David D’ Sa, is today without a hand, thanks to the Goa Medical College. How could this have possibly happened? How did he enter the hospital with a fully functional, normal hand and leave without one? JONQUIL SUDHIR investigates.

DAVID D’ SA, a 30 year old man, suffers from a seizure disorder. He is required to take his medication regularly. But on the 20th of May, 2004, he missed a dose. As a result of which he had an epileptic attack on the 21st of May. His body began convulsing. He was frothing at the mouth and needed immediate attention. His elderly mother rushed him to Cottage Hospital, Chicalim. Since the required medication was not available, he was referred to the Goa Medical College (GMC), Bambolim. At the GMC, he was admitted to the Department of Medicine. Dr. Edwin Gomes was the consultant on duty. Since David was in no position to be given oral medication, he was administered an intravenous injection. The attack subsided. He complained of acute pain in the area he was injected. It was dismissed as nothing. The entire day he complained of the growing pain in his arm, in vain. He was told to flex his arm and was discharged the next day.

Hand Amputated!

DAVID SHOULD have gone back to leading a normal life. To being the handyman about the house, helping his elderly mother in her daily chores. But, that didn’t happen. The ache in his arm turned into a throbbing pain. His arm from the elbow to the tips of his fingers began to swell. The very next day, his forearm turned a deadly blue. He could not move his fingers. A neighbour, upon seeing his plight, rushed David to the GMC. The resident on duty told him that nothing could be done. Gangrene had set in; the hand would have to be amputated. Shocked and bewildered, David, his family and the concerned neighbour questioned the doctor. “Why does it need to be amputated? How could this have happened?” The doctor merely said that there were any number of possibilities. No explanations, no reasons. Just a number of possibilities.

He was not prepared to sacrifice his limb without proper justification. Which is why he was then referred to KLE Society’s Hospital and Medical research Centre, Belgaum. Where he was told that his artery had been blocked. That the blood circulation to his forearm had been cut off. And after establishing the line of demarcation (the point to which the infection had spread), his hand would have to be amputated. Still unable to comprehend how he could have such ill fortune, David chose to return to Goa and try alternative treatment. But, after several attempts at Ayurvedic and homeopathic treatment, it became clear that there was no way out. His hand would have to be amputated. On the 23rd of June, David underwent the operation to amputate his hand at the GMC.
But, his question remains answered. How could this have possibly happened? How did he enter the hospital with a fully functional, normal hand one day and leave without one?

No Answers

DR. EDWIN Gomes, the Consultant on duty, is not very clear in his answers. He avers that “it is possible David hit himself whilst he had the convulsion. That maybe he hit his hand, causing trauma to the artery, leading the blood to clot. As a result of which the artery constricted and blood flow was stopped. The real reason, he said, will be known by the surgeon. It will be in his case papers.”
“The surgeon amputated the hand because gangrene was formed in it. And that is the only cause that the case papers from the surgeon will reveal. It is for the consultant to establish the cause,” says a senior doctor. The doctor dismisses Dr. Gomes’ explanation. From the case papers presented and the photographs taken, the cause of gangrene looked obvious. The senior doctor opines that the injection was administered incorrectly. That the needle penetrated the vein and entered the artery. That this, in turn, caused the artery to constrict and shut off the blood flow. If detected earlier, his hand could have been saved. An open and shut case.

“Not likely”, claims a very highly placed doctor at the GMC. “The patient had a drinking problem in the past. Even though he has stopped for the past three years, he is suffering the side effects of it now. Drinking causes narrowing of the vessels and this is what stopped his blood circulation.” Is it a coincidence, then, that his artery constricted only after he was admitted at the GMC? “Yes”, he quickly replied.

“These are all very unlikely possibilities”, said Dr. N.G. Dubhashi, Head of the Department of Medicine at the GMC. “If the injection was administered in the artery, the blood would enter the syringe and the nurse would immediately know that she had touched the artery. The patient would have been in excruciating pain and would not have been able to tolerate it. And no doctor in his senses would discharge a patient if the patient complained of pain. Besides, the nurse would not have been able to place the canula in his arm to inject him eight hours later.”

“Unless the artery was slightly irritated and it took a long period of time to constrict. But that is unlikely.” “The second possibility is that there was already a thrombus in the chamber of the heart due to a prior heart disease which caused the blood to clot and the arteries to constrict. But his is a less likely possibility.” “The third is that the artery was traumatised during the seizure. An even less likely possibility.” Which leaves Dr. Dubhashi extremely baffled. And leaves us and the patient’s relatives even more confused.

And while the list of ‘unlikely possibilities’ grows longer and longer, David D’ Sa is left to ponder over what he is going to do now that he has only has one arm. Without two, full arms to work with, how is going to repay the loans his family had to take for his medication, trips to several hospitals and his operation? Another question that is yet to be answered.

WHAT DO THE GMC CASE PAPERS TELL US? Very little, if nothing at all. @ The OPD case folder consists of four sheets. Other than the general particulars of the patient (name, age, sex, marital status, occupation and address), the folder also has a table to record the history, examination, treatment and progress of the patient. The Examining Doctor is supposed to sign and date all entries while writing a tentative diagnosis or impression. David D’ Sa’s folder was blank. Other than the general particulars, the folder was blank. No record of history, examination, diagnosis, treatment or progress. No doctor’s signature. @ The discharge card had the wrong date written on it. David was discharged on the 22nd of May (confirmed by the Department of Medicine). The discharge card says he was discharged on the 21st. A common occurrence reveals a doctor. @ The name of the consultant is written on the top of the card. But it has come to our notice, that very often, the name mentioned may not necessarily be the doctor that was actually consulted. @ The discharge card is supposed to be signed by the Senior Resident in charge. It wasn’t. @ When David returned to the GMC on the 23rd, the doctor in charge refused to look at the case papers. He said he did not consider them ‘worth anything’. @ The resident doctor then went on to check David and wrote his findings on a plain, white paper, not on a GMC letterhead or official stationery. @ The ‘diagnosis’ is supposed to have the doctor’s full name and signature on it. All that one finds, is an illegible signature. And this is what is really disturbing. It is virtually impossible to find out which doctor the patient has consulted. The average patient at the GMC comes to the hospital from some treatment or the other. He does not make a note of the doctor that he has seen. As long as he gets the treatment he requires and feels better, he is satisfied. He may even be too sick to notice. As is the case with David D’ Sa. He was definitely in no position to make small talk with the doctors who saw him. Nor was he in a position to see what he looked like. And his elderly mother cannot remember. And since the GMC has a large number of patients to cater to and insufficient doctors, patients are very often visited by different doctors, whoever is free at the time. Which means that if you are admitted to the GMC for a day, you may be visited by three to four different doctors. And as mentioned earlier, very few make a note of their names. So how does one know who has treated them? Who is to be held responsible if something goes drastically wrong? No doctor is going to admit that he has been negligent. Each one is going to pass the buck onto the other. The hospital administration is going to play dumb (compensation for negligence can be anywhere between tens of thousands of rupees and lakhs) and the hospital records definitely don’t reveal anything. Which makes one wonder if this is all done with a motive. So that in the event of a complication or a tragedy, as in David’s case, no one can be held responsible. So that the blame cannot be traced to any single doctor. In which case, should we trust the GMC? Patients go to the GMC in good faith and with total trust in the Institution and the doctors. And if the doctors and the hospital are not willing to be responsible for their actions, maybe we should rethink going to the GMC.

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