High-handed behaviour by Bengaluru cancer hospital: The case of Sudhansu Mohanty
June 6, 2012
Several issues need to be critically examined in Sudhansu Mohanty’s case. Instead of taking pot-shots at Aamir Khan and threatening to sue him, the IMA will do itself and the nation a great service if it gets cracking on such cases
Ramesh Arunachalam The comments to Moneylife's article on the Indian Medical Association (IMA) (http://www.moneylife.in/article/the-indian-medical-association-should-indeed-sue-aamir-khan/26122.html) just shows how deep rooted the anger is there in the country with regard to the medical fraternity. While all of the comments brought out various aspects related to medical malpractices and corruption, one of the most shocking stories was related by Sudhansu Mohanty (as a comment to the above article).
Read on… to visualize and experience what Sudhansu perhaps went through on 24 May 2012 at HealthCare Global Enterprises (HCG), a Bangalore-headquartered specialist in cancer care. According to its own website, HCG "is the only dedicated cancer care network with quality care across 25 centres. …Each centre is provided with a business system, management expertise and capital resources to bring patient-focused, state-of-the art cancer care to new regions." (http://www.hcgoncology.com/about-us). As the website further notes, HCG's approach to cancer care is supposedly unique:
"We do extensive research and develop innovative treatment methods to provide the finest cancer care. This is supported by the most advanced technology to make cancer a manageable health condition and improve the quality of life of patients. It is our goal and commitment that one day India will be free from the agony of cancer. …For over five years HealthCare Global Enterprises (HCG) has been defining the future of cancer care in India by designing, building and managing cancer centres with a steadfast vision: To transform cancer care environment by bringing core clinical services to one central place. The intent of this single place is to help patients achieve longer, better lives-and to improve cancer care one centre at a time. …At HealthCare Global Enterprises (HCG), we view each centre as a model of excellence, a place where physicians can achieve professional fulfilment and breakthroughs in patient care. …Patients are the beneficiaries of these achievements-every accomplishment brings us one step closer to our ultimate goal of longer, better lives for cancer patients and their families." (http://www.hcgoncology.com/about-us).
"I seek to put in public domain my recent experience (just about 12 days ago, to be exact on 24 May 2012) in the HCG cancer hospital (also known as Bangalore Institute of Oncology) in Bangalore. I am a patient ofcarcinoid cancer. A month ago, I experienced pain in the anastomotic site. The CT scan done shortly after showed up cysts in the liver, apart from inflammation and ulceration in my colon. The most effective treatment for carcinoid is the complete, surgical removal of the tumour(s), which in my case had been performed. But microscopic cells could even show up after years and it's the tumour diasporic proclivity that prompted my doctors advises me a nuclear scan called Gallium-68 PET CT DOTANOC to zero in on the problem.
After the scan got over, I requested the nurse if I could speak with the doctor and get a preliminary idea of the scan before the detailed results came a day later. She said, "No doctors around. The technician did it."
I couldn't believe what I heard. "You mean to say that this nuclear scan was done without the supervision of a doctor, a consultant of nuclear medicine?" She looked at me, speechless. I walked over to the edge of the console room and asked the technician if he could do the scan without the specialist in nuclear medicine being around. In my money receipt the specialist's name was mentioned. I demanded an answer.
The technician panicked and spoke to the specialist seated in Tower 1. My scan was in Tower 4, about 200 meters away from where the doctors-consultant, nuclear medicine and the radiologists-sat.
Within minutes the technician materialized. "You can speak to Dr Kallur", he said, handing me the cordless phone.
"Doctor," I asked, "how is it that no doctor was around when my scan was done?"
His reply was pat. "I can't be present in all the 60-70 scans done everyday. You can take your money back!"
For all my ailments and my sundry visits to doctors across hospitals/cities wherever I've lived, I had never heard anything remotely resembling this. "That's okay but what happens to the radioactive isotope injected that's gone into my body? And is this the medical protocol your hospital follows?"
Silence. Later, I heard a voice say, "If you want to meet Dr Kallur, you can."
"But am I not speaking to him?"
"No, this is Pravin speaking." I asked him to come meet me.
He came half hour later-after two reminders. I demanded to meet the chairman. "The chairman is in a meeting," Pravin promptly conveyed.
"That he must be," I said, my voiced dipped in sarcasm, "but know that that ploy won't work. Please set up my meeting with him. Quickly."
He shuffled from one foot to another. Then moved away.
I sought him out again, as my wife and I sat in the patient's room in the high radiation hazard zone. It was getting to six in the evening.
Finally, Pravin after his string of meetings and phone calls materialized to take us. But no, it wasn't the chairman of HCG, Dr Ajaikumar. It was Elizabeth, the chief administrative officer. I told him I had nothing to do with her. After confabulation with Pravin, Elizabeth came over, now seated in the reception of Tower 2. I told her I wanted to see the chairman and there was no point repeating things time and time again. She hadn't been purveyed the full story. When she heard it, her face mirrored her shock.
I was fasting since morning. More than two hours after my scan got over, we're being escorted to the chairman. I was asked for my visiting card. "I'm a patient. You know my name, below it write PATIENT.
Dr Ajaikumar quickly apologized on Dr Kallur's behalf. "I've already told him," he said, "and I'm going to tell him again". I asked if his hospital followed the medical protocol prescribed for nuclear scans. He was politeness personified but his disembodied answers waffled with US examples. I knew they were faux excuses.
