FROM THE PRESS
Guidelines on investigating medical negligence
The Medical Council of
India (MCI) is formulating guidelines to investigate cases of medical
negligence. The decision has been taken in view of the Supreme Court (SC)
directive in a public interest litigation alleging lack of transparency and
proper mechanism on the part of the MCI in dealing with cases of medical
negligence. During the hearing of the case, the SC learned that there are no
formalised procedures for the investigation of medical negligence.
Jayashree Padmini.MCI drafts
investigation guidelines for professional misconduct.Express Health care and
Management,February 16–23, 2003
Doctors absconding in Nepal
Faced with the crisis of
personnel scarcity in the district health services, the Nepal government
initiated action against 50 doctors employed in these organisations. These
doctors are abroad, ostensibly for specialised training. ‘Doctors deputed to
various districts either take training or education leave and leave the country,
causing a scarcity of doctors in remote areas,’ said Mahendra Nath Aryal,
secretary at the ministry of health, explaining the ministry’s decision to take
stern action against these doctors. However, despite the ministry’s action, not
a single doctor who went abroad on government or other scholarship programme,
has shown any willingness to return. A few doctors have faxed their resignations
from their government jobs.
Perina Pathak.Govt takes action against erring doctors.
Kathmandu Post. www.nepalnews.com, February 25, 2003
Patient ‘dumping’ in Islamabad
Mahfeela Bibi from Islamabad, suffering from possible haemorrhagic fever, was
refused admission by the Rawalpindi General Hospital (RGH) and ‘dumped’ in the
casualty ward of the Pakistan Institute of Medical Sciences. Dr Asif Mehmood,
deputy executive director, was bitter about the way the patient was abandoned at
their casualty ward by the RGH staff. He said, ‘This is against medical ethics.’
official accuses RGH of violating medical ethics.Dawn, www.dawn.com
March 12, 2003
Discussion on government-fixed fees for doctors in
A discussion on doctors’
consultation fees was held between the Nepal Medical Association, Ministry of
Health, Association of Private Health Institutions in Nepal, medical experts,
consumer organisations, human rights organisations, journalists and lawyers. The
discussion followed the government’s new regulations fixing consultation fees.
As of December 2002,
doctors’ consultation fees were fixed at between Rs 75 and Rs 275, depending on
whether they are MBBS, postgraduates, diploma holders, postgraduate MD or MS
degree holders, and superspecialists. Follow-up visits within 10 days should be
free of charge and later visits for the same health problem are charged at 50
per cent of the initial fee. There have been reports that the new regulations
are not being followed.
quasi-hearing on doctors’ consultation fee.Kathmandu Post,
www.nepalnews.com,March 29, 2003
HIV and discrimination by doctors
The Lawyers’ Collective,
an Indian legal cell working in the field of AIDS/HIV, has filed a petition on
behalf of the Delhi Network of Positive People against the discrimination
HIV-infected AIDS patients face at the hands of the medical community. AIDS
workers point out that patients are discriminated against both directly and
indirectly. Direct discrimination is when hospitals refuse to admit such
patients; indirect bias is when a person is given a bed in a hospital but is not
treated after that.
Experts say that one of
the reasons for discrimination at health care centres is that medical personnel
in India are not equipped with the basic precautionary gear needed to protect
themselves against infection.
HIV-positive patients move court against uncaring health care system.
southasia.oneworld.net, May 28, 2003
Banned abroad but not in India
The recent death of a
two-year-old boy after being given an anti-nausea injection has once again
brought into focus the use of banned drugs in India, unethical medical practices
and the lax drug control system. Since 1995, metoclopramide—sold under the brand
names Perinorm and Reglan—is globally prohibited for use in people below 20
years of age. However, in India it can be given to newborns. Two-year-old Akash
died within hours of being given the drug. He reportedly died of acute dystonic
reaction, a side-effect of metoclopramide known to occur predominantly in
children and adolescents. The literature provided with Perinorm recommends its
use for nausea and vomiting for all age groups, whereas Reglan does not give any
information about its side-effects.
Toufiq Rashid.Use of banned drug leads to
death of a toddler now.TheIndian Express,June 3,
Class action suit against Bayer
A class action suit has
been filed against Bayer and three other companies for distributing contaminated
blood products in Asia and Latin America after they were withdrawn from the US.
Thousands of people with haemophilia contracted HIV infection or hepatitis C
through tainted blood products supplied by the companies. In a statement Bayer
said: ‘Bayer complied with all regulations in force in the relevant countries
based on the amount of scientific evidence available at that time.’
