(We reproduce below the decision of the Sri Lanka Medical Council (as received) regarding a complaint made against a Judicial Medical Officer for his failure to carry out a proper medical examination of a torture patient who was produced before him by the police and who subsequently died in prison custody).
The case also came up before the Supreme Court in 2003 where the court held that the police officers had violated the rights of the victim. The case is available at: http://www.alrc.net/doc/mainfile.php/cl_srilanka/224/
26 JULY 2007
IN THE PROFESSIONAL CONDUCT COMMITTEE OF SRI LANKA MEDICAL COUNCIL
In the matter of an Inquiry under the Medical Ordinance read with the Medical Disciplinary (Procedure) Regulation 1990
Mullankandage Amitha Priyanthi
315A, Weragala,
Payagala
COMPLAINANT
Vs
Dr. W.R. Piyasoma,
No. 42/21, Tappawatta Road
Godigamuwa, Maharagama
RESPONDENT
Decision of the Professional Conduct Committee dated – July 2007 Re: Complaint against Dr.W.R. Piyasoma (Case No. PPC 53)
Ms. Mulle Kandage Amitha Priyanthi of 315A, Weragala, Payagala tendered an affidavit dated 5th April 2001 to the Registrar Sri Lanka Medical Council which was then referred to the Preliminary Proceeding Committee (PPC) inter-alia making a complaint against Dr. W.R. Piyasoma. In her affidavit, she stated that her brother deceased Mulle Kandage Lasantha Jagath Kumara was arrested by Payagala Police on 12th June 2000 and he was subject to cruel and inhuman treatment by Officers of Payagala Police Station. She further stated that whilst her brother was in the custody of Police, Police assaulted him and consequently he sustained and when he was produced before Judicial Medical Officer (JMO) Dr. W.R. Piyasoma for a medical examination as he failed to discharge his professional obligation and duties the death of her brother occurred on 20th June 2000.
The Preliminary Proceedings Committee (PPC) considered this matter on 24th October 2001. The evidence of the Complainant was recorded and in her evidence she stated that her brother was arrested on 12th June 2000. When she visited the Police Station on 14th June 2000 to see her brother, her brother informed her that Police assaulted him. In her detailed evidence she spoke about the sates on which she visited her brother and she found that her brother was not provided with medical assistance. Her main complaint was that Dr. W.R. Piyasoma filled the Medico-legal form without examining her brother.
PPC when it met on 2nd November 2001, Dr. W.R. Piyasomas evidence was recorded. In his evidence he stated that be examined the patient after removing his shirt. He obtained verbal consent only. He conceded that it was his mistake on his part for not obtaining written consent. He further stated that the patient told him that the Police with a pole assaulted him. He also stated that he did not take a detailed history from the victim. He admitted that he had not recorded at what time the patient was taken into custody and further he concluded his examination within 15 – 20 minutes,
He also admitted that he did not check the blood pressure. He checked the pulse, but did not enter in his report. He accepted that it is Important to assess the time of the injury, although he did not mention in his report. He agreed that he has no proof of examining the patient except his word and the report. He admitted that he did not put the patient on a bed and examine his abdomen he did not see any necessity for doing a general examination of the patient, in spite of having 5 Injuries. He further admitted that history taking observation, palpation and investigation are necessary for a JMO to assess a patient and advise the Police whether to admit him to hospital for treatment.
The PPC (one of the members of PPC is a JMO) having considered the matter and as it was satisfied that a prima-face case has been established against Dr. W.R. Piyasoma referred this matter to this committee.
Accordingly, Dr. Piyasoma was sent a notice dated 20 January 2005 and he was informed that the following 8 charges are framed against him.
1. You did not take written consent of the said patient prior to examining him when produced by the Payagala police notwithstanding that the patient had informed you that the police had assaulted him.
2. You examined the patient in the presence of a Police officer/s.
3 You failed to take a detailed and adequate history of the said patient
4. You did not ask the said patients the names of the Police Officers alleged to have assaulted the patient and thereby failed to record the names of the said Police Officers.
