ASK’s Fact Finding: Removal of Two Kidneys Instead of One

Date of the Incident:               05 September, 2018

Place of the Incident:              Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka

Date of Fact Finding:              24 September 2018 and 01 October 2018

Fact Finding Team                  Anirban Saha (Senior Investigator), Hasibur Rahman (Investigator),

    Topote Bhattacharya (Senior Investigator)

Incident

Rowshan Ara, wife of Md Wazed Ali Sikder, lost both her kidneys instead of the one infected non-functional one, when she went for its surgery.

She was admitted to the Bangabandhu Sheikh Mujib Medical University (BSMMU) on 28 August 2018. On examining her physical conditions, Dr Md Habibur Rahman (Dulal), Associate Professor, Department of Urology, BSMMU, noticed that her left kidney was infected and non-functional and thereafter advised for its removal. As per his advice, the family consented to the surgery and a surgery was performed on the victim on 5 September 2018, upon which the condition of the patient deteriorated.

ASK’s fact finding team, through fact finding, and statements from several sources, gathered that none of the two kidneys of the patient was visible and functioning. Either way, the current status of the patient is that she is no more alive.

Findings

According to the facts found by the fact finding team, Rowshan Ara was initially admitted under Dr. Yusuf of Mirpur BIHS Hospital for her critical conditions of her left kidney (hurting and swelling of left side), on 27 June 2018. Due to the lack of surgical instruments and expertise, Dr. Yusuf referred them to BSMMU, Hospital (PG Hospital). On 1 July 2018 she was admitted to the hospital under Dr Habibur Rahman of Urology Department of BSMMU, where after several diagnostic tests it was found that her left kidney is infected and with a stone while her right kidney is functioning well. Surgery was performed on her to remove the infective urine from her kidney, after which her health improve returning to normal. Professor Rahman afterwards suggested the patient for the complete removal of the left kidney for better health, to which the family consents to. Later, on 5 September, 12 noon, the surgery to remove her infected kidney was performed under the guidance of Professor Rahman and his team. During the surgery there were several complications but finally at roughly 3pm in the afternoon, it was over.

Despite the surgery, the patient’s health started to deteriorate on the completion of the surgery; the spot of operation (the left side of the belly) was bleeding. The doctors, upon further questioning revealed that the patient was suffering from “Acute Renal Failure”, where her kidney on the right side stopped working after the operation. She was required to be admitted in an ICU, but due to the absence of such bed in the PG Hospital, the doctors advised the family to move to a Private Hospital’s ICU. The patient was thus shifted to Insaf Barakah Kidney and General Hospital in Moghbazar on the morning of 6 September 2018.

Later, upon the suggestion of Professor Fakhrul Islam, a CT scan was conducted from LabAid. Based on the review of the CT scan report, Prof. Fakhrul conversed with Dr Habibur Rahman for her admission in the PG Hospital once again. During their visit, Dr Habibur Rahman assured the patient’s family that the patient does have a kidney inside and thus her recovery is inevitable on dialysis. Meanwhile, the patient’s family took Rowshan Ara to the Chairman of Nephrology Department of BRB Hospital, Prof. M A Samad. On viewing the reports and her health condition, he advised to do another ultra-sonogram at BRB Hospital. It was found out from the ultra-sonogram that before the surgery, she had both her kidneys, one infected and one healthy; but after the surgery, she had none; i.e. she had no kidneys present in her body at that moment. She had to go through dialysis to recover as her creatinine count (kidney test) rose from 0.61 to 6 points after the operation; moreover, the water getting stored in the body resulted in her swelling.

The BSMMU authorities set up an investigation committee on 22 September to inquire into this issue with 7 members and set up another team of 6 members to ensure proper surgical means for her health

Complainants’ Statement

“At one point we informed various mass media about the incident,” said Shafiq Sikdar, elder son of Rowshon Ara, during the investigation. “We also lodged a complaint to the director of PG Hospital. As a result, the hospital authority formed a medical team. Yesterday (September 23, 2018) we were informed by the medical team: ‘The patient needs to do dialysis twice in a week. You have to manage a kidney donor. We will transplant the kidney into her body, she will recover.’

