Rejoinder

The Dr. Anamika Ray Memorial Trust takes note of the allegations by Dr. Satyajit Borah, Secretary of the Assam branch of the Indian Medical Association, and finds them prejudicial and manipulative with an intent that is not above suspicion. He calls into question the data provided by the Managing Trustee Dr. Ankuran Dutta in his rejoinder (published on the 21st of May 2016) to his original objections. In his article, he claims Dr. Dutta’s data as “totally absurd, imaginary and outrageous”. He refutes the data claiming that if 2% of cases amounts of 52 lakhs, then total cases amount to “one-fifth of the total population of the country”. However, this calculation is fallacious and manipulative due to two reasons.

The first reason is that no statistical information related to percentage of incidents was shared by Dr. Dutta in his reply on the 21st, to which Dr. Borah claims to be responding. So where did Dr. Borah obtain the numbers that he is using to show the “falsity” of Dr. Dutta’s claims? In fact, the data was provided in an earlier article (14th May 2016) published in the Assam Tribune. In that article, Dr. Dutta had mentioned, “The situation is such that about 52 lakh of medical injuries are recorded in India, of which around 98,000 victims lose their lives every year.” In another news report, an opinion of an invited guest to the first advocacy meeting that only 2% medical malpractice victims sue for compensation and 98% of malpractice victims never receive compensation because they never start a suit even in developed countries was also mentioned. Dr. Borah has combined the two separate and disparate figures and provided a calculation aimed to mislead the readers.

The second reason is that the only data provided by Dr. Dutta in his reply on the 21st May pertained to the research by Dr. Mukesh Yadav and Dr. Pooja Rastogi, for which Dr. Dutta cannot be held responsible. Similarly, information discussed in the television programme is information in the public domain and Dr. Dutta cannot be held responsible for using such information as he has not “invented'” it but has clearly used publicly accessible data.

Moreover, Dr. Borah also attempts to undercut the seriousness of the issue raised by the movement “Stop Medical Terrorism” and present it as a non-issue to further confuse the reading public. However, some data that he provides to refute Dr. Dutta’s claims itself shows the glaring lacuna in his judgement pertaining to the matter. Dr. Borah himself states with reference to the study by Mukesh Yadav and Pooja Rastogi that 68.7% cases were not proven. However, this leaves us with a number of 31.3%, which is almost a third of the cases and is not an insignificant number. In fact, in a country where documentation is always an issue and much of interaction even with medical professionals is carried on verbatim, it is extremely difficult to prove incidents like this. This does not undermine the significance of the 31.3% cases that were proven.

The Trust also wonders about Dr. Borah’s and the IMA’s motives and intention. Why is Dr. Borah focusing on the terminology and not on the issue, especially after the meaning, scope and relevance of the term was already clarified by the Trust on the 21st? Why is not focusing on the seriousness of the malpractices in the medical profession, which should be a primary concern for the IMA? Is this a deliberate attempt to cloud the issue and discredit those who are raising this issue?

No data is provided by the IMA as to the 'actual' number of cases according to them. Have they conducted any research into this extremely serious issue? If so, where are the results of that investigation? Why were they not quoted by Dr. Borah when he claims Dr. Dutta's data to be false? If not, then why have they not conducted any investigation into an issue that seriously undermines the relationship between doctor and patient?

The Trust feels that there is a deliberate attempt to overshadow the significant goal of medical reforms through misdirection towards the term “Medical Terrorism”. The purpose of the movement, as has been clearly stated before, is to improve health care services in India. Why would Dr. Borah or the IMA or other medical practitioners be against such a goal? The medical profession is a noble one and the movement aims to work with doctors who believe so as partners in the process of re-establishing people's trust in the medical system and to ensure that the sacred relationship between a doctor and a patient remains so. Anyone who believes in the nobility of the medical profession and does not see it as a business alone would be willing to support the movement rather than opposing it.

