Thursday, June 7, 2012

Reply from the doctor accused by Aamir Khan in Satya Meva Jayate

There was a lot of buzz on the site after the article about Aamir Khan and Satya Meva Jayate. Thanks for all your comments and insights. If there are so many people who think like this, I must recant my words of hopelessness. Change is possible if just a few good men and women begin it and work for it. Maybe we can stem the rot and rebuild the standing of our profession. Thanks again and do keep the ideas and comments coming.

In the programme that Sunday, there was a long segment on a gentleman who accused a nephrologist and transplant surgeon of a multitude of crimes which led to the death of his wife. At the time, I did feel that this level of malpractice could not happen in the strictly monitored field of transplant surgery and hence did not mention it in the previous post. Dr. Jeevan Kuruvilla, a dear friend who works in my old hospital in Jharkhand (whose excellent blog you can access here) forwarded me this letter which is supposedly from the nephrologist who was accused in the programme. And here is a news articles that substantiates what he has written in the letter with the concerned documents (see bottom of the article)

My e-mail to Aamir Khan is noted below:
Respected Aamir Khan Ji

I watched with shock and despair the Satyamev Jayate program of May 27,
2012. I am responding since you referred to me although you do not know me.
I am the Nephrologist that you referred to while conversing with Mr. Rai.
Mr. Rai has been making false and fabricated allegations for the past 2
years. While talking to you, in addition to providing you with false
information, he also withheld crucial facts.Over the past 2 years, Mr. Rai
has been harassing the Transplant surgeon and myself (Nephrologist) and the
Hospital by filing multiple and concurrent complaints at various fora
whether or not they have any role on his complaints. With his
manipulations, he has succeeded to a great extent in bringing to a
standstill transplant surgeries at the the Hospital which has caused a
great deal of hardship to several patients. In addition, he has also caused
immense damage to the noble field of cadaver transplantation in Karnataka
State.Once you are aware of the actual facts, I have no doubt that you will
express regret for having given platform to a sophisticated lier with
immense theatrical and manipulative skills.Here are some facts that shed
light on the truth.

1. Mr. Rai never informed you that Mrs. Seema Rai underwent cadaver donor
transplantation and was registered for a cadaver transplantation more than
one year prior to surgery. The phone call on the night of admission was
made because a suitable cadaver donor had been identified by ZCCK
(Government body that allocates cadaver organs) and not by the doctors or
the Hospital. Cadaver transplantation has to be done emergently, otherwise
the organ(s) will decay within hours and become useless. That is why the
patient was admitted on Saturday night (1 May 2010). The patient and her
family were all informed about risks and benefits of transplantation for
more than 2 years (since June 2008). In fact, whenever the patient
consulted me she was eager to get kidney transplant so that she could stop
the misery of undergoing dialysis. You can ask any dialysis patient, they
will inform that they do not want dialysis but prefer transplantation.

2. Mr. Rai, Mrs. Rai and Abha Rai all were again counseled for more than 1
hour on the night of admission about kidney and pancreas transplantation.
Subsequently they also discussed with their relative in New York. Then on
the night of 1 May itself Mr. Rai personally informed me and other doctors
to proceed with kidney + pancreas transplantation. The Informed Consent
form was signed on the night of 1 May itself and handed over the ward
doctor. These facts have been documented by the nurse as well as the ward
resident doctor. The State Medical Council as well as the National Law
School of India have investigated the Informed Consent issue and clearly
stated that Informed Consent was indeed taken prior to surgery. In fact, if
the Informed Consent was not given on the night of 1 May, the cadaver organ
would have been allocated to the next patient on the waiting list for
cadaver transplantation who was also admitted to another Hospital on the
same night for possible transplant surgery. (Whenever a cadaver donor is
available, several patients on the waiting list such as Seema Rai are
called and advised to get admitted so that the cadaver organ does not get
wasted in case one or more patients are found to be unfit or do not want
surgery.) If Mrs. Rai and her family had not consented for the surgery on
the night of 1 May, then a surgeon from another Hospital would have
proceeded to retrieve the cadaver organ on the night of 1 May. The surgeon
from our hospital would have gone home. The very fact that our surgeon
traveled on the midnight hours of Saturday to the donor Hospital and
brought back the cadaver organs by about 5.30 AM on a Sunday morning
suggests that the patient and family indeed had agreed for the surgery.

3. Mr. Rai also concealed from you the fact that he had telephoned the
Nephrologist several times on the night of 1 May to seek help to arrange
for a special medicine (Simulect) that was to be given to the patient in
the Operating Theater before the transplant procedure. The Nephrologist had
personally called the Pharmaceutical company on Saturday night to help Mr.
Rai to procure the medicine. The Nephrologist had given personal surety to
the Company since Mr. Rai told him that he did not have cash to purchase
the medicine in the middle of the night. In fact, Mr. Rai procured the
medicine at about 7.30 AM on 2 May (Sunday) and handed the same to the
Operating theater staff. If the patient and Mr. Rai had not consented for
the surgery, why would he purchase the medicine and hand it over to the
Hospital staff?

