AIIMS fires senior resident doctor over nurse’s death

Image result for AIIMS fires senior resident doctor over nurse’s death

The nurse, Rajbir Kaur, with husband Manish Behl

Taking a serious view of the death of a pregnant nurse, Rajbir Kaur, at AIIMS on February 4, the institute’s administration Tuesday terminated services of a senior resident of the anaesthesiology department, who had been accused of medical negligence.

The administration said the moves comes after the inquiry committee found the senior resident “guilty” of “wilful absence” of his duties.

It also said the AIIMS director will issue a “displeasure of memorandum” against another senior resident of the gynaecology department, involved in the surgery. A formal declaration will be issued against the doctor, and she will not be employed with AIIMS once her contract ends.

The administration also issued a showcause notice to the consultant on call of obstetrics and gynaecology, under whose supervision the surgery was performed, asking why action should not be taken against him. Officials said the panel found that the consultant on call “was not present for the emergency operation despite being informed”.

Following Kaur’s death, three senior residents — two from gynaecology and one from anaesthesia — had been accused of medical negligence. The administration had said they would be “off duty” till a final call is taken based on findings of the eight-member inquiry panel headed by Professor S C Sharma, head of the ENT department.

“Based on the committee’s findings and two rounds of meetings at the level of director, AIIMS, the following administrative action has been taken. An amount of Rs 10 lakh compensation shall be given to the nurse’s next of kin,” V Srinivas, deputy director, administration, AIIMS, said.

Officials said a “warning” will be issued to the junior resident in the anaesthesiology department as the panel found he had “left the operation theatre under pressure from residents of obstetrics and gynaecology”.

Officials told The Indian Express that the inquiry had found that Kaur’s was a “low-risk pregnancy” and that labour was was “progressing well” till there a was a “sudden drop in heart rate, necessitating emergency surgery”.

The administration also directed the head of department, anaesthesia, to “ensure that a consultant will be available” to supervise anaesthesiology services in ICU, main OT, radiology department, and maternity OT.

‘Baby was limp at the time of birth’

The eight-member inquiry committee looking into the death of nurse Rajbir Kaur has concluded that her “baby was limp”, indicating that the brain tissues possibly did not receive enough oxygen due to the difficult birth, sources said.

“When the newborn is out, it cries and moves its limbs. But in this case, the baby was limp. It can happen when the brain tissue is not receiving enough oxygen. This happens if labour is obstructed, or if there is an issue with the mother. It happens during difficult birth,” said a senior doctor.

Even as the AIIMS administration terminated a senior resident doctor, the Department of Forensic Medicine and Toxicology has kept the findings of Kaur’s post-mortem “pending” and sought “queries” from the Delhi Police. Sources said a final opinion will be given after the police’s reply.

Kaur’s family said they were “satisfied” with the AIIMS administration’s decision. “But we are waiting for the police to register an FIR on a complaint filed by us,” said Manish Behl, Kaur’s husband.

AIIMS doctors blame ‘infra lacunae’ for nurse’s death

AIIMS doctors blame 'infra lacunae' for nurse's death

The controversy over death of an AIIMS nurse, allegedly due to medical negligence, is far from over.

The hospital’s resident doctors have cited ‘infrastructure lacunae’ in the maternity operation theatre as the main reason behind the staff nurse’s death during an operation.

The resident doctors of anesthesia department have written to health minister J P Nadda to reconsider the decision. Calling the final report by AIIMS as inappropriate, the doctors have said there was an infrastructure lacunae in the back table of the maternity OT, where Rajbir Kaur was operated, leading to her death.

“We have found a number of infrastructure lacunae in the back table of the OT, where Kaur was operated upon, which directly contributed to poor outcome in her case,” says the letter written to Nadda, also the president of AIIMS.

According to resident doctors, the back table in the maternity OT was never meant for general anesthesia practice as it lacks basic life-saving facilities. A committee was constituted to investigate the alleged negligence by doctors. Kaur had suffered a cardiac arrest during the surgery on February 4, leading to her death.

Resident doctors said the senior resident whose services have been terminated had clearly denied Kaur’s case initially, considering the maternal safety issues for conducting anesthesia in back table.

