56-Year-Old Woman Dies After '200% Safe' Operation Costing Rs 43 Lakh Turns Disastrous In Mumbai

Thane resident Mithulal Bafna raised Rs 43 lakh with much difficulty to pay the medical bills for his 56-year-old wife, who died a fortnight ago. But what is eating him up is that a heart valve specially ordered for his wife "fell" into her heart during a procedure carried out in the presence of top heart specialists at Hinduja Hospital in Mahim.

In a complaint to the Maharashtra Medical Council on December 28, Bafna (60), who is employed with a private firm, said the doctors had assured him that the new procedure ¡ªtranscatheter mitral valve repair¡ªwas "200% safe" and his wife, Manju, would be back home in five days. Instead she left the hospital in a comatose state after almost 60 days and died a few minutes later in an ambulance on December 19. Complaints and bitter discussions preceded her exit even as the hospital refunded Rs 12.47 lakh to Bafna on "humanitarian grounds". The hospital authorities told TOI there had been no negligence in care.

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The case underlines soaring healthcare costs and crumbling doctor-patient ties.

The family insisted they were not informed about the full extent of the risk; the cardiologist who flew down from Jaipur for the transcatheter procedure, Dr Ravinder Singh Rao, never met them before the procedure; and the sale papers of the imported valve mentions Rs 1.5 lakh, when they paid Rs 11 lakh for it. One of the doctors claimed the family threatened him over the expenses.

Of the Rs 43 lakh expense, Bafna got Rs 12.47 lakh refund from Hinduja Hospital and another Rs 11 lakh from medical insurance. "We were told the total expense would be Rs 20 lakh, but it ballooned," said Bafna's son-in-law Bharkatiya.

Bafna said he would never have agreed to the new procedure if he knew of the risks involved. "There wasn't an emergency that needed an immediate fix," he said, showing a picture of his wife smiling into the camera just before the operation on October 25. "In fact, she walked a kilometre from her home to ours every day," said her son-in-law.

But the medical men in the case¡ªHinduja Hospital's medical director Sanjay Agarwala, cardiac surgeon Kushal Pandey and Singh Rao¡ªdisagreed. Pandey, who operated on Manju six years back, insists she was very sick with barely six months to live. "There was no negligence," added Dr Agarwala. The valve failed to deploy but the surgeons saved the day and fixed a mechanical valve, he added.

Dr Singh Rao, who is among the few trained in the new transcatheter method of replacing heart valves, said every procedure carries a risk. "Valves slip away after placement in 20% of these cases. This is valve embolism, a well-documented entity," he said, adding he had waived his charges in the Bafna case. The family claimed they were not forewarned about valve embolism.

Manju had an unusually small mitral valve. This was discovered six years back when she was undergoing an open heart surgery for aortic and mitral valve replacement. Dr Pandey replaced her aortic valve, but couldn't find a mitral valve replacement of the right dimension. "We only repaired the valve," said Dr Pandey.

Manju was normal till six months back when she started feeling breathless again. A second open heart surgery was ruled out as being too risky by Dr Pandey and other specialists in Chennai and Bengaluru whom the family contacted.

TOI

The family then took up Dr Pandey's suggestion of a transcatheter repair performed by Dr Singh Rao. "We talked to the Jaipur doctor and some of his patients who had their aortic valve fixed using this technique, but he never put us on to a patient who had undergone a mitral valve repair," said Bharkatiya.

Despite repeated attempts by TOI, Dr Singh Rao didn't share the number of mitral valve procedures he has carried out using the new technique. He spoke about a patient who is doing well for a year after the operation. Mitral valve cannot be wholly replaced by the transcatheter method. "We can do a partial one if a ring has been previously placed as was done in Manju Bafna's case," said Dr Singh Rao.

On special permission sought by Dr Pandey from Hinduja Hospital, Dr Singh Rao flew down to Mumbai to perform the procedure on October 25. The family alleged Dr Singh Rao never met them, a charge refuted by the doctor.

Dr Pandey said medical teams are always prepared for emergencies. "When the valve failed to be deployed, we did a re-do surgery. She was critical for the first 48 hours. But she made it back to the ward. She was recovering till she vomited and that triggered an infection," said Dr Pandey. He said he listened to the family's every request. "They asked me to speak to their family doctor who is in the US," he said. The doctors feel they did all they could for Madhu. "Her only option was a highly risky heart surgery. We tried an easy option first. If it had been successful, the family would have reacted differently," said Dr Singh Rao.