A little over two years ago, when 40-year-old Gowri (name changed), married for nearly 15 years and childless, got admitted to MS Ramaiah Hospital for a surgical procedure to remove uterus fibroids, she hoped to be a mother soon. She went through the mandatory blood tests before surgery and everything was fine barring a low haemoglobin level. A blood transfusion done at the hospital to improve her platelet count, however, changed the course of her life for the worse.
Though she was not operated upon in that period, she was given one unit of blood and asked to come back in five days by which time the Hb percentage was expected to improve. What followed came as a total shock. Subsequently, when Gowri came back for admission and after another round of blood tests, the results said: Reactive to HIV 1. And the interpretation was screaming: "The above sample was repeatedly reactive for HIV I and II antibodies by three different test methods and therefore positive for HIV as per NACO guidelines."
The family was caught unawares. Not even a week prior to this second blood test, her sample showed HIV negative, in the same laboratory, of the same hospital. The
hospital, which denied the allegations, reportedly told the family that Gowri was already infected before she came to them.
It's been two years since her diagnosis and Gowri is on medication; her family has approached the Karnataka Medical Council and is fighting a case in the magistrate's court. The issue was brought before the state health department, and a committee was formed, but it did not see any action. A petition moved by V S Ugrappa, chairman of the expert committee on preventing sexual violence against women and children, has set the ball rolling with the police taking up the case.
The complaint was filed recently at Sadashivnagar police station against the hospital, a gynaecologist, and two employees of the Integrated Counselling and Testing Center for cognisable offence of "forgery with medical records and medical negligence".
"It is submitted that the accused hospital is involved in gross medical negligence by causing HIV infection via contaminated blood transfusion. Thereafter, the accused have tampered with the medical records to cover up the crime. The chain of events shows that within all human probability, the offence of forgery of medical records to conceal evidence of medical negligence. This complaint may be specially taken in record and speedily acted upon, because of the gravity of the crime, the maneuvers of the other side to hush up matters and cause great harm to me and my family,'' the complaint has stated.
The major offences recorded are: Forgery of medical record (IPC section 466); cheating (420); forgery (463), making a false document (464). Subsequently, the police have taken up an FIR and investigations are on -- they are examining the medical records and have questioned the hospital staff and the doctor.
Documents show that on February 13, 2014, Gowri was admitted to the hospital and discharged on the 15th. Her discharge summary says that her Hb% is 7.5m, platelet count 2.29; VDRL, HIV I & II negative and one unit of blood transfusion was advised. Accordingly, on the 14th, one unit (300 ml of RBC) was given (blood unit number 17093 for which the family has the record) and on the 15th she was discharged and asked to come back on the 19th.
Subsequently, on February 19, Gowri was again admitted and the same set of blood tests were carried out. And this time the results were: Hb% 10.2, platelet count 2.23 and HIV I & II negative (in fact it is very unclear and looks like a scribble). The discharge summary read: "Patient came with the above mentioned complaints, diagnosed to be Retro Positive and counseling done. Hence discharged on February 22.'' Surprisingly, the blood unit number was changed to 12093 in the hospital records.
The patient gave another sample for testing at the Integrated Counselling and Testing Center on February 24 which also showed her positive for HIV. Intriguingly, the same Center has another record to show that on February 12, Gowri's sample was tested and came back HIV positive. But the catch is that Gowri was admitted to MS Ramaiah only on February 13, hence where did this blood test come from. The family sees something amiss.
"This is a fraudulent document. When my sister was admitted on 13th and her blood sample drawn for testing at MS Ramaiah, why would she go for blood tests on the 12th? This document was created subsequently to show that the patient was infected before she was admitted. But the hospital's first discharge summary says that the blood tests are negative for HIV. This has to be investigated thoroughly,'' said the patient's husband Rajanna (name changed).
MS Ramaiah Hospital termed the issue an "allegation" and its chief administrator Dr V Narendranath, who did not want to divulge much on the case, said, "It is in court and it is sub judice. We will respond to the court and give a reply to the appropriate authority. We respect our patients and we cannot divulge the patient's medical history. We will not breach the patient's confidentiality at any cost." Expressing his resentment over the police "harassing the doctors and para-medical staff for four days", Dr Narendranath says: "Why is this a criminal case? These days, hospitals have become a soft target. Every patient has a right to express his/her grievance and somebody has to decide what is right and what is wrong."
Why the mess?
For a start, MS Ramaiah Hospital doesn't come under the state government's Individual Donor Nucleic Acid Testing (ID-NAT) project where blood is tested at the highest standard. The normal process followed for testing of donated blood in private blood banks in hospitals is the Elisa test, which detects Hepatitis B and C and HIV for antigens and antibodies. However, under ID-NAT, the blood sample is tested for HIV, HBV (Hepatitis B) and HCV (Hepatitis C) to detect direct Ribo Nucleic Acid and DNA of the virus. All government hospital bloodbanks and Rotary-TTK are a part of this project where donated blood is mandatorily tested by ID-NAT. This test is done at Bowring Hospital, the only certified blood testing facility.
According to specialists, a virus, after entering the bloodstream, has a window period and only after that can the antigens or antibodies be detected. HIV has a lower window period than HBV or HCV -- around 15-20 days. In case an HIV-infected person donates blood and the window period is just four to five days, the virus will go undetected and there is a fair chance that it could infect the person undergoing the blood transfusion.