Friday, July 22

Two doctors declared guilty for amputation

LAHORE – The enquiry committee of the Mayo Hospital declared two doctors of the orthopaedic surgery guilty for the amputation of Muhammad Tassawur’s leg, and recommended their transfer to other wards, it was learnt on Wednesday.
The enquiry committee, comprising Head Orthopaedic Department Prof. Dr. Iqbal Ahmed Bhutta and Additional Medical Superintendent Dr. Manzoor Alam Ch, maintained that the staff on duty carried out treatment in the acceptable routine manner. However, two experienced members of the team on duty Dr. Javed Hassan and Dr. Khalid Awan failed to identify an ominous indicator of gas gangrene and did not seek opinion of the on-call senior staff before discharging the patient for which both of them may be transferred.
Statistically very ‘low incidence of complication of gas gangrene (which is life threatening illness and is directly caused by nature of injury and contamination of wound by a bacteria), the amputation of the limb was mandatory to prevent the death of Muhammad Tassawur (Tasawar Ali according to the hospital record) from Toxaemia of specific nature for which adequate treatment is not universally established and available.’ On the other hand, the committee suggested the hospital administration to provide subsequent care free of cost treatment, including the prosthetic leg for the amputee.
The committee interviewed the concerned doctors and sifted through the available record of emergency and subsequent treatment of Tasawar apart from listening to the complainant Amanat. It established Tassawur walked into the A&E Department on June 16 with open wound on his left leg. He was attended by the on-duty North Surgical Ward. According to triage effective on ground, immediate life threatening medical condition was ruled out and major vascular injury of the limb, needing limb saving surgery, was excluded and the patient was handed over to Orthopaedic Unit on duty in Emergency Department. The team of doctors on duty was headed by Dr. Javed Hassan (FCPS), included Dr. Khalid Awan and Dr. Kaleem, who treated the patient and discharged with follow up instructions of coming back to the OPD after a week and getting external treatment of the wound. Debridement of wound and splintage of the fracture of fibula was performed in Emergency Operation Theatre by Dr. Kaleem in the presence Dr. Imran FCPS, Medical Officer and Senior Registrar East Surgical Ward. The medical treatment, including antibiotic injections, were given. Subsequently the patient attended the Mian Munshi Hospital (MMH) and received some treatment there. But both Amanat and the MMH declined.
On June 18, Amanat reported again at the Mayo Hospital Emergency and was admitted in the South Surgical Ward with diagnosis of gas gangrene involving the injured limb. In Emergency Operation Theatre, the Senior Registrar performed procedure of debridement. However, the condition of gas gangrene worsened and below knee amputation was performed by Associate Professor South Surgical Ward as a life saving procedure.
According to the report, Tassawur was promptly attended by the hospital staff according to triage in place and was treated accordingly and was discharged according to the principle of managing the patients suffering from non-serious illness or injury as out patients. “The type of wound in its given location and fracture of fibula is managed as it was in this particular instance. However, considering the technical factors, there remains statistically very low incidence of complication of gas gangrene which is one of the life threatening nature and where mainstay of treatment amputation above the involved level in majority of cases. It is feasible to admit all injuries reporting to the A & E Department for in house treatment and monitoring. The nature of complication of this gas gangrene, however, has grave consequences for the injured one (Tassawur),” it stated.
However, the committee deemed that the grief of Amanat may not be unfounded, however, “the nature of present injury and statistically very low chances of this complication do not implicate attending medical personnel for malpractice. The available practical guidelines in medical literature do not support the contention of the aggrieved. The complication of gas gangrene leading to life saving amputation is not preventable with 100 per cent fidelity,” said the report.
It is pertinent to mention that Tassawur’s father Amanat Ali has repeatedly knocked door of every concerned health authority, but it took about a week to complete the enquiry, launched by the Medical Superintendent Dr. Fayyaz Ahmad Ranjha. However, he is waiting for ‘justice’ from the health secretary to chief minister Punjab.
MS Dr. Ranjha maintained that the punishment is according to the required standard. “We have an established accountability process and punishing those found guilty. Transfers of Dr. Javed Hassan and Dr. Khalid Awan to Paeds Surgery and Radiotherapy respectively is a huge punishment as it has virtually put an end to their careers in orthopaedic surgery to which they had already invested quite a number of years,” he said.
When contacted, Amanat was disappointed at the justice done for such grave negligence, which had crippled his son Tassawur for life. “It is no justice. Transfers are mere eyewash. It will not do any good to others as they are free again to commit bigger blunders. Patients will be at their mercy again. The minimum they (enquiry committee members) could do was a recommendation for the cancellation of their licences (of the Pakistan Medical Council). Why is not a criminal case should be registered against them? Criminal negligence must be treated according to the criminal law. I will go to the health secretary, health minister and chief minister to seek justice. I will also move a competent court against them,” he said. He declined that any free medication was being provided to his son.

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