“If the administration does not reconsider this decision to sack the senior resident doctor of anesthesia, while not acting against senior faculty and administration responsible, we will be forced to go on strike,” said a resident doctor. Sources said even the victim’s family was not happy with the institute’s action and may seek legal recourse for justice.

Kaur was admitted on January 16 for a normal delivery. The labour was progressing well till 5am the next day when there was a sudden drop in fetal heart rate, necessitating an emergency surgery. A probe by an internal committee found that an anesthesiologist was not present during the caesearean section operation. Instead, the job was performed by a junior resident who neither had the experience nor was trained enough to handle such a complicated case.

The child was stillborn and Kaur went into distress due to aspiration- entry of stomach material into the respiratory tract.

A neurosurgeon’s night

Image result for neurosurgeon

Author: Sachin Baldawa

It was a fine Sunday evening. I had just finished my dinner and planned to enjoy some rare moments with my family, before beginning my chaotic schedule next day, when my phone ring. A call from my hospital: “Doctor, we have an emergency. Two patients have suffered serious injuries following a road traffic accident. We need you now. Better hurry up.” I was up in a second and was ready to go.

My drive to the hospital takes about 10 minutes. During this drive, numerous thoughts started racing down my mind. What could it be? Another polytrauma, or just a severe head injury? Will one or both of them need emergency surgery in the middle of the night?

As soon as I reached the hospital and walked into Casualty, I was directed to the CT scan room where one of the patients was undergoing a scan of the brain. As the images appeared on the console monitor, I knew this was going to be one of those tiring, sleepless nights. The person had a life-threatening blood clot on the left side of his brain. I said: “Prepare him for emergency surgery.”

By the time the patient was being shifted to the intensive care unit, I turned to examine the other victim who was lying in a pool of blood, a kid with no signs of life. The resuscitation team member looked up and said: “Sorry, we could not resuscitate him.” I walked back to the intensive care unit to examine the other patient. I was told he was the father of the kid, who had been declared dead. The father was in his mid-40s, lying unconscious on a ventilator. The team was preparing him for surgery.

I walked down to the counselling room to see his relatives. Only his father-in-law was available for counselling. As I looked at him, I could see the desperation in his eyes, waiting for me to tell him about the condition of his son and grandson. I had this difficult job of breaking the bad news, that his grandson had succumbed and his son-in-law needed emergency life-saving surgery.

It is this aspect of my profession that I hate the most: breaking the bad news. “I’m afraid your grandson is no more,” I told him. He just sat there looking at me, not a sign of grief, not a sign of breakdown. “Your son-in-law has a life- threatening blood clot which needs emergency surgery.”

It was then that he spoke. “Doctor, please go ahead and do whatever is possible. Please save my son-in-law.” I assured him that the best possible efforts would be to save him, and walked to the operation theatre.

Neurosurgery is often considered a glamorous branch of medicine. No other field allows you to look into others’ minds, so to speak, to cut through the very matter that forms thoughts and memories. Neurosurgeons are often looked upon with admiration. They handle matters of life and death. This in fact means desperate attempts to save someone’s life by evacuating a life-threatening clot.

However, all that glitters is not gold. There is a flip side to this field. What lies beneath are some of the darkest secrets that have never been revealed. Once the mask is unravelled, it reveals the occasional success stories as well as the enormous morbidity and mortality associated with this field of medicine. Hours of work behind the microscope looking down into the narrow corridors of the brain may mean nothing if at the end of it all the patient is left wrecked. The physical and mental exertion of surgery is compounded by the stormy post-operative course that some patients undergo.

As I sat in the operation theatre with my eyes closed, my assistant told me the patient was ready. It meant it was time to get going. I scrubbed up and looked at the ticking watch. It was close to 1 a.m. As I was about to place the knife and cut through his scalp, a silent prayer went up: “God, help me do what is best for him.” By the time I had worked through his skull bone and finished taking the blood clot out from his brain, it was close to 3 a.m. I and my team heaved a sigh of relief, knowing that probably the patient would make it.