3. Mr. Rai never asked the doctors or any other Hospital staff not to
proceed with the surgery at any time. He was plainly lying when he made a
statement to that effect to you. If in fact, the patient and her family had
not consented for the surgery, that would have been Mr. Rai's first and
major complaint when he filed an FIR with the police on 30 May 2010
accusing the doctors of murder. In his initial complaint to the police as
well as to the State Medical Council, Mr. Rai never complained that he or
the patient had not consented for the surgery. This fabricated allegation
is clearly an afterthought on Mr. Rai's part.
4. The patient did not receive 119 units of blood, i.e., 60 liters of
blood.  She received 33 units of blood over 4 days which is about 13 liters
of blood since she had developed a massive bleeding condition called
Disseminated Intravascular Coagulation (DIC). She also received platelets,
FFP and other blood products to correct DIC. The doctors never told Mr. Rai
and his family that 390 cc of blood would be required. No doctor can
predict the exact amount of blood loss in a given patient who undergoes
surgery. Besides, the large requirement of blood in this patient was due to
the fact she developed a medical complication called DIC which can happen
after any major surgery or major trauma. Normally in transplant surgeries,
we do not transfuse any blood at all.

5. The transplant surgeon is highly qualified to conduct pancreatic
transplantation as well as kidney transplantation. He is trained at well
known Hospitals in the United States where he had conducted numerous
multi-organ transplantation surgeries. All relevant documents were reviewed
by the Health Department before the Hospital was granted registration for
multi-organ transplant surgeries in March 2010.

6. Mr. Rai was again lying when he stated that the doctors had switched off
their phone on 6 May after the patient's death. In fact, Mr. Rai spoke to
the doctors several times after the patient's death. This can be easily
verified by looking at Mr. Rai's phone records.

7. The Hospital was registered for multi-organ transplantation. There was a
clerical error in the Certificate which was acknowledged by the Health
Department. The Health Department have clearly stated in their report that
registration for liver includes pancreas as well (since the skill required
for transplantation of both these organs is one and the same).

8. Mr. Rai also withheld from you that the Karnataka Medical Council has
thoroughly investigated the case and found no evidence of any negligence on
the part of the doctors.

9. Mr. Rai also withheld the fact the Hospital bill was not for the surgery
alone. Most of the cost was due the use of blood and blood products and
other medicines which was necessitated by the development of DIC and
infection. If the patient had not developed DIC, the bill for a transplant
surgery would have been about Rs. 3.5 lakhs. In fact, there was no
additional charge for pancreas at all. Whether the patient received cadaver
kidney or cadaver kidney + pancreas, the bill would have been the same.
There was absolutely no financial motive in recommending the combined
surgery. The surgeon recommended combined surgery because diabetic kidney
failure patients do much better with combined cadaver kidney + pancreas
surgery than cadaver kidney transplant alone. This has been well
established in the medical literature. The surgeon made the recommendation
with the best interest of the patient in mind. Even todate Mr. Rai has not
produced any scientific evidence or professional opinion to contradict the
recommendation of the transplant surgeon. All transplant specialists who
have reviewed the case (from AIIMS-New Delhi, PGI-Chandigarh, Chennai,
Bangalore, and USA) have unanimously opined that the patient received the
best possible treatment and that her death, although very unfortunate, was
not due to any negligence on the part of the doctors or the Hospital.

10. Mr. Rai also did not inform you on the Air that he has filed a
complaint with the Consumer Forum seeking compensation of Rs.
84,55,933/-.  I am sure Mr. Rai has used his theatrical skills to convince
you and your team about his false allegations. I am also confident that you
will realize the lapse your research team has done once all the facts
become apparent. I am enclosing a detailed Medical History as well and
other documents that shed light on true facts.After my medical college, I
studied and then worked in the United States for nearly 16 years. I came
back with a dream to serve my countrymen. However, now after going through
the mental trauma caused by a reckless individual who is inadvertently
abetted by a corrupt officialdom and a thoughtless media, I am beginning to
wonder if I made a mistake in returning to India. Perhaps, I should also go
back to the United States like the doctor that you showed in the opening
sequence of your program who returned to the UK because of the corrupt
system in India.

I invite you and your team to visit the Hospital, meet other patients who
have undergone/undergoing dialysis, patients who have had transplant
surgery, and meet the Transplant surgeon so that you can clarify all the
facts for yourself.Please do not hesitate to contact me if you need any

-Dr. R. Sreedhara


  1. First of all AJM, it's good to see you back. I had almost given up on you ever returning to active blogging and I hope this isn't just a sojourn in blogdom.

    Reading your last two posts together today, I was just about to reply to the first one when I read this, which exemplifies what I was about to say. I watched the much maligned episode of SMJ and while I agree with much of what Aamir had to say about current medical practice in India, I have an issue with the way he went about things.