Dr. Borah and others have opposed the term 'medical terrorism' on grounds of negativity and insisted that 'medical negligence' is more appropriate. However, 'negligence' indicates a crime of omission. What should we call a crime of commission committed in the arena of the medical profession using the knowledge, power and superior position provided by that profession? To deny the existence of such incidents where patients have been deliberately harmed by medical professionals either for money or for other vested interests is like saying that there is no corruption in India - a laughable and obviously invalid claim. And to give the name 'negligence' to such heinous acts is an insult not only of the victims but also of the entire medical profession and those doctors who are working diligently to uphold the greatness of the medical profession.

The Trust reiterates that the purpose of the movement is to bring about improvement in health care services in the country through legislation aimed at systemic changes. It is a distant and difficult goal but the movement is determined to succeed so that victims of Medical Terrorism can find justice, so that doctors who wish to and are trying to make a difference through their actions can do so with greater ease, and so that there is greater and justified trust in the relationship between medical professionals and patients. The Trust urges the public not to be swayed by divertive and misleading arguments and to support the movement. To support the movement launched by this Trust, any supporter can type JOIN ATRUST and ‘SMS’ it to 9220092200 or give a missed call to 02262116842.

Professor Madhab C Sarma
Chairperson
Dr. Anamika Ray Memorial Trust

Rejoinder

“I solemnly pledge myself to consecrate my life to service of humanity”

“I solemnly pledge myself to consecrate my life to service of humanity” this is the first sentence a doctor took oath when s/he joins into the medical profession. They are considered as God knowing that they are human being, as the profession gives ‘hope’ of life to a patient and his family on this earth.

The statement of the Secretary of the Assam branch of the Indian Medical Association (IMA) Dr Satyajit Borah (Assam Tribune May 17, 2016) has been taken note of by Dr. Anamika Ray Memorial Trust. Firstly, the Trust initiates this movement ‘Stop Medical Terrorism- a campaign for better health care services in India’ aiming for a better and transparent health care service in the country. The Trust condemns all kind of violence against any heal care provider, not only the doctors including para-medical staff and the people in the management of the hospitals. The basic mission of this movement is to have a separate law in the country to prevent medical malpractice and negligence. The trust also wishes to create a healthy and safe relationship between patients and health service providers and also to create awareness on patients’ rights.

Regarding the statistics mentioned in the first advocacy meeting by the Managing Trustee Dr. Ankuran Dutta, the Trust would like to clarify that the statistics of 98,000 people who die due to medical error has been borrowed from the television programme “We the People” of NDTV, where Padma Shri Dr. Krishan Kumar Aggarwal of IMA was also a panellists. Another statistics 5.2 million medical injuries are recorded in India has been taken from the research paper titled “A Study of Medical Negligence Cases decided by the District Consumer Courts of Delhi” by Mukesh Yadav and Pooja Rastogi, which was published at the Journal of the Indian Academy of Forensic Medicine in the issue Jan-March 2015, Vol. 37, No. 1 with ISSN 0971-0973 (online available). “10 people fall victim to medical negligence every minute and more than 11 people die every hour in the country due to medical error”- is only a quantitative analysis drawn from the references mentioned above.

Regarding the disclosure of details of two isolated case reports that finds mention in Dr Dutta’s article, I would like to submit that the Trust believes that the same should not be disclosed to maintain the ethical standards. As doctors cannot disclose any information of any patient under section 2.2 of the Code of Ethics Regulation 2002 of the Medical Council of India, the Trust doesn’t disclose the name of the doctors and associated hospitals. The Trust believes in open discussion for improvement of the patient- doctor relationship.

The Trust also wants to mention here that the guests invited to the first advocacy meeting were from different fields and had their own views on the issue. Dr Putul Mahanta mentioned in the meeting about the present scenario of doctor vs patient (ratio) highlighting the issue of how to build up a strong, safe and healthy doctor patient relationship. He also advised to change the term “Medical Terrorism” to “Medical Negligence”.

The trust never generalised all the medical professionals and in its view “when a medical professional or a service provider does any inhuman behaviour creating an environment of terror using medical knowledge or license, then it is not only negligence, it is also medical terrorism.” Hence, it is the request of the Trust to all medical professionals not to misinterpret and generalise the term and mislead the readers to maintain a better and healthy relationship with their patients. As Dr. Borah mentioned, the Trust also feels that the issue should be taken up seriously by the Government and an urgent measure should be taken in the training up of doctors and changing medical curriculum effectively.