Over the next few days in the intensive care unit, he received good care. Follow-up imaging of the brain revealed e needed another life-saving surgery as his brain stem, the vital part of the brain which controls respiration and heart, was getting compressed by brain oedema. It came as no surprise to me that his father-in-law readily agreed.

The second surgery was successful, and over the next few days the patient gradually regained consciousness. It was now only a matter of time before he would recover completely. He was shifted out of the intensive care unit once he was fully awake and started comprehending speech. During the entire stay, his father-in-law stood by him.

Doctors, especially neurosurgeons, are always advised not to get too emotionally attached with their patients. If they do, their patient’s neurological disability is likely to take a heavy toll on their personal lives. As I treated this patient, I got to know more about his family. Here is the father who had lost his only son, yet once he came to know about it, all that he told me on the day he was about to be discharged was, “Doctor, I lost my son.”

I stood there helpless, speechless and just walked off, unable to console him. He was destined to survive, against the odds. His father-in-law hung on to hope in spite of adversities. I was destined to treat him. Ultimately I treat and he gets cured. A year later he has resumed his business and is hoping for another child.

That’s the cycle of life. Every dark cloud has a silver lining.

Students with PoK degrees left in the lurch

Image result for azad jammu kashmir medical college

Medical Council of India refuses to recognise their MBBS degrees, has disallowed them to write revalidation exam

Over 30 students from Jammu & Kashmir have been left at a crossroads after the Medical Council of India (MCI) refused to recognise the MBBS degrees acquired from medical colleges located in Pakistan Occupied Kashmir (PoK).

Speaking to PG Times from Muzaffarabad, the Capital of PoK, an MBBS student said, “I enrolled at the Azad Jammu Kashmir Medical College in 2012. After completing my degree, I applied to the MCI for degree validation and entry examination. I was disallowed to write the examination.”

Meritorious student

The student, a resident of Srinagar, was informed by MCI officials that only MBBS degrees from Pakistan, but not PoK, were recognised.

“I am a meritorious student. I secured an MBBS seat in Pakistan against my Class X (94%) and Class XII (92%) marks. Those who landed us in this situation should be held accountable,” the student added.

There are three medical colleges in PoK —Azad Jammu and Kashmir Medical College in Muzaffarabad; Mohtarma Benazir Bhutto Shaheed Medical College in Mirpur; and Poonch Medical College in Rawalakot. All were set up after 2011.

For years now, about 20 students are sent to medical colleges in Pakistan annually on the recommendation of separatist leaders and relatives of divided families in the Kashmir Valley. The children of slain militant commanders are also offered seats in Pakistani medical colleges.

Student protest

The PoK-based medical colleges, which are affiliated to both the University of Azad Jammu and Kashmir, and the Pakistan Medical & Dental Council, have reserved 6% seats for students on this side of the Line of Control (LoC). Over 50 students from J&K are pursuing medicine in PoK currently.

The protest by Kashmiri students in 2016 had forced the PoK authorities to shift 18 students to medical colleges in Karachi and Punjab.

“I am left with no other option but to prepare for the Professional and Linguistic Assessments Board test in the United Kingdom. It’s an extremely costly affair and not all students can afford it. I am an only child and my parents are based in Srinagar, but I don’t want to practice in Pakistan,” said another student.

Srinagar-based lawyer Babar Qadri blamed the Hurriyat for the mess.

“Most students have been recommended by the Hurriyat and their careers are in jeopardy now. I appeal to the governments on both sides of the LoC to recognise each others’ degrees. When we can trade onions, etc., why can’t we exchange students?” said Mr. Qadri.

Mirwaiz Umar Farooq-led Hurriyat spokesperson Shahid-ul-Islam told The Hindu that the Hurriyat “will look into the matter”.

Quotas for Kashmiris

“There are quotas only for Kashmiri students across the LoC and in Pakistan. I appeal to the SAARC nations to intervene in the matter and ensure that no student is victimised. At least education should remain above politics,” said Mr. Islam.

A bus service between J&K and PoK was allowed by India and Pakistan in 2005 and trade links restored in 2008 as part of the confidence-building measures. The links have made it easier for students to travel across for studies.

