Would more openness and transparency have protected the credibility of the institutions involved better?

Do hospitals help VVIPs maintain secrecy to violate public trust
Voices Opinion Monday, December 12, 2016 - 14:16

This is a sombre and politically incorrect time to raise the dubious role of hospitals in the lives and deaths of VVIPs. Regional media reports in south India have raised several uncomfortable questions about the role Apollo Hospital played in the last days of Tamil Nadu Chief Minister Jayalalithaa.

Medical professionals are bound by the fiduciary obligation of keeping the medical details of their patients confidential and to protect privacy. Information is therefore given out only if the patient or their next of kin allow it. However, news reports are emerging that the close relatives of Jayalalithaa had not been allowed by security personnel to visit her, except at the time of her funeral. The time of death is also being questioned. In the name of protecting the privacy of the patient, the hospital seems to have played along with those who took over the management of the affairs of the sitting chief minister, even though they are not members of her immediate family.

Between the political forces, the hospital and the security personnel, an iron curtain of secrecy was maintained around the prolonged hospitalisation, the line of treatment and the final moments of the leader. Nothing much is known about the nature of illness that kept Jayalalithaa in the hospital for so long. Only bits of information about using thumb impressions instead of signatures have become public knowledge, primarily because of the dogged coverage attempted by sections of the media.

This is not the first time this nexus played out blatantly in public, with impunity. Several other instances come to mind.

One high-profile case was that of Satyam Computers’ founder, Ramalinga Raju. After being charged with breach of trust, conspiracy and falsification of records in the     Rs 8000-crore rupee global scam, he was arrested in January 2009. By August 2009, Raju checked into the Nizam’s Institute of Medical Sciences (NIMS) in Hyderabad with complaint of chest pain. He and his wife were given a VIP suite ICCU in the hospital.

Soon the hospital found that he was suffering from Hepatitis C and chronic liver problems that required in the doctor’s words, “immediate in-patient treatment of Raju for 6-8 weeks, which was not possible on an out-patient basis”. From then on Raju went on to stay in the VIP suite of the hospital where he could receive visitors, but did not show up for any of the hearings of the court citing health reasons.  When finally, the court ordered the hospital to file a status report on the health of Raju, an Indian Express story reports, “Professor and Head of Gastroenterology Department of NIMS Dr Ajit Kumar filed a report last week before the court. Today he had filed another report saying the treatment of Raju needs to be continued as in-patient for further four to six weeks, as he carries very high risk for morbidity on out-patient management.”

At one stage, the CBI accused the hospital of prolonging his treatment to delay the trial. An Economic Times report quotes a NIMS doctor as saying at a press conference, “Raju is being treated for chronic liver infection. If left untreated he may develop liver cirrhosis and liver cancer. Then he might even have to undergo a liver transplant.”

According to a Times of India report, “Raju had stayed for almost a year at the VIP suite No 11 of the Mettu Ranga Reddy Private rooms wing of NIMS until the AP High Court released him on bail on August 18 that year (2010).” 

A more entertaining case is that of Telugu actor Balakrishna. Balakrishna shot two persons, Bellamkonda Suresh and the astrologer Satyanrayana Choudhary, in his house causing grievous injury to them. A third person present at the incident admitted the injured people to Apollo hospital, which the hospital did not report immediately to the police as per the procedure in such cases. Balakrishna then admitted himself into another hospital, Care, for treatment claiming injury to his finger. Yes. Finger.

The weapon used, belonged to Balakrishna’s wife. The police arrested the actor at 3.20 am in the morning, produced him before a magistrate, and brought him back to Care Hospital. A day later, the actor’s wife also admitted herself in the same hospital. The hospital refused to reveal the nature of her injuries though it was a medico-legal case and she did not admit herself in the hospital on the same day as the actor.

According to the Hindu report, the doctors at Care Hospital held a press conference and explained the line of treatment given to the actor thus: “Though the bleeding injury he suffered due to a cut to the finger was "managed within minutes," the actor was put under close supervision for any potential internal blunt injuries as he was earlier treated with blood thinning agents for ‘pulmonary embolism’ and such patients could bleed even without any injury.”

