Medical Negligence Cases

Reproducing a sad, scary and informative email thread from a mailing list I susbcribe to about some cases in some of the most well known hospitals in India. Please read on and share.

Hi All

I have to add another case of negligence here, about my grandfather at the Sitaram Bhartia Hospital in South Delhi. So here goes :

My grandfather got admitted to Sitaram Bhartia for lung infection. He has been going there for his annual heart check up and insisted that he would be comfortable there. When he got admitted it was a simple,uncomplicated case. But the next day he was put in the icu as a 'precautionary measure'. We were assured he will be back in 24 hours. And then for the next 3 days we were told that he is fine and that they just want to monitor him for a day more..

Suddenly on the 4^th day we were told he is not well and his condition was worsening. We met the doctor in charge and asked her if she,  if the institution is competent to handle the case and if they had all the necessary equipments.  If not then we could shift him to a super specialized hospital. We were assured that they were quite capable of handling it and had all the necessary equipments.

 But within 2 weeks his condition steadily worsened. And doctors would not (could not?) explain any development or complication. The doctors behaved as if they were obliging us with their time instead of doing the duty of explaining procedures to the patients family (who is paying the steep bill of a fancy hospital). For patients in ICU the specialist would not turn up for 2 whole days.(We got to know this was because he did not refer his patients to this hospital so he was only interested in consultation and was not available for anything else).

We were also told that Bronco-scopy was not required. And he was being given the best treatment possible. ( they forgot to mention  to us at that time that they didn’t have a bronco-scope). Bronco scopy is done to check the organism in the lung so that right line of treatment is taken.

On 3^rd Aug, we were told he will be shifted to the room tomorrow and on that same night we got a call from the hospital that they needed to shift him to the ventilator!

When we reached the hospital we found out that the AVG machine is not working which is mandatory for putting a patient on the ventilator as it tests the co2 level in the patients blood. They had also made no effort to get it tested from other centers. They had not even bothered to tell  us that the machine is not working and that this test was not done. We knew about all this bcoz we have doctors in the family .. and they enquired about the avg results before signing the consent for the ventilator.

Finally when my cousin threatened the doctor on duty, the next morning we were told by the doctor in charge  that  my grandfather was now “ almost dead and decaying here “ and we were now asked to shift him as the hospital could not do anything more and the chances of survival were almost none !! The specialist was sitting in his opd and after repeated requests  did not visit the patient ..

We shifted him to Jaipur Golden, where my sister-in-law works. Here, bronco-scopy was done with in 15 mins of him being admitted.  He was diagnosed within 2 days with acenito- bacter which is a hospital  icu acquired super bug which is highly resisted to  antibiotics.

Its been more than a month now and my grandfather is still on ventilator. He use to be fitter than most of us and now he  is fighting it out in the ICU. But he never would have been in this situation in the first place had it not been for the pathetic management of his case at Sitaram Bhartia.

 Basically these hospitals know that they can get away with anything.

For us there were some important lessons here:

- Going for a doctor you know personally is better than going for a 'brandname' of a hospital.  Efficiency of a doctor and institution is more important than the five star facilities that it can provide.

- Sitaram Bhartia is good only for OPD. Don't bother going there for specialist treatments. They are ill-prepared with either equipment or expertise.

- A patient should  be shifted to icu only as a life saving measure and not as a precautionary measure. And relatives need to be very careful and be a little skeptical when your patient is asked to shift to the icu. And do a lot of research and ask a lot of questions bcoz thats your right and it just might save your patients life !

On Mon, Sep 5, 2011 at 11:01 AM, XXXX wrote:

Dear All,

@AAA, BBB, CCC: It is indeed extremely unfortunate that something like this happened. I can't even apologize for what happened. Since the forum raised a few concerns pertaining to doctors, I thought I'd my two cents.

