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കേരളത്തിലെ ആശുപത്രികളില്‍ പതിയിരിക്കുന്ന മരണം (ഡോ. തോമസ് ജോണ്‍ കോളാകോട്ട്)

Published on 27 March, 2017
കേരളത്തിലെ ആശുപത്രികളില്‍ പതിയിരിക്കുന്ന മരണം (ഡോ. തോമസ് ജോണ്‍ കോളാകോട്ട്)

പാര്‍ട് ടൈമായി ആശുപത്രിയിലെത്തുന്ന ന്യൂറോ സര്‍ജന്‍ അലംഭാവത്തോടെ നടത്തിയ ശസ്ത്രക്രിയ, ഐസിയു സ്റ്റാഫിന്റെ അശ്രദ്ധ മൂലം വീണു കാലിനുണ്ടായ ഒടിവ്, ചികില്‍സാ നിര്‍ണയം മുതല്‍ തുടങ്ങിയ പിഴവുകള്‍ – തിരുവല്ല മെഡിക്കല്‍ മിഷന്‍ ആശുപത്രിയില്‍ എന്റെ സഹോദരന്‍ മാത്യു ജോണ്‍ കോളാകോട്ടിന്റെ (63) ജീവന്‍ അപഹരിച്ചത് ഇതെല്ലാമാണ്. ചികില്‍സാ പിഴവാണെന്നു വ്യക്തമായ തെളിവുകളുണ്ടായിട്ടും ഖേദം പ്രകടിപ്പിക്കാന്‍ പോലും അധികൃതര്‍ തയാറായില്ല. കണക്കുപറഞ്ഞ് 5.3 ലക്ഷം രൂപ വാങ്ങുകയും ചെയ്തു.

എന്റെ സഹോദരനെ ശരീരഭാരം കുറയലും തലകറക്കവും ക്ഷീണവുമായി കഴിഞ്ഞവര്‍ഷം ഓഗസ്റ്റ് 22നാണ് ആശുപത്രിയില്‍ പ്രവേശിപ്പിച്ചത്. സിടി സ്കാനിങ്ങില്‍ ഹൈഡ്രോസെഫാലസ് (മസ്തിഷ്കത്തില്‍ സെറിബ്രോ സ്‌പൈനല്‍ ദ്രവം നിറഞ്ഞ് മര്‍ദമുണ്ടാകുന്ന രോഗം) എന്ന അവസ്ഥയുണ്ടെന്നു മനസ്സിലായത്. ജന്മനാ ഉള്ള ഈ അവസ്ഥ കൊണ്ടാകാം സഹോദരന്‍ ഓട്ടിസം ബാധിതനായിരുന്നു. തുടര്‍ന്ന് ഷന്റ് ഇംപ്ലാന്റ് നടത്താന്‍ ന്യൂറോ സര്‍ജന്‍ തീരുമാനിച്ചു. ശസ്ത്രക്രിയയ്ക്കു ശേഷം സെപ്റ്റംബര്‍ 13ന് ആശുപത്രി വിട്ടു; 1.3 ലക്ഷമായിരുന്നു ചെലവ്.

എന്നാല്‍ പിന്നീട് എന്തുകഴിച്ചാലും ഛര്‍ദിക്കാന്‍ തുടങ്ങി. സിടി സ്കാന്‍ ചെയ്തപ്പോള്‍ ഓട്ടമാറ്റിക്കായി പ്രവര്‍ത്തിക്കാത്ത ഷന്റ് (വില 9000 രൂപ) ഘടിപ്പിച്ചതു മൂലമുള്ള പ്രശ്‌നങ്ങളാണെന്നു കണ്ടെത്തി. 1.3 ലക്ഷം വാങ്ങിയിട്ടും നല്ല ഷന്റ് ഘടിപ്പിക്കാത്തത് എന്താണെന്ന ചോദ്യത്തിന് ഉത്തരമില്ല. എന്തായാലും പഴയ ഉപകരണം നീക്കി 50,000 രൂപയുടെ ഓട്ടമാറ്റിക് ഷന്റ് ഘടിപ്പിച്ചു. ശസ്ത്രക്രിയ വിജയമാണെന്നു പറഞ്ഞ് ഒരാഴ്ചത്തെ ഐസിയു വാസത്തിനു ശേഷം വാര്‍ഡിലേക്കു മാറ്റി. സഹോദരന്‍ അപ്പോഴേക്കും തീരെ അവശനായിരുന്നു.