Sharif Sikdar, youngest son of Rowshon Ara, added, “Dr. Mostofa of PG Hospital opined that a person can live for 20/25 years on dialysis and without kidney. But we do not believe on what they say. They removed the good kidney of my mother and now they are denying the matter. The condition of our mother is not good. We want her healthy kidney back.”

During investigation, the victim, Rowhon Ara, told the ASK representative that the condition of her body after operation has been really bad. She cannot urinate, she cannot eat normal food.

Rafiq Sikdar, eldest son of Rowshon Ara, opined the same. He demanded her mother’s kidney replacement and compensation for the loss. He also demanded trial of those responsible for the loss of the healthy kidney (right) of their mother.

He also informed ASK representative that in the news, about his mother’s healthy kidney (right) removal, Dr. Habibur Rahman Dulal on Ekattor TV said, “The left kidney cannot be seen since it is non-functional. If it is a case of non-visual, we think in two ways. One is the kidney may become non-functional. Another is the kidney is absent. We think the kidney is mainly non-functional.” Responding to the comment by Dr. Habibur Rahman Dulal, Professor of BRB Hospital MA Samad in the same news story said, “Since the kidney is not working, creatinine will go up. Then we understood that it is not working. That has become non-functioning. But if we do ultrasonogram and CT scan, we will find if the kidney is there.”

Doctors’ Statements

Dr. Habibur Rahman (Dulal), Professor, Department of Eurology, BSMMU

When ASK’s representatives approached Dr. Habibur Rahman on Septermber 24, 2018 regarding the treatment of Rowshon Ara, he informed, “Actually I did not see this patient (Rowshon Ara) earlier. She had an operation in 2016 in a different hospital. It was an operation of stone in the tube of her left kidney. It was her first operation. This patient was admitted in my unit in July this year. As far as I heard, after the investigation, the damage of her left kidney was found and she was suggested removing the left kidney through operation. During that time, the pus of her left kidney was taken out. Afterwards, the patient was admitted in PG Hospital on September 5, 2018 for operation. Operation started in the noon of 5 September. When there was complexity at one stage of the operation, junior doctors called me. Then I went to the operation theatre and got myself involved with the operation.”

He further informed that there were complications during the operation as the patient was bleeding heavily, everything—blood vessel, esophagus and kidney—were mixing up with each other. The patient went into shock on the operation table at that moment. The operation was completed finally when she returned back from shock. After that the patient was taken to post-operative. At around 5 pm, duty doctor told us the patient was not able to urinate. Then again around at 1 am, the duty doctor reported that the patient was facing respiratory problem. Then he advised shifting the patient to ICU, if necessary. On the next day Professor Fakrul Islam of Insaf Barakah Kidney and General Hospital informed him that one of his (Habibur Rahaman) patients was there. He asked to bring the patient to PG Hospital as she did not need ventilation. But they (patient’s relatives), after doing CT scan at Lab Aid Hospital instead, came to know that she had no kidneys. Bringing the patient to PG Hospital, they wanted to know why the patient was in such condition. That time Dr. Habibur Rahman told them that the kidney might be absent or non-functional.

Upon being asked Dr. Habibur Rahman Dulal informed the ASK representatives that currently he is considering kidney replacement of the patient. If necessary, in future he will bear all the expenses related to dialysis and kidney replacement of the patient.

M A Samad, Chairman, Department of Nephrology, BRB Hospital, Panthapath, Dhaka

ASK representatives approached Head of Department of Nephrology of BRB Hospital Professor M A Samad in his room at round 12.20 pm on October 01, 2018 to know about the removal of kidney of Rowshon Ara who is under treatment at BSMMU Hospital. Dr. Samad said, “The patient was brought to the hospital by her son Rafiq Sikdar, who informed them the status of his mother’s condition regarding the dialysis and no urination. Being confused I asked for the medical reports and papers of the patient. On the receipt of the documents, from what I could see from the CT scan and ultra-sonogram, was the expanding huge size of the left kidney resting on the right kidney.” He shared his lack of knowledge in comparison to specialists but shared what he knew. As per his understanding, there was presence of the kidney in the earlier reports.

On asking for the kidney test (creatinine count) report, he was provided with such as well, by looking at which he stated that a count of 0.65 is normal. Thus, looking into previous reports, it seemed that now she had a fully functional kidney, which is measure by the creatinine count.

