High-profile hospital death raises questions

High-profile hospital death raises questions
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First Published: Wed, Nov 12 2008. 12 06 AM IST

Final adieu: A remembrance ceremony in New Delhi on Monday for Jayant K. Bhuyan (inset), former deputy director general of CII, who died following a triple bypass heart surgery at Max Devki Devi Heart
Final adieu: A remembrance ceremony in New Delhi on Monday for Jayant K. Bhuyan (inset), former deputy director general of CII, who died following a triple bypass heart surgery at Max Devki Devi Heart
Updated: Wed, Nov 12 2008. 12 06 AM IST
New Delhi: A month after Jayant K. Bhuyan, a man widely credited with raising Brand India’s flag overseas, died suddenly following heart surgery, his wife is publicly pushing the hospital to take action against what she says are errant doctors.
Bhuyan, a well-regarded deputy director general of industry body Confederation of Indian Industry (CII), died following a triple bypass heart surgery at Max Devki Devi Heart and Vascular Institute on 6 October.
According to his wife, Ramola Bhuyan, the hospital has privately admitted to her that the 58-year-old Bhuyan died because of an “error” committed during the surgery.
“The hospital told me that a wrong tube was inserted into his heart, which released oxygen into his brain in a large dose,” she said. “He died because his brain shut down due to the oversupply of oxygen.” Another person familiar with the situation, a leading Indian industrialist with key ties to CII who didn’t want to be named, had described a similar sequence of events to Mint on 7 October.
Max Devki Devi institute is among the more prestigious— and expensive—hospitals in New Delhi.
Ramola Bhuyan, who works with the World Bank here, says she is speaking out because she wants to make sure those responsible for this medical negligence be punished either under the rules of the Medical Council of India or under Indian law. “I don’t want this to happen to anyone else,” she said in an interview.
Hospital investigates
The Max hospital, part of the health care division of Max India Ltd, for its part, had initiated an investigation into Bhuyan’s death. The investigation report is ready, but has not been shared with the family yet.
“I am obliged to tell the family about the report, not the media. We have been 100% honest and 100% transparent. This is between me and the family,” said Analjit Singh, chairman and managing director of Max India.
Final adieu: A remembrance ceremony in New Delhi on Monday for Jayant K. Bhuyan (inset), former deputy director general of CII, who died following a triple bypass heart surgery at Max Devki Devi Heart and Vascular Institute on 6 October. Bhuyan was widely credited with raising Brand India’s flag overseas. Harikrishna Katragadda / Mint
Singh, who according to the same industrialist who described the events of 6 October, was in the hospital the next morning, personally overseeing the situation after Bhuyan’s death, was combative in the brief telephone interview with Mint, saying: “If you misquote me, I will take you to court.”
Singh is a prominent member of CII and was the chairman of the lobby’s international committee last fiscal year.
“We know what exactly caused the death of Mr Bhuyan,” said Pervez Ahmed, executive medical director, Max Healthcare. “The result of the investigation is out. If the family wants to share (it) with the press, it is their prerogative. We are making arrangements to meet the family.”
The cause of Bhuyan’s death, which had stunned many people in New Delhi, hasn’t received much attention despite his high-profile connections.
While Mint cannot independently confirm the sequence of events beyond what Ramola Bhuyan and the other person said, in general and not specifically referring to any Max hospital, medical errors are commonplace in India though there isn’t much of a mechanism in place to accurately report or track such instances.
Heart attack
Ramola Bhuyan says her husband was taken to a Max hospital in Gurgaon, a satellite town of New Delhi, on 29 September after he suffered his first ever heart attack. Later, Bhuyan was moved to the Max Devki Devi institute at Saket in south Delhi.
“The ECG did not show that a heart attack had happened,” said Ramola Bhuyan. “So, the hospital insisted on further investigation and I also wanted a thorough check-up.” ECG refers to electrocardiograph, an equipment used to monitor the heart’s rhythms.
An angiography was then performed on Bhuyan, after which it was found that three of his cardiac arteries were blocked. He was recommended an open heart surgery to remove the blockages and then given blood thinners for the next few days to prepare him for the operation, she recalled.
Bhuyan’s surgery on 4 October was scheduled for around 11am. Inderjit S. Virdi, a senior consultant and chief of cardiothoracic and vascular surgery at Max Devki Devi institute was heading the team performing the operation, Ramola Bhuyan said, which was confirmed by Dr Ahmed.
Around 6.30pm, the surgery was declared “successful” and Bhuyan was moved into the intensive care unit, Ramola Bhuyan said.