ഫിസിയോതെറപ്പിസ്റ്റ് നോക്കിയപ്പോള്‍ കാല്‍മുട്ടില്‍ നീരും മുറിവുകളും ഓയിന്‍മെന്റ് കൂടുതല്‍ പുരട്ടിയതിനെ തുടര്‍ന്നു പൊള്ളിയതുപോലെയുള്ള പാടുകളും കണ്ടു. തുടര്‍ന്നുള്ള സ്കാനിങ്ങില്‍ കാലില്‍ ഒടിവു കണ്ടെത്തി. തനിയെ ശുചിമുറിയില്‍ പോകുകയും നടക്കുകയുമെല്ലാം ചെയ്തിരുന്ന വ്യക്തിക്ക് ഈ അത്യാഹിതം സംഭവിച്ചത് ഐസിയുവില്‍ വച്ചാകാം. തൊട്ടടുത്ത ദിവസങ്ങളിലാണ് ഒടിവുണ്ടായതെന്ന് അസ്ഥിരോഗ വിദഗ്ധന്‍ സ്ഥിരീകരിക്കുകയും ചെയ്തു. കയ്യബദ്ധം പറ്റിയതാകാം. കാലിലും ശസ്ത്രക്രിയ വേണ്ടിവന്നു.

ആശുപത്രിയിലെ സമ്മര്‍ദങ്ങള്‍ക്കിടയില്‍ അപസ്മാരമുണ്ടായി. മരുന്നു കൊടുക്കരുതെന്നു കെയര്‍ ടേക്കര്‍ ആവുന്നതു പറഞ്ഞിട്ടും നഴ്‌സുമാര്‍ കേട്ടില്ല. മരുന്നു കുത്തിവച്ചതോടെ മാത്യു അബോധാവസ്ഥയിലായി. വീണ്ടും ഐസിയുവിലെ പീഡനങ്ങളിലേക്ക്. ഭക്ഷണം കഴിച്ചുകൊണ്ടിരുന്നിട്ടും ഫീഡിങ് ട്യൂബിട്ടു. അതിന്റെ ആഘാതത്തിലുണ്ടായ കടുത്ത പനിയില്‍ ബ്ലാങ്കറ്റ് പോലുമില്ലാതെ മാത്യു ഐസിയുവില്‍ കിടന്നു വിറച്ചു. ഇക്കാര്യം ഡോക്ടറെ അറിയിച്ചപ്പോഴാണു ശരീരം മുഴുവന്‍ മൂടും വിധത്തില്‍ വലുപ്പമുള്ള ബ്ലാങ്കറ്റ് അനുവദിച്ചത്.

വിവിധ വകുപ്പുകളുടെ ഏകോപനം ചികില്‍സയില്‍ വേണ്ടിയിരുന്നെങ്കിലും ഡോക്ടര്‍മാരുടെ ‘ഈഗോ’ പ്രശ്‌നങ്ങള്‍ കാരണം അതും ശരിയായി നടന്നില്ല. തലയിലെ ശസ്ത്രക്രിയയ്ക്കുവേണ്ടി കഴുത്തിലുണ്ടാക്കിയ ദ്വാരമാകട്ടെ, അപ്പോഴേക്കും പഴുത്തു വീര്‍ത്തിരുന്നു. വീട്ടില്‍ പോകണമെന്ന മാത്യുവിന്റെ ആഗ്രഹം മനസ്സിലാക്കിയ ഞങ്ങള്‍ ഡിസംബര്‍ രണ്ടിന് ആശുപത്രിവിട്ടു, ആറിന് അദ്ദേഹം മരിച്ചു.