5. You did not do a comprehensive examination to ascertain the condition of the patient and failed to check his blood pressure, failed to record the pulse rate in the report, and failed to examine the patient in bed.
6. You failed to assess or estimate the time the injuries were inflicted.
7 You failed to note down/diagnose the serious/grievous injuries sustained by the patient and merely making a note of non serious/grievous injuries.
8. You failed to recommend admission of the said patient to a hospital, considering the nature of the injuries and the condition of the patient
The prosecution called the following witnesses to testify before this committee.
1. Dr. Mrs. L. Ratnayake AJMO Colombo
2. Mrs. Mulle Kandege Amitha Priyanthi (The Complainant) and
3. Dr. L.B.L. De Alwis – JMO Colombo
Dr. Piyasoma did not testify before this committee. When his counsel closed his case, this committee directed the Registrar to communicate with Dr. Piyasoma who is currently residing in London and to inform him to present himself before this committee to record his evidence. However, Dr. Piyasoma in his response to the Registrar informed that he would not be able to accede to the request of this committee.
Dr Piyasomas counsel led only the evidence of Prof Ravindra Fernando. According to the records maintained by the Registrars Prof Ravindra Fernando was in communication with SLMC from 14th December 2004 to obtain documents (on behalf of Dr. W. R. Piyasoma) in connection with this inquiry Dr. W. R. Piyasoma in his letter to this committee on page (2) dated 22/02/2004 states that Prof. Ravindra Fernando on his behalf obtained documents from SLMC. At the commencement of the inquiry, Prof. Ravindra Fernando, took the seat next to Attorney-at-Law appearing for Dr. Piyasoma and when counsel for prosecution objected he informed that he would require to sit there-at in order to provide instructions on behalf of Dr. Piyasoma. Notwithstanding those matters, on an application made by Counsel appearing for Dr. Piyasoma, this committee agreed to consider the evidence of Dr. Ravindra Fernando as an expert evidence, however it is necessary to place on record that at the end of the inquiry this committee is not certain as to what extent his evidence could he treated as an expert witness, particularly in the absence of the required independence of such a witness.
Be that as it may, Prof. Ravindra Fernando in his evidence has stated that a short history in the case of torture should record who assaulted, when, where, and with what, provided the person stated all these to the Doctor (vide page 17 proceedings of 12th October 2006). Further in his evidence (page 29 – 5th July 2006) he has stated the patient would need to have a full general check of pulse and oilier investigations and a bed is required if he suspected internal organ damaged. In page 34 5th July 2006 he has stated that Dr. Piyasoma has not mentioned anywhere he palpated. The cause of death is given as Acute renal failure due to musculo cutaneous injuries following blunt trauma, Prof, Fernando has stated that he visited the JMO Office Kalutara on 20/9/2005 and still that office did not have a bed or a blood pressure recording instruments.
Interestingly Dr. Piyasoma did not personally speak to any of these matters or adduce any evidence to this committee in relation to his complaints, if any, to the authorities with regard to this matter. In any event, event this be correct, as a responsible JMO it was the responsibility of Dr. Piyisoma to have taken up this matters with the authorities and taken necessary steps to rectify matters in this regard. Due to the ignorance or inaction of Dr. Piyasoma, the interest of the patient could not he sacrificed. This committee of the view that the conduct of Dr. Piyasoma clearly demonstrates the negligent manner in which he has discharged his obligations and responsibilities as a JMO.
Dr. L.B. de Alwis in his evidence (vide proceedings of 8 September 2005) had slated that Dr. Piyasoma should have obtained the written consent of the Patient as It is a cardinal rule. In page 8 of the proceedings of 21st September during his cross examination Dr. Alwis has stated that when it comes to medico legal matters, one has to get the express written consent of the Patient.