1. The string of e-mails comes as a surprise to me as well. From what I've heard in the doctors community, Artemis Gurgaon and Fortis Noida are the most reputed hospitals in NCR. Well, I also know that medical negligence is a deep-rooted reality. So lets leave it at that.
2. The logic of doctors paying bribes/donations to get admissions into medical schools doesn't quite apply to corporate hospitals. The doctors working here are most often from prestigious institutes like AIIMS, PGI (Chandigarh), JIPMER, CMC  etc. or Indian MBBS graduates who pursued their 'Residency education' and super-specialization abroad (especially US). Those who pay donations of 35 lakhs usually have their own family set-ups (they don't need to work for somebody else).
3. Well that doesn't mean that they don't care about money, but it's also true that not all they care about is money. From what I've noticed and I can vouch for this coming from family of doctors that sometimes the conflict of interest is not money but time. The real problem is absence of communication. Whether honest or dishonest, doctors are not spending time with the patients. It is imperative that doctors empathize with the patient and his/her family members and also communicate in advance the hazards associated with any medical/surgical intervention. Some of the things cannot be avoided and it's best that they are told about in advance.
4. I hate to say this but quoting too much information from the Internet pi**es off doctors to the core. My uncle in US has himself refused to undertake treatment for a few cancer patients (not in an emergency of course) because they seemed to question his expertise based on information available from the Internet. Medicine is an art; it can't be rationalized to an algorithm all the time. Even "Evidence Based Medicine" (using statistical correlation to justify every activity) would defy some of the basic norms. For e.g. if the EBM says that there is a 15% chance of patient surviving with an XYZ drug, would you not go for it if it concerns your family. Although, you can then be questioned in the court of law in a country like US if something happens to the patient. 
5. So what's the solution? It is important to look up information beforehand but try not to question the doctor. Whenever in doubt, you should try seeking second and third opinion from other doctors in the same domain. Not all doctors are corrupt. The simplest filter is- choose one of the doctors from a Govt. Hospital like G B Pant, AIIMS, RML Hospital etc. If you need any contacts, please let me know.
6. Moreover, we have so many alums working in reputed chains like Apollo, Fortis, Max. It's best if you keep their contacts handy. This will ensure that you are made aware of everything at every little step in the process when admitted. If not doctors, nurses will try their best to keep you at ease all the time. Trust me, it helps allay fears.
7. Worst some worse, there is an option of filing a compensation case in the court. Unfortunately, this is of not much use in India (the Doctors lobby in India is too strong for someone to be convicted) and is mostly used to defame others in competitive rivalry. The media has further added fuel to the fire in the case of the latter.

I'd be more than happy to listen in to alternative views.

Hope this added to the constructive criticism I aspired for.

Apologies for spam


Kind Regards,

DDDD

On Sun, Sep 4, 2011 at 10:38 PM, AAA wrote:

Hi, it's heart wrenching to hear these cases. So sad for the families who had to suffer.

I lost my dad 3 years back and at that time we thought our case was unique - but I have realised over time, and after reading the below emails, that it probably wasn't. My dad was diabetic and on complains of breathing trouble he was admitted to max hospital saket in the night in emergency. He passed away after a 3month hospital stay and my experience was the same as mentioned by others - there were " teams" of doctors who continuously disagreed on the line of treatment, there was never clear and transparent communication from the doctors, the seniors most doctor seemed to be the most irresponsible, no one doctor who took charge of the medical situation, And to top it all an administration which wasn't sympathetic to our situation - the director operations ensured that we pay the hospital on a daily basis or in advance whatever may be the medical situation on ground. My dad  passed away not because of the illness which he came to the hospital with but from an icu infection. It hurts because at times you feel he suffered without reason and so did the whole family.

Its  scary that if tomorrow you don't know which hospital to go to because all of them seem to be no good.

Uncanny but this seems to be the situation with all these hospital chains in Delhi NCR. My cousin had a severe life threatening injury and was admitted in a hospital in bangalore - the attitude of the doctors and administration was radically different.