ചികില്‍സാ പിഴവിന്റെ വിവരങ്ങളെല്ലാം കൃത്യമായി വിശദീകരിച്ച് ആശുപത്രി അധികൃതരെ സമീപിച്ചെങ്കിലും തികച്ചും മോശമായിരുന്നു പ്രതികരണം. ഞാന്‍ ഇക്കാര്യങ്ങള്‍ തുറന്നെഴുതുന്നത് അതുപോലെയുള്ള ഒട്ടേറെ കുടുംബങ്ങളുടെ കൂടി ശബ്ദമാകാനാണ്.

ചില നിര്‍ദേശങ്ങള്‍: സ്വകാര്യമേഖലയിലെ ആശുപത്രികളെ നിയന്ത്രിക്കാന്‍ കര്‍ശന നിയമം നടപ്പാക്കുക, ഡോക്ടര്‍മാര്‍, നഴ്‌സുമാര്‍ തുടങ്ങി ആശുപത്രിയിലെ എല്ലാ ജീവനക്കാര്‍ക്കും മൂല്യബോധനം നല്‍കുക, രോഗികളെ കൈകാര്യം ചെയ്യുമ്പോള്‍ പാലിക്കേണ്ട സുരക്ഷാ ചട്ടങ്ങളില്‍ എല്ലാ വര്‍ഷവും പരിശീലനം കൊടുക്കുക, ഐസിയുകളില്‍ സിസിടിവി നിരീക്ഷണം ഏര്‍പ്പെടുത്തുക, രോഗിയുടെ മാനസികവും ശാരീരികവുമായ നില മനസ്സിലാക്കി അവരുടെ ബന്ധുക്കളെ ഐസിയുവില്‍ അനുവദിക്കുക, പുരുഷ രോഗികളെ എടുത്തുയര്‍ത്താനും നടത്താനും മറ്റുമായി കൂടുതല്‍ പുരുഷ നഴ്‌സുമാരെ നിയമിക്കുക, ചികില്‍സ നിര്‍ണയിക്കാനാകുന്നില്ലെങ്കില്‍ മറ്റ് ആശുപത്രികളിലേക്കു റഫര്‍ ചെയ്യു, ഡോക്ടര്‍മാര്‍ക്കു കമ്മിഷന്‍ കൊടുക്കുന്നത് അവസാനിപ്പിക്കുക, ചികില്‍സയില്‍ വിവിധ വകുപ്പുകളുടെ ഏകോപനം ഉറപ്പാക്കുക.

(പ്രശസ്ത രസതന്ത്ര ശാസ്ത്രജ്ഞനായ ലേഖകന്‍ യുഎസിലെ ജോണ്‍സണ്‍ മാത്തേ കെമിക്കല്‍ കമ്പനിയുടെ ഗ്ലോബല്‍ റിസര്‍ച് ആന്‍ഡ് ഡവലപ്‌മെന്റ് മാനേജരും ടെക്‌നിക്കല്‍ ഫെലോയുമാണ്)


To: Mr. Benny Philip                                                                          January 12, 2017                                                                                                                      Secretary, Thiruvalla Medical Mission Hospital                                                               Thiruvalla, Kerala.

From: Dr. Thomas Colacot, Ph.D, FRSC, MBA

113 Simi Ct, Cherry Hill, NJ.

 

Dear Administrator and Board of Directors of TMM Hospital:

I am writing this petition because of the recent premature death (due to involuntary manslaughter) of my brother, Mathew John Colacot on Dec 6, 2016, who was a patient at your hospital. By reviewing his case, it is apparent that medical ethics and the Hippocratic oath are totally violated at TMM. Despite two botched neurosurgical procedures, neglect and abuse by the ICU staff, which ultimately led to his untimely demise, the hospital did not issue an apology and instead shamelessly collected a fee of Rs. 5.3 lakhs. Therefore, I demand a written apology with the refund of the hospital fee collected. If this had happened in any other developed countries, the doctors would have lost their license and the hospital would have been fined. My sincere hope is that this letter will help to restructure the hospital to “do no harm to the patient” so that future patients will benefit from my brother’s tragedy and I also hope that this letter will give a voice to the other voiceless patients.

