Friday, July 27, 2012

The Cunning of Healthcare

In my last post I had mentioned about my experience with a doctor named Dr K. G Kallur, Consultant Nuclear Medicine at HCG Bangalore Institute of Oncology during a nuclear scan. I had lodged an FIR against him with the police who, in turn, had referred the case to the Karnataka Medical Council (KMC) for investigation.

I had in my written submission brought to the notice of the Hon’ble Council (KMC) that according to Atomic Energy Regulatory Board (AERB) Safety Code, it is mandatory for a specialist doctor/nuclear physician to supervise scans such as mine and had annexed a copy of the relevant code.

The Code inter alia spells out that the nuclear physician shall:

(a) have the responsibility of dosage administration and maintenance of records providing name of the patient, nature of procedure, radiopharmaceutical prescribed, quantity prescribed, name of the nuclear medicine physician with signature and date, and name of the person administering the radiopharmaceutical with signature and date;

(b) prevent any possibility of misadministration and promptly report to the licensee and the competent authority in the event of any misadministration, adverse reaction or death of a patient administered with radioactivity;

(c) consider factors such as proper choice of radiopharmaceuticals, monitoring of procedure and immobilisation of the patient in order to minimise absorbed dose to the patient;

(d) inform patient on safety measures to be observed to avoid radiation exposure to the family members and others;

(e) instruct nursing and ancillary staff on radiation safety and precautions in nursing/management of therapy patients;

(f) obtain an informed consent from the relatives of the patient, prior to administration of therapeutic dose;

I had stated that all the above mandatory prescriptions of AERB were flagrantly disregarded by the specialist doctor, Dr Kallur, Consultant Nuclear Medicine, since neither he (who as per the money receipt was mentioned as the doctor to oversee the scan) nor any nuclear physician supervised the said scan. In fact, the doctor had not seen, leave alone examined and discussed any issue with me, the patient.

I had further brought to the notice of the Council that the HCG Bangalore Institute of Oncology Speciality Centre claims to have accreditation from National Accreditation Board for Hospitals & Healthcare Providers (NABH) Government of India. According to chapter 2 (CPP) Control of Imaging Processes and Procedures of National Accreditation Board for Hospitals & Healthcare Providers (NABH) [Page 41]:

“The imaging protocol shall address general population as well as provide for specific modifications in patient with special needs, e.g. children, pregnant, females etc. The quality of images shall be verified by the technician as well as by the supervising radiologist/nuclear physician in terms of its technical nature and the diagnostic content relevant to the patient’s condition.”

The above stipulation enjoined as a “Shall” requirement in the NABH’s Standard for Medical Imaging Services (MIS) was violated with impunity by Dr Kallur.

I had brought out that my apprehension that the nuclear scan was done without the specialist’s supervision was further vindicated upon receiving the report. While the radiologist’s signature was affixed to the report, names of three consultants in nuclear medicine were printed alongside, including Dr Kallur’s, though no signature of any of the three consultants had been affixed. This clearly shows that the nuclear scan was examined only by the radiologist, not the nuclear medicine specialist, Dr K. G. Kallur.

I had concluded that from the foregoing it was evident that Dr K. G. Kallur, Consultant Nuclear Medicine has breached every conceivable norms and standards prescribed by AERB Safety Code 2011, NABH, Society for Nuclear Medicine India, Code of Medical Ethics prescribed by the Medical Council of India. Also that the behavior of Dr K. G. Kallur, Consultant Nuclear Medicine, HCG has caused tremendous mental agony and harassment to me and the damage caused is incalculable. Such behavior – inexcusable from any denizen of a civilized society in normal times – is entirely unacceptable coming as it does from a service provider (specialist doctor) to whom the patient had gone seeking specialized service on payment of requisite fees.

In light of what has been mentioned above, I had prayed to the Hon'ble Council that it may be pleased to investigate the matter and find out the following:

i.            Can a Nuclear Scan be done without the supervision of a specialist doctor in the concerned medical speciality and if this is as per the universal medical protocol that HCG Bangalore Institute of Oncology Speciality Centre espouses and is required to follow? Does this not amount to criminal neglect in patient care?

ii.           How could the hospital, a service provider, flout its own stated commitment of a nuclear scan under Dr K. G Kallur and not perform the task for which they have charged an amount of Rs 17,000? Is there no accountability?

iii.            Can a doctor – because of being stressed, busy and/or excess workload (taking about 60/70 nuclear scans a day) – absent himself from a critical nuclear scan being taken? Is this as per the medical protocol prescribed for nuclear scans as well as critical care illnesses like cancer?

iv.             Was it fair and appropriate for the doctor to tell a patient – “You can take your money back”? Was not the doctor breaching the code of ethics and conduct by retorting to the patient in such a manner? It is well to remember that (as I had told the doctor) while money can be returned, what about the actual scan procedure experienced, the radioactive isotope injected into his body and the ramifications therein? Isn’t Dr K. G. Kallur’s insensitive words and behavior reprehensible/abominable and completely bereft of the moral and ethical fibre expected of a doctor in his dealing with the patient? Is this as per the MCI’s Code of Medical Ethics relating to the PROFESSIONAL CONDUCT, ETIQUETTE AND ETHICS for registered medical practitioners?

v.            Can a nuclear scan be done and findings prepared by a doctor who is not a specialist in that discipline when the specialist is available and whose name is mentioned in the money receipt? Does this not amount to cheating and fraud? I’d stated that since the issue is of wider public interest, as it affects the lives of vulnerable section of people (patients) who often are voiceless – the illiterate, uneducated masses knowing nothing what doctors they trust blindly do – and with wider ramifications, appropriate punitive measures as deemed fit in the form of cancellation of his license be passed against the errant doctor, Dr K. G. Kallur, in the interest of justice and in the cause of upholding the Hippocratic Oath that all doctors are sworn to.