If Not Medical Terrorism, What Is It?

About 52 lakhs medical injuries are recorded in India, of which about 98,000 people lose their lives every year. It is a matter of serious concern for the entire nation that ten people fall victims to medical negligence every minute and more than 11 people die per hour in the country due to medical error.. It is the eighth leading cause of death in the world. Approximately 30 lakhs years of healthy lives are lost in the country each year solely because of medical negligence. This is not acceptable at any cost. A nationwide movement called “STOP MEDICAL TERRORISM” has been initiated by a group of victims and supporters under the platform of Dr. Anamika Ray Memorial Trust, Guwahati demanding a separate law in the country to control unpardonable callousness of the medical professionals and malparctices at the hospitals.

After initiating this movement for better health care services in India, we have been aware of hundreds of similar incidents relating to medical negligence. In many cases it is found that a few doctors not only neglect their duty to care for their patients, but also they create terror. A victim recently complained that his wife collapsed in a city hospital where she was admitted due to negligence and the doctors tried to create a situation of terror. The first day doctors advised to get some tests done after her admission into the hospital. The second day they told that they were waiting for the reports, although all the tests of the heart condition of the patient were done in the hospital itself. The third day doctors told that her condition was poor and needed an operation immediately. When the husband requested them to do the needful, the doctors told that they were unable to do the surgery as they did not have their team and also refused to shift her to another hospital. The fourth day the patient went to the ventilation and collapsed after two hours.

In another incident, after the untimely demise of a newly married young girl her brother approached the doctor to know the cause of his sister’s death the doctor replied that he was aware of the patient’s abnormal pregnancy and wanted to experiment in continuing her pregnancy to learn more. The doctor admitted that it was his fault and also threatened the elder brother of the patient not to go for any legal action. How do we term such activities? Are they not medical negligence?

A few days back a senior doctor telephoned us and told that he stands for the cause we are fighting for. But what he suggested is that the term “medical terrorism” needs to be changed. Here our justification comes. Why we coined the term “medical terrorism”? To explain it let us clarify two important terms- “medical error” and “medical negligence.”

Not all medical injuries are the result of negligence. In fact, a vastmajority are due to inherent risks that cannot be prevented. Preventable errors that cause injury, on the other hand, are considered negligent. However, how “preventable” is defined is not always clear. But in case of a minimal access surgery like gallbladder or appendicitis removal this confusion does not arise. It can not be an error. It must be due to a negligent act.

Medical error may occur due to a wrong judgment. For a patient, the doctor is like God. And, the God is infallible. That is a patient’s conviction. In reality, doctors are only human beings. And, to err is human. Doctors may commit a mistake. It is medical error and there is no way accepting it. Andwhen doctors tend to benegligent, the support staffs also become careless and two acts of negligence may give rise to a much bigger problem. It becomes gross negligence at large.

It is difficult to define negligence, however, the concept has been accepted in jurisprudence. The authoritative text on the subject in India is the ‘Law of Torts’ by Ratanlal and Dhirajlal. Negligence has been discussed as it is the breach of a duty caused by the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Actionable negligence consists in the neglect of the use of ordinary care or skill towards a person to whom the defendant owes the duty of observing ordinary care and skill, by which neglect the plaintiff has suffered injury to his person or property.

The definition involves three constituents of negligence: (1) duty of care: a legal duty to exercise due care on the part of the party complained of towards the party complaining the former's conduct within the scope of the duty. It is clear that all doctors and other health professionals owe a duty to their patients to exercise reasonable care in carrying out their professional skills. In most medical negligence cases, establishing a duty of care is unlikely to be a problem; (2) breach of the said duty: The second element is for us to establish a breach of duty of care, i.e. showing that the doctor has been negligent. In the case of Bolam v Friern Hospital Management Committee (1957) the test for establishing medical negligence was set out. A doctor is required to exercise the ordinary skill of a competent doctor in his or her field. He or she must exercise this skill in accordance with a responsible body of medical opinion skilled in that area of medicine; and (3) consequential damage: If it can be proved that the doctor was negligent, the next step is to show that the negligence caused you some harm. Often, establishing causation can be problematic in medical negligence cases because you will have been receiving treatment in any event.

