Good morning. Two of today's five stories are about what happens to residents inside hospitals, and neither of them reads well. A third is a court telling the regulator it cannot strike a surgeon off the register without writing down why. We open in Jodhpur.

— DR. ADITYA SETH, EDITOR-IN-CHIEF

