How AMRI, Kolkata treats patients

I had mentioned earlier of one site http://pbtindia.com/ which high lights corruption in the medical profession.It also invites mails from patients and their relatives who have been at the receiving end of such negligence.
The following complaint is one such complaint sent to PBT by one Mr. Jana.
I would like to request all our readers in India to report any such negligence, direct to PBT


To
The Registrar,
West Bengal Medical Council,
8, Lyons Range, 3rd Floor, Mitra Building,
Kol-700001, West Bengal.
Tel : (091)(033)2231-5662,2213-7679
E-mail : wbmc@vsnl.net

Ref. No.- 2461-C/73-2010 dated 27/10/2010

Sir,
Please refer to the above, We Sri Vivekananda Jana and Srimati Alomoni Singh (Jana), the parents of Asmita Jana, a six month old female child , like to bring your kind notice the detailed case history of the course of treatment undergone by our child for a period of about 26 days at AMRI Hospital, Dhakuria, kolkata.

Our child initially started suffering from fever during the middle of September 2010, when she was at East Midnapure and was taken to local doctor (Dr. Sujan Jana, Pead Medicine of Haldia S.D Hospital, On 18/09/2010m at 12p.m) for treatment. The local doctor suspected it as a case of septicemia as the Childs CRP was high (72mg/L) total count normal (8300/cmm.) and advised to take XONE XP KID (IV) and AMITAX – 50mg.from 18/09/2010. But when she did not respond, we took her to Kolkata immediately on 21/09/2010 and consulted Dr. Avijit Dutta (attached with R.G.Kar Medical College, Kolkata). He attended our baby and advised that it was a case of Meningitis and advised immediate hospitalization of the child.

We took our baby to REPOSE NURSING HOME and admitted her (on 21/09/2010 at 8 p.m.) under Dr.Apurba Ghosh & Dr. J Chowdhury. On the basis of Dr. Ghosh’s advice over telephone her initial treatment was started with MEROPENAM, ZENOCIN and GURDINAL as her total count was very high and she was in convulsion. Next day (22/10/10) Dr. Apurba Ghosh attended the patient at about 9 a.m and advised us for immediate transfer to any hospital with adequate set up for treatment of our baby.

It may be mentioned that though patient’s father is a high school teacher and a non medical person, her mother is a trained nurse attached to R.G.Kar.Medical College and Hospital and she had an erstwhile attachment with AMRI,Dhakuria and as advised, we transferred our baby to AMRI, Dhakuria (IP NO: IPC2.0030139, UHID: AMRD.0000188821,Bed No: 1376A) and she was taken in NICU at about 10 am on 22/09/2010 under Dr. Jemsy Jain. From 23/09/2010 she was kept under ventilation and her condition was serious till 25/09/2010. Her total count was 47800 on 25/09/10. She was treated with MEROPENAM, VANCOMYCIN, FLUCONAZOLE and PENTAGLOBULIN. The patient was reportedly responded to the course of treatment on 26/09/2010 and her total count came down to 20900 on 28/09/2010.


On 27/09/10, a central channel was prepared on her left femoral vein by Dr. Subhasish Saha, Pediatric surgeon to give her medicine, which took around three hours and ended up with a kind of unnatural stir in the attending group of medical staffs. After 36 hours of channel preparation, it was noticed by the baby’s mother, that flow of blood in the lower left limb of the baby was gradually reducing and a reddish patch appeared on the left limb which was also noticed as well as pointed out by her mother (being an experienced Nurse at Govt. Medical College). On being asked about the patch, attending doctors assured us that it has happened due to leakage of Caicium fluids and curable by hot compress.

Though we noticed that the lower portion of our baby’s left limb was getting defaced and discolored, it was surprising to note that neither any medical attendant nor the visiting doctor pay much attention to the fact and reassured us not to be worried. Whilel we were repeatedly pointing out our concern over the fact, Dr.Saha, suddenly communicated us on 02/10/2010 at about 4 p.m, and advised us through attending RMO Dr.Suvayu Dutta that FASCIOTOMY was immediately needed to restore blood supply of her left limb and advised for surgery under G.A.