Cause of action for negligence arises only when damage occurs; for, damage is a necessary ingredient of this tort. Thus, the essential components of negligence are three: 'duty', 'breach' and 'resulting damage'. Again, when a doctor misleads a patient for his own benefit? When he acts violence? When he creates a situation of fear in the mind of the patient and their family? After doing a negligent act, when he refuses to admit? When he takes advantages of dependence or blackmails on the helplessness of a patient or his family? Are they only medical negligence? They are medical terrorism.

The term terrorism needs no explanation. It is a systematic use of violence and intimidation to achieve some kind of goal or other. It is the state of being terrorized or creating a terror situation. Medical terrorism may be defined as creating a situation of terror using the medical knowledge as weapon. A blogger Stephen Murathe explains the term as “we have heard of Biological Terrorism before. Today, there is a new form of Terrorism. Medical Terrorism. This is the New Term of Murdering Patients. If they don't have the money (if they can't afford it), let them die. The pain, the anguish, the condemnation, the distress and humiliation that the Patients are going through in our time is incomprehensible. People who are already helpless and in need of care are subjected to further trouble by people who should be taking care of them. Instead of embracing them they are adding salt to injury through neglect, lack of concern and sheer abandon until money is deposited in the facility account so as to commence any form of treatment.” Medical negligence is under the umbrella term of medical terrorism. When a medical professional or a service provider does any inhuman behaviour creating an environment of terror using medical knowledge or license, then it is not only negligence, it is medical terrorism.

Indian Penal Code, 1860 sections 52, 80, 81, 83, 88, 90, 91, 92 304-A, 337 and 338 contain the law of medical malpractice in India. A physician can be charged with criminal negligence when a patient dies from the effects of anesthesia during an operation or other kind of treatment, if it can be proved that the death was the result of malicious intention, or gross negligence. Before the administration of anesthesia or performance of an operation, the medical professional is expected to follow the accepted precautions.

Author Ankuran Dutta is is head of Department of Communication and Journalism, Gauhati University.

Campaign Against "Medical Terrorism" in State.

Guwahati, May 14 - Medical negligence has been leading to loss of around 30 lakh years of healthy life in the country annually. The situation is such that about 52 lakh of medical injuries are recorded in India, of which around 98,000 victims lose their lives every year. In India, 10 people fall victims of medical negligence every minute and more than 11 people die per hour due to medical error and negligence.

This was the statement made by Dr Ankuran Dutta of the Dr Anamika Roy Memorial Trust while addressing the first advocacy meeting as part of the countrywide movement named ‘Stop Medical Terrorism’ by the Trust, at the Bishnu-Nirmala Trust Auditorium here today.

The Guwahati-based Trust is demanding better health care service in India.

To support the movement launched by this Trust, any supporter can type JOIN ATRUST and ‘SMS’ it to 9220092200 or give a missed call to 02262116842, said Dr Dutta. He proposed that June 25 should be observed as the medical awareness day and a day in the month of July should be observed as anti-medical terrorism day.

Addressing the function, senior police officer R Chandranathan, ADGP, CID, laid stress on generating awareness among the people on the issue of medical negligence. Things related with the treatment of the patients should also be made transparent and efforts should be there to cover both the Government and the private healthcare institutes under this transparency-related initiative, he said.

Dr Putul Mahanta, Editor-in-Chief of the International Journal of Health Research and Medico Legal Practice, regretted that once medical service was regarded to be a mission and gradually it emerged as a profession and now it has turned into a business and unethical practices in this profession are growing day by day. Organ-lifting rackets are also operating in some parts of the country, he lamented.

It has also become known that many doctors are now visiting foreign lands along with their families in trips sponsored by the pharmaceutical companies. Cases of nexus between doctors and clinical laboratories also come to the fore these days.

It also observed that the doctors are refusing to provide treatment to some patients, like those suffering from HIV, he rued.

Referring to “surgical terrorism”, he said there are surgeons who calculate their charges on the basis of the screws and stitches they append, he said, adding, charging high fees or rates from the patients is nothing but medical terrorism.

