By RN Sen
The term ‘Medical Terrorism’ has been creating a huge public opinion since May 14, 2016 in many parts of the world, particularly in Assam. Various opinions from the medical fraternity and civil society are going on in the newspapers and in social media. It is also understood that Amika Ray Memorial Trust is going to observe 19th July, as Anti-Medical Terrorism Day. As such, it is my duty also to bring it to the notice of all readers, a few points for initiating more constructive discussion on the issue.
I would like to quote with Dr Yatish Agarwal, a professor of Radiology at Safdarjung Hospital and Dr Bipin Batra, executive director of the tiol Board of Examitions (NBE), in their article titled ‘Heal Thyself, O Dear Physician!’ (January 9, 2016 available at www.indiamedicaltimes .com) — “If you have lived to be fifty, and don’t mind going down the memory lane, even if briefly, you would readily agree that a striking change has overtaken the medical profession. The charisma, the goodness, the nobility that once defined this hallowed profession, and its amour-propre, has taken a full-blown punch on its nose.” They also added, “Needless to say, the arguments are all robust. Yet, these cannot be an alibi, just as two wrongs never make a right. Live we might in a market-driven ecosystem, the very spirit of the profession must not allow us to turn into merceries, or agents of deceit and defrauds, traders of merchandise that may not benefit a man, leave alone harm them.” Now the question is whether Dr. Agarwal & Dr. Batra should also be asked for apology for using such sentences/words?
The term ‘Medical Terrorism’ might be a new term for IMA Assam branch as they believed that, it is an invention of Dr. Amika Ray Memorial Trust. However, the same term has been used by the hon’ble Central Information Commissioner, in the judgement Prabhat Kumar Vs. Directorate of Health Services, Delhi, File no.CIC/SA/A/2014/4, Date of decision 03/11/2014/7-4-15, in point no. 56, part of which is appended herewith, “...i.e., forcing the private hospitals to give medical records of the patients on day to day basis, because this daily disclosure will prevent undesirable practices of altering records after damage caused to patient. Forcing the private hospitals to provide dailywise medical records will also act as a check on some hospitals from resorting to extortionist, inhuman and ruthless business of prescribing unnecessary diagnostic tests, unnecessary surgical operations, caesarean deliveries, unwarranted angioplasties, inserting stents without need or of substandard ture or putting low quality stent while collecting price of high quality stent, and several such malpractices amounting to medical terrorism, etc. They should not be allowed to such malpractices with all impunity and get away without any legal consequences as if there is an absolute immunity. The Government, Medical Council of India and the health regulatory has to see that licence to practice medicine will not become licence to kill and extort and come to the rescue of helpless patients.” [*medical records mean not merely test reports, but all the contents in BHT (Bed Head Ticket)]
It can be perused above that the term ‘medical terrorism’ has not been invented, but reused from the above said judgement by Dr. Amika Ray Memorial Trust. It is for a better and transparent healthcare system in India with a separate legislation, so that doctor-patient relation is improved; in case of harm or death of the patient due to negligence, justice can be felt by patient or relatives of deceased patient, within short reasoble period/span.
In the above said judgment, words or sentences like extortionist, inhuman and ruthless business, licence to kill and extort, also have been used. Now, whether IMA Assam branch would also like to take action for that judgment and file defamation suit against the Central Information Commissioner of India? But it is already delayed by 15 months!
Mostly, in line with the above said points in the judgment and in much detail, we can refer to an article in Indian Heart Jourl of January-Feb 2015, Volume 67 Issue I, titled ‘Other Side of Moon, What Ails the Practice of Medicine: The Atlas has shrugged’ by Dr. Sundeep Mishra, renowned professor of Cardiology at All India institute of Medical Science, New Delhi. After going through the article, whether IMA Assam branch would like that Dr. Mishra should also apologise to his own fraternity for such stringent beautiful article? Why do associations like IMA always criticise aware non-medical persons, when they try to improve the situation?
In line with above, an exemplary case study can be worth mentioning here. After a few months of losing his wife (due to alleged medical malpractice & negligence), an elderly patient with high blood pressure (non-diabetic) had episodes of palpitation (heart rate even 135 beats per minute, normal is 72-80 BPM) and breathlessness while working or even walking, in mid-2015. Various tests were done and medicines prescribed, but the symptoms did not subside. So the patient decided for a psychiatric consultation to rule out neuro-hormol triggering factor. As no significant psychiatric reason could be found, the doctor advised for urgent cardiologist consultation, which he did at a well known private hospital with a renowned cardiologist.
The cardiologist — without going for ECG & TMT to establish provocable ischemia/ischemic heart disease — just by examining pulse, advised for CAG (Corory Angiography, which is done to find any blockage of blood flow in any area of heart) and Cath profile (documented) with a verbatim advice to do it immediately, which may require stent, or otherwise there is life risk factor. As this type of approach was not accepted by the patient, he did not visit the doctor further.
The patient then went on deteriorating, even after hospital admission (other than above, which was inconclusive), fainting episodes (and consequent physical injury), low blood pressure, high heart rate etc, & was compelled to continue with compromised quality of life. In early 2016, he had a feeling of severe chest compression and became semi-conscious with low blood pressure and low heart rate. He was rushed to the same private hospital with oxygen support (where advice for stent had been given), but under a different interventiol cardiologist.
At the hospital, after oxygen support and other therapy (and of course after initial stabilisation), an EP study was done (Electrophysiological study, which examines electrical related activity of heart), which revealed 3rd degree AV Block (at HR 110 BPM); which is an electrical activity related issue. With TPI (Temporary Pacemaker Insertion) followed by urgent implantation of PPM (Permanent Pace Maker), the patient had much relief.
My question to readers is, what term should be used for the above said advice for CAG and verbatim advice? While consulting, do you keep evidence of verbatim advice? Whether CAG and stent could have resolved the issue? The patient is myself! Is it not medical terrorism?!
Whether IMA Assam branch can indicate such data in public domain of Assam Medical Council from 2002 onwards are available (like in wbmc.in/ pel cases), whereas agreed on the point of possible negligence, but no such data available in MCI site (mciindia.org/Information Desk/Indian Medical Register/list of blacklisted doctors/ of Assam Medical Council). Is it not contradictory? What nomenclature is appropriate for such course of action?
Justice delayed is justice denied.
(RN Sen is retired (in 2013) Joint Gen. Mager of Airport Authority of India, worked as in-charge of communication, vigation, surveillance at different airports since 1989 and also had opportunity to work as Airport Director at Gaya and on different occasions at Pat.)