As the baby was under ventilation, we helplessly signed on risk bond (specially written by Dr. Suvayu Dutta) for another operation (experiment?) with little hope of betterment of child.

The operation was done by Dr. Subhasish Saha and was assisted by Dr. Gunadhar Jana on 02/10/10 at about 10:30 p.m. and took more than one hour. After the operation Dr. Subhasish Saha categorically told us that they have examined in detail and the patient’s left limb was improving both in color and softness. Hence they did not do any operation on limb, but prepared a central channel through jugular vein.

In the very next morning, i.e. on 03/10/10, the baby was again taken to O.T. for preparation of channel as the channel previously prepared was reportedly blocked due to unfiltered blood given at the night of 2nd Oct, 2010.

On 5th Oct, 10 she was taken out of ventilation. Though we felt that the left limb was gradually becoming discolored and dried just below the knee forming a ‘ring’ with ‘reddish’ to ‘blackish’ patches, but Dr. Saha told us that the patient’s limb was improving. No doubt, he has lacking confidence and after that he has avoiding our face to face consultation.

Unfortunately, these sort of statements & assurances were delivered to us to hide the actual medical condition of our child, specially in regard to her left lower limb, and to suppress & shield the negligence in the part of Dr.Saha, the attending medical team (RMOs) and the Hospital, itself as became evident from the next course of so called “treatment’ received by our daughter in the next few days with a ‘dramatic u-turn’ from their stated position.
On the morning of 6th Oct,10 the patient’s attending doctor Mrs.Jemsy Jain went out of station for five days for reason best known to her leaving such a critical patient, a two month old baby , at the hand of Dr. Runa Majumder who acted just like a helpless ‘care-taker’.

In the evening of the same day, 6th Oct, Dr. Anirban Chatterjee did DOPPLER TEST and gave the verdict that her left limb should be amputated immediately as there was no blood circulation on left femoral artery below knee joint.

This verdict, we think, is a pre- decided one and conveyed/declared in the absence of Dr .Jain and Dr. Saha.

However, being helpless, we requested the hospital authority to arrange for consultation with renowned micro vascular and plastic surgeon Dr. Anupam Golas,Dr. Soumen Mitra, Dr.Manish Mukul Ghosh, Dr. Seshadri(of Apollo), Dr. Debasish Banerjee(of AMRI). The said doctors visited the baby and there was difference of opinion amongst them.

The attending doctors of AMRI decided to follow the opinion of Dr. S Mitra and Dr. M.M .Ghosh who opined not to amputate immediately but to wait and watch.

A special meeting was held with us on 08/10/10 in presence of Dr.Saha & Dr.Mitra apparently more to defend Dr.Saha than to address the planning of future course of treatment. It was pleaded that it was not a mistake, rather an accident which may have occurred because of certain other reason not associated with the surgery done by Dr. S. Saha. (How they became confirmed?) Then we were advised by the hospital authority (Dr. Suman Ghosh, Medical vice president) to shift our baby to either Salt Lake AMRI or Apolo hospital as reportedly they are lacking NICU facility for such an infant patient and admitted that they shouldn’t have admit our baby as they were not having any PICU at Dhakuria AMRI. This, in our opinion, was simple to shrug out responsibilities and to avoid further trouble. We were not in a mental state to ask them even, if adequate facilities were not there to treat our child why they admitted or if so, why they didn’t advise us to shift our baby earlier? When we expressed our helplessness and asked about the financial implication ( as that time already we expended a major amount towards the treatment), Dr. Suman Ghosh, AMRI Med Superintendent/VP assured us not to worry and being on back foot, advised us to write an application addressing to him, so that he can minimize the hospital expenses by awarding a special discount on the total bill on discharge.

As advised we helplessly decided to shift our baby to Salt Lake AMRI (for better co-ordination between AMRI Dhakuria & AMRI Salt Lake, being under same management) and requested Dr. Suman Ghosh to make necessary arrangement for shifting. During the meeting one of the lady RMO tried to establish that there was same type of black color spot like left limb on the right leg which was seconded by Dr.Mitra & others, that it can happen to any part of the body, although baby’s mother did not see anything while she checked the same in presence of RMOs just after the meeting. In the evening attending RMO dramatically told us that they took proper care (giving Heparin) at right time and they could save the Right Leg. (Annex – D).

