Friends, kin allege medical negligence in woman’s death

Tejas Bajgowali. File pic

The family and friends of a 24-year-old woman who was administered a dye for conducting a CT Cerebral Venography (Plain and Contrast) scan at a private diagnostic centre in Dombivli, have alleged that she died due to a reaction from the dye. They have also claimed that no doctor was present at the time of the scan, only a technician was there and no antidote was given when there was a reaction to the dye. A forensic surgeon has also expressed his concerns that ‘cardio respiratory arrest' has been given as a provisional reason for cause of death. He has said it cannot be the cause of death, as there needs to be some underlying reason that led to it.

Tejas Bajgowali, a 24-year-old Bachelor of Paramedical Technology (BPMT) from Grant Medical College and Sir JJ Group of Hospitals, who hailed from Gadchiroli, was employed at the same diagnostic centre in Dombivli where she underwent the scan on September 26. She had been complaining of a severe headache for the past 15 days. The CT-scan was suggested to her by a doctor at the JJ hospital, whom she had consulted and instead of getting it done at JJ, she preferred to get it done at the private diagnostic centre in Dombivli, where she worked.

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‘Drug reaction' alleged

Tejas's close friends and college mates, who were alerted after she was taken to another local hospital, have alleged that the contrast (dye) reaction led to convulsions and she lay unconscious, soon after the scan was completed on the evening of September 26.

"Tejas was rushed to the KDMC-run Shastri Nagar hospital in Dombivli (W) by the staff at the diagnostic centre, where ECG and preliminary examination was done. But the patient's condition was deteriorating and the hospital did not have ventilator support. A doctor then, advised that the patient be shifted to a private set up, Apple Hospital, where she was declared brought dead," explained her friend and senior Ram Prasad Karpe, a resident of Parel village, who with other college friends of Tejas, was at Rukminibai hospital where she was taken. These facts were also corroborated in the OPD case paper (no 12042 of Shastrinagar hospital) where she was taken at 6.30 pm and a detailed history of MRI scan and subsequent ‘contrast reaction' mentioned therein (see picture).

‘Police refused PM at JJ'

"Tejas is the youngest sister of Dr Pranali Bajgowali (Medical Officer at a Primary Health Centre, at outskirts of Pune). Dr Pranali who had also been alerted, and Tejas's friends insisted that the post mortem be conducted at JJ's post mortem centre, but the local police allegedly refused, stating it should be conducted at Rukminibai Hospital which conducts all post mortems from KDMC area. "Pranali and we friends fear that the police are allegedly working to save the scan centre, which was working with many civic bodies in the state," said Karpe.

CT reports normal

The diagnostic centre submitted the CT - Cerebral Venography (plain and contrast) report on September 26, to Tejas's relatives. It was normal. It read: "The CT has been done by injecting nonionic contrast intravenously. Axial 2mm sections have been obtained. MIP has been done in the region of interest. No immediate contrast reaction observed. The report concluded with ‘No significant abnormality in brain parenchyma and no significant abnormality in central venography.'" The report ends with advice - SOS follow up / SDA study.

Attempts made to contact the diagnostic centre's management did not yield result.

Cannot be cause of death

Forensic surgeons say that ‘Cardio Respiratory Arrest' cannot be the cause of death, as there needs to be some underlying reason that led to it. A surgeon even cited the Medical Certification of Cause of Death (MCCD) Training module, issued by Dy. Director of Health Services (SBHI &VS), Pune.

The forensic surgeon added, the module clearly states, "The underlying cause of death is the condition that started the sequence of events between normal health and immediate cause of death. The mode of dying (eg Heart failure, Respiratory failure) should not be stated at all since it is no more than a symptom of the fact that death occurred and provides no useful information"

Police speak

Sub-Inspector S S Deshmukh of Vishnu Nagar Police station, Dombivli (W), said, "The post mortem has been done today (September 27) and now we will start our inquiry into the case."

When asked the reason for not allowing the deceased's sister's and friends' request for the autopsy at JJ Post mortem Centre, the police officer said, "We had discussed with the concerned doctor at Rukminibai hospital, Kalyan, and the doctor consented to do the autopsy."

Those accompanying her and the next of kin of the deceased had also consented for the same, said the police.

"We have registered an accidental death case under section 174 of the Criminal Procedure Code (CrPC) and will probe the case from all angles. We are yet to record the statements of technicians and other staff at the diagnostic centre," said PSI Deshmukh.

‘We had no choice'

Mohammed Ali, a close friend of Tejas, confirmed to consenting to the post mortem at Rukminibai hospital and said, "We initially demanded that the autopsy be conducted at JJ hospital, but the police refused citing jurisdiction issues. However, once we reached Rukminibai hospital, Kalyan in the wee hours of September 27, the doctor, there was okay with us getting the autopsy done at JJ, but as already over 12 hours had passed since the death, and we had to take the body to Gadhchiroli (another 14 to 15 hours of road travel), we agreed to the autopsy being done at Rukminibai hospital, as we had no choice."

Both Ali and Tejas had recently been selected by a diagnostic centre for the post of ‘Laboratory Scientific Officer' and were looking forward to flying together to Kuwait.

Ali, who originally hails from Nandurbar said, "Our data verification process was under way and once that was done, we would have flown within a month thereafter. She studied with me at JJ, and we became close friends. We were also doing our master's programme through correspondence and the Kuwait job would have fetched us a monthly salary of over R1 lakh."

When asked about her family, Ali said, "Tejas's father Basavaraj was a school teacher and mother Vanimala, was attached to a local political party. Tejas is the third amongst four siblings. While her sisters are in the medical profession, her younger brother is studying at IIT, Indore."

KDMC speak

Dr Ashwini Patil, Medical Health Officer, KDMC said, "I learnt about the incident on September 27 and have initiated an inquiry into it. I have asked for all the medical papers and will go through them."

When asked if the diagnostic centre was still operational pending inquiry, she said, "I will have to check, as I have not got the papers till now. It will be premature for me to comment."

And on the cause of death cited in the post mortem report, she said, "I haven't received the death certificate or provisional cause of death either."

Expert's view

Dr Rajesh Dere, secretary, Maharashtra Medico Legal Association, "Considering the significance of the case and the nature of allegations by the next of kin against the diagnostic centre, such medico-legal post mortem cases should be preferably done at tertiary care centres like medical colleges. This is because the medical colleges have a full-fledged department for forensic medicine and toxicology, with adequate infrastructure to handle such technical cases, especially when it is a case of medical negligence."

"Cause of death like ‘Cardio Respiratory Arrest or Cardiac failure or Respiratory failure" should be avoided, and terminal events causing death should be preferably given, to avoid any confusions," said Dr Dere.

"We have many unanswered questions pertaining to the manner in which CT scan was done at the diagnostic centre and we hope that the viscera samples are not tampered with, as the diagnostic centre also provides services to Rukminibai hospital under KDMC. We are already in touch with the forensic surgeons at the Department of Forensic Medicine and Toxicology, Grant Medical College, and will have their opinion too," said Karpe.