It is a well accepted rule that failure to listen to a patient who is describing symptoms which would affect diagnosis and treatment will amount to negligence where harm results. Dr. Piyasoma in his evidence has stated that he had examined the patient for 15 20 minutes. This committee is able to take note that in an Australian case of Giurelli Vs. Girgis (1980) 24 S.A.S.R 264 it was held that the Plaintiff was not given sufficient time or opportunity to describe its symptoms, or the Defendant did not ask sufficient questions as the Doctor concerned had allowed only 5 – 10 minutes. Furthermore, complaint of serious pain is a significant indicator of movement at the fracture site and the possibility of non-union, and the full facts were vital to a correct diagnosis.
It was also held in the Barnetti Vs. Chelsea and Kensington Hospital Management Committee (1969) I Q.B 13 428 that the Doctors examination should have been more thorough, and the severity of the symptoms demanded that the patient should have been admitted to Hospital for further test.
In this matter, the patient has complained to Dr. Piyasoma that the Police used a Pole to assault him and Dr. Piyasoma had recorded that the patient sustained seven injuries, and subsequently he stated five injuries. He agreed that history taking observation, palpation and investigations are necessary for a JMO to assess a patient and advise the Police whether to admit him to hospital for treatment. As mentioned earlier, Dr. Piyasoma in his evidence before PPC has conceded that there had been several lapses on his part.
It is a well known and accepted principle that the patients medical history may include not only signs and symptoms of illness or injury for which the patient is seeking treatment, hut also details of any previous treatment either for the same condition or, in appropriate circumstances, a previous injury or disease. However, Dr. W.R. Piyasoma did not think it is necessary for him to make such investigation as per his letter to this committee dated 22 February 2004.
It is Dr. W. R. Piyasoma who in his capacity as a JMO who was required to examine the patient. It is he who gave evidence before PPC and it is he who could have clarified matters to this committee pertaining to the complaint against him. This is the reason that this committee directed the Registrar to communicate with Dr, W.R. Piyasoma in London and to inform him that his counsel has closed this case and accordingly this committee wishes to grant an opportunity to him to present himself and to clarify matters. However, for reasons best known to him Dr. W.R. Piyasoma decided not to avail of this opportunity. In this background, this committee was compelled 1ok for information provided by his counsel. This committee when it made its ruling with regard to an objection raised by counsel for prosecution directed both counsel to extend their co-operation to this committee to conclude this inquiry expeditiously.
Thereafter, although both counsel agreed to tender their written submissions on a date convenient to them, As Counsel for Dr. Piyasoma did not tender his written submissions, this committee directed the Registrar to communicate with him and request him to tender his written submissions. Counsel for Dr. Piyasoma informed this committee that as he was in personal difficulty he could not submit his written submissions on the due date and eventually he tendered his written submissions on l0 June 2007.
This committee having perused the paragraph 11(1) in page 22 of the written submissions of Counsel for Dr. Piyasoma noted the position of Dr. Piyasoma as follows: he did not feel that there was a necessity for the patient to be admitted to the Hospital after the examination as he expected the Police to hand over the patient to the Prison upon been produced before the Magistrate. Further the patient had not made any such request either in which event he would not have hesitate (sic) to recommend him for admission.
It is admitted that the patient informed Dr. Piyasoma that the Police assaulted him with a Pole. Thus, this committee is of the view it is the responsibility of the JMO to have carefully examined the patient and to ascertain as to how far the patient was affected by the injury caused by the Police, it is not the function of a Doctor or a JMO to anticipate what order the Magistrate would make in future and to come to conclusion based on anticipation. What is most interesting is the statement that the patient had not made any such request and had the patient made such request, Dr Piyasoma would not have hesitated to recommend him for admission, This committee is baffled by this statement.