Dr Reddy of Care also said Balakrishna was under "tremendous acute stress reaction with marked agitation … and needed heavy sedation” … "the medical management plan consisted of adjusting the blood thinning agents and closely watching for any deterioration in the depressive illness." The report quotes Dr. Reddy as saying, “The actor was still in a ‘stabilising' condition as the prothrombin test results were below the desired levels as on Monday morning … Balakrishna requires continuous medical treatment even if as an outpatient … Media were denied access to the actor while in hospital as per the instructions of the police.”

Later, the actor was shifted to the state-run Nizam’s Institute of Medical Sciences (NIMS) on the orders of the court, where the doctors continued with similar support for the actor accused of shooting two people in his residence.

The Hindu quotes the Director of Nizam's Institute of Medical Sciences, Kakarla Subba Rao, as saying, “the actor was disturbed in the sleep on Sunday night and the team of psychiatrists examining him in the morning found him frequently yawning.” The press conference also revealed a new injury to the leg, which was again managed thus, according to the good doctor: “The bandage on his injured leg would have to remain for some more time. If we remove it, he will start hopping all over again as was the case on an earlier occasion." In another bulletin released to the media, the hospital says: “N. Balakrishna, who is under observation at Nizam's Institute of Medical Sciences (NIMS), has complained of ankle pain … but the neurological status of the actor is normal and that he has been ‘quite active' in the last 24 hours, reading books and sleeping well.”

The actor was under judicial custody for 20 days and he was undergoing treatment at the Nizam's Institute of Medical Sciences (NIMS) for depression and pain in the ankle “while in judicial custody.”

In another equally entertaining but less serious case of the then Congress MP Lagadapati Rajagopal, “Wearing a pair of jeans and a blue pullover, … ran straight into the Acute Medical Care unit of the hospital, chased by TV cameramen, and crashed into a bed.” And again, “doctors refused to give information on the condition of the MP who had been on fast for the last four days supporting a unified Andhra Pradesh.” This was again at Nizam’s Institute of Medical Sciences in Hyderabad, which also raised the question of total chaos caused by the invasion of the VVIPs on public service facilities like hospitals.

All the cases are indicative of a country whose elite are deeply cynical of rule of law and have scant respect for institutions, or public opinion. In all the cases, senior police personnel and doctors from premier medical institutions have actively played along for the powerful, even if that could potentially undermine rule of law.

In the cases of Raju and Balakrishna, the ‘patients’ have been shielded using the fiduciary relationship of doctors and patients as an excuse, turning a professional ethics requirement into a weapon to fool with the legal process. The ‘facts’ trotted out by the hospitals may say one thing, while the larger ‘truth’ that emerges from the situation points to the subversion of important institutions of the state, with the collusion of those who are mandated to protect them.

On April 9, 2015, Raju along with his co-accused was handed 7-year rigorous imprisonment and Rs. 5.35 crore fine. A month later in May, they appealed against the sentence saying that they ALREADY SPENT (RIGOROUS?) 35 MONTHS IN “JAIL” (of the 84 months of the rigorous imprisonment sentence) and that the fine was “exorbitant”. Their sentence was suspended. For the Rs 8000 crore rupee scam they were involved in, all of them were granted bail on surety – of one lakh rupees for Raju and his brother, and 50,000 rupees for the others.

In the case of Balakrishna and Jayalalithaa, the threat of public reaction was built up to ramp up police presence and clamp down on information. Balakrishna’s fans arrived in busloads from the districts to protest his possible arrest.

Though Jayalalithaa was admitted to the hospital for medical reasons and not for a legal problem, public unrest was ‘expected’ at the news of Jayalalithaa’s death and police were deployed everywhere and much more so, near the hospital. Considering the speculation about those close to her at the time of death, as a sitting chief minister of the state, did she not deserve more protection from the system too? The doctors in Hyderabad released reports about Balakrishna’s yawns and ankle pain, duly accompanied by photographs of the ‘ill’ actor. Not a single image of Jayalalithaa has been put in the public domain by the hospital, whose personnel are now reporting cheerful conversations with the leader in the hospital.

Would more openness and transparency have protected the credibility of the institutions involved better? Who gets to decide this? The political power centres? The hospital management? The police? Does anyone care? 

 

(Note: The views expressed by the author are personal.)

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