Doctor sends Wasim Akram legal notice, puts record 'straight'

Just wondering what other people make of this whole thing. Initially was sympathetic toward Wasim Akram, and what happened to him, but now I’m not too sure. Here is interview with one of the doctor who treated his wife.

DAWN.COM | Cricket | Doctor sends Wasim Akram legal notice, puts record ‘straight’

Doctor sends Wasim Akram legal notice, puts record ‘straight’
By Zofeen T. Ebrahim

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.

Re: Doctor sends Wasim Akram legal notice, puts record 'straight'

Upto now i have only seen one patient of mucormycosis survive. If she indeed had mucormycosis chances of survival are extremely, extremely low. It would be interesting to know whether infection involved sinuses or lungs.

Re: Doctor sends Wasim Akram legal notice, puts record 'straight'

What causes this infection?

Yeah, it doesn't seems like that the doctors were neglecting her and the inquiry committee should have interview the panel of doctors before accusing them of anything.

This infection is high among risky groups such people with AIDS, and some kind of cancers etc.

Body's immune system is highly comprised before these types of infections could take a hold.

Re: Doctor sends Wasim Akram legal notice, puts record 'straight'

*moral of the story *

"Professional ppl like (doctors, accountants and lawyers etc) are inherently very "kaminay" one shud think atleast 10 times before waging a war against them. They know how to save their asses and will definitely knock u out on the technical grounds (atleast in 90% cases).
(By the way I m an accountant ………………. Lols)
The committee will fix the responsibility in days to come after forensic investigation. However the way wasim has behaved during the whole show does make me very convinced. initially i had sympathy 4 him coz he had to suffer the loss but he taken the war too far without considering the fact that case of her wife was of complex nature ( i m not professionally qualified to comment on it but the story of case suggest so).

Suspending 19 doctors widout even hearing their point of view is totally ridiculous. Newayz now wasim will have to face the heat. now he will have to prove on technical and medical grounds that doctors were negligent and they did not take the case seriously and professionally. And that is very difficult to prove since the doctors involved in the case and examine the patient many times provide the treatment as well.

Professional can put their efforts to give u a desired result but they cant ensure the desired outcome. Like in the case of auditor (a professional accountant) *can provide a company with a reasonable assurance about the fairness of the accounts of the company but never and can never provide the absolute assurance about the fairness accounts of the company, coz it is beyond its power and professional responsibility.. *

Beside we shud keep this fact in mind that we are part of the third world and even most of our good hospitals are not equipped wid the state of the art technologies.

Looking things in the hind sight is different than to manage a crises situation when the things were actually happening. Beside the huma case was not a like a delivery case that went wrong it was some disease that doctors witness once in a blue in their whole career.

Professional are human beings after all and to err is human. Professional ppl are expected to make an intelligent and honest judegement on the basis of given information and circumstances. U cant never blame them about the outcome if it proved that they put their effort diligently and label them as a criminal as it is happening in the current case.

I’m not a doctor, but this is what I found by googling it.

