Dr Desai speaks after acquittal in India's longest medical negligence case
One of the country's most eminent cancer surgeons, Padma Bhushan Dr Praful B Desai, acquitted of all criminal charges by Supreme Court. He talks about his 25-year-long ordeal and eventual redemption
It was a case that had the medical fraternity on edge -- top consulting cancer surgeon Padma Bhushan, Dr P B Desai traversing through the corridors of justice for so many years. Three lower court judgements against him and then finally, the Supreme Court ruling in his favour. The win cemented Desai’s belief in the credo of standing for your conviction and for what you believe is right.
Three days after Dr Desai’s return from San Francisco (USA), the enormity of this victory has still to sink in completely. “I have won a battle, but I still have to win the war,” says a cautious Dr Desai allowing himself a tentative half-smile. “There is a civil case pending against me in the High Court, I shall take that to the Supreme Court, if need be too,” says the sprightly 80-year-old who belies his years not just with his physical presence but mental alacrity too.
Right now, though, it is celebration time for what one could term the Dr Desai support bench -- family, friends, patients and well-wishers. After some prodding, Dr Desai admits that a “small get-together” has been arranged at his Worli residence on Sunday evening, to celebrate this “victory.” When that champagne flows (make that a Dom Perignon doc,) one thinks some tears will too, as the mental toll of the battle falls away. Here, the tennis-loving doc serves up an ace as he talks about philosophy, friends, foes, falsehoods and why he still has that fire in his belly to fight for what he thinks is right.
Where were you when the Supreme Court verdict in your favour was read out?
Desai: I was in San Francisco (USA) at a symposium on breast cancer. This verdict was expected a long time ago. I thought it would come in the first week of May this year, then, July, August went by there was no verdict. I was told that you may not know when the verdict would come, it might just come, suddenly.
How did you hear the news?
Desai: My son, Jay, called me from India. All he did was say on the phone: ‘Dad we won, we won, we won’. I am comparatively less exuberant (laughs). I fought for 25 years because I had the courage of my conviction. I knew I had done no wrong. She (L Singhi) was not my patient. I was merely asked for my opinion as a senior doctor and I gave that. I was not inundated by phone calls post the verdict, since I did not have my regular cell phone number, I was carrying a matrix card, so it was another number. But my wife and son of course, were inundated with calls and congratulatory messages.
Dr, you fought this for 25 years. Besides your legal team and supporters, did you at any time, find your friends or people close to you, moving away from you, keeping distance or changing in some way?
Desai: Good friends do not change. Throughout this ordeal, and I can certainly call it that, I did have support and there were well-meaning people who gave me lots of advice. My wife, Dr Meena Desai (endocrinologist) was eloquent even in her silence. People used to tell me: why are you worried? You have done nothing wrong. I knew my conscience was clear. Some people told me there were other ways to resolve this, non-straightforward ways to, ‘buy peace’. Yet, I did not want to go down that path.
We hear of increasing incidents of doctors and nurses being beaten by irate relatives alleging medical negligence, hospitals being demolished in case a patient dies...
Desai: The psyche of the society has changed. We are living in an environment where might is right. People with allegiance to certain political parties or in power in some way, feel they can do anything and get away with it. On the other hand, science and technology has progressed so much, that success is taken for granted, it is taken as a given. If something goes wrong, people think it is okay to destroy the hospital.
Do you think Dr A K Mukherjee trapped you? (Go through box titled 'Background' to understand context of this question)
Desai: Trapped? Well, not exactly. Mukherjee joined forces with Singhi, after initially being accused by Singhi. I knew I had better ways to fight this, with my conscience and with the truth.
The Supreme Court verdict is in your favour, but three lower courts ruled against you, earlier. Those must be very challenging times, dark days...
Desai: Yes, they were in a way, I cannot deny that. More than dark, I would spend time wondering why the truth was not prevailing, not coming out...
Has this case changed you in a certain way, both professionally and personally? As a doctor, and as a person, have you become less trusting of people in general?
Desai: Yes, it has. It is impossible for something like this to happen and not change you at all. Earlier, before this I would go to any lengths to help a person, however difficult the case may be. Now, I may not give my opinion so easily, I have become defensive. This applies to the medical fraternity in general. I had said earlier that all this would make doctors afraid of giving their opinion. This is called defensive medicine. My relationships with people as a person, on a personal level though, have remained unchanged.
Was Bombay Hospital supportive in your case?
Desai: It was Bombay Hospital’s policy to have a senior doctor’s stamp. That is what got me into trouble. This is not to say that the hospital did not stand up for me. The hospital did support me and stand up for me.
You had said once that sometimes you get out of the wrong side of bed and that is what happened to you that morning...
Desai: Yes, I did say that earlier (smiles). That had happened to me on January 22, 1987.
More than two decades is such a long time, do you think we need a quicker legal system?
Desai: Well, maybe, but that is the way our system is. The corridors of justice are very long.
What is your message for Dr A K Mukherjee?
Desai: You have to be confident -- you must have the courage of your conviction. When you have made a mistake, you must admit it, but when you have not, you have to stand up for what is right. You do not age because of grey hair, cataract or creaking joints, you age when you compromise on your principles and stop believing in the truth.
Did your patients still have the confidence in you?
