Subject MRCGP MCQ Practice Course based on oxford Hand - DOC - DOC

							Punjab Health Care Bill 2009


Pakistan Academy of Family Physicians(regd) protesting against the
proposed Punjab Health Care Bill and demanding that all stake holders
like PMDC,CPSP,PMA,PAFP(regd) and other doctor organizations
should be consulted and necessary amendments be made before
implementing such bill. PAFP(regd) also emphasizes on the Punjab
Government to take up the issues of "Quackery" and "No Medicine
Without Prescription" on top priority basis.


Waseem Akram Case
Doctors Send Wasim Akram Legal Notice
Doctor sends Wasim Akram legal notice, puts record 'straight' By Zofeen T. Ebrahim
Wednesday, 16 Dec, 2009 | 01:35 PM PST |
LAHORE: On October 25, Huma Akram,42, wife of former cricketing legend Wasim Akram, breathed her last in Chennai’s Apollo
Hospital, while on her way to Singapore.
Four days later, a grief-stricken Akram, asked for a government inquiry at the highest level into, what he termed sheer ‘negligence’ on the
part of 19 leading doctors of Lahore, at the two private hospitals, in Lahore, where she was admitted and being treated from October 6 to Oct
19.
The inquiry committee set up on the directive of Prime Minister Yusuf Raza Gillani, and conducted by a three-member doctor’s committee
from Pakistan Institute of medical Sciences, concluded that the doctors were unable to diagnose Huma’s problem resulting in deterioration of
her condition.
Following the inquiry, the National Assembly’s Standing Committee held another inquiry and recommended that the 17 doctors be
suspended and their general practice licenses cancelled.

Terming the allegations ‘entirely inaccurate’ and ‘unsubstantiated,’ Dr Kamran Chima, 48, a pulmonolgist and a critical care
specialist, who was among the 19 doctors to have faced these charges, has sent a 13-page legal notice to Wasim Akram refuting the
latter’s allegations and saying Akram had influenced the ‘course of the inquiry proceedings’ by making incorrect statements.
Further, he has asked Akram to tender an ‘unconditional apology’ and pay damages to the tune of a hundred million rupees. Failing
to send an apology, Akram, he said would have to cough up five hundred million rupees and slapped with a criminal suit for the
‘irresponsible conduct’. The entire amount, Dr. Chima said, would be contributed to Shaukat Khanum Memorial Trust Hospital.

In an exclusive one-on-one interview to Dawn.com, 48-year old Dr Kamran Chima, breaks the code of silence in order to protect the
Hippocrate’s Oath, he took some twenty three years ago.

Q. Why did Huma die?
She had developed extensive fungal infection called Mucormycosis that had blocked all her blood vessels. There is no reported case
in the entire medical literature of the world in which this may occur without the person falling in certain risk groups…. Huma
denied falling in those groups.
Such a condition can rarely be identified, as in Huma’s case, before the person dies. Hers became apparent two days after her death
when the report of her skin biopsy was issued. The biopsy was done after she developed skin blisters on Oct 23, after she left
Pakistan.

Q. So it was not medical negligence then as Akram alleges and the inquiry committee concludes?

No, definitely and certainly not! None of the top Infectious Diseases experts in Lahore who saw her, can be blamed for not
diagnosing this particular infection. We knew she had an infection but did not know what the infecting organism was. Furthermore,
some facts appear to have been concealed by the patient and her family and if that should be so, had they been revealed, it could
have provided a clue and given direction and help to the doctors’ investigation.
Q.Had the diagnosis been made, would you have been able to save Huma?

Now that I know what the problem was, I don’t think she stood a chance. All her affected organs would have to be surgically
removed.

Q. But when she was leaving for Singapore, did you think she’d make it?

Her condition was quite stable. She was not only conscious and breathing on her own but was able to walk. She was in a private
room not in the intensive care unit which showed that she was fit to travel. I thought with routine dose of anti-biotics she would get
well. Of course, at that time I did not know the infecting organism – therefore I was optimistic. But with hindsight, now that we
know the infecting organism, one can say for sure that the optimism was ill founded.

Q. How many doctors and paramedics have been suspended and their licenses to practice cancelled?

There are to my understanding 19 consultants who are under threat of suspension but it is against the law as the Standing
Committee of the Parliament, to my understanding (and I am not a lawyer) does not have the jurisdiction to pass such directives to
the Pakistan Medical and Dental Council (PMDC) – particularly without even hearing the doctors.

Q. What do you have to say in your defence to the conclusions of the inquiry committee?

I have only seen the brief report issued by the inquiry committee – that too has not formally been provided to us. In that report there
is no specific allegation of negligence against any particular doctor, just a general statement. What are the odds, I ask you, that all
the 19 doctors have been negligent! Some of them had very little role to play. So the issue of negligence cannot be addressed without
looking at the specific role of each doctor, and what he advised. Moreover, let us be clear – this inquiry committee report is not the
final verdict. Nor can it be. Indeed, if any body wants to investigate this matter seriously, then a precondition would be a complete
autopsy and toxic tests of the patient’s body – which is necessary for instance to answer the question whether she and Mr. Akram
disclosed all the relevant facts to the doctors.

Q. Isn’t it strange that the Standing Committee inquiry never probed the doctors in question, nor did they even invite the investigators --the
three-member team that conducted the inquiry – and without hearing all sides sent a directive to PMDC to suspend so many doctors? What
do you make of this?

I have been so busy with my patients that I haven’t had the time to find the answer. But it is an intriguing question, which you may
need to explore further.

Q. Talking to the press (Dec 10), Wasim Akram has said that doctors were unavailable for his wife? Do you refute that?

It hurts to hear this. We are all quite upset. We treated the wife of our national hero with utmost commitment and not just me, but
the entire team of consultants. In the legal notice you will find a chronology of the phone calls, text messages between him and myself
and between me and the various other doctors involved. Not for a fraction of a second, in all honesty, did I or other doctors, shrug off
our responsibility towards our patient.
In fact, before she was to leave for Singapore, I painstakingly prepared a detailed summary of her medical history. Then I called
Akram and he profusely thanked me for all the care I extended to her.

Q. Akram also mentioned that one of the doctors asked for $150,000 to arrange for an air ambulance service to ferry her off to Singapore?

He didn’t say ‘one of the doctors’ he said ‘Dr. Kamran Chima’ made this proposition. I would like to take the opportunity to clear
this up. On Oct. 17, Akram told me his intentions of taking his wife to Singapore and that arrangements had been made.

Upon hearing that, by way of informing, and all in good faith, I mentioned that one of my patient’s families had arranged for an air
ambulance which charged approximately $125,000 to shift her to the Cromwell Hospital in England. In my legal notice, I have
attached the invoice which this other patient’s family has kindly provided me, to substantiate this. I don’t understand why Akram
would bring this up and what the relevance is.

And why should I make any such proposition to arrange air travel.

He said on a lighter note: ‘I don’t have a flying license, seems my medical license is in jeopardy now…which will leave me with just
my driver’s license to make a living of!!!’

Q. What took you so long in responding to Akram’s allegations?
We were obviously flabbergasted by his making these scurrilous public attacks, but we decided to initially keep quiet respecting the
fact that he was grieving. But there seems to be no stopping him now. His vitriolic statements have gone too far and the record needs
to be corrected. One cannot tolerate non-sense indefinitely