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Locum oncologist is struck off over death of patient in India

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3486 (Published 10 August 2018) Cite this as: BMJ 2018;362:k3486
  1. Clare Dyer
  1. The BMJ

A locum consultant oncologist working in the UK has been struck off the UK medical register over a patient’s death that occurred four years ago in India.

A medical practitioners’ tribunal concluded that Pantula Sastry had knowingly given high dose BEAM chemotherapy followed by autologous stem cell transplantation to a patient with lymphoma whose test results suggested she would not survive it when he was working at Kokilaben Dhirubhai Ambani Hospital, Mumbai.

The therapy destroys bone marrow, and patient survival depends on bone marrow regenerating from stem cells that are harvested from the patient before treatment and infused afterwards. The patient needs time between treatments to produce enough stem cells.

Expert witnesses in the case disagreed on the proper delay, but agreed that the 20 days allowed by Sastry had been inadequate. The patient’s bone marrow did not recover and she died, though not before her family asked for Sastry to take no further part in her care.

The patient’s son reported Sastry to the General Medical Council, which is allowed under the Medical Act 1983 to consider events overseas that might affect the fitness to practise of doctors working in the UK.

The quantity of stem cells harvested from a patient is nowadays estimated by counting the number of CD34 positive cells per kilogram of body weight. Sastry argued that he had been given two different CD34 numbers by the laboratory, so had reverted to an older method of estimating stem cells.

But the written laboratory report, Sastry’s contemporary case report, and the death report he wrote a few weeks later all gave the same, lower figure for CD34 cells. Sastry told the tribunal that he had been pressured into writing these figures by hospital management, but this claim was not accepted.

“Your oral evidence was not consistent with the explanations that you had previously provided in writing,” tribunal chairman Matthew Fiander told Sastry. “The way in which your account of events changed to fit the evidence casts doubt on your credibility.”

The tribunal found not proved an alternative charge that Sastry had given BEAM therapy without knowing the CD34 count. Instead it found that he had gone ahead in full knowledge of the inadequate number “for reasons that are entirely unclear,” said Fiander.

Sastry’s counsel asked for conditions to be imposed on his registration. His actions should be seen in their Indian context, she argued, where national and hospital guidelines for the treatment were lacking. Sastry’s lack of apology or apparent regret was made necessary by litigation he faced in India, she added.

The GMC asked for him to be suspended for a period, but the tribunal chose to strike him off. The public would find it “unacceptable and disgraceful,” said Fiander, “that a doctor proceeded with high dose chemotherapy with BEAM in the knowledge that there were not sufficient CD34 stem cells available to enable that patient to recover.”

He added, “Throughout these proceedings you have demonstrated a persistent lack of insight into the consequences of your misconduct on the patient, her family, the public, and the profession.”

Sastry will be erased from the register after 28 days unless he appeals.

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