 In summary, three major mistakes contributed to my brother’s death: the decision made by TMM to conduct the surgery by an inexperienced part-time neurosurgeon, leg fracture that occurred during his stay in the ICU, and abuse and neglect by ICU staff/doctor that incapacitated him, ultimately leading to his untimely death.

Medical ethics emphasizes the principle of nonmaleficence, which mandates the hospital or its staff to “do no harm to the patients”, either due to negligence, poor decision making or for financial profits. The principles of nonmaleficence supports several moral rules, examples include: do not kill, do not cause pain or suffering, do not incapacitate and do not deprive others of the quality of life.

My brother was autistic, but brilliant in many other aspects. He reminds me of the autistic character played by Dustin Hoffman (OSCAR performance) in the 1988 movie, Rain Man, where Tom Cruise was his younger brother. My brother was a loving, caring and giving person, innocent, funny and at the same time stubborn. He loved to compose his own songs. He was many things to me… my father, my brother and my son.  He may not have been important to you, but to me he was a precious individual and I miss him terribly.  The same is applicable for the many other innocent patients who died under your care.

My brother was first admitted at TMM on 22/8/16-13/09/16 under the care of Dr. Umesh, as he was suffering from weight loss, dizziness and fatigue.  Dr. Umesh, ordered multiple tests including the test for multiple myeloma. All the tests came back negative, except that his hemoglobin level was low. The doctor concluded that this was due to malnutrition. However, his CT scan showed that he had hydrocephalous, a congenital condition which might have resulted in autism. Hydrocephalous is a treatable condition with shunt implant.  Both Dr. Umesh and Mr. Benny Philip (Secretary) recommended Dr. M. Srikumar, a neurosurgeon (new to TMM) to perform the surgery. Since, Dr. Umesh vouched for Dr. Srikumar, I finally agreed to the surgery despite my initial misgivings. After surgery my brother was sent home with a hospital bill of 1.3 lakhs, of which Rs. 50,000/- was for the Theater charges alone.

 Soon after his discharge, I had noticed that my brother was vomiting after every meal.  I took my brother for a follow up with Dr.Srikumar, who asked him to be readmitted after two weeks based on the CT scan of his head. The second round of hospital stay was from 19/10/16 until his discharge on 02/12/16.  Dr. Srikumar again ordered a CT scan of his head and diagnosed hematoma in the brain caused by the high pressure of the shunt. This was due to the non-automatic Rs. 9000/- locally made shunt.  He drained the “burr hole” and replaced the original shunt with the automatic improved Rs. 50,000/- shunt. Per Dr. Srikumar the surgery was a success and my brother was released from the ICU to the regular ward after a week.  At this point in time my brother was unable to get up or sit up and in great pain especially his right leg.  His Physiotherapist stated that my brother was crying whenever the physiotherapist came to mobilize him.  He also noticed bruises and swelling of the right knee and burned marks were observed due to the application of ointment close to the knee area. The doctor ordered a scan, which revealed a fracture of the femoral neck. This might have happened in the hospital as he was able to walk at home (I was with him for two weeks).  As a matter of fact he had got into the car by himself on his way to the hospital, witnessed by many people (including my sister) and the fact that he was able to walk to the bath room at the hospital. We suspect that the fall occurred after the surgery in the ICU. Dr. Srikumar had also texted me that the Orthopedic surgeon confirmed that the fracture was very recent and that it must have happened in the ICU when they had tried to mobilize him. It could have been an accident, not intentional, however it was the moral responsibility of the hospital to report it on his chart. The leg surgery was conducted successfully later by the orthopedic surgeon. When he came back from the ICU, the physiotherapist and the orthopedic surgeon mobilized him and he was able to take a few steps in the room.