    First of all, there are two sides to every story - as you have so very responsibly demonstrated above. Providing just one side with a public platform in a so called 'open forum' is frightfully unjust. One can say just about anything when there is no opposition to the argument. Whatever happened to the tenet 'Innocent until proven guilty'? Not that I'm suggesting any of the doctors presented are innocent, just that they haven't been given the same opportunity as the accusers to prove their innocence or to justify their actions. Being a surgeon yourself, you should be able to understand that God forbid, one day you might find yourself in the unfortunate position where in spite of your best intentions, a procedure does not go according to plan and a patient dies on the table. If a misguided family member takes it upon himself to blame you for the calamity and goes on national television proclaiming the same, would you not want to be given the chance to put your view across? Would you like to be pronounced guilty just because Aamir Khan says you are? A single telecast could mean the end of a career, even if there is no truth to the matter.

    The people of India love a sob story. If it involves someone successful ripping off a less fortunate individual, so much the better - they will lap it up. I could create a fictitious email about a cruel, money minded doctor swindling a poor man of his hard earned money and send it to 10 people and within a week, it would have gone viral. You will find the story being mentioned on blogs, Facebook and on Twitter. After all we are the land of burning effigies, chappal and rock throwing, self immolation and public lynching.

    I believe Aamir was right in raising the issue of corrupt doctors. However, what he achieved was to instigate mistrust in a profession that does not necessarily tolerate it. In the increasingly expensive field of healthcare, patients wanting second and third opinions and doctors wanting more investigations to protect themselves from accusations of negligence leads to a self propagating vicious cycle that has only one loser - the patient. Either way, it means more money in the doctors' pocket and less in the patient's.

    The problem is that he has raised several questions but provided no solutions. Rabble rousing speeches and fake tears do not improve society. The MCI is a toothless organisation with its own internal problems (or it does not want to use its teeth - take your pick). Judging by the body language of Dr. KK Talwar, I do not think anything is going to come of his promises for change. We need some glasnost of our own.

    It is almost universal for doctors to take cutbacks for investigations and incentives from drug companies. The government needs to go after the people providing these 'cuts'. Cut off the money at the source and make an example of a few doctors and the rest will fall into line. Right now, what is happening is not illegal, just immoral. The law needs to make a stand since appealing to doctors' morality does not appear to do any good. The argument that doctors need to make up the money spent on their medical seats does not pass muster. If money has to be made, by all means, do so but do it by legal and ethical means.

    Continued in the next post...

    - The Black Mamba

  2. .....continued from previous post

    Like many of the social problems that beset our country, is there really a solution? We need change and we need it now! To quote the lyrics of one of your favourite songs:

    "Take me to the magic of the moment
    On a glory night
    Where the children of tomorrow dream away
    In the wind of change"

    - The Black Mamba

  3. This comment has been removed by the author.

  4. Hey old friend! Good to have you back too - thought you had forgotten this tiny little spot on the www! And I must say that I do agree with most of what you said. I think now that we have more data on the doctor, the truth may actually not be on Aamir's side - he should have got both sides of the story. Having said that, he did try to bring in some solutions - government funded insurance (Dr. Devi Shetty), generic drugs (though I am not in complete agreement about this), more number of government colleges and so on.

    But the main take home message for me was a wake-up call to our profession - like we said glasnost is necessary and it has to start from me.

    As for Winds of change - I have another clue and I now ask - does your pseudonym have anything to do with your looks?!!

  5. Hmmm.... 'Black' could refer to the colour of my heart, my Afro-Caribbean ancestry, the black hole that I live in or the dinner plate sized mole I have bang in the centre of my face.

    'Mamba' cold be pointing out my serpentine visage (rather Voldemort like, if I say so myself), my personality, my being a parselmouth, my forked tongue, my cold-bloodedness or the tough scales on the back of my neck.

    And I guess either of those terms could refer to my warped sense of humour!

    - The Black Mamba

  6. Hey TBM. This sounds like the riddling game between Bilbo and the dragon in 'The Hobbit'. Remember the dragon won in the end. And btw, do the first two letters of your name have some colorectal significance?!!

  7. Well AJM, the aim of the game is for you to find out who I am in the end. It would be a dang shame if you went to your grave with your last emotion being regret that you never did discover who the Black Mamba really was. I'm kind of a Clark Kent/Bruce Wayne/Peter Parker character. Btw, I look much more like a dragon than your sweet, cherubic, angelic face - I'm the reptile, remember?

    Hmm, colorectal huh? You mean something like UC, CD, RC, Ca, IBD, FAP or HNPCC? Nah! But I'm sure you got something from my answer because I chose to give it to you. Also remember that I'm a seasoned liar with absolutely no commitment to honesty, so take what I say with a generous pinch of salt. On second thought, a bucketload of salt would be more appropriate.

    My love to Amy.

    - The Black Mamba

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