SRI LANKA: Death of a patient through negligence at the Kandy Teaching Hospital

Dear friends,

The Asian Human Rights Commission (AHRC), received information concerning Mr. Ranjith Sunil Jayatissa (55) of No: 114, Walgowwagoda, Danture in the Kandy District. On 6 July 2016, while being treated at the Kandy Teaching Hospital, he died due to medical negligence by the doctors. He underwent hernia surgery at the hospital on 27 June. He developed post-surgical complications which resulted in severe pain. Though the wife made continuous complaints about the pain he was experiencing, the doctors angrily refused to even examine him. Finally, when they did look at him they found a surgical mistake. The surgeon had cut the patient’s colon necessitating a second surgery to repair it. After surgery, on 6 July 2016, while being treated in the Intensive Care Unit (ICU), the patient. Jayatissa’s relatives, seeking justice, and considering credible investigations, made one complaint after another to the authorities. However justice was denied them.

CASE NARRATIVE:

Ranjith was a professional cook. He was married to Jesmine. They lived together with 2 daughters and a son. He was well-built, healthy, had no ailments and took no medicine of any sort for a long time.

In June, 2016 he was diagnosed with a hernia. He was admitted to the Kandy Teaching Hospital ward No: 18 on the 27th June 2016. He underwent surgery on 29 June 2016. Dr. Pitagalaarchchi and his team performed the surgery. Soon after the operation, when Ranjith was given food, he complained of severe pain in the stomach. The doctors were informed. They said it was due to the surgery. Nevertheless, while still experiencing severe pain, he was discharged on 30th June 2016. Since Ranjith was in pain, his wife requested that the doctor do an abdominal scan. The house officer in the ward scolded the wife and tried to force her to take him home.

But Jasmine adamantly refused, leaving him in the ward. When Ranjith started screaming at night with the pain, his wife informed the doctors. She asked Dr. Pitigalaarchchi to do a scan and examine her husband physically. She begged the doctor to initiate a more proper treatment to support Ranjith’s life.

At last, the doctor ordered an abdominal scan which showed the colon was cut and damaged initially. There was an urgent need for a second surgery. It took place on 1 July, lasting for nearly 5 hours

As his condition turned serious, Ranjith was immediately admitted to the Intensive Care Unit (ICU). Throughout this entire period he was on life support systems including artificial ventilation until 6 July 2016. On that day the wife was informed that her husband had expired.

A Death Inquest was held on 8 July, 2016. The wife, Jesmine, objected to the Post Mortem Inquest being conducted at the Kandy Teaching Hospital. She candidly informed the authorities that she believed her husband died due to criminal medical negligence by the Doctors of the hospital. She requested the authorities to allow the Post Mortem Inquest to be carried out by a senior, independent, Judicial Medical Officer (JMO) at another hospital. Her requested was not honored and the Inquest was performed at the JMO’s office at the Kandy Teaching Hospital. She learned that, JMO Dr. Subramanium, conducted the Post Mortem Examination. In summary, the doctor informed her that, the colon of the deceased had been cut during the hernia surgery and the patient had died due to complications septicemia. The cause of death was concluded as due to post-surgical complications. They told her that parts of Ranjith’s intestine were sent to the government laboratories for further analysis and investigation.

The coroner who conducted the Death Inquest declared that the death was suspicious. It needed to be reported to the Magistrate’s Court so further steps could be taken under the Criminal Procedure Code of Sri Lanka. All the facts were reported to the Magistrate’s Court as case No: B/39075/16 on 7 July 2016. When the wife questioned this, the coroner explained the situation to her. It was now up to the Magistrate’s Court and the Police Department to investigate and initiate prosecution against those who were responsible. It takes in all the illegalities of a wrongfully conducted surgery and also all the illegalities and irregularities in post-surgical care. Immediately after conclusion of the examinations, on July 21 2016, the JMO reported his findings to the Magistrate’s Court. The JMO and several witnesses were summoned to appear. The Government Analysis report was requested and received by the Courts in November 2016.

