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.
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. All of them have said that 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 at 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 with the patient and her family," he said.
"About a year later, in April 2009, she registered for cadaver kidney transplantation with a government body called Zonal Coordination Committee of Karnataka for Transplantation. 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 but when I got the call from ZCCT 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.
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 with 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 operation 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 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 immuno-suppressive 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 this 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.Supporting documents
- AA Chairman Letter to R Chandrashekara 10 Mar 2011
- AA Order 22 Dec 2010
- Anaesthesiologist opinion Dr Keshav
- Cardiologist opinion Dr Venkatesh
- Dr TKS Rao opinion
- Dr. Ramcharan experience in pancreas transplantation
- Dr. SK Agarwal opinion
- Facts about cardiac evaluation and angiogram
- Facts about informed consent and information about surgery
- Facts about registration of Fortis Hospital for transplantation 30 Jan 2012
- Georgi Abraham opinion
- Gokulnath affidavit
- Informed consent
- Medical case history
- Nurses note May 1 and vitals graph
- Ramcharan detailed resume
- Sreedhara CV March 2011
- Licence and application paper