On Sunday, September 4, 2011, BBB wrote:
>
> My heartfelt condolences to you and many like you who have had to suffer irreparable loss because of sheer medical negligence.
>
> ...I'd actually like to add Artemis Gurgaon to this as well, for the way my mom's case was handled last year.
>
> She was a 69 year old blood cancer patient on oral chemotherapy (presumably, as per PGI doctors, despite her condition, she still had a few years left -- before the incident I narrate took place), who had a stroke when she was admitted to Artemis. She ended up being right-side paralyzed, with long-term prognosis being quite poor in her case. But instead of trying to reduce the pain and focus more on palliative care, she was kept in ICU for a long time; and even when she was discharged, her condition had significantly deteriorated (full recovery wasn't possible). She further developed abdominal distention subsequently in a few weeks and had to be taken back again and again, in emergency conditions -- but the doctors kept on treating her symptomatically for constipation, with the result of an extremely late diagnosis of GI perforation, despite those multiple visits. At that point, there was insistence on doing an operation to remove the necrotic GI part, despite knowing that post-operative survival was almost impossible now in this case. Then, they put her on a ventilator for almost 2 days, before declaring her dead (as a result of a cardiac arrest that happened while she was in ICU on the vent).
>
> My doctor friends tell me that return of a patient having gone on a vent is less than 5% (even less for patients with multiple complications), and hospitals primarily have it to churn some extra money before declaring the person dead.
>
> But the two cases below, are much much worse in comparison. Wondering if ethics has totally gone out of the medical profession, and it is just another business now -- with it's share of good, bad and outright ugly manifestations?!!
>
> On Thu, Sep 1, 2011 at 11:24 PM, AAA wrote:
>
> Dear All,
>
>
> This is my duty to warn you and your family about two well known hospitals of Delhi-NCR; Medanta Medicity-Gurgaon and Fortis Noida.
>
>
>
> My mother was admitted to Medanta for a by-pass surgery on the 25th of March 2011. As assumed by many, we had faith in the man behind Medanta (Dr Trehan).Unfortunately, we suffered such a harrowing experience at the hospital that after 3.5 months(discharged on 17th July) of hospital stay and a bill of 15 lacs, my mother was discharged with a permanent damage to her brain. She is now completely bed ridden and cannot do even the basic activities like speaking and eating food. Her heart still does not function well.
>
>
>
> Our experience is similar to what you will read in the message below. My mother is still alive because fortunately we were very particular of checking with doctors all around us as well as the internet before any procedure was performed on my mother. Also, while in the ICU we kept a check on her health through telephone and personal visits. Additionally, there was immense negligence by the doctors and an extreme lack of co-ordination among doctors of different speciality. Despite of our regular escalation of the matter to Dr. Trehan, the mistakes by doctors and nurses continued till they managed to ruin the patient severely. There were episodes when ICU nurses failed to notice internal bleeding, failed to notice the increase in drowsiness and recurrent coma.
>
>
>
> I sincerely advise you against using Medanta.
>
>
>
> 
>
>
>
>
>
> -----Original Message-----
>
> From: ZZZZ

> Sent: Wednesday, August 31, 2011 1:23 PM
>
> Subject: FW: Please do not visit Fortis Noida - A must read !!!!!!!!!!
>
> Importance: High
>
>
>
> "Be the trendsetter in energy solutions by consistently exceeding stakeholder's expectations."
>
> Subject:
>
> From: "Srijan very sad news , May God's blessings and peace be with you and your family.
>
>
> Hi
>
>
>
> With deep regret I want to inform you the demise of my wife PPP due to post operative complication after brain surgery.
>
>
>
> I would also like to bring to your notice how private hospitals like FORTIS are robbing people of their life and money. Please be very careful while dealing with such hospitals. Find below the details of my experience with Fortis Noida.
>
>  

PPC Account Management Activities

We recently put together a brief of activities that should be performed on accounts on a weekly basis. Have also put in an estimate of the time each should take. And we have already come up with about 30 hours of work per account per week. So before you decide to bring PPC in-house do keep in mind the amount of work it takes!