Niti Aayog wants axe on homoeopathy, ayurveda bodies

Niti Aayog wants axe on homoeopathy, ayurveda bodies

Continuing with its drive to streamline the country’s medical system, the Niti Aayog is expected to recommend scrapping of two more institutions — the Central Council of Homoeopathy (CCH) and the Central Council of Indian Medicine (CCIM).

A senior government official told PG Times that the Aayog is working on two new bills suggesting ways to replace the two statutory bodies under the health ministry, which govern higher education in homoeopathy and Indian systems of medicine including ayurveda.

A draft bill suggesting creation of an all-new body to replace the decades old statutory bodies is ready, but a final decision will be taken up by a Niti Aayog vice-chairman Arvind Panagariya-led panel set up to suggest sweeping reforms in the department of Ayush under the health ministry.

Last year, the panel looked into the issue of poor regulation of education by Medical Council of India and proposed replacing it with National Medical Commission.

The proposal awaits the Cabinet approval, following which it will be tabled in Parliament. “Like the Medical Council of India, even these two statutory bodies have outlived their utility. Besides, they continue to unnecessarily complicate things because of stringent regulations, which makes it difficult to impart quality education in homoeopathy and ayurveda,” the official said on the condition of anonymity.

According to the official, the Niti Aayog has completed stakeholder consultation on the two new bills and these would be soon put up for public opinion before they are finalised for the Cabinet approval.

CCH, a statutory apex body under the health ministry, was set up by the government in 1973 to monitor homeopathy education in India. This means any institution desiring to grant a qualification in homeopathy is required to apply to CCH, which prescribes course curriculum and maintains central registers of homoeopaths.

Similarly, CCIM, a statutory body under department of Ayush in the health ministry, was set up in 1971 under the Indian Medicine Central Council Act to monitor higher education in Indian systems of medicine, including Ayurvedua, Siddha and Unani.

2 year post-PG bond in Odisha

Image result for odisha

Students pursuing post-graduate courses in the three government-run medical colleges will have to serve the state for a minimum of two years failing which they could be penalised.

While making the provision mandatory, the government has asked the Directorate of Medical Education and Training (DMET) to ensure execution of the bond that students will have to sign to this effect while taking admission in the state-run medical colleges.

The decision, taken last week by the state’s health department stressed that “all candidates taking admission in government medical colleges, either under state quota or all India quota in post-graduation in medicine (MD), post-graduation in medical master of surgery (MS), master of dental surgery, or doctor medicine (DM) courses” would have to execute the bond. The decision will not be applicable to under-graduate courses such as MBBS, BDS and paramedical courses.

The government will allow the bond to lapse if it cannot provide employment to the candidate within six months of the candidate completing the PG course.

The announcement also said that in the event of a student getting an opportunity to pursue higher studies immediately after completion of the PG course, he or she would be allowed to join the course.

But, after completion of higher studies, they would have to serve the state government for the stipulated two years. Such students would be required to make affidavits before first class judicial magistrates.

Defending the decision, state health secretary Pramod Kumar Meherda said: “The state has an acute shortage of doctors. The government spends a lot in providing medical education in the state. But, most of the students are reluctant to serve the state. The purpose of the bond is to retain graduating doctors and utilise their services.”

About 1,300 of 4,700 posts of doctors are vacant in the state at present.

In November 2015, the state government had dismissed 408 doctors for abandoning duty.

At the specialists’ level (doctors with PG degree holders), the state faces an acute shortage. There are nearly 450 post-graduate seats in the three colleges – SCB Medical College, Cuttack, MKCG Medical College, Berhampur, and VSS Medical College, Burla.

An official said that if a student fails to adhere to the bond and does not serve the state for two years, the government would impose monetary penalties.

“The penalty will be double the amount of stipend/salary received during the study period (post-graduation). We will also not release their pass certificate, college leaving certificate or any other certificate in the custody of the authority.”

The official said candidates leaving the pos-graduation course before completion would be liable to face monetary penalty of Rs 10 lakh, the amount of stipend and the salary received by him or her till that period.

An official said the bonds would be made on non-judicial stamp paper of Rs 21. The bonds would have to be signed by the candidate, two sureties (parents or guardians), the dean and the principal of the institutions concerned. The bonds would be collected centrally at the time of provisional admission by the selection committee, and to be handed over to the respective institutions after final admission.

