At HealthCare Global Enterprises, Sudhansu Mohanty was subjected to nuclear scan by a technician when a specialist’s supervision is mandatory. Instead of threatening to sue Aamir Khan, the IMA will do the nation a great service if it gets cracking on such cases
The comments to Moneylife's article on the Indian Medical Association (IMA) 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." 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." (To read more about HCG click here).
To be honest, if you ask me, anyone reading the above descriptions (on the HCG website) would be convinced to go to them for "Cancer Care".
Given that context, let us see what Sudhansu has posted on the Moneylife website the same is also available at his blog:
Mr Sudhansu states as follows...
"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 of carcinoid 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 neglect in 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…
First cancer centre in India to be accredited by NABH, NABL and CAP
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."
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.
Here is what Dr Kallur has said in a reply to our mails...
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. 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.)
The ‘Sunday Mail’ obtained ‘shocking’ information under the RTI on hygiene in eateries in Brisbane. Indian cities are not far behind; all you need to do is invoke the RTI Act, like it was done in Pune
We generally believe that Indians have a bad sense of hygiene and that our municipal corporations are lax when it comes to food safety in restaurants. This myth is dismissed with last week's revelation in tourist hot-spot Brisbane, when one of its leading daily "Sunday Mail" used the Right To Information (RTI) Act to get details about "black listed" restaurants on the Queensland health public register-a policy implemented by the Labour government in 2006 to put the names of offending restaurants in public domain, to safeguard health of citizens.
The article published on 3rd June in the Sunday Mail, (ww.) on the basis of documents procured under the information act is titled "Brisbane's black-list eateries named and shamed". The information procured from Brisbane City Council has revealed that names of influential restaurants which were heavily fined and prosecuted, for risking the health of citizens have not been made public in the Queensland Health Public Register, while small-time offenders are included in the list.
Also accessed is the dismal state of kitchen hygiene in the 'culprit' restaurants which debunks the theory put up by CWG (Commonwealth Games) official Lalit Bhanot that hygiene standards in India are different. If Mr Bhanot is to be believed, one would have thought that rat and cockroach-infested restaurants exist only in India but it is surprising to know that an otherwise forward nation like Australia is also marred by such problems. The article describes, "hundreds of cockroaches, and rat poison on a kitchen bench-these are some of the restaurant nightmares being kept from the public... Diners are being left in the dark about filthy rat and cockroach-infested restaurants thanks to the state's broken 'name and shame' regime."
The report states that documents under the Right to Information law revealed that a leading sushi restaurant, which was fined $45,000 because it was found to be a serious risk to public health during an inspection, has not been included in the public register. Another café which was also penalized heavily and has court cases against it for hundreds of cockroaches in its premises has also been protected from public eye. A Red Rooster restaurant which was fined $50,000 is not named in the public register. Similarly, 200 such restaurants have been protected and worse, instead of improving the system of food safety scrutiny, the Queensland council is contemplating shutting of the public register and instead introducing a mandatory board outside each restaurant with rating grades in order that the visitor instantly knows the cleanliness and hygiene standards. However, a research study conducted by New Zealand's food safety experts along with the government's food safety authority shows that visitors generally miss seeing the board and so the researchers have designed a special board which will not miss the eye of the visitor. For details: (ingentaconnect)
Among those penalised is an Indian restaurant too by the name of "Bombay Dhaba". The report states: "Bombay Dhaba, Shop 5, 220 Melbourne St, West End (relocated to Shop 2, 220 Melbourne St in May 2012)
"Action: Food licence cancelled January 2012. New licence issued 1 May 2012. Prosecution pending.
"Rat poison on bench tops, rodent faeces on shelving and flooring, rusting dishwasher racks, filthy floors and dirty dishes found during a council inspection in September, leading to the cancellation of the food licence. Photographs show green rat poison pellets on a food preparation bench, including close to a pair of tongs. Another business using the same name as Bombay Dhaba opened a short distance away on Melbourne St under a new licence last month after a fire in the old premises in January. A spokesman last week said the restaurant had a new premises and was under new ownership."
Other restaurants that have been prosecuted include Chinese as well as those serving European food.
The scenario in Pune
In 2010 and 2011, inspection of files under the RTI Act revealed that even posh restaurants, some of them five-star hotels, did not adhere to necessary food safety, kitchen and staff hygiene. Inspectors from the health department of the Pune Municipal Corporation (PMC) which conduct a bi-annual inspection (there are 11 inspectors for over 7,500 eateries), carry with them a form that is filled during an inspection. It contains a list of 29 items that the restaurant is expected to adhere to strictly under the BPMC (Bombay Provisional Municipal Corporation) Act.
Leading restaurants in various localities were given show cause-notices. Most shockingly, none of the restaurants (which were inspected) had conducted medical examination of their staff even once, let alone on a regular basis, which is mandatory for every restaurant. When asked, most of the restaurant managers had the audacity to say that they could not afford to spend on medical examination. This means that we could be eating food served by, or even prepared by someone who is suffering from skin disease or something worse including stomach infections.
What the PMC inspectors found:
What can we do?
Since laws are weak, we need to be very careful about eating out. Home food is best, but when tempted, be finicky. At least once a year, invoke the RTI Act on five of your favourite restaurants to check if they have been sent show-cause notices. Any other idea is welcome as the WHO's (World Health Organization) report is disturbing. Read this: "The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce food-borne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators.
Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. In India, it unarguably the worst and we must not forget that we pay through our nose even to bite into a 'dosa'.