Desai: My patients were my supporters. When my patients told me that: doctor, we have faith in you, you have done nothing wrong, it was such a morale booster. It is our patients who are our greatest educators. The poor patients of Tata Memorial Centre, who I treated, used to tell me while being discharged: ‘doc, we have nothing to give you...’ their families would say: here is a flower garland and our blessings. I think it is this aashirwaad that has paid off today. I cannot forget their faces or their blessings. Name and fame is so transient, here today, gone tomorrow. Money? Of course, it is important but I think it is blessings like these that are worth much more. Even human life itself - it is transitory, you are here today, and not here tomorrow, but it is this that lives on. Am I sounding a bit philosophical? Maybe, you should not write this... (laughs). I had a formidable legal team, the most expensive lawyers in the land. I would have sold my last shirt to be able to afford them, yet, when I sent them cheques, they returned them, with letters saying they do not want money. That is the goodwill, which is much more than money.
You still have a civil case, you say...
Desai: Yes, there is a civil case still in the High Court against me. That is why I say the battle is won, but the war is not over. I will fight if need be right till the Supreme Court. I sometimes think, this is a pyrrhic victory, it comes at so much cost, mental stress, but it is the success of truth. Truth is the victor, not Dr Desai.
To move a little away from the case itself, do you see a cure for cancer in the near future?
Desai: There will be no magic bullet for cancer, I don’t see that. No jab or vaccination that could be the cure. There are hundreds of different types of cancers. Yet, what I do see is that cancer will become a chronic disease in the future, like maybe, asthma or hypertension. People will live with it, longer and longer. Already, I see cancer losing its sting, people living longer with cancer...
In the end, you are 80, still practising, what about retirement? Desai: I have a four-pronged retirement plan -- music, sports, reading and writing. I play the piano and sitar. I have also been playing tennis for 50 years. One of my ambitions is to watch the US Open and Wimbledon live. People say it takes two years to get tickets... maybe, when I finally retire (laughs).
What is defensive medicine?
Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. Fear of litigation has been cited as the driving force behind defensive medicine. Defensive medicine is especially common in the United States of America particularly in emergency medicine, obstetrics, and other high-risk specialties.
Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a) reduce adverse outcomes, b) deter patients from filing medical malpractice claims, or c) provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated, liability can be pre-empted. Avoidance behavior occurs when providers refuse to participate in high risk procedures or circumstances.
Theoretical arguments based on utilitarianism conclude that defensive medicine is, on average, harmful to patients.
In a nutshell
After a 25 year-old medico-legal battle, Supreme Court acquits Dr Praful B Desai, of all criminal charges, setting aside his conviction by the lower courts in 2011.
Doctor travels for a quarter of a century, through the long corridors of justice.
Former Director of the Tata Memorial Centre (TMC), stands his ground, after Magistrate Court holds him guilty of criminal medical negligence in July 2011, and the Sessions and High Court dismisses his appeals in 2012.
After a 25-year medico-legal battle, the Supreme Court acquitted oncologist, Pamda Bhushan Dr Praful B Desai, of all criminal charges, setting aside his conviction by the lower courts in 2011.
This Former Director of the Tata Memorial Centre (TMC), stated the background of this high profile case in his press note in chronological order:
P C Singhi, filed the case in 1991 against Dr Desai, for alleged medical negligence in the treatment of his wife, L Singhi. She was the patient of Dr A K Mukherjee (formerly a co-accused in the case) for a decade, from 1977.
In November 1987, she had visited the Sloan-Kettering Memorial Cancer Center in New York, where she was to undergo a hysterectomy, to remove the uterus, due to excessive bleeding. Since the bleeding stopped, the surgery was not performed. Back in India, she started bleeding again in December 1987, when Dr A K Mukherjee visited her residence and advised immediate hospitalization.
Dr A K Mukherjee gave an admission note to L Singhi to The Bombay Hospital on December 9, 1987. As per the existing policy of the Bombay Hospital at that time, only senior doctors were allowed to admit patients directly in the First Class category. The Admissions Officer at Bombay Hospital automatically admitted the patient under the name of Dr Desai, without consulting him.
Four days later, on December 12, 1987, Dr A K Mukherjee wrote a formal reference request for Dr P B Desai to examine L Singhi. Based on Dr A K Mukherjee's formal written request, Dr P B Desai examined the patient on December 17, 1987 and gave an opinion to conduct an “exploratory laparotomy”, to see if the uterus could be removed, to stop the worrisome bleeding. The surgery was performed on December 22, by Dr A K Mukherjee in OT2.
Dr P B Desai was performing another surgery at that time on his own patient in the adjoining OT1. After completing his operation in OT1, Dr P B Desai was in the corridor outside when he was informed by Dr A K Mukherjee from inside OT2, that the tissues in the abdomen were plastered and he could not proceed further. Dr P B Desai therefore advised him to close the abdomen.
The patient, L Singhi, was discharged from the hospital on April 5, 1988 and died 1 year and 2 months later, in Jaipur, in February 1989, after having survived cancer for more than 12 years.
Dr A K Mukherjee, who was originally the co-accused and conducted the exploratory surgery, was acquitted in 2010 after the complainant, P C Singhi, withdrew his complaint against Dr AK Mukherjee, after almost 19 years.
P C Singhi and the now acquitted co-accused Dr A K Mukherjee, had formed an NGO called ‘Society for Public Health Awareness & Action’ back in 1995, after the criminal complaint had already been registered against Dr Mukherjee.
Former IAS officer P C Singhi launched the legal battle after losing his wife Leela, a cancer patient, who was admitted to Bombay Hospital under Dr Desai’s name in 1987