To err is human; error of judgment is not crime; difference
of opinion is not crime, failure of outcome is not crime; routine complications
are not crime; mere deviation from standard practice may not be crime, BUT what
a crime is " not taking standard precautions, neglecting the patient or
not taking proper consent. This can only be found out after proper
investigations.
I have written to MCI to take this case suo moto and
investigate. Punish the doctors if he is guilty or protect him and restore the
image of the medical profession if he is not guilty.
Following MCI ethics
regulations clauses are applicable in such mishaps
2.4 The Patient must not be neglected: A physician is free
to choose whom he will serve. He should, however, respond to any request for his
assistance in an emergency. Once having undertaken a case, the physician should
not neglect the patient, nor should he withdraw from the case without giving
adequate notice to the patient and his family. Provisionally or fully
registered medical practitioner shall not willfully commit an act of negligence
that may deprive his patient or patients from necessary medical care.
7.16 Before performing an operation the physician should
obtain in writing the consent from the husband or wife, parent or guardian in
the case of minor, or the patient himself as the case may be. In an operation
which may result in sterility the consent of both husband and wife is needed.
7.22 Research: Clinical drug trials or other research
involving patients or volunteers as per the guidelines of ICMR can be
undertaken, provided ethical considerations are borne in mind. Violation of
existing ICMR guidelines in this regard shall constitute misconduct. Consent
taken from the patient for trial of drug or therapy which is not as per the
guidelines shall also be construed as misconduct.
Grass root facts
• Camps are
common, standardized and happen with the knowledge of government authorities.
• Government
pays incentives for patients, doctors and staff
• Day care
surgeries are done in conveyer belt fashion
Issues to decide
negligence or accident
• Proper
consent
• How many
laparoscopes were used
• Time
taken for laparoscope sterilization
• Time
between two surgeries
• Type of
anesthesia given
• Type of
drugs used
• How many
surgeries are done in how much time
• Qualification
of the surgeon
• Experience
of the surgeon
• Autopsy
reports
• CO2
used: quality
• Quality
of instruments used
Government steps on
the tragedy
• Meanwhile
even as reports said that rusted equipment were used in the surgeries, a team
of doctors from Delhi's premier AIIMS hospital is in Bilaspur to investigate
what happened.
• The
medicines used have been sent to a lab in Kolkata for analysis
• Autopsy
reports are awaited
Media Trial
"Times Now"
TV channel news at 7-15 p.m. on 13-3-2014 equated Dr. R K Gupta,
surgeon, of Chhattisgarh as "Doctor Death", "Butcher of
Bilaspur" and "Merchant of Death".
Comments by fellow
colleagues
• "Till
the results of the enquiry are released the doctors should not be harassed. The
medic should not project the negative image of the profession" : Dr
Narendra Saini Honorary Secretary general IMA
• "It
is for the IMA to digest it and to be blind to it and to ignore it or to
launch media blitz against this channel and to send a legal
notice demanding within 72 hours an unqualified apology to be prominently
telecast on the same channel, failing which the IMA should initiate appropriate
legal proceedings. Please note that IMA has full locus standi to move on these
lines because it represents the whole medical profession and ought to preserve
its dignity and respect. Dr M C Gupta"
• "
http://scdrc.up.nic.in/judgement/A-1893-2008.pdf: "Held that the tubectomy
was done free at a primary health centre as part of government’s family
planning programme without payment of any money and hence it was not within the
ambit of consumer act…………………………………." M C Gupta
• The
government has announced a relief of Rs. 2 lakhs only ( Dr Mehra)
• "
Here in chhattisgarh government pay 1400 to the patient for sterilization
operations and if operation fails than 30000 as compensation to be paid but
they are not consumer still so many cases are going on in consumer court for
the same and our treating surgeon keeps on attending the trials on behalf of
govt. I don't understand why consumer court accepted these cases" Vicky
bansal
• "
PAYING 30,000/- as compensation for failed tubectomy is in itself a wrong step
as any procedure can fail. So what is the big deal?" Dr Sodhi
• " We
are talking of doctors & doctors alone. Please remember that this is a
government programme, government doctors, government everything. There is
something called vicarious responsibility. There is another thing which is
"owning up responsibility". And finally there is something (though
rare) called "shame". Another rare item is "moral
ground" Do you all not feel that
the health minister should own up responsibility and resign on moral grounds?
Dr Sodhi
Questions which need
to be answered ( Dr Neeraj Nagpal)
1. Is
Surgeon responsible for deaths in family planning camp?
2. Is
setting of targets for family planning responsible for such mishaps?
3. Is the
team including nurses, helpers, OT assistants equally responsible ?
4. Is the
team including nurses, helpers, OT assistants equally responsible ?
5. Should
the nurses, OT technicians and helpers who were part of team also be arrested?
6. Is
arrest of Surgeon without finding cause of mishap correct?
7. What are
various reasons one can think as cause of 14 deaths in family planning camp?: Lack
of sterilization of instruments by paramedical staff/ Reaction to medicines or
anesthesia used/ Chemical contaminant in CO2 used for insufflation/ Poor skill
of surgeon leading to bleeding/ Carelessness of surgeon while operating/
Carelessness of surgeon in preoperative and postoperative care/ Mischief by
someone part of surgical team
8. Are Doctors pressurized to do more and more surgeries in
Family Planning camps by their superiors?
9. Does the concept
of medical and surgical camps in sub optimal settings need to be abolished
10. Should those who pressurize doctors to achieve 'targets'
also be punished ?
11. Should compensation awarded by Govt to deceased not be
raised to 20 lacs or more in such a mishap ?
12. How should such tragedies be avoided in future ?: Reduce
number of surgeries which can be done in one camp to 10; Use minimum 3
Laproscopes and instrument sets for one camp; Qualified nurses and OT
assistants to accompany doctor on such camps; Penalize superiors if more than
10 tubectomies are done in one camp; Abolish family planning camps totally or
Punish surgeon severely to make example of him
13. Should awards be given as incentive to surgeons who
perform more surgeries in family planning camps?
14. Is labeling the Surgeon 'Killer' by our print and
electronic media appropriate ?
15. After such media condemnation if it is found later the
surgeon was not at fault ? Should he be
compensated by his employers / Should he be compensated by the Press/
Should he be compensated by his professional Associations
who did not support him ?
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