(Vinita Deshmukh is the editor of Life 365 (www.life365.in). She is also the consulting editor of Moneylife, an RTI activist and convener of the Pune Metro Jagruti Abhiyaan. She is the recipient of prestigious awards like the Statesman Award for Rural Reporting which she won twice in 1998 and 2005 and the Chameli Devi Jain award for outstanding media person for her investigation series on Dow Chemicals. She co-authored the book "To The Last Bullet - The Inspiring Story of A Braveheart - Ashok Kamte" with Vinita Kamte. She can be reached at [email protected])
A strong move may have started. But wait for intraday corrections to buy. If the Nifty closes above 5,020 tomorrow we may see the index reaching 5,200
Hopes of a rate cut by the Reserve Bank of India (RBI) in its policy meeting later this month and strong global cues helped the market close higher for the third day in a row. Yesterday we had mentioned that if the market closes above the day's high, we may see a short rally. Today, the Nifty's intraday high of 5,010 was its best in the last six days (including today), but the index closed slightly below that level. Also, the benchmark recorded its highest percentage gain of 2.75% since 3 January 2012. If the Nifty manages to close above 5,020 tomorrow, we may see the index reaching the level of 5,200. The volume of 68.48 crore shares on the National Stock Exchange (NSE) was higher than its 10-day moving average.
The Indian market opened on a firm note on positive cues from across the world. Markets in the US closed higher on better-than-expected ISM data, which showed that the index for non-manufacturing business rose to 53.7 in May from 53.5 in the previous month. Reflecting the US sentiment, the Asian pack, with the exception of the Chinese benchmark, was up in morning trade. Asian markets were also supported by comments from the G7 leaders who agreed to synchronise their actions to the European debt crisis.
The Nifty opened 24 points higher at 4,887 and the Sensex added 79 points to its previous close to resume trade at 16,100. The opening figures on both the benchmarks were also their intraday lows.
Across-the-board buying led by banking, fast moving consumer goods and technology stocks helped the market move to a higher trajectory. Speculations that the Reserve Bank of India (RBI) would look at a rate cut on the back of easing of global crude prices also supported the gains.
Meanwhile, the rupee appreciated by 11 paise to 55.53 against the dollar in early trade, supported by a higher opening on the stock market amid selling of the greenback by exporters. The rupee had closed flat at 55.64 on Tuesday.
The benchmarks extended their gains in the noon session as the key European indices were in the green. The market hit its intraday high at around 3.00pm with the Nifty touching 5,010 and the Sensex climbing to 16,495.
The market pared a small portion of its gains and closed off the day's high. The Nifty added 134 points (2.75%) to settle at 4,997 and the Sensex jumped 434 points (2.71%) to finish at 16,454.
The advance-decline ratio on the NSE was in favour of the gainers at 1308:384.
Among the broader markets, the BSE Mid-cap index climbed 1.78% and the BSE Small-cap index advanced 1.78%.
Today's rally saw all sectoral gauges closing higher. BSE Auto (up 3.86%); BSE Capital Goods (up 3.63%); BSE Power (up 3.49%); BSE Bankex (up 3.01%) and BSE Fast Moving Consumer Goods (up 2.95%) were the top gainers.
Tata Motors (up 5.71%); Larsen & Toubro (up 4.77%); Jindal Steel (up 4.63%); Hero MotoCorp (up 4.29%) and Sterlite Industries (up 4.06%) led the Sensex today. There were no losers on the index.
The top gainers on the Nifty were Tata Motors (up 5.41%); Hero MotoCorp (up 5.08%); Jindal Steel (up 4.87%); Reliance Infrastructure (up 4.62%) and Ambuja Cements (up 4.59%). Cipla (down 0.34%); BPCL (down 0.26%) and Dr Reddy's Laboratories (down 0.21%) were the losers on the index.
Markets in Asia, with the exception of the Shanghai Composite, closed higher on global optimism. Better-than-expected services data from the US and assertion by G7 leaders on Tuesday that they would coordinate efforts to help countries like Spain and Greece ease their liquidity problems.
The Hang Seng climbed 1.43%: the Jakarta Composite jumped 3.32%: the KLSE Composite rose 0.58%; the Nikkei 225 surged 1.81%; the Straits Times advanced 1.79%; the KOSPI Composite gained 1.05% and the Taiwan Weighted closed 0.80% higher. Bucking the trend, the Shanghai Composite lost 0.10%.
At the time of writing, the key European indices were trading with gains of 1.38% to 2.03% and the US stock futures were in the green.
Back home, foreign institutional investors were net sellers of stocks totalling Rs680.86 crore on Tuesday while domestic institutional investors were net buyers of shares amounting to Rs794.65 crore.
Alstom T&D India today said it has bagged a contract worth Rs41 crore from Power Grid Corporation for setting up transmission network at Daltonganj in Jharkhand. The contract envisages supply, erection and commissioning of the substation. Alstom T&D surged 2.32% to close at Rs171.90 on the NSE.
Pharma major Dr Reddy's Laboratories has entered into a pact with Merck Serono, a division of Germany-based Merck KGaA, to co-develop biosimilar compounds. The tie-up will focus mainly on monoclonal antibodies in the oncology segment. The deal will also cover manufacturing and commercialisation of the compounds. The stock settled at Rs1,615 on the NSE, down 0.21% from its previous close.
Credit rating agency, CARE has assigned 'BBB' rating to Reliance Mediaworks' Rs45 crore Non-Convertible Debentures (NCD) programme, the rating agency has reaffirmed 'AAA(SO)' rating to the company's NCD programme worth Rs350 crore. The stock closed at Rs53 on the NSE, up 3.82% over its previous close.