 My brother was anxious to go home as he was very uncomfortable in the hospital setting.  He was susceptible to getting epileptic seizures when he gets stressed out or does not get enough sleep. However, once he rests for a few minutes he becomes okay without administering any medication. He had a seizure episode and ignoring the pleas of his caretaker, the nursing staff immediately injected him with Eptoin and other sedatives which rendered him unconscious. They readmitted him to the ICU (ICUs in Kerala are a money pit for a death trap) again. The staff asked the care taker to bring rice porridge (kanji). The ICU staff tried to feed him the rice and powdered capsules, he resisted.   During his previous ICU stays, they had allowed the caretaker to feed him.   According to the other patients in the ICU, this time the attending ICU nurse restrained him and put the feeding tube with the authorization of Dr. Srikumar. We do not know whether or not they incapacitated him as he lost his ability to speak and also his ambulatory skills.   This caused him “aspiration type pre pneumonia” with severe fever.    I called Dr. Umesh to intervene when the care taker informed me that my brother was in the ICU shivering in the bitter cold without any blankets fully covered. Dr. Umesh reprimanded the ICU staff to and ordered them to cover him fully with blankets. This shows the negligent and irresponsible behavior of the ICU staff. After about 10 days in the ICU, my brother was released to his room. Dr. Umesh told me that his hip had dislodged, and had to be fixed by the orthopedic surgeon. I had been in communication with Dr. Srikumar every day and he was only giving me positive news and I chose to believe him.   However, when my relatives visited my brother, they noticed that his condition was deteriorating.  They requested me to move him to another hospital as the care at TMM was subpar.  Dr. Srikumar tried to convince me that my brother’s condition will improve once his general health improves. The irony is that Dr. Srikumar did not contact the nutritionist to recommend a proper diet especially when he was malnourished.  The staff had asked the caretaker to feed 150 ml of rice porridge and tea.  Again I called Dr. Umesh, who recommended a nutritionist and started treating him aggressively including TPN, blood transfusion, etc. However, he indicated to me that he always needed to get permission from Dr. Srikumar (surgery ward) even though he was his original primary Physician.  From then on, things went “downhill”.   Although he was there for 2 months his neck wound had also not been healed and with blood and puss coming out. Since it was my brother’s wish to go home, he was discharged from the hospital on Dec 2nd.  Sadly, my brother passed away on Dec 6th.  Many of the TMM staff told us privately that several mistakes happened at the hospital.

This is a sad story which happened in a mission hospital started by a service minded missionary doctor to provide quality medical care.  My family has a long history with this hospital.  In fact my grandfather would always get treated at this hospital because of the excellent care he obtained by the missionary doctors. He actually breathed his last at this hospital (1951) and later my brother was born at this hospital as well. The quality of the hospital went downhill after the missionaries left due to poor administration and the lack of service by the doctors and the nursing staff.  In fact this hospital was resurrected by another British FRCS doctor, the late Dr. P. M.  George who happened to be my neighbor and family friend.  He had worked hard to improve the quality of this hospital.

Ever since my brother’s death I have heard horror stories about this hospital not only from relatives and friends but also total strangers who had contacted us after seeing my brother’s obituary in the newspapers.  One that particularly comes to mind is of the lady surgeon who always recommends amputation even if there is no need.  This same surgeon was also adamant about amputating my brother’s leg during a visit about two years ago. There were also complaints about a physician, called Abraham.   However, thankfully Dr. Mohan Varghese started the treatment for his diabetics, which was continued by Dr. Umesh after Dr. Mohan’s departure to Believer’s hospital and they were able to save my brother’s toe. The TMM surgeons are always looking to perform surgeries to get the bonus or commission to fatten their pockets.  This is not only very detrimental for the patient but it also violates medical ethics. It is a similar situation with the ICU. Other hospitals are also doing the same thing. If so what is the differentiation factor for a mission hospital?

