Unveiling Truths: Why Every Death Deserves an Autopsy

Need for Autopsy in every death –

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On 03^rd. June, Palash got an intimation from an insurance company to investigate into the health conditions of an octogenarian who has been reportedly admitted in a hospital with cardiac ailments. Since, it was late evening, hence Palash decided to follow up the case the next day morning, and managed to obtain necessary permission from the insurance company itself.

The triggers were:

The patient admitted for Syncope & Collapse. Coronary Angiography has been done on 31^st. May. Following which Permanent Pacemaker was implanted on 01^st. June, which has already been approved.  During the process of enhancement – Insurance Repository against revised bill was raised as per Special Contract Rate. The hospital has sent an enhancement letter for the procedure of PTCA + stent. The Insurance Company have raised the Insurance Repository.

The queries those which were raised:

Please justify why PPI was needed immediately after Angiography, followed by PTCA – since proper justification has not been received from the hospital authority.

While conducting a thorough physical investigation, please arrange the supporting documents & printed echo report, and relevant OT notes, alongwith indoor case papers.

As per schedule, on 04^th. of June, when Palash had reached the hospital, the authorities turned hostile, and was reluctant in allowing Palash to pursue the investigations. Apprehending possible foul play, the seasoned investigator Palash insisted for the patient’s treatment file. After being kept waiting for long the file was produced.  

Case History –

the octogenarian patient had a syncope, and had felled inside his house at 08.30 hours on 30^th. May, thus injuring his head. He was brought to the hospital at 18.05 hours – where an ECG Report had demonstrated the fact that there are Atrial Premature Complexes stating the report as Abnormal ECG. The Echo Cardio report demonstrated that the Left Ventricular Ejection Fraction is 60% (considered to be steady with regards to the age). Several discrepancies were visible; the Admission Evaluation stated Syncope, while Treatment Notes demonstrated Pre-Syncope. After administering Injection Pan & Injection Zofer the patient was shifted to CCU, with a conservative care plan suggested by the treating team.

After being shifted to CCU, the attending doctor had adviced for CT Scan of the Brain followed by a 24 hours Holter Monitoring. The same advice was documented after 24 hours on the 31^st. May. The following treatment sheet had documented the fact that on 31^st. May, Coronary Angiography has been performed wherein it has been diagnosed that the patient is a case of Degenerative Valve Disease (DVD) with a plan for conducting Percutaneous Transluminal Coronary Angioplasty (PTCA). Another treatment sheet dated 31^st. May documented the fact that another doctor has adviced for the Implantation of Permanent Pacemaker.

On 01^st. June, treatment sheet has documented – a Permanent Pace Maker been implanted as the patient is a case of AV Nodal Disease & Presyncope. Following which the treating doctor has adviced for PTCA on 03^rd. June. Accordingly, the hospital authorities have raised a bill of more than 3.5 Lakhs.

The reports were apparently self-contradictory, for which Palash insisted to visit the patient for a physical verification. This is when situation exaggerated, and chaos prevailed inside the hospital premises. The investigator, Palash informed the authorities that without a proper physical verification, the claim would be repudiated. It is then the authorities revealed, that PTCA could not be formalised on 03^rd. June, since the patient has gone into COMA; bill was raised much before the PTCA could be performed. Looking into the gravity of the revelations, the authorities finally allowed Palash to visit the patient in the CCU.

Coronary Care Unit (CCU):

The octogenarian was found to be in a Persistent Vegetative State with a Leukoplast Tape on the left throat. Upon enquiry the attending doctor informed Palash that Coronary Angiography followed by Angioplasty has been performed vide the same injured spot.

For Foul-Players, the confusion, distraction and vulnerability stemming from crises spells opportunity. The attending doctor in the CCU was unaware of the revelations by the hospital authorities; moreover, Coronary Angiogram (CAG) is both a diagnostic X-ray imaging procedure, using the cardiac catheterisation technique by inserting a 2 mm-diameter catheter along the artery through the wrist, elbow, or groin up to the coronary arteries and injecting a contrast dye to take images. Moreover, PTCA, or Percutaneous Transluminal Coronary Angioplasty, is a minimally invasive procedure – wherein a catheter is inserted into an artery, usually in the groin but sometimes in the arm or wrist. The catheter is advanced to the heart, and a series of x-ray pictures (coronary angiogram) are taken to clearly visualise the heart arteries that are narrowed. Then a balloon-tipped catheter is advanced to the heart, and into the narrowed coronary artery. Inside the artery, the balloon is inflated and deflated several times, compressing the plaque against the artery wall and widening the artery improvising blood flow.

The authenticity of the attending doctor was dubious, hence Palash asked him to furnish his credentials. The doctor who was utterly dismayed immediately cried for help. The hospital authorities rushed to the rescue act, and vehemently requested Palash to suppress the facts, and settle the matter. Palash reported the dubiuosity to the Insurance Company, who in turn had informed the kin of the patient.

The next morning arrangements were made to transfer the patient to a higher management centre, but in the process the patient had succumbed to his sufferings. Later, Palash was apprised of the fact that the hospital authorities have diligently issued a Death Certificate – citing the cause of death as Respiratory Failure.

If the provision of autopsy was parri-passu, then the cause of the sufferings along-with the fallacies of treatment would have been surfaced.

To be continued…………

Writer Suvro Sanyal

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