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Indian doctors decry decision to move raped woman to Singapore

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8725 (Published 31 December 2012) Cite this as: BMJ 2012;345:e8725
  1. Ganapati Mudur
  1. 1New Delhi

The Indian government’s decision to transfer a woman who had been raped and severely injured from the intensive care unit of a government hospital in New Delhi to Singapore, where she died on Saturday, has provoked anger in medical circles.

Many doctors suspect that the government had put pressure on the medical team treating the 23 year old woman to recommend her transfer to Singapore in an attempt to appear to be doing its best to save the woman and to curb public outrage.

The woman, who had been raped and assaulted with an iron rod on 16 December, died from complications of her injuries and infection, including multiple organ failure, after 10 days in New Delhi’s Safdarjung Hospital and two days in the Mount Elizabeth Hospital in Singapore.

She had lost her small intestine after surgery to remove sections of it that had been irreversibly damaged during the attack. “I have never seen such grievous injuries after sexual assault in nearly 30 years of practice,” a doctor who was part of the team at Safdarjung Hospital told the BMJ. The doctor, who requested anonymity, declined to say whether the decision to send her to Singapore was influenced by the government.

Senior doctors not associated with her treatment have questioned the ethics of the decision.

“I think it was a 100% political decision,” said Rajesh Pande, director of critical care at the private Bishambar Lal Kapur Hospital in New Delhi, who is also the secretary of the National Capital Territory branch of the Indian Society for Critical Care Medicine. “I cannot imagine that her doctors would have suggested the transfer on their own,” Pande told the BMJ.

Doctors have rejected claims by some members of the medical team treating the woman that the move to Singapore would have helped prepare her for an intestinal transplant in the future.

Sri Prakash Misra, a senior gastroenterologist at the Moti Lal Nehru Medical College in the city of Allahabad, Uttar Pradesh, said, “In her critical condition the entire focus of the treatment should have been on controlling the infection and supportive therapy. An intestinal transplant was irrelevant at this stage.”

The woman had developed infection and sepsis and had had a cardiac arrest and possible hypoxic brain damage at Safdarjung Hospital, a senior member of the team caring for her told the BMJ.

Critics believe that the decision to send her to Singapore was also intended to dampen public outrage. University students and other protestors seeking speedier justice and the death penalty for rapists clashed with police in New Delhi last weekend. A police constable died in the clashes.

“The decision to send her abroad could create a wrong impression among the public that Indian hospitals cannot manage such critically ill patients,” said Samiran Nundy, a senior gastrointestinal surgeon at the Sir Ganga Ram Hospital in New Delhi.

Nundy and others said that the episode has exposed how the government can influence doctors in government hospitals. Nundy said, “The lesson for the medical community is to learn to take decisions independently, based only on the best interests of patients.”

Misra said, “We need more doctors who can stand up to such pressures.”

Notes

Cite this as: BMJ 2012;345:e8725