Government doctors and their associations have raised certain critical questions on the way the Health department had handled the case relating to the death of 17-year-old footballer Priya early this week. They have strongly objected to treating this case as criminal negligence on the part of the treating team and have expressed their opposition to the move to arrest the doctors.
On November 15, Priya underwent an arthroscopic procedure for ligament tear repair in the right leg at the Government Peripheral Hospital, Periyar Nagar, and subsequently her leg was amputated at the Rajiv Gandhi Government General Hospital due to complications. She never recovered and died of multiple organ failure. Delay in removing the compression bandage was cited as the main cause of complications, resulting in suspension of two doctors — a casualty medical officer and assistant professor of Orthopaedics — of the Government Peripheral Hospital, while the inquiry committee has held a few more persons, including the theatre anaesthetist and post-operative ward staff, responsible.
The way the health department has handled the case has drawn criticism from its own workforce. They have raised a number of questions : Why was a case of civil negligence turned into criminal negligence? Why was a procedure such as arthroscopy allowed to be performed in a government peripheral hospital that has constrained resources including in staffing, post-operative care and infrastructure to handle complications? Did the hospital have a supply of digital pneumatic tourniquets that are used largely in tertiary care centres in such cases?
K. Senthil, president and N. Ravishankar, general secretary of Tamil Nadu Government Doctors Association, in a statement, cited Supreme Court guidelines in cases of deaths occurring during the course of treatment. The police should get the opinion of a senior specialist of the respective department. They can file a case under Section 304A of the Indian Penal Code only if the specialist finds criminal negligence during the treatment. Even if the section is invoked, the Supreme Court guidelines have said that arresting doctors should be avoided.
“In this case, the expert committee has not stated that there was criminal negligence. It has found civil negligence. The police department has violated court guidelines in this case,” the association said. The association resolved that if the two doctors are arrested, it will be forced to go for a State-wide protests.
P. Saminathan, president of Service Doctors and Post Graduates Association (SDPGA), called for an impartial and proper inquiry after which the case should be taken to court. No punitive action should be taken until the final order.
SDPGA, in a statement said, “Without a concrete committee report of criminal negligence, SDPGA demands the government to follow the SC guidelines. If any criminal action is taken, SDPGA will immediately boycott all elective surgeries in all government hospitals without prior notification.”
“We are running a system in which institutions are understaffed and under-equipped. The solution is to increase the number of doctors and staff nurses. Auditing is acceptable but ostracising doctors will only discourage and demoralise the workforce,” he said.
P. Balakrishnan, president of Democratic TNGDA, said doctors already had the National Medical Commission and Tamil Nadu Medical Council to deal with cases of negligence. “It is an irreparable loss for the girl’s family. But at the same time, the action taken amounts to harassment of doctors and has hit the morale of government doctors. This will lead to an increase in public harassment of doctors,” he said.
“First of all, there is no criminal intent in this case. It is negligence. I do not think there is a need to treat doctors like criminals just because this is a sensational case. The fault lies on many levels - a system is not in place nor is there a constant review mechanism,” a senior surgeon said.
Why expect doctors to conduct deliveries in a small centre when any pregnant woman can develop complications? he asked. “Every surgeon would have had complications in his/her career. This is human fallibility. It is to reduce this fallibility that we need to have a system.” The government should put an end to the trial by media, he added.