Deborah Josefson.Haemophilia patients launch action
against Bayer over contaminated blood products.BMJ,June 14,
Unapproved drugs available in India
The Indian government
admitted that drug formulations unapproved by India’s drug regulatory agency and
not evaluated for effectiveness are prescribed and sold across the country. The
government made this statement at a court hearing on a public interest
litigation challenging the use of the non-steroidal anti-inflammatory drug
nimesulide in children, and unapproved combinations of nimesulide and other
drugs for adults.
The drugs controller
justified his decision to allow the use of nimesulide in children with
statements from the Indian Academy of Paediatrics and personal opinions of
several practising doctors that there was no justification for imposing a ban on
the drug. Paediatricians, however, allege that medical opinion is
being influenced by drug companies. Only Italy, India and Brazil allow the use
of nimesulide in children.
G Mudur.India admits to unapproved drug formulations in
market.BMJ,June 14, 2003
Hospital refused care because she was HIV positive
A woman in labour,
suspected of being HIV positive, was turned away by several hospitals and
nursing homes before she gave birth
to a child in a government hospital in Rourkela. She was taken to the Ispat
General Hospital, the Vesaj Patel Hospital and a few nursing homes where she was
turned away, her relatives said. A press release from the Vesaj Patel Hospital
said that the woman had undergone an ELISA test and was found to be HIV
positive. ‘We thought that it would be better if she went to the Ispat General
Hospital which has an AIDS cell and other required infrastructure to ensure the
safety of the patient,’ it said. The Ispat General Hospital also refused
admission to the woman.
Hospitals turn away HIV-positive woman in labour.The Hindu, August 3,
Private medical colleges—part 1...
The Association of
Andhra Pradesh Private Medical Colleges has asked the government to reserve 50%
of the total medical seats in the private sector as management quota with fees
of Rs 5 lakh per annum. At present, there is a three-tier annual fee
structure in private colleges—‘free’ seats for Rs 15,000, payment seats for Rs
90,000 and NRI seats for US$ 10,000 (around Rs 5 lakh). Of these, the last
category constituting 15% of the seats, is left to the management. Ajay Kumar,
president of the Association, said a study found that colleges incurred an
expenditure of Rs 3.18 lakh per student annually.
correspondent. Private medical colleges in AP want annual fees of Rs 5 lakh.
Pharmabix Hospital Review, June 1–15, 2003
Private medical colleges—part 2
The Medical Council of
India has decided to accord permission for three more medical colleges in Andhra
Pradesh, adding 450 seats to the 2,975 already available through 21 medical
colleges, including 10 government colleges, in the state. Of these, 1,100 seats
are in the private colleges.
correspondent. Three more colleges given permission.Pharmabix Hospital
Review, June 1–15, 2003
Negligent doctors—part 1…
Rajnis Patel of Bhawanipore, West Bengal, was admitted with a shin-bone fracture
at the state SSKM Hospital. He died four months later after five botched
operations, the first two reportedly carried out by postgraduate trainees.
Following a police complaint, a three-member committee found prima facieevidence of negligence on the part of Dr Majumdar, a senior doctor who led
the team of attending doctors. The West Bengal government suspended Dr Majumdar.
Rajnis’ family said that the doctors hardly attended to the teenager.
Sabysachi Bandopadhyay.Govt acts after teenager dies due to
botched-up surgeries.The Indian Express, June 7, 2003
Why did the transplant donor die?
Subhash D donated part
of his liver to be transplanted into Srikant Nahata but died 10 days after the
trans-plant. Apollo Hospitals, Delhi, apparently did not feel the need to
conduct a post-mortem even though death is extremely rare in the case of a donor
in a liver transplant. Anupam Sibal, director medical services, Apollo
Hospitals, said, ‘We did not conduct a post-mortem because there was no doubt in
our minds as to why the donor died. If there was something wrong with the
operation he would have died right away, not 10 days after the transplant.’
Subhash was found to be
medically fit to be a donor. The Authorisation Committee concluded that the
donation was a voluntary one and not a commercial transaction. Mr Sibal claimed
that Subhash was Mr Nahata’s cousin but was unable to elaborate on the details
of this relationship.
Sachin Parashar.Date of
liver donor’s death shrouded in mystery.The Times of India, July 12,
Negligent doctors—part 2
Three doctors of a South
Delhi hospital were sentenced to 14 days’ judicial custody by the metropolitan
magistrate after a patient died due to their negligence.