But at the end of the day, they decided not to shift the baby because there was lack of doctors in Salt Lake AMRI due to ensuing Durga Puja vacation.
Dr. M.M .Ghosh, the visiting surgeon, visited our baby again on 9th, Oct and told us that amputation would be done after Durga Puja. It is worthwhile to mention that during this period our baby didn’t receive any specific restoration treatment for her left limb and we had no other way than to wait for Dr. Jemsy Jain (the attending Doctor, under whose care the baby was admitted) as neither the care-taking attending doctor Mrs.(Dr.) Runa Majumder nor any of the RMOs could offer any positive solution/advice.

In the mean time, we decided to shift our baby to C.M.C vellore. Dr. Jemsy Jain returned on 11th Oct. Monday, We requested her to make our baby ready (out of ventilation) so that we can transfer her to Vellore safely. It took 3-4 days to prepare the baby. From 9th to 16th Oct. no treatment of leg was done. At last, on 16th our baby got discharge and we set off to catch flight to CMC Vellore straight from AMRI.Dhakuria on 16th Oct by Jet Airways 9W-844 Sat, 16 Oct 2010, 10:30 hrs.

Inconsistency of decisions, delay or wait and watch policy of the doctors for taking up the case of amputation and also the comment of Dr. Subhasish Saha that the portion of the limb with dry gangrene may automatically be detached in course of time if we wait etc. Annex-D led us to apprehend that the case was being dragged towards unfortunate fatal end and as such the patient was transferred to CMC, Vellore on 16th Octber, 2010.

The CMC received the patient with Meningitis, Pneumonia, and dry gangrene on the left lower limb. They underwent some preoperational tests and amputation was done on 19/10/2010. The discharge reports are enclosed as Annexure –C.

During the treatment at CMC Vellore also, we got various inputs during consultation / conversation (may be those are not documented), which strengthen our belief about the misdeed of Dr. Subhasish Saha at AMRI, Dhakuria.

Nevertheless to mention here that even after the ‘act of negligence’ in the part of Dr. Subhasish Saha, if our baby be properly treated and / or had we been rightly mentioned about the medical condition of our baby and given early chances to shift the baby and to provide restorative treatment, our baby wouldn’t have lost her limb for ever.

The treatment summary given by AMRI hospital, Dhakuria enclosed herewith may please be perused. We would request you to kindly see underlined/highlighted portion of Para (1) and (3) of said summary wherein you will see that no remarkable symptom of meningitis and pneumonia were detected.

In Para (4) leg gangrene, you will see that there was a failed attempts at Right femoral vein insertion so that Paed. Surgeons had inserted a Left femoral vein line after a cut down. We think another experiment was done on our baby. The effect of which they have stated in the report “unfortunately the leg started getting cold and after 36 hours there was reddish discoloration of the (L) lower limb with ischemic changes of few toes. The line was immediately removed and it was thought that this was due to leakage of Ca containing fluids leading to spasm of the femoral artery”. Once again, we see the lack of confidence of a doctor.

We would request you to kindly see the reports and, we think, you will have the same opinion with us that series of experiment/tests have been undertaken without confidence leading the patient towards fatality of amputation of leg. We think that the ailment /disease, with which the patient came, cannot be sufficiently reason for amputation of leg of the patient. Rather, we are confirmed that due to wrong channel preparation, blockage of channel, stoppage of blood circulation etc., dry gangrene was formed on left lower limb of our baby and ultimately she became the victim of wrong treatment, improper medical care, indecision of doctors and she had to lose her left limb below the knee forever and she will be PHYSICALLY HCHALLENGED for the rest of her life for no fault of her.

On the sorrowful state of affairs as stated in the foregoing paragraphs, we the parents of Asmita Jana pray to you to kindly find out the lapses caused by medical persons and/or organization looking after the case at any stage or point of time and arrange for exemplary punishment to the faulty person/organization.

N.B: Points of negligence as we have experienced during our stay with the hospital are stated below.
1) Simultaneous use of central A.C. and Warmer over the baby inside the NICU. This automatically invites pneumonia ailing babies (according to the opinion of doctors attending in CMC Vellore).