Choking in womb: 30% preterm births in capital due to pollution

Pregnant women who expose themselves to outdoor pollution too often are putting their babies in danger. City doctors warn that one in every four babies born is preterm. And one out of four preterm deliveries could be due to exposure to automobile and industrial exhaust.

Reacting to an international research study conducted by the Stockholm Environment Institute (SEI) that links outdoor pollution to preterm births and low birthweight babies, city doctors reveal that the rate of preterm births in Hyderabad is between 20 and 24 per cent of live births. They also list outdoor pollution, particularly automobile and industrial exhaust, as one of the major causes for preterm deliveries and birth of underweight babies.

In the absence of official data on preterm deliveries and low birthweight babies, city doctors estimate that at least 20 per cent of the live births fall short of the gestation period. On the higher side it is 24 per cent. Increased incidence of asthma and autism in children of age group 0-5 years is also linked to their mothers being exposed to air pollution during pregnancy .

Dr Roya Rozati, head of the department of obstetrics and gynaecology, Owaisi Hospital and Research Centre, says, “ Alt hough there are no accurate statistics for Hyderabad, the preterm birth rate is around 24.5 per cent. The incidence is increasing.“

“Currently we are working on epidemiological study on pollution and preterm births, low weight babies and infertility in different populations under different conditions of exposure. The consistency of results strengthen the weight of evidence for a true association between exposure and outcome,“ points out Dr Roya Rozati. According to Dr Sharmila Khaja, consultant paediatrician, Apollo Hospitals, Hyderabad is no different from other major cities when it comes to pollution and premature births. “Particulate matter of 2.5 microns is known to cause preterm births. Almost 30 percent of all preterm births is due to pollution,“ she adds.

Dr Vimee Bindra, consultant gynaecologist and infertility specialist, estimates that between 21and 25 per cent of babies born in the city are pre term. “ Antenatal exposure to air pollutants can increase the risk of preterm delivery and low birth weight babies. Severe pollution may lead to stillbirths or sudden infant death syndrome,“ she warns.

According to Dr Harikishan Boorugu, senior consultant physician, vehicular pollution can result in worsening of asthma and lung problems. The morality rate depends on how preterm is the baby just before 37 weeks of pregnancy or much before (28 weeks etc).

Private hospitals reuse disposables, make you pay for them

Disposables like catheters, guide wires and balloons used in every angioplasty are reused and billed repeatedly in many private hospitals.

Adding to the risk of infection, you could be paying for something that has already been paid for. And the hospital may be making a profit of Rs 20,000 to Rs 30,000 on every procedure with simple reuse and rebilling, say industry sources.

The practice is so rampant that the health ministry has issued an office memorandum warning against reuse of disposable surgical items, particularly in cardiology, when they are meant for one-time use.

“The items after one procedure are sterilised and reused and (patients) are charged full amount of these items,” stated the memo dated December 21, 2016. The matter had been “viewed by this ministry seriously”, it said, and clarified that “reuse of disposable items, particularly in cardiology and other specialties, is not permitted in healthcare organisations empanelled under CGHS (Central Government Health Scheme)”.

It goes on to warn of “suitable action including withdrawal of CGHS empanelment” against defaulters. It is silent on action against big corporate hospitals that are not empanelled under CGHS.

“Most private hospitals, especially hospitals chains, insist that cardiologists reuse these items. While reusing these items a couple of times might be justified in some cases where you want to help bring down costs for a patient, in most of these hospitals, not only do they reuse four or five times, patients are also billed afresh for each of these items, helping the hospitals make a profit of Rs 20,000 to Rs 30,000 on each procedure or patient,” explained a cardiologist who has worked in several leading private hospitals.

All disposable items have clear instructions on the packaging saying they should be used only once and cannot be resterilised. Some cardiologists in private hospitals admitted that reuse was common but said it was not a problem if the items were properly resterilised. Companies, they said, insisted on single use to sell more of their products.

Cath lab technicians and dealers who sell disposables and stents to hospitals also confirmed that such reuse was common. Hospitals like AIIMS and PGI hardly ever reuse these items as there is no pressure to cut corners to make profit.

