Apollo Hospitals, a prominent hospital chain in the country, is in the dock over the death of J Jayalalithaa, former chief minister of Tamil Nadu. Justice A Arumughaswamy Commission, which was set up to look into the circumstances that led to the demise of the former CM, has concluded that doctors of Apollo made some serious lapses while treating Jayalalithaa who was admitted in Apollo Hospital, Chennai for 75 days prior to her death.
On what basis did the commission, headed by retired Madras High Court judge A Arumughaswamy, find fault with the hospital, the services of which are availed by thousands of people? Let's find out.
Five Reasons Why
The commission has held Jayalalithaa’s treatment at the hospital suspect primarily for five reasons:
Jayalalithaa was not surgically treated for an underlying heart condition
Jayalalithaa was allegedly kept in the dark on some crucial aspects of her treatment
The government was allegedly not informed of the true nature of Jayalalithaa’s health condition
The hospital authorities allegedly misguided the public by not revealing Jayalalithaa’s true health status
The hospital allegedly did not record the exact time of death and delayed recording it by several hours
Jayalalithaa was admitted in Apollo Hospital, Chennai on 22 September 2016, and was treated there till her death on 5 December 2016. She was 68 when she died.
Justice Arumughaswamy Commission has now recommended that the Tamil Nadu government initiate a probe on Apollo Hospital Chairman Dr C Pratap Reddy and two doctors of the hospital Dr YVC Reddy and Dr Babu Abraham. The government has decided to refer the report to a team of medical experts to substantiate the need to conduct such a probe.
#1 - Commission Asks Why Surgery Was Not Performed on Jayalalithaa
Jalayalithaa was allegedly diagnosed with a heart condition – Left Ventricular (LV) Dysfunction – late in 2015. “There is vague evidence without supporting documents,” towards this, the commission has observed. According to the commission, when Jayalalithaa was admitted in Apollo Hospital on 22 September 2016, the initial diagnosis was that she was suffering from sepsis, community-acquired pneumonia and acute LV failure. According to the commission, while the hospital treated her for sepsis and pneumonia, she developed “perforation and vegetation” on the heart on 29 September 2016.
The commission has quoted two doctors as having recommended that the patient needed a valve surgery. Dr Ram Gopalakrishnan (consultant for infectious disease at Apollo) and Dr Rajeev Soman (infectious disease specialist based in Pune), suggested surgery, the commission has found.
All India Institute of Medical Sciences (AIIMS), New Delhi doctors Dr Nithish Naik and Dr Deva Gourou Velayoudam, who deposed as commission witnesses, also stated that surgery alone could solve vegetation (or bacterial infection of the heart valve), "even as health condition of the patient has to be taken into account while performing the surgery."
Further, Dr Shamin Sharma of Mount Sinai Hospital, New York, who was called in by Jayalalithaa’s relatives, had also recommended surgery. She had offered to perform the surgery, which was denied because Apollo doctors took the advice of Dr Richard Beale, an intensive care medicine specialist based in UK, the commission has noted.
The commission has asked why a cardio-thoracic surgeon was not consulted to surgically deal with the vegetation. It is to be noted that the commission has, however, observed that some doctors of Apollo and AIIMS had ruled out the need for surgery. This was a wrong call, the commission has indicated in its report.
“Of course, it is true that some of the doctors attached to Apollo who are essentially physicians opined that no surgery need be done. However, the fact remains that at no point of time during the course of treatment any cardio thoracic surgeon was asked to attend on late CM.”Justice A Arumughaswamy Commission
The commission has also asked why the former CM was not flown out to any health facility abroad for medical care. In fact, Dr Richard Beale had recommended treating her abroad and had even agreed to accompany her in an airbus, the commission noted, based on Beale’s statement.
#2 - Commission Asks Why Jayalalithaa Was Kept in the Dark
The commission has observed that while Jayalalithaa was treated for sepsis during the first 15 days of hospitalisation, in the next 60 days she was treated for lung and heart ailments alone.
During this time Dr Stuart Russell, a US-based advance heart ailment specialist and cardiologist, who was being consulted by Apollo doctors, had recommended an angiogram that could diagnose further heart and blood circulation ailments.
However, Dr Babu Abraham of Apollo Hospital ruled out the need for this angiogram, the commission has observed. According to the commission Dr Beale had also recommended an angiogram in the early stage of treatment.
While Apollo Hospital doctors have allegedly not clarified the reason for postponing the angiogram, a major concern the commission’s report has raised, is that Jayalalithaa was not informed of the possible need for an angiogram. Though the former CM was lucid, she was not given this vital information, the commission has alleged.
“…Whereas about procedure of angiogram, as suggested by CW 120, the late CM was not aware and that is the reason R.2 hospital had postponed the angio procedure.”Justice A Arumughaswamy Commission
The commission has also stated that Jayalalithaa’s signature was not seen on any of the hospital documents. It was her aide, VK Sasikala and the then chief secretary who had signed the treatment documents on her behalf.