2) Taking around three hours for preparation of femoral channel and doing it in bed side condition.

3) Black patch of radius 0.5 cm on the left leg was first noticed by baby’s mother, and not by any medical attendant although the baby was admitted in NICU.

4) Treatment of left leg was not started immediately after the black patch was noticed. No Doppler test was done immediately.

5) Doctors told and assured us that not to worry about the leg as because it would be cured by hot compress only. Only SILVER X gel was used. Later on Dr.M.M.Ghosh stopped this.

6) On 2nd October evening, they informed us that Fasciotomy should be done immediately on left leg. Otherwise the leg could have been amputated. We helplessly signed the risk bond.

7) During operation, channel was prepared through right jugular vein. Dr. saha told us that the left leg was improving both in color and softness of tissue. So Fasciotomy was not necessary at that moment. It could have invited more infection.

8) Immediately after O.T. was done, unfiltered blood was given to such serious patient through the jugular channel. The channel was blocked.

9) On.3rd October, early morning, the baby was again taken in to O.T for another channel preparation through jugular vein again by signing another risk bond. Again Dr. Saha told us not to worry about the leg, it was much better than the previous night.

10) From 2nd to 6th Oct, the doctors consoled us again and again that the left leg was improving and not to worry about the leg. They worry about her brain although a cranial USG was done on 27/09/10 which did not show any ventricular dilatation or cerebral edema.

11) One or two sisters were allotted for four to five severely ailing babies inside NICU.

12) Poor maintenance of channel, incorporation of bubbles, nobody noticed that air bubbles entering the body of such severely ill patient through the channel. When baby’s mother noticed and asked for attention of attending sisters, they misbehaved with us.

13) Dr. Jemsy Jain went for a leave without giving proper guidance to Dr. Runa Majumder, who handled the case during the interim period.

14) Adult DOPPLER machine was used for the baby.

15) Vacillation of decision of the hospital authority: in the morning they are talking to shift the baby, in the evening they are on the opposite pole & telling us not to shift the baby on 08/10/2010.

16) Patient’s family not factually informed about the patient, since the mother is a medical person and old staff of AMRI, she was allowed inside the NICU. Otherwise they did not bother to communicate with the patient’s family/parents regarding the condition of the patient.

17) According to them if Right Leg was saved due to proper care in right time (while there was no symptom at his right limb at all). If so, why not left leg? Negligence?

18) The hospital authority finally expressed their inability to treat the baby there owing to non-availability of requisite infrastructure viz. ‘Pediatric Care Unit’ & Doctors/Micro vascular Specialist.

19) The hospital authority was too ‘commercial’ and not at all transparent to provide quality health care.
a) Nobody helped us giving any idea of costs of any operation/tests.
b) Cumulative bills of day by day reports differ from final billing.
c) Missing of reports although tests were done. (Sl. No 82,83,84,95,100 of final billing.
d) Dr. Jemsi Jain assured us that she would not take any consultation fees out of sympathy but on final billing they added Rs.3000 for consultation fees for Dr. Jain.
e) They added a bill amount of Rs.5825 for the Doppler venous & arterial test (sl.no-106). Actually it was not done. Finally they had to cancel.
f)The hospital authority, being on backfoot committed (in the Spl Meeting) discount on total bills for hospital stay and diagnostic investigations carried out there, and accordingly, we applied for concession of bills through doctors to medical vice president Dr.Suman Ghosh. Finally their assurance and concession given to us are far different and during discharge, Dr. Suman Ghosh acted step-motherly, denied his commitment and offered us a minimal reduction.
g) By comparing between the bills of AMRI and CMC Vellore it will be clear that which one actually means healthcare apart from doing BUSINESS.

The facts stated in the foregoing paragraphs are true to the best of our knowledge and belief. We reserve rights to add or to clarify anything contained above by modifying / producing more documents or evidences, if required and so called for.

We rest our faith on the council and pray for justice and meaningful recommendation so that no other parents face the same fate in the hands of so called Doctors & Clinical Establishments.
Your’s faithfully.

Date: 10/03/2011
Place: Belgharia, kol-56 Vivekananda Jana
Alomoni Singh (Jana)