against the complainant in the case. No proper hearing takes place.

The council conducted the hearing of my case without reference to the medical records of the case. When I received an order from the medical council, I found that my statements had been altered to favour the accused doctors. The statements that went against the accused doctors had been deleted. No doctor sitting on the panel was a cardiologist or cardiac surgeon though my case was related to cardiology.

Once the verdict is passed against you in the medical council, it becomes very difficult to get it amended as it is a decision of a body of medical experts. There appears to be no point in filing a case at the medical council. It may be better to file a civil suit or go to a consumer court.

The lay person and the Consumer Protection Act (8)

There is good news for consumers as yet another hurdle in matters of medical negligence has been removed thanks to Justice Balkrishna Eradi, president of the National Consumer Disputes Redressal Commission.

Consumer courts will not admit a charge unless there are expert medical opinions stating that the complainant has made a sustainable case. The only exception thus far has been in cases where medical negligence is obvious to the lay person. When Justice Eradi’s attention was called to the fact that patients and their families experience difficulties in getting the requisite medical opinions, he ruled that in such cases, the consumer court will seek the opinion of experts attached to renowned public or private hospitals. He stated that under no circumstances should complaints of medical negligence be dismissed by consumer courts for want of an expert’s opinion. If a court does dismiss a case on such grounds, the consumer should immediately go into appeal against the order.

Justice Eradi also ruled that doctors accused of malpractice and the complainant must be granted the opportunity of cross-examining witnesses. Where such an opportunity has been denied, the National Commission should be approached for redressal.

The opinion given by a medical expert witness can be used only as a guide by the presiding judge and is not binding upon him. It merely unravels the medical intricacies for the judge.

References

  1. Anonymous: Pregnant woman falls victim to quack in south Delhi. Indian Express 23 May 1996 p 3.
  2. Gillon Raanan: Sometimes we have a duty of care not to intervene. The Guardian (U.K.) 7 March 1996 Online Supplement p 12.
  3. Marpakwar Prafulla: Has DMER misled Govt over doc criminal nexus in JJ Hos-pital? Indian Express 30 March 1996 p 9.
  4. Press Trust of India: Medical board to examine Chandraswami. Indian Express 16 May 1996 p 9.
  5. Anonymous: Judge rejects report on Chandraswami’s illness. The Times India 18 May 1996 p 8.
  6. Fein Esther B: Verdict on suicide raises questions in USA New York Times. Reproduced in The Times of India 10 April 1996 p 14.
  7. Raheja RG: No justice from the medical cowsil. The Asian Age 8 June 1996 p 1
  8. Rahehja Shirish V: Justice is now a bit more accessible with CPA. Bombay Times (The Times of India) 12 June 1996 p. 5
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