“The doctors told us that his liver and kidney were functioning well,” she said, describing the sequence of events. “He was put on a ventilator and they said that they will let us know about the functioning of the brain later as he was under heavy sedation.”
A relieved family—the Bhuyans have no children—went home. The next morning, when Ramola Bhuyan called the Max Devki Devi institute at around 8 to check in on her husband, she said she was told that he had suffered an extensive brain injury and was asked to rush to the hospital.
“I reached the hospital around 10.30am and a team comprising the cardiologist, surgeon and the hospital’s human resources (HR) person met me,” she said. “The minute I saw the HR person, I knew something was wrong. They told me a terrible mistake had happened during the surgery and something went wrong with the procedure, which made him brain dead.”
According to Ramola Bhuyan, the hospital immediately accepted its mistake and did not try to shift the blame.
Dr Ahmed insists that at no point did the hospital tell the family that everything was fine. “The family was told after the surgery that there was a problem with the brain, which we can tell only after the effects of sedation wear off,” he told Mint.
On 5 October, at the insistence of Bhuyan’s family, the hospital called in two doctors from the All India Institute of Medical Sciences (AIIMS), a well-regarded government-run hospital in the Capital. Those doctors explained to the family that nothing could be done to revive Bhuyan. The family, through CII, also got in touch with the chief cardiologist of Sir Ganga Ram Hospital to also check on Bhuyan.
In the meantime, Bhuyan was put on various machines, including a dialysis support, because his organs were failing one by one, says Ramola Bhuyan.
On 6 October, around 11am, the hospital formally declared Bhuyan “dead”.
Having just returned home after spending some time with family in Hyderabad, Ramola Bhuyan says she wants Max Devki Devi institute to go after the guilty. “No leniency should be shown to the doctors,” she said. “The doctor should not be allowed to practise again. If the hospital wants more time, let them have it.”
Dr Ahmed says Dr Virdi was only heading the team that did the surgery and he was “not responsible” for the error. He declined to name any other doctors on the team.
Max Healthcare has a “four-page code of conduct under which we evaluate the mistake, understand, reason and take action on it”, said Dr Ahmed. “Based on the learnings from the case, we also put in checks and balances to ensure that such mistakes are not made again.”
Dr Virdi’s office told Mint he was travelling until 21 November and would not be available to respond to questions.
Dr Ahmed said he was meeting the Bhuyan family on Thursday. Meanwhile, Ramola Bhuyan says she is also waiting for two more parts of a post-mortem report from AIIMS. A complete post-mortem report is needed to file a police complaint.
Legal experts unrelated to the saga say that the recourse available to the Bhuyan family, if they choose to, is to file a lawsuit against the hospital in a consumer court.
Medical law is still developing in India when compared with countries such as the UK and the US where there is an established tradition of sorting out medical malpractice issues and law firms specialize in taking on hospitals and doctors.
These legal experts that Mint spoke to say there are three options available for Ramola Bhuyan: she can file a suit in the consumer court againstthe hospital for monetary compensation, file a suit against the hospital alleging criminal liability due to medical negligence in a trial court, or initiate a process to get the licence of the hospital cancelled by the state government of Haryana.
They also point to a 2005 Supreme Court decision that laid down guidelines for prosecuting medical professionals for negligence.
In the case of Jacob Matthew v. the state of Punjab, the court held that in a case of medical negligence, it is enough for a doctor to show that the standard of care was that of an “ordinary competent” medical practitioner “exercising ordinary skill” to escape criminal liability.
“The court felt that a Damocles sword must not hang over a doctor and he must be given a free hand,” Supreme Court lawyer K.V. Viswanathan said, explaining the court’s logic. “After the Jacob Matthew judgement, doctors are to be given a long rope. A doctor cannot be held liable for mere error of judgement or accident.”
If recklessness or rashness can be proved on the doctor’s part, then a case can be made, Viswanathan added.
According to Rahul Singh, assistant professor of law at the National Law School of India University in Bangalore, it is tough to estimate the exact number of cases on medical negligence as there is no pan-India database for trial courts across states where such suits are filed.
“Very few people file such cases as there is no incentive to do so,” he said. “This is because the probability of detection of negligence is very low, a stringent level of proof is required, the courts are not keen on awarding damages to consumers and legal literacy is low. Some cases also get settled outside court.”
Ramola Bhuyan says she will await the various reports as well as what Max plans to do about the doctors involved in the case before deciding what to do.
“Bhuyan was a very gentle soul...people loved him,” she said, speaking through visible distress. “The hospital should not shelter such people.”
Malathi Nayak contributed to this story.
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First Published: Wed, Nov 12 2008. 12 06 AM IST