Moreover, he said, prescribing wrong medicines and wrong doses are also considered as medical negligence, besides leaving apparatus, etc., inside the body of the patient after a surgical operation. Fifty per cent of the cases of medical negligence recorded are against the surgeons.

But the situation is such that 98 per cent of the cases of medical negligence are not reported, he said.

Former Vice Chancellor of the KK Handiqui State Open University, Prof Srinath Baruah, laid stress on videographing the surgical operations conducted inside the operation theatres.

Partha Parasar of Dergaon also narrated how he lost his sister Mousumi because of doctors’ negligence.

Source: Staff Reporter, Assam Tribune, 14 May, 2016.

First Advocacy Meet to Combat Medical Negligence Held

Guwahati, May 14 (PTI) A nationwide movement ‘Stop Medical Terrorism’ was initiated today by a group of victims of medical negligence and supporters of the cause under the platform of Dr Anamika Ray Memorial Trust, Guwahati, demanding better health care services in India.

At its first advocacy meet, Dr Putul Mahanta, researcher of medico legal practices at Tezpur Medical College, spoke about the growing rate of medico legal issues in the country and their root causes.

Another speaker R Chandranathan, Additional Director General of Assam Police, expressed his views on combating the alleged criminal negligence of medical profession. Prof Srinath Baruah, former Vice Chancellor of Krishna Kanta Handique Open University, said 90 per cent doctors are dedicated and only a few are selfish.

He advocated that all surgical operations be video recorded for transparency.

A few victims of this movement also shared their views on the pain, and humiliation that patients and their family members face because of ‘harassment’ by doctors.

Dr Ankuran Dutta, convenor of this movement and managing trustee of Dr Anamika Ray Memorial Trust, urged all the victims and well wishers to support this movement by sending an SMS with the text JOIN ATRUST to 9220092200 or by giving a missed call to 02262116842.

At the meeting it was resolved that June 25 will be organised as the nationwide protest day against ‘medical terrorism’ and July 19 will be observed as the Anti-Medical Terrorism Day.

Source: The Arunachal Times, 15 May, 2016

First Advocacy Meet to Combat Medical Negligence Held

A nationwide movement 'Stop Medical Terrorism' was initiated today by a group of victims of medical negligence and supporters of the cause under the platform of Dr Anamika Ray Memorial Trust, Guwahati, demanding better health care services in India.

At its first advocacy meet, Dr Putul Mahanta, researcher of medico legal practices at Tezpur Medical College, spoke about the growing rate of medico legal issues in the country and their root causes.

Another speaker R Chandranathan, Additional Director General of Assam Police, expressed his views on combating the alleged criminal negligence of medical profession.

Prof Srinath Baruah, former Vice Chancellor of Krishna Kanta Handique Open University, said 90 per cent doctors are dedicated and only a few are selfish.

He advocated that all surgical operations be video recorded for transparency.

A few victims of this movement also shared their views on the pain, and humiliation that patients and their family members face because of 'harassment' by doctors.

Dr Ankuran Dutta, convenor of this movement and managing trustee of Dr Anamika Ray Memorial Trust, urged all the victims and well wishers to support this movement by sending an SMS with the text JOIN ATRUST to 9220092200 or by giving a missed call to 02262116842.

At the meeting it was resolved that June 25 will be organised as the nationwide protest day against 'medical terrorism' and July 19 will be observed as the Anti-Medical Terrorism Day.

Source: Press Trust of India, Business Standard, 14 May, 2016

Activists Launch Drive Against "Medical Terrorism"

Guwahati: With more and more people falling prey to medical negligence in the state, a group of victims met here on Saturday to combat what it called 'medical terrorism'.

The victims launched 'Stop Medical Terrorism', a campaign seeking a separate law to combat medical negligence, under the aegis of Dr Anamika Ray Memorial Trust. An 'SMS and missed-call' service was also launched to help victims of medical negligence join the forum.

"The recent incident of a child receiving HIV-positive blood during a routine transfusion at Gauhati Medical College and Hospital (GMCH) is shocking. Around 52 lakh medical injuries are recorded in the country. 98,000 people lose their lives every year because of medical negligence," said Ankuran Dutta, managing trustee of Dr Anamika Ray Memorial Trust.