But the JMO did not submit his report to the Courts on time. Instead, he sent the report through a second person, Nilantha, who is attached to the staff of the Kandy Teaching Hospital. Seemingly, the report from the Court had gone missing! Without the relevant JMO medical reports, the case at this stage could not proceed. To save something of the situation, the Magistrate’s Court Registrar, asked the victim’s wife, Jesmine, for her record of the postmortem to submit to the Court. Jesime was asked to retrieve the report and Nilantha would bring it to the Court from the hospital.

Jesmine states that the State Health Department Officers, the JMO’s office and the Judiciary are working together to cover up her husband’s death. There appears to be a conflict of interest among these officers as they try to subvert the course of justice.

She learned that police officers of the Kandy Headquarters Police Station were requested to conduct a criminal investigation and report to the Court regarding the death of her husband. Jesmine approached the police officers and asked for a copy of the necessary medical reports that they had collected. The officers refused, stating that they were instructed by Health Ministry Authorities not to hand out any reports to private parties.

Finally, Jesmine’s lawyer wrote a letter on 3 May 2017 addressing the Officer-in-Charge (OIC) of the Kandy Headquarters Police Station. He requested information (under the provisions of the Right to Information Act (RIA)) about the statements of the doctors and nurses responsible for conducting the two surgeries and post-surgery care. His letter was ignored by the police.

Jesmine took recourse with the higher authorities of the Ministry of Health. She asked for a prompt, efficient, credible and independent investigation into the death of her husband. The Ministry of Health responded by letter on November 2016, stating that Mr. G.A S.K Abeysinghe had been appointed to investigate her complaint. When she looked into this, she learned that the only work the investigator had done was to speak to her son. As a result, the family feels that they have not received any justice as yet,

Jesmine filed a written complaint to the Sri Lanka Human Rights Commission (HRCSL) recorded under reference No: HRC/14/633/16-1. However, no progress was made regarding the investigation.

They have also suggested that the Medical Council of Sri Lanka (SLMC) reappraise their Medical Code of Ethics. Adjustments need to be made in relation to surgery, medical treatment and informed consent for every patient to prevent such a future tragic event.

ADDITIONAL COMMENTS:

State obligations for the highest attainable standards for physical and mental health:

“The State of Sri Lanka has signed the International Covenant on Economic, Social and Cultural Rights (ICESCR) on 28 Sept. 1976 and made its Accession on 27 Apr 1977. Following that the state of Sri Lanka is supposed to fulfill its obligations within Article 2 of the convention, undertake steps, individually and through international economic and technical assistance and co-operation, to the maximum of its available resources. This is with a view to achieving, progressively, the full realization of the rights recognized in the present Covenant by all appropriate means, including the adoption of legislative measures. The state of Sri Lanka has undertaken to guarantee that the rights enunciated in the ICESCR Covenant will be exercised without discrimination of any kind as to race, color, sex, language, religion, political opinion, national or social origin, property, birth or other status”

“According to Article 12 of the ICESCR, the state of Sri Lanka recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It is obligated to take steps to achieve the full realization of the rights envisaged in ICESCR. This includes the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would insure the provision of medical attention and medical services in the event of sickness”

Right to Informed Consent:

We recall the rights of patients to all the details of the prognosis which is also strictly emphasized and stressed by the World Health Organization. These rights are a protection of every citizen of Sri Lanka.

SUGGESTED ACTION:

Please send a letter to the authorities listed below expressing your concern about this case, requesting:

1. Investigation into alleged negligence by surgical and medical doctors at the Kandy Teaching Hospital.
2. Prosecution of those proven to be responsible under the Law. 
3. Internal investigation of police officers involved for breach of Departmental Orders.
4. The Inspector General of Police (IGP) investigate the professional conduct of the surgical and medical doctors as to their involvement in this felony.

The Asian Human Rights Commission has written a separate letter to the UN Special Rapporteur on the right of everyone to enjoy the highest standards of physical and mental health.

To support this case, please click here: SEND APPEAL LETTER