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Inquiry absolves Apollo in Ranga's death

The inquiry committee which went into the death of former power minister P R Kumaramangalam has revealed that the line of diagnosis adopted by the Apollo Hospital did not cover the immune status of Kumaramangalam.

The committee report, which was released by Health Minister C P Thakur Wednesday, however, observed that had the minister returned to the hospital (Apollo) with persistent symptoms, a different diagnostic approach may have been adopted.

The report says that Kumaramangalam had been suffering from occasional fever since October-November, 1999. The fever recurred and became persistent in April this year after his return from the tour of the Andaman and Nicobar Islands.

On the advice of two doctors, he was admitted to the Apollo Hospital on April 14. There he was empirically prescribed a course of medicines for malaria as he had returned from a malaria-endemic area, even though his blood sample did not show malarial parasites.

The report says that such a practice was not unusual in the country.

Examination of the minister also indicated a patch in his right lung and the urine culture revealed e-coli infection. However, further investigations for this lung patch ruled out the presence of cancer cells and tuberculosis.

In view of the urinary tract infection and suspected atypical pneumonia, antibiotics were administered to Kumaramangalam. Since the fever showed a tendency of settling down, and because the patient was keen to attend the Parliament session, he was discharged from the hospital. He was advised that he would be required to have a check-up at frequent intervals if the symptoms persisted.

The report observes that Kumaramangalam, who was discharged from the Apollo Hospital on April 23 and admitted to the All India Institute of Medical Sciences on August 14, actually came to the hospital for a follow up treatment only once on May 8 and on that day also he did not meet the treating physician, but had his chest x-ray and blood sample taken from the office of the chairman of the hospital.

While noting that several tests indicated an inadequate polymorphonuclear leucocyte response to sepsis by the bone marrow, the committee felt that consultation with a clinical haematologist was warranted to evaluate the immuno-haematological status of the patient.

It also observed that Kumaramangalam had been occasionally using wysolone (steroid) which had not been mentioned to the treating physicians in the hospital. This may have had the effect of masking/altering the clinical symptomology and may have diverted the attending physician from pursuing a different course of investigation and treatment.

The ministry on the basis of the inquiry report, therefore, concluded that had the treatment after discharge from the hospital been followed up with the same treating physician, perhaps the persistently low blood count may have prompted further tests including bone marrow examination.

In its action taken report, the ministry, which outlined three major initiatives relating to health care, says that in principle it had been decided to bring into force an enabling legislation at an early date for fixing of minimum standards of equipment, physical infrastructure and manpower in all medical institutions.

This, it said, would give the state governments an appropriate technical format through which to ensure requisite standards in different medical institutions.

Besides, the ministry had also decided to issue suitable ordinance making it mandatory for a medical institution to make available the medical records of a patient to him or his kith and kin, on demand.

It has been decided to introduce an early legislation requiring re-registration of doctors with the Medical Council of India every five years after undertaking a prescribed module of continuing medical education. This will ensure that medical personnel keep abreast with the latest advances in medical sciences.

UNI

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