Members said the forum is not aimed at maligning doctors or the medical profession but creating awareness about rising cases of medical negligence in the country. They expressed concern over growing 'capitalism' in the profession which makes the poor and the middle class vulnerable.

Meanwhile, the Human Rights Law Network (HRLN) on Friday filed a writ petition at Gauhati high court on behalf of the father of the boy who received contaminated blood. HRLN sought a court-monitored committee to investigate the incident and punish those responsible.

HRLN, in its petition, said the boy should be kept at GMCH till he recovers from the burn injuries for which he was being treated. It also asked for monetary relief from the state government.

Members of HRLN told TOI that the condition of other state-run health centres and blood banks was also pitiable. Last year, they found that there was not a single blood bank in Baksa district.

Source: TNN, Times of India, 15 May, 2016

First Advocacy Meet to Combat Medical Negligence Held

Guwahati, May 14: A nationwide movement Stop Medical Terrorism was initiated today by a group of victims of medical negligence and supporters of the cause under the platform of Dr Anamika Ray Memorial Trust, Guwahati, demanding better health care services in India.

At its first advocacy meet, Dr Putul Mahanta, researcher of medico legal practices at Tezpur Medical College, spoke about the growing rate of medico legal issues in the country and their root causes. 

Another speaker R Chandranathan, Additional Director General of Assam Police, expressed his views on combating the alleged criminal negligence of medical profession.

Prof Srinath Baruah, former Vice Chancellor of Krishna Kanta Handique Open University, said 90 per cent doctors are dedicated and only a few are selfish.

He advocated that all surgical operations be video recorded for transparency.

A few victims of this movement also shared their views on the pain, and humiliation that patients and their family members face because of harassment by doctors.

Dr Ankuran Dutta, convenor of this movement and managing trustee of Dr Anamika Ray Memorial Trust, urged all the victims and well wishers to support this movement by sending an SMS with the text JOIN ATRUST to 9220092200 or by giving a missed call to 02262116842.

At the meeting it was resolved that June 25 will be organised as the nationwide protest day against medical terrorism and July 19 will be observed as the Anti-Medical Terrorism Day.

Source: PTI Correspondance ESB NN, India Today, 14 May, 2016

Stop Medical Terrorism Campaign Launched in City

Guwahati, May 14: A nationwide movement—Stop Medical Terrorism—was formally initiated today by a group of victims of medical negligence and supporters of the cause under the platform of Dr. Anamika Ray Memorial Trust, Guwahati, demanding better health care services in India.

The first advocacy meeting to combat ‘medical terrorism’ and negligence was organised at the city based Bishnu Nirmala Auditorium, where a large number of victims of medical negligence and supporters of this movement participated and prepared a roadmap for a nationwide movement. 

“About 52 lakh medical injuries are recorded in India each year, of which around 98,000 result in fatalities. It is a matter of serious concern for the entire nation negligence every minute and more than 11 people die per hour in the country due to medical error and negligence,” said an organizer.

He said it is the eighth leading cause of death in the world. 

“Approximately 30 lakh of healthy life are lost in the country each year due to medical negligence, which is not acceptable at any cost,” he added. 

Dr Putul Mahanta, Professor of Tezpur Medical College, enumerated the growing rate of medico legal issues in the country and its root causes. 

ADGP R Chandranathan expressed his views to combat the criminal negligence of medical profession. A few victims of medical negligence and supporters of this movement shared their views on the pain, the anguish, the condemnation, the distress and the humiliation that the patients and their family members face. 

They also highlighted how people who are already helpless and in need of care are subjected to further harassment by people who should be taking care of them. 

Dr Ankuran Dutta, convener of this movement, urged the victims to support this movement by sending an SMS with the text JOIN ATRUST to 9220092200 or by giving a missed call to 02262116842. 

It was resolved in the meeting that on June 25, 2016 a nationwide protest against ‘medical terrorism’ will be organised and July 19 will be observed as ‘Anti Medical Terrorism Day’.

Source: Staff Reporter, The Sentinel, 16 May 2016.