After my brother’s passing, Mr. Benny Philip invited me to the hospital on Dec 15th to meet with the respective doctors, Medical Director, Asst. Director, the hospital PR officer and the nursing superintendent. Sadly Dr. Umesh and Dr. Srikumar conveniently avoided meeting with us. The Medical Director was very condescending to us. The Director  came to the meeting without reviewing the case, he had his facts wrong and all the while he was accusing the caretaker of mishandling my brother. What does she have to do with the treatment provided at TMM hospital? Dr. Samson’s argument was that in God’s time we all have to die, where you get treatment or not.  He even mentioned that Jayalalitha, with all her wealth and power she had to die. This shows the callousness and the lack of experience and bed side manners of the top administrators of the hospital.  This is an absolute shame to the hospital.  

Dr. Umesh did tell me when I called him after the meeting on Dec 15 th that this death could have been easily avoided. Now the question at hand is…   who is ultimately responsible for it? Dr. Samson told me that Dr. Srikumar was not sure about this surgery. If so, why did he undertake the surgery?  Was my brother a guinea pig for his experiments? If so he has already violated the major ethic, “do no harm to the patient”.  If the risk outweighs the safety to the patient, then he should not have undertaken the surgery.

Since Umesh found that my brother’s problem was poor absorption of hemoglobin due to malnutrition, he could have asked the dietician to prescribe the proper diet after checking his Vit D and Vit B’s early on. Or if surgery was necessary he could have suggested a well-equipped hospital with experienced neurosurgeons. The principles of “beneficence” in medical ethics state that doctors must take positive steps to help people and not merely refrain from any harm by acting honestly to the patients or their relatives, in this case they should have been forthright with me.

Both Dr. Umesh and Dr. Srikumar acted unprofessionally, although Dr. Umesh was rated as one of the highly respected doctors in Thiruvalla.  They did not divulge the truth.  They did not communicate with each other as to what was the best option for their patient and did not develop a comprehensive treatment plan for saving a human life.

Here are my suggestions/demands:

1.    Refund the “blood” money as early as possible to show that the hospital is taking a moral responsibility.

2.     Provide a written apology, admitting your mistakes.

3.    Discipline the medical staff (doctors and nurses) involved in my brother’s case. The ICU nurse who restrained him should be specially “charged” as she “persuaded” the doctor, which caused his painful ending.

4.    Formulate a corrective action plan which should include, mandatory training of medical staff on medical ethics (to act responsibly and to put the patient first) and also safety training as part of the onboarding and also as an annual refresher.

5.    Video monitoring and installation of closed circuit monitoring of ICUs should be implemented so as to discourage unethical practices.

6.    Hiring of more Male nurses to handle male patients to avoid potential falls and injuries.

7.    If the hospital or doctor cannot handle the case, be honest and recommend the patient to a well-equipped hospital.

8.    Avoid giving commissions to doctors and surgeons for ordering tests and for conducting surgeries, so that the patient’s interest comes first.

9.    Discourage Doctors and nurses from selling diabetic shoes and wheel chair to get commissions.

10.  Hire experienced and qualified medical staff and medical administrators with good work ethics regardless of their race, gender or creed.

11.  Encourage physicians to communicate and collaborate with each other especially when it involves a patient with multiple medical problems.

കേരളത്തിലെ ആശുപത്രികളില്‍ പതിയിരിക്കുന്ന മരണം (ഡോ. തോമസ് ജോണ്‍ കോളാകോട്ട്)കേരളത്തിലെ ആശുപത്രികളില്‍ പതിയിരിക്കുന്ന മരണം (ഡോ. തോമസ് ജോണ്‍ കോളാകോട്ട്)
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