#3 - Commission asks Why AIADMK Govt and Leaders were Kept in the Dark
According to the commission, it was not just Jayalalithaa who was allegedly left in the lurch. Even the government and her party colleagues in All India Anna Dravida Munnetra Kazhagam (AIADMK) were not aware of the exact nature of her ailments and the treatment given to her, the commission has stated. The then Health Secretary J Radhakrishnan failed to pass detailed information about Jayalalithaa’s health status to the government, the commission has implied.
The commission says:
“Witness testimony reveals that when the patient was conscious and had her faculties intact, she was not informed of the health issues she was facing and the treatment protocol to be adopted. It is incomprehensible why the patient herself was kept in dark and the in-charge CM (O Pannerselvam), cabinet colleagues and officials were not taken into confidence.”
The commission has observed that decisions regarding Jayalalithaa’s health were mostly taken by Sasikala and Jayalalithaa’s personal physician Dr KS Sivakumar in consultation with doctors at Apollo Hospital. Even her relatives were not informed of key decisions, the commission has observed.
The commission has also observed that the treatment was “shrouded in secrecy.” The report read:
“The whole line of treatment was shrouded in secrecy and there was lack of transparency, as much as there was no authentic and reliable disclosure of facts pertaining to her exact health condition and course of treatment.”
If the government had knowledge of Jayalalithaa’s critical condition, the cabinet could have passed a resolution to get her treated at a foreign medical facility, the commission has claimed. While the government was not keep in the loop, Apollo Hospital misguided the public too, the commission has claimed.
#4 - Commission Asks Why Apollo Hospitals’ Chairman Misguided the Public
In a press conference held on 12 November 2016, Apollo Hospital Chairman C Pratap Reddy allegedly claimed that Jayalalithaa’s heath had improved and that she could leave the hospital any time she wished. The commission, however, has come down heavily on this statement.
As per medical records at the time, the patient was in no condition to leave the hospital, the commission has claimed.
“(C Pratap Reddy’s) interview gave an impression that the late CM was out of danger and was perfectly alright, requiring no more hospitalisation. But the truth, as revealed from the medical records and the evidences of the doctors discussed in this report elaborately, was absolutely otherwise.”Justice A Arumughaswamy Commission
The commission has called this statement “highly condemnable” as it misinformed people about the CM’s health status. It is to be noted that Jayalalithaa died when she was still the chief minister of Tamil Nadu. This was at a time when millions were eagerly awaiting news about Jayalalithaa’s health status. The former chief minister, who also had an illustrious film career before she stepped into politics, was one of the most popular leaders of Tamil Nadu.
For his statement alone, Pratap Reddy’s conduct should be probed, the commission has recommended.
The commission’s report read:
“It is also shocking that the head of such a world renowned hospital made such an irresponsible statement to the Media. Was there any pressure upon him to make such a false statement?”
The damning report has also held the hospital responsible for not recording the patient’s time of death correctly.
#5 - Commission Asks Why the Hospital Did Not Declare Death on 4 December 2016
According to statements made by nursing staff, duty doctors and technicians who were present in Jayalalithaa’s room on 4 December, she suffered cardiac arrest in the afternoon on the same day, the commission has found. However, the doctors were not able to revive her either by administering CPR or sternotomy till 3.50 pm on 4 December.
“The duty doctor present at that time also stated that there was a change in the heart rhythm, noticed by her in the VPC monitor; heart VF changed, heart alone vibrated, there was no blood circulation.”Justice A Arumughaswamy Commission
Jayalalithaa was then placed on ECMO (Extracorporeal Membrane Oxygenation) for the next many hours, the commission has observed, adding that the hospital's decision was to “satisfy themselves.” ECMO is a machine which replaces some of the functions of the patient’s heart and lungs. The hospital placed her on ECMO as brain death had not happened, the commission has observed.
If there was no chance of revival or even the possibility of a heart transplant, why was Jayalalithaa’s death not declared on 4 December, the commission has asked. A team of doctors from AIIMS too had examined Jayalalithaa when she was on ECMO.
The commission observes:
“The AIIMS doctors visited on 5.12.2016 at 5.00 pm, they asked the hospital authorities to bring the temperature of the patient to normothermia and two to three hours later they examined and opined that no heart function was seen. Hence, they instructed to remove the late CM from ECMO. Once they had no idea of doing transplantation, then why did they put her in the normothermia and this could not be explained by them.”
The time of death was declared as 11.30 pm on 5 December 2016.
The observations of the Arumughaswamy Commission have essentially contradicted the report of a medical board set up by AIIMS. The medical board in its report had stated that Apollo Hospitals had followed all the required treatment protocols in Jayalalithaa’s case. VK Sasikala too has refuted the findings of the commission and has said that she acted only on the recommendation of trusted and qualified doctors.