On September 15, 2002,
Vikramjit Singh was admitted to the Bhagat Nursing Home in Safdarjung Enclave
for surgical treatment of a sinus. He was taken to the operation theatre by Dr
Monica Bhagat, a gynaecologist, and given anaesthesia by Dr Chawla, a surgeon,
and Dr Chandra Prabhakar. After about two hours, the doctors informed the
patient’s father that Vikramjit had suffered a cardiac arrest as a reaction to
the anaesthetic. He was shifted to another hospital and died the same evening.
Dr Bhagat was charged
with running a private nursing home without being registered with the
Directorate of Health Services. Drs Prabhakar and Chawla were accused of
operating without making proper arrangements for a cardiologist and life-support
systems such as a ventilator. The Medical Council of India suspended Dr
Prabhakar’s license to practise for six months and directed Dr Bhagat to stop
all patient activities in Bhagat Nursing Home until it was registered with the
Directorate. Meanwhile, a case under section 304 of the Indian Penal Code for
culpable homicide not amounting to murder was registered against the three
doctors for which they have been put behind
Vidya Krishnan.Three doctors sent to Tihar for negligence.
18-year-old dies after sinus operation.The Pioneer, August 2,
Treatment for AIDS patients
The Supreme Court issued
notices to the centre, states, the National AIDS Control Organisation and union
territories in response to a public interest petition alleging that AIDS
patients were not given treatment in government hospitals. The petition was
filed by the Voluntary Health Association of Punjab. It sought a direction
to the government to recognise and implement the right of AIDS patients to
treatment and health as their fundamental right and provide free and equitable
access to anti-retroviral treatment to HIV-positive
Rakesh Bhatnagar.SC notice to govt for treatment to AIDS
patients.Times News Network, August 4, 2003
Children don’t get life-saving surgery
Some 9000 children are
born every year in Tamil Nadu with heart defects that need surgery. Barely 10
per cent of them get it, according to K R Balakrishnan, head of cardiothoracic
surgery at the Sri Ramachandra Medical College. Many die before their parents
can raise the funds. Girls with heart problems are less likely to get treatment.
There is a shortage of paediatric cardiac surgeons because adult cardiology is
much more lucrative.
Feroze Ahmed.Parents have the heart to let them die.
Hindu Online, August 18, 2003
Ethics review boards in developing countries
Leading ethicists called
for the establishment of effective national and institutional ethics review
committees in developing countries to protect biomedical research
participants from any possible harm or exploitation. They were speaking at the
Second Symposium on Ethical Issues in Health Research in Developing Countries
held in Karachi, Pakistan, from August 14 to 18, 2003. The ethicists also
recommended the same standard of care and treatment for individuals
participating in externally funded clinical trials in developing countries as
would be provided to participants in the country funding the study.
Khabir Ahmad.Developing countries need effective
ethics review committees.Lancet,August 23, 2003
No charity, no tax exemption
Refusing to believe that
private trust hospitals were doing sufficient charity work to warrant state
concessions, the Municipal Corporation of Mumbai identified 22 hospitals and
withdrew the octroi tax exemption on imported surgical equipment and life-saving
drugs. Among those blacklisted are Lilavati Hospital, Bombay Hospital,
Breach Candy, Jaslok, Nanavati and Hinduja. Trust hospitals registered with
the charity commissioner are exempted from octroi duty and income tax. In
return, they are expected to provide free treatment to 10% of their patients.
The hospitals were unable to produce evidence of doing charity
The trust hospitals have
challenged the circular in the Bombay High Court. ‘We regularly submit returns
of free or concessional treatment to poor patients to the charity commissioner,’
said M L Bhakta, president of the Association of Hospitals.
Kaajal Wallia.Hospitals get charity check.The Times of
India, August 30, 2003
Agreement on cheap generic drugs
The World Trade
Organization reached an agreement that allows developing countries stricken with
HIV/AIDS, tuberculosis and malaria to import cheap generic drugs.
The agreement waived the
rule that production of cheap generic drugs without the consent of the patent
holder—so-called compulsory licensing—must be primarily for the domestic market.
This rule had effectively prevented developing countries without their own
manufacturing capacity, such as India, from importing cut-price drugs from
generic producers. The statement also called for special measures, such as
distinctive packaging and different coloured tablets, to prevent drugs being
smuggled back to rich country markets. Middle-income nations such as Mexico,
Hong Kong and South Korea, promised they would resort to the patent waiver only
in times of national emergency. However, Médecins Sans Frontières and Oxfam
criticised the accord, saying it would do little to cut the price of essential
Clare Kapp.World Trade Organization reaches agreement on
generic medicines.Lancet, September 6, 2003