He then queried the patients about the reports after the operation; he further shared the plausible possibility of the patient suffering from acute kidney failure, i.e when a kidney refuses to work due to low pressure. He then queried about the ultra-sonogram report, which he was then provided with. In the ultra-sonogram report, there was no evidence of the presence of any kidneys. He then queried about the CT scan report. In that report also he did not find the presence of kidney. Meanwhile, when the history of the patient and event of getting a new CT Scan from another hospital was shared with him, he replied, “I saw the CT scan report and I am telling again I am not a radiologist. Radiologists can see things minutely. We see at gross level. As I saw it, I did not find any kidney at the right side. Anyways, the kidney was not working, not even a single drop of urine. It could be because during operation they cut it off due to some complications. Then Rafiq Sikdar asked me, if the kidney is not being seen due to it not working temporarily. I said him that is not what it should be according to science. It is because it is a structure; it should be visible even if it is not functioning. The presence of the kidney must be visible. It should be visible in the CT scan. And in the blood test creatinine reading will show very high. But it must be visible in the CT scan and ultra-sonogram reports. But I cannot see that. Maybe somehow they removed it because it was necessary.”

Upon being asked by the ASK representative, Dr M A Samad informed: “I probably told the patient to do ultrasonogram from BRB Hospital. I do not remember if they showed me the report. I clarified the report.” He further told, “I do not know what happened next. I saw previous reports, and the final report. I did not find (kidney) in the final ultrasonogram report though I found them in the previous ones. I found two kidneys in previous CT scan report also.”

(Abridged version Prof. M A Samad speech, recorded during ASK’s investigation)

ASK’s intervention:

ASK’s panel lawyers issued a notice demanding justice to the following persons on 29 September 2018, on behalf of the victim family:

  1. Bangladesh, represented by its Secretary, Ministry of Health and Family Welfare, Bangladesh Secretariat;
  2. Bangabandhu Sheikh Mujib Medical University (BSMMU) represented by its Vice-Chancellor;
  3. Associate Professor Md. Habibur Rahman (Dulal), Associate Professor, Department of Urology, BSMMU, Urology (Surgery for Kidney, Ureter or Urinary Bladder);
  4. Bangladesh Medical & Dental Council (BMDC) represented by its President of 203.

In the notice, the recipients were called upon to show cause as to why the following actions should not be taken against them:

  1. Appropriate disciplinary action against Md Habibur Rahman by removing him from his post at BSMMU;
  2. Cancel the professional registration of Md Habibur Rahman and debar him from medical practice for his edical negligence and professional misconduct under Section 23 of the Bangladesh Medical and Dental Council Act 2010;
  3. Pay a compensation of Tk. 50 Crore to the Victim’s family.

They were additionally warned that failing to comply with the notice within 48 hours would result in the filing of writ petition against the persons under Article 102 of the Constitution.

After the issuance of the notice, Md Habibur Rahman approached the victim’s family for a settlement through mediation, due to which no writ petitions were filed against anyone.

Later, 01 October, 2018, Rafiq Sikder, on behalf of Rowshon Ara Begum, and Md Habibur Rahman, signed a contract settling on the following points:

  1. Upon the consent of the patient’s sister, Jaheda Begum, one kidney of her kidneys will be donated to Rawshon Ara Begum on the next treatment.
  2. The treatment expenses of Rowshon Ara will be borne by the second party.
  3. The donor of the kidney, Jaheda Begum, will be given Tk 800,000 (eight lac)
  4. The treatment expenses of Jaheda Begum will be bourne by the second party till she recovers

However, it is disappointing that Rowshan Ara’s treatment had not commenced on time, after nearly month since the date of contract. On 26 October, 2018, Rafiq Sikder informed ASK’s representative over phone that even though she was admitted in the ICU of BSMMU, Hospital with a ventilation support, her condition was very critical due to not getting any treatment till that date. Unfortunately, as of date, she is no more alive.

Based on this incidence, Ain o Salish Kendra has filed a Public Interest Litigation on medical negligence and to seek compensation for the victim family.

ASK – Ain o Salish Kendra
BRB – BRB Hospitals Limited
BSMMU – Bangabandhu Sheikh Mujib Medical University
BMDC – Bangladesh Medical & Dental Council