Activity	Activity Duration (Est)
Check search query report for keywordless ads and add negatives or change budgets if required	1.00 hours
Check search query report for entire account and add negatives or expand account as applicable	4.00 hours
Check ad-copy performance report and pause/add ads as applicable. This should include text ads, WAP ads, image search ads and image ads on the search and content network	4.00 hours
Check impression share report at a campaign and account level and alert agency/team when levels are too high or too low.	0.25 hours
Check avg CPC report at a campaign and account level and raise alerts as applicable	0.25 hours
Check brand CPC, brand avg position and brand spends as a percentage of total spends.	0.25 hours
Check CTRs at account, campaign and ad-group level and raise alerts as and when applicable. For low CTR ad-groups, initiate action on ad-copy optimization	0.25 hours
Scrutinize quality scores at keyword level and initiate action on QS<=4 and Impressions>100 keywords (weekly numbers) ASAP	2.00 hours
Check 10% of the keywords for relevance and suggest structural changes for better relevance and targeting	2.00 hours
Review IP targeted campaigns for performance compared to same keywords in untargeted campaigns	2.00 hours
Review all landing page tests in progress and report on performance and suggested next steps	1.00 hours
Check 10% of all content ad-groups (on a rotation basis) and suggest structural changes for better relevance and targeting	2.00 hours
Diagnose keywords which are below first page bid, or have low search volume and suggest next steps and strategy for the same	1.00 hours
Check the status of all running promos and update status and next steps	0.50 hours
Review progress of API based projects such as dynamic ads, automate reports, automated bidding etc.	1.00 hours
Look at ad-group and keyword level conversion reports in vendor tool as well as Omniture and identify best/worst performers and next steps for the same. If requried, discussions with product also needs to be initiated	2.00 hours
Audit the destination URLs for all keywords and check whether all have correct tracking or not, whether all have relevant product-specific dynamic paramters such as origin, destination etc. or not and whether all point to the correct/desired landing pages or not	1.00 hours
Run the Google Keyword Tool and use the generated file to attempt next round of account expansion	2.00 hours
Think of one new business dimension for account expansion. Make keyword suggestions based on that. This has to be completely independent of Google Search Query reports or tool.	2.00 hours
Review mobile campaigns using search query report, comparison with search account for expansion opportunities, avg CPC and daily spend changes, daily call data movements, cost-per-call metric and scope for budget reductions/increases	4.00 hours
Total	32.50 hours

Making Money Online

Yeah, you can make money online without doing anything other than "being" online. And I am not running a scam here fellas, I am just sharing some new things I am learning about the web. Actually note that I said learning and not knowing.
So while most of us know about domain squatting, click fraud and content farms, it takes a bit of learning to actually believe in their power and get 5 figure monthly checks from Google for them.
To begin with you have to put up a website and some content and let it age like wine. Then you have to get some juice through SEO efforts. One option is to use the famous seo tool shamelessly like I am doing :) But there are other more eclectic and aesthetic options. And as this post grows I will talk more about them. Do come back for more!!

ISB O Week

This is an old post I wrote but never got around to publishing... here goes...:)

Enthu rises in wild waves and crashes against the shores of realities. Aah the moment just before one goes for the 90 degree bent on the path of life. The allure of the yonder, the draw of the unknown !! Somehow I feel something huge is about to happen. And finally the boat falls over. A crash.. a bang... it twists and turns and swerves for a while... and then slowly settles back. And then you realize few things have changed... but quite a few have not. The physical, the external changes.

The location changes - now you are in Delhi, now you are in Hyderabad,

the activity changes - now you are a coding now you are studying,

the focus changes - now you are waiting for the pay-day now you are waiting for the grades-day

and more....

but YOU don't change... others don't change... and the connection between you and the others doesn't change.

You still like the kind of people you liked before...

You still talk the way you talked before...

You still look the way you looked before...

But then, what change is more important ? Answer is obvious.

let me start by saying that I love ISB. What I love most is the lack of structure. YOU are ISB - ISB is YOU. There is no other campus I know

Chappal Elections

Here is a list of people at whom chappals have been thrown in the past few months

1. Goerge Bush (where it all started)

2. P. Chidambaram

3. L. K. Advani

4. Jeetendra

If anyone knows of more please let me know. Please also share pictures/videos of the same and your views on which is the best according to you.