Mucormycosis

BACKGROUND
Mucormycosis, also known as zygomycosis, is an aggressive, opportunistic fungal infection of the sinuses, skin, gastrointestinal tract, brain or lungs that usually affects individuals who are immunocompromised.
Mucormycosis, first described in 1885, refers to several different diseases that are caused by the fungi in the order of Mucorales. Rhizopus species are usually the cause of mucormycosis. In descending order, the other genera with mucormycosis-causing species include Rhizomucor, Cunninghamella, Apophysomyces, Saksenaea, Absidia, Mucor, Syncephalastrum, Cokeromyces and Mortierella.
Depending on where the fungal spores are deposited, mucormycosis may affect the sinuses, lungs, gastrointestinal tract, brain or skin. Most mucormycosis infections are life threatening. Most patients who have mucormycosis experience severe infections of the facial sinuses, which may extend into the brain. Pulmonary, cutaneous and gastrointestinal infections also occur. Complications may include loss of neurological function, blindness or blood clots in the brain or lung vessels (thrombosis).
Conditions most commonly associated with mucormycosis include diabetes, chronic steroid use, metabolic acidosis, organ transplantation, leukemia/lymphoma, AIDS and treatment with deferoxamine (a chelating agent that removes excess iron from the body).
Diabetic patients are predisposed to mucormycosis because of the decreased ability of their neutrophils to phagocytize (engulf pathogens) and adhere to endothelial walls. In addition, the acidosis and hyperglycemia provide an excellent environment for the fungus to reproduce.
Until the 1950s, mucormycosis was almost always a fatal disease. Researchers estimate that about 25-80% of cases today are fatal, depending on where the infection is. Successful treatment requires correction of the underlying risk factor(s), antifungal therapy (usually with amphotericin B) and aggressive surgery. Permanent residual effects of the disease, such as blindness and cranial nerve damage, occur up to 70% of the time.
COMPLICATIONS
Loss of neurological function can occurs when the infection affects the central nervous system.
Mucormycosis can cause blood clots in the brain or lung vessels (thrombosis).
If the infection spread to the optic nerve, it may result in permanent blindness.
RISK FACTORS
Individuals who are immunocompromised are at the greatest risk of developing mucormycosis. Historically, patients with uncontrolled diabetes mellitus (especially with ketoacidosis) are at the greatest risk for infection. This is because funguses thrive in acidic environments. Immunocompromised patients, especially those who have cancer (particularly those who are neutropenic, have received broad-spectrum antibiotics or are undergoing chemotherapy or radiation therapy), liver problems, chronic renal failure, are taking immunosuppressive agents, are malnourished, have burns and recently suffered from trauma, are at an increased risk.
TYPES
Rhinocerebral mucormycosis: Rhinocerebral mucormycosis is an infection of the sinuses that spreads rapidly to the eye and brain. Rhizopus oryzae account for many cases of rhinocerebral mucormycosis.
Most patients with rhinocerebral disease have diabetes (especially with ketoacidosis) or have malignancies (cancerous tumors) and neutropenia and are receiving broad-spectrum antibiotics like tetracycline (Helidac Therapy®, Sumycin® or Sumycin® Syrup).
Seventy percent of patients diagnosed with rhinocerebral mucormycosis also have diabetes mellitus, although this percentage is declining with the use of chemotherapy and as the frequency of other immunocompromised states become more common. Fewer than four percent of cases occur without a recognized underlying condition. Hyperglycemia (high blood sugar) enhances fungal growth and impairs neutrophil (type of white blood cell that fights against disease and infection) function. Lactic acidosis prevents the white blood cells from performing phagocytosis (engulfing antigens).
Pulmonary mucormycosis: Pulmonary mucormycosis occurs when fungal spores are inhaled into the lungs. It is a rapidly progressive pneumonia that may spread to the chest, heart and brain. Immunocompromised patients, especially those who have malignancies and are neutropenic (low levels of neutrophils, which are the most common white blood cells in the bloodstream) are at an increased risk for developing pulmonary mucormycosis.
Gastrointestinal mucormycosis: Gastrointestinal mucormycosis occurs when the fungus is ingested. Gastrointestinal mucormycosis is most prevalent among individuals who are severely malnourished. The infection may occur throughout the gastrointestinal tract, but it is most likely to affect the stomach, ileum (lower end of the small intestine) and colon.
Cutaneous mucormycosis: Cutaneous mucormycosis occurs when the fungus enters the body through broken skin. Cutaneous mucormycosis causes cellulitis (inflammation of the connective tissue), which eventually results in dead skin and scabs. Patients who have cutaneous mucormycosis may have had prior trauma or have been exposed to contaminated medical equipment, such as bandages. Rare reports of cutaneous mucormycosis have occurred at catheter sites and insulin injection sites.
Central nervous system mucormycosis: Rhinocerebral mucormycosis can potentially spread to the central nervous system, causing central nervous system mucormycosis. Patients with central nervous system mucormycosis often experience headaches, loss of consciousness and focal neurologic symptoms. Patients with this form of mucormycosis may have a history of open head trauma or cancer.

Re: Doctor sends Wasim Akram legal notice, puts record 'straight'

Doctors Hospital is just trying to divert attention. They killed Imanae Malik, by negligence. Look here: imanae.co.uk and look it other victims too. These Dakus running this Hospital are in big trouble nowadays.