"How can a doctor ever mutter such words you can take back your money to a patient?"
"Stress", he tried to reason. "He's a busy doctor!"
"Who isn't? Certainly you don't do 60-70 DOTANOC scans everyday! Your hospital says about 3-4!"
Little later, he said Kallur is "compassionate" and "an icon!"
"Compassion" to a cancer patient I'd freshly experienced. So I told him to disabuse culting his icon. "My personal ethics prompted me to meet tell you before I hammer out the next course of action for the criminal neglectin medical care in your hospital. This isn't the Hippocratic Oath that you doctors are sworn to, this is Hypocrites' Oath! I speak here not for me but for the voiceless-the illiterate, uneducated masses-who know nothing what doctors, whom they trust blindly, do!" In my throat I added, "As you go pursuing Mammon relentlessly throwing all medical ethics out the window!"
The next morning I saw a half-page advertisement on the front page of a national daily enticing cancer patients to the hospital. In the evening I got my report. I found the radiologist's signature; three names (without signature) of consultants in nuclear medicine printed alongside, including Kallur's-conveying unmistakably that the nuclear scan was examined only by the radiologist, not the nuclear medicine specialist! So today, as I ready for another surgery, I must seek out another nuclear medicine specialist for an expert opinion-this after paying Rs17,000 and with the radio-isotope in my system. And how right you are Aamir!"
Very interestingly, I came across another item on the HCG's blog which is incidentally dated 25 May 2012-exactly a day after Sudhansu's experience of 24 May 2012 (as stated above). Read on…
25th May, 2012, Bangalore: HealthCare Global Enterprises, The Specialist in Cancer Care, Bangalore, is the first cancer centre in India, to have accreditation from National Accreditation Board for Hospitals & Healthcare Providers,(NABH) Government of India, College of American Pathologists ( CAP), State of Illinois, and National Accreditation Board for Testing and Calibration Laboratories (NABL), Government of India. The combined accreditation for quality from three distinguished accreditation bodies was possible because of HCG's focus on robust process for patient quality, efficient practice of diagnosis and improvements in medical outcome.
Dr. B S Ajaikumar, chairman, HCG, said, "We are proud of this achievement of a combined accreditation from three bodies which endorses our hat or clinicians and non clinicians' together have been working together ensuring highest quality standards in cancer care with a focus in delivering the best in medical outcome. I'm happy to note that our team was the first to get these three accreditations in India." (http://www.hcgoncology.com/hcg-blog/first-cancer-center-in-india-to-be-accredited-by-nabh-nabl-and-cap)"
It seems unbelievable as well as ironical that an institution (like HCG) which has received accreditation from several bodies-including the National Accreditation Board for Hospitals & Healthcare Providers,(NABH) Government of India; College of American Pathologists (CAP), State of Illinois; and National Accreditation Board for Testing and Calibration Laboratories (NABL), Government of India - has allowed its process of treating its patients to degenerate to the levels suggested in Sudhansu's stated experience above. Specific questions that arise in this regard are:
a) Was it alright for a specialist doctor not to be present when the procedure-nuclear scan-was being actually done on the patient? This is especially a critical question given that the disease in question is (specialized) cancer and also given the fact that in the money receipt, the name of the specialist had been mentioned. Further, I have heard that to provide proper diagnosis, it is imperative for a specialist doctor to be part of the process of scanning - as much is learned from the process of scanning as the scanned output. That being the case, how does one explain away the doctor's absence when the patient (Sudhansu) was being scanned?
b) Can a doctor-because of being stressed, busy and/or excess workload (taking about 60/70 nuclear scans a day)-absent himself from a critical nuclear scan being taken? Is this appropriate as per the medical protocol prescribed for nuclear scans as well as critical care illnesses like cancer?
c) Was it fair and appropriate for the doctor to tell a patient-"You can take your money back"? Was not the doctor breaching the code of ethics and conduct by retorting to the patient in such a manner? And as Sudhansu argues, while money can be returned, what about the actual scan procedure experienced, the radioactive isotope injected into his body and the ramifications therein?
d) And, can a doctor who has behaved as described above be referred to as either "compassionate" or "an icon!"?
Moneylife sent an email to Dr Ajaikumar and other authorities at HCG, which was acknowledged by one official over phone. He said HCG will respond to Moneylife's mail after speaking with top management and the doctor concerned.
Without any doubt, several issues need to be critically examined in the light of Sudhansu's narration above as also other comments that have come in response to the Moneylife article (http://www.moneylife.in/article/the-indian-medical-association-should-indeed-sue-aamir-khan/26122.html). And I hope that instead of taking pot-shots at Aamir Khan and threatening to sue him, the IMA will do itself and the nation a great service if it gets cracking on such cases (which seem to be in plenty) and takes appropriate action against those who break its (very own) code of ethics and medical protocol…
(Ramesh Arunachalam has over two decades of strong grass-roots and institutional experience in rural finance, MSME development, agriculture and rural livelihood systems, rural and urban development and urban poverty alleviation across Asia, Africa, North America and Europe. He has worked with national and state governments and multilateral agencies. His book-Indian Microfinance, The Way Forward-is the first authentic compendium on the history of microfinance in India and its possible future.)
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