Among other things, Dr K. G. Kallur in his written submission has given a new twist to his not signing the report. To wit from para 8 of his written submission: “I submit that Mr Mohanty’s PETCT report was dictated by me and left early on the day of this episode i.e. on 24th May, 2012. However, next day the driver of Mr Mohanty came to collect the report and he was in urgency to collect the report and repeatedly pressurized Mrs Chandrakala (PETCT – Coordinator) to hand over the report and that he has to leave urgently. Since I was not in station on 25th May, 2012, the report was not signed by me. Mrs Chandrakala had clearly informed the driver that I was not in station and that the report has been signed by Dr Shiva Kumar Swamy. S (Consultant Radiologist). Since the driver was in urgency, he informed that he would collect this report. Though there is list of names of doctors in the report, it is not mandatory that all should sign. PETCT report is a multidisciplinary approach. Radiologist is also involved. He is also a responsible person reporting. It is customary in most of the centers that at least one of the members signs the report if not all. In view of the unpleasant scene created by Mr Mohanty the previous day and based on the driver’s request, Mrs Chandrakala handed over the report. I submit that as per the hospital protocol, original report will be issued after getting the receiver’s signature in the outward register. In this case, since the original report was not issued, signature was not obtained from the receiver. The original report signed by all is still with us and the same has not been collected by Mr Mohanty or his authorized representative.”

The Karnataka Medical Council has passed the following ORDER on 19.07.2012:

‘Karnataka Medical Council is of the unanimous Opinion that the Respondent Dr K. G. Kallur has followed the Standard protocol while performing the PET Scan. The Complainant has failed to establish “Negligence” on the part of the Respondent. With the result the Case is dismissed.’

I desist from giving my impressions here. I am merely putting the facts in public domain for readers to judge for themselves. I need only remind readers to compare Dr Kallur’s version conveyed in his letter dated 8.6.12 published in Moneylife article titled Callousness and high-handedness of Bengaluru cancer hospital HCG with the one he has given now and quoted above [about my driver collecting the report (and even the CD of the scan – that he forgets to mention] in his written submission to the KMC. On 8.6.12 he had said thus: “He (i.e. me) has abused front office people and taken the report away from the front office of people even before I signed off the report. Now he is alleging that that I have not seen his scan images and not reported and this amounts to medical negligence.” Heavens! In my reply dated 10.06.2012 posted in the Moneylife site, I had said: “You (Dr Kallur) don’t have to give me an answer, nor to any one else, let you dialogue with your conscience. How your petulance, which prompted you to refuse signing the report because I had complained against you, has coiled you today in so many knots? To tell one lie, you’ve to manufacture few more numbers; the lies get squared and cubed, and on and on it goes gathering momentum and flight – an infinite loop that you’ll find hard to keep pace with. It’s already happened, and the more you try defending yourself through lies, more lies, and still more lies, you’re likely to get ensnared more and more, inextricably, and get caught in your very own self-created web of lies.” How gloriously Dr Kallur has lived up to the expectations I had reposed in him! This is, what I call, the cunning of healthcare in India today.

This has become rather long and I apologize! But truth must prevail. I know it’s a long haul. Well, I’m happily ready to travel the distance – seeking out every available constitutional mean in quest of justice.

Satyamev Jayate!


  1. Such inhuman behaviour and callous attitude by responsible persons in society (so called saviours of mankind) needs to be condemned in the srongest possible way.God save us from such Doctors who play with human lives!
    A Pradeep

  2. Collective conscience shapes and is shaped by individual conscience. The flow is one of abdication of responsibility everywhere. That makes it even more necessary to take a just viewpoint further into the battle ground; to the very cliff where truth hoists the flag. The pool of justice must be deep and expanding. Everyone needs to contribute.

  3. Kudos to you,Sudhansu for taking the bull by horns and in what irrefutable manner!It's not easy for an average person to take on a doctor,assailed and tormented as he is with the disease;the line of treatment and schedule of investigation hardly intelligible to him,he trustingly reposes his faith in the doctor.Such as your experience is most common happening in INDIA's today life and doctors in large numbers have purely mercenary approach towards patient's treatment.Such callous approach brings only disrepute to medical fraternity,the noblest of profession sworn to Hippocratic oath and requires to be dealt in sternest of manner by Karnataka Medical Council.All good wishes to you on behalf of suffering-at-the-hand-of-doctors majority in your fight; and sincerely wishing you God's grace and speed for recovery to normal health.

  4. Sir, with all due respect to your pain and suffering. A PET-CT scan is not a critical scan. You cannot claim a demand for supervision from a doctor during procedure.

    You can take the matter up with AERB, though.

    1. I really appreciate your Thinking..SethiStone deals with Kota Stone & Mandana Stone in a timely Manners.