India Questions ‘Stenting’ Medical Practices

Cases of medical negligence or cheating have hit news in the past couple of years in India.

india-stenting-medical-practiceA study published recently in The Journal of American Medical Association suggested over 50 percent of cases involving the use of stents while performing angioplasty in the United States may have been “unnecessary.” And, the issue as touchy in India get predictable attention.

In India, media reports have been pointing to the unnecessary use of stents during procedure for quite some time now. A section of doctors too have admitted to the fact that many doctors use stents in cases when not required.

In 2009, when a Kolkata-based septuagenarian’s wife fell ill, doctors at a leading multi-speciality clinic suggested she opt for angioplasty and put five stents in his wife’s arteries.

And, when she died within a few days, the arbitrary use of stents first made headlines.

50 percent of stenting done in the US, unnecessary: JAMA

In the article titled “The whole truth about coronary stents: The Elephant in the room,” Dr. Malhotra has cited a study published by JAMA in the US involving 1,44,737 patients in a total of 1,091 hospitals which suggested almost half the stenting done was unnecessary.

He cited another study which found that 88 percent of patients undergoing a procedure for stable angina (chest pain or discomfort due to poor blood flow through blood vessels in the heart) believed that angioplasty would prevent a myocardial infarction and given various scenarios, 43 percent of cardiologists would go ahead with stenting even when they thought it would not be of any benefit.

In fact, a study by National Heart and Lung Institute in the US last year suggested 1-2 percent of people who have stented arteries develop a blood clot at the stent site which can cause a heart attack or stroke.

In India, the last few years have witnessed an almost identical trend. Although, in most cases, stents are used when the blockage is more than 70 percent, a few doctors have conceded using stents even when the blockage is around 30 percent.

3.50L stents used in a year in India for 2.6L patients

The use of stents has been on the rise in different states across India. In February, it was reported that an increasing number of cardiac patients in Kerala were using heart stents. Last year, reportedly 3.50 lakh stents were implanted in more than 2.6 lakh patients in the country.

Concurrently, this spurt in the use of stents could also be attributed to the fact that the government had successfully brought down the cost of stents. “We felt that there was urgent need for the government’s intervention to reduce the prices of drug-eluting stents, the cost of which vary from Rs 50,000 to Rs 1.5 lakh. We successfully came to a decision to cut down on the price,” had said the state’s minister for public health Suresh Shetty.

The fact of the matter is that patients have to be educated about their condition fully so that their decision is a sound one. The decision made by the patient or his/her kin has to be an “informed” one. But, most doctors tend to scare the patient into accepting the “only” option available. With the doctor getting a “cut” out of the cost of the stents used, there is a direct conflict of interest in the treatment involved.

Spreading awareness, informing the patient of every possible treatment option available including briefing the patient and the kin about the risks and benefits involved are the cornerstones of medical treatment. Coaxing a patient into opting for a “favorable” option or scaring one into making a hasty, misinformed decision does amount to a breach of law.

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Cases of medical negligence or cheating have hit news in the past couple of years in India. Patients, assuming the role of consumers, have learned to question things and when wronged, are not afraid to take the hospital or the doctor to court.

Rs 11 crore compensation awarded in negligence case

Last year, the Supreme Court passed a landmark judgement in which the kin of patient was rewarded a compensation of Rs 11 crore in a case involving medical negligence. Just a few years before this landmark judgement, an RTI application revealed, in West Bengal, only nine percent of the doctors, accused of “medical negligence” or “ethical violations” in the preceding 10 years, were prosecuted or dismissed. For the rest of the cases, either the cases were closed or the concerned doctor, let off the hook.

According to data revealed by the RTI application, a total of 515 cases were filed against doctors in 10 years’ period and of those, only 15 doctors had been removed from the council’s list of registered practitioners and another 30 had been let off after “warnings.”

In 2013, a worrying fact had come to light. In India, there is no centralized collection of data on medical negligence cases filed or details of their outcome. In 2012, the Medical Council of India had said it would make the names of doctors convicted in medical negligence or ethical violation cases, public on its website. But, there still isn’t any centralized data pool of such cases.

The USA and Canada keep a database of such cases and make public the names of hospitals and doctors involved to help prevent cases of medical malpractice, negligence and ethical violation. India needs to take cue and put similar processes, tweaked to meet domestic needs, in place and swiftly.

250 patients sue US doctor for using stents arbitrarily

In the state of Maryland in 2013, around 250 patients filed a lawsuit against a doctor in a hospital alleging he had performed hundreds of procedures to implant heart stents that were not medically necessary.

The patients later reached a settlement with the hospital in question but the doctor accused of malpractice lost his job and his medical license.

India too needs to monitor, track and maintain a record of cases of medical malpractice and ethical violations to better her medical facility and ensure such cases are reduced to naught.

From a time when “no action were taken in 91 percent of medical negligence and ethical violation cases” as revealed by an RTI query in 2011 to compensation of Rs. 11 crore for a medical negligence case of 15 years ago, India has come a long way.

There yet is a lot that needs to be done to enhance accountability and eliminate ethical violations and malpractice within the medical fraternity.

Gajanan Khergamker is an independent editor and legal counsel with over three decades of experience. He heads DraftCraft – an India-based media-legal think tank. His areas of expertise include policy, inclusion, foreign affairs, law and diversity. His firm’s website is www.draftcraft.in and he can be reached at gajanan@draftcraft.inRead other articles by Gajanan.

  • Dr.Ravi Kumar.B.

    Stent was inserted in the coronary artery for gastrointestinal bleed and it’s related symptoms. The history of MALENA was not taken. Now the patient is having malena due to aspirin which cannot be stopped since the stent is in place.
    for details contact mobile 9496153097, 9349312325. land line 0471-2727659.

  • Maryam

    hmm