What more could the patient have told the JMO, other than stating that he was assaulted by Police with a pole; and, is it the responsibility of the patient to make a request to recommend him for admission? Or is it the responsibility of the Doctor/JMO to examine the patient and determine as to whether the injuries that he has sustained require medical attention in a hospital and therefore ho should be admitted for such treatment,
This committee would have expected Dr. Piyasoma as a responsible JMO to listen to the patient carefully with regard to his complaints, to have examined the patient and to decide as to whether the injuries were so severe to require medical attention in a hospital forthwith. While doing so, if Dr Piyasoma had thought it was necessary to find out from the patient as to whether he requires hospitalization he could have done so. Further when the patient complained that the Police had assaulted with a pole, as a reasonable and prudent JMO, Dr. Piyasoma should have requested the Police to permit him to examine the patient without the Police being present there and created an environment to the patient to provide more information with regard to the assault which would have certainly assisted him to conduct more investigation in regard to the nature of the injuries hence, this inaction of JMO Dr. Piyasoma deprived the patient an opportunity to provide more details with regard to assault by the Police. Counsel for Dr. Piyasoma has marked the judgment in SC 471/2000 (FR) as R1.
According to the said judgment, the Hon. Supreme Court had ordered the 1st Respondent the Officer-in-Charge Payagala and OIC (Crimes) Payagala Police Station to pay compensation to the wife of the deceased (wife of Jagath Kumara), The assertion of Counsel for Dr. Piyasoma that Dr. Piyasoma expected the Police to hand over him to the Prison upon being produced before Magistrate is not acceptable to this committee, This committee is extremely disappointed to observe the manner in which Dr. Piyasoma has handled matters in this regard.
As Dr. Piyasoma did not testify before this committee, this committee is left with his un-contradicted evidence before PPC and his explanation tendered to this committee by his letter dated 22 February 2004 in relation to the 8 charges. This committee having taken into consideration paragraph 1 4 (page 25) of the Written submissions of counsel for Dr. Piyasoma where it is stated that mere omission, lapse or ideal procedure not been followed would not amount to this type of disgraceful and dishonourable conduct. It should be such a magnitude as to shake the conscience of fellow medical men for it to be disgraceful and dishonourable, is of the view that the manner in which Dr. Piyasoma has failed to discharged his obligations in the instant case would undoubtedly shake the conscience of fellow medical men and was disgraceful and dishonourable as a medical practitioner.
Considering the evidence placed before this committee, this committee consisting of several Doctors who have wide experience in the field of medicine and the practice for several years are sad to note that Dr. W,R. Piyasoma has failed and neglected to discharge his duty as a Doctor and JMO. This committee is of the view that had Dr. Piyasoma taken adequate precaution to discharge his obligation it is very likely that he could have save the life of Jagath Kumara.
It is further noted that Dr. W.R. Piyasoma failed to act in accordance with the standards which a medical officer should adhere to in circumstances such as this where the complaint is of police assault and where it is clear that the JMO should ordinarily have acted with care and attention befitting his role as medical officer, the total absence of which has led to the death of a person whose life may have been saved if he performed his proper role, In the circumstances this committee unanimously conclude that the conduct of Dr. W. R. Piyasoma is guilty of infamous conduct in a professional respect.
This committee is convinced that it should take steps against Dr. W.R. Piyasoma as provided in the section 33 of the Medical Ordinance and to erase the name of Dr. W,R. Piyasoma from the Register permanently, however having taken into consideration of the fact that this is the first occasion a complaint of this nature has come before this committee and the age of Dr. W.R. Piyasoma this committee has decided and direct the Registrar of Sri Lank Medical Council to take steps to erase the name of Dr. W, R. Piyasoma from the register for three years with effect from 7, 7. 2007.
Furthermore, this committee directs the Registrar to send a copy of the decision in this matter to Dr. W.R. Piyasoma and to the Judicial Medical Officer to seek his assistance to provide necessary guideline to JMOS to ensure that future occurrence of this nature are avoided.
1. Sgd
PRESIDENT
2. Sgd . .
Dr. N. AMARASEKERA
3. Sgd
DR. SARATH GAMINI DE SlLVA
4. Sgd
DR PALITHA ABEYKOON
5. Sgd
DR. TISSA WICKRAMASURIYA
6. Sgd
DR. S. SIVAKUMARA
7. Sgd
DR. SYDNEY JAYASURIYA