“In the US, solid catheters or catheters without holes can be resterilised and reused but only once or twice. But reuse of catheter with holes like a guide catheter used in angioplasty is not allowed as it is difficult to clean the insides where blood residue might remain. This is to prevent any chance of HIV and Hepatitis B infection. Also, resterilising affects the quality of the item as it hardens the plastic, making it less flexible,” explained a senior AIIMS cardiologist.

Chain hospitals are the worst offenders, according to a cardiologist who has worked in one such institution. “If doctors in one hospital in the chain reuse an item five or six times, that is lauded as a great example of cost saving. It is pushed as standard operating procedure across the entire chain, putting enormous pressure on doctors who try to resist such unethical overuse of a disposable item,” explained the cardiologist.

“Reuse is bad and doing so without the patient’s consent is criminal,” said another cardiologist. “And charging for resued items is fraud of the highest order being done in most elite hospitals to push up profits. It is easy to investigate and expose this. The government can get the number of angioplasties done in a hospital and ask for proof of purchase of the disposables for the last two years. There is a formula for how many disposables are needed for each angioplasty. They will find that far fewer disposables have been purchased than the required number, which will show clear reuse. Such hospitals should be prosecuted,” he said.

However, reusing of items with patients’ consent to reduce costs for the poor should not be treated as criminal acts, he added.

Many drugs using active Viagra ingredient: Govt

Many drugs using active Viagra ingredient: Govt

After registering a case against a pharma company based in Bihar, the health department suspects that there are other ayurveda and homeopathy drugs using sildenafil citrate, an active ingredient in Viagra.

Sildenafil citrate can only be sold on the prescription of an authorised doctor but the action of health department officials against such drugs shows that it was easily available as over-the-counter drug in the form of ayurveda and homeopathy medicine.

The drug is prescribed for erectile dysfunction but it can cause cardiac arrest and other severe complications.

Around four days ago, ayurveda department and health department jointly conducted a raid and collected medicines of ayurveda and homeopathy suspecting them having sildenafil citrate in Jaipur and Bihar.

“We are awaiting the report of seven samples collected. After receiving the report of laboratory test, we will take further action,” Ajay Phatak, drug controller, health department, said.

He said that use of sildenafil is allowed in allopathic medicines only as it is an allopathic content. No other alternative medicine like ayurveda or homeopathy can use it. It makes drugs spurious.

The health department officials had conducted raids in Bihar, where the manufacturer’s unit was situated.

Phatak said that they would take action against ayurveda and homeopathic medicines which are using allopathic contents. “We are taking it as a campaign against spurious drugs,” Phatak said.

After the raids, the drug controller imposed prohibition on sale of seven such drugs which were suspected to be using allopathic content- sildenafil. The cost of the drugs was over Rs 2 lakh.

HRD to rank law, medical colleges from this year

From this year, students will be able to know where a particular medical, dental and law college stands in terms of standard of education as the HRD ministry has included these institutions in its India Rankings 2017 which will be released on April 4.

The HRD ministry had released the first-ever national rankings last year when it had included Technical, Management, University and Pharmacy institutions as categories.

“From this year medical, dental and law colleges will also be ranked,” a source told PTI.

Nearly 49 law colleges and 43 medical or dental institutions have come on board to be ranked this year, the sources added.

In the coming years, however, it is expected the number of medical, dental and law colleges will significantly go up.

President Pranab Mukherjee will release the rankings in the first week of April at an event where HRD Minister Prakash Javadekar would also be present.

Another key aspect of the rankings this year is that institutions will also be given weightage over the number of patents or path-breaking research that is conducted by them, it is learnt.

Unlike last year, when each category had a separate list, the India Rankings 2017, would have a single list where the best institutions from all categories would compete against each other.

However, an additional category wise list may also be released.

“There may be a single list of say the hundred best colleges in the country whether they are varsities, IITs, IIMs, Medical or law colleges. However in addition, category wise lists will also be released,” an official source said.

Officials also said a significant emphasis has been laid on the public and peer perception of the institutes which will participate in these rankings.

The data provided by the institutions was put up and there has been a very enthusiastic response from the public, a senior official added.