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Obituary:
P.R. Kumaramangalam
The
Bones of Contention
The
tragedy of Union power minister P. Rangarajan Kumaramangalam's untimely
death was compounded by a controversy over the role of the Indraprastha
Apollo Hospital, where the minister had got himself admitted in April
but was discharged with the diagnosis that he had "pyrexia of unknown
origin" (POU), or unexplained fever. More than three months later,
the All India Institute of Medical Sciences (AIIMS) in Delhi, where he
was laid up on a respirator till his end, had found him suffering from
acute myeloid leukemia (cancer of the bone marrow and blood). It led Parliamentary
Affairs Minister Pramod Mahajan to charge Apollo with negligence in diagnosis
and treatment.
Apollo is
no ordinary hospital. It is a favourite of the VIPs, and Kumaramangalam
had a special reason to visit it, his sister-in-law Geeta Chadha being
a doctor in the hospital. However, the physicians who had treated him
at Apollo say that from April 14 to 23, when he was admitted, they were
only told of a nagging fever that had been bothering the minister for
two weeks. He underwent various tests at Apollo-CT scan, chest x-ray,
bronchoscopy, and a complete blood test. As nothing showed up in the tests,
he was finally administered drugs for malaria since he had been to the
Andamans recently. "A biopsy and scan ruled out tuberculosis and
lung cancer," says Apollo's spokesperson.
When the
minister arrived at AIIMS on August 12 he was down with a host of new
complaints such as terrible bone pain, body ache, weight loss-he had lost
10 kg-and loss of appetite. A bone marrow scan at AIIMS spotted the disease.
An AIIMS doctor, requesting anonymity, says, "How anybody could have
missed this diagnosis is beyond me." Apollo doctors argue that such
a test is not part of the internationally accepted protocol for treatment
of unexplained fever, but doctors at AIIMS insist that whenever a non-localised
fever presents itself, a routine work-up would include a bone marrow examination.
The point
is, Kumaramangalam visited Apollo with a minor complaint but months later
at AIIMS he was a terminal patient of cancer. This is not impossible as
acute myeloid leukemia can spread in a few weeks. Says Prathap C. Reddy,
chairman of the Apollo Hospitals Group: "There was no indication
in the minister's condition for us to test his bone marrow." Yet
the debate is unlikely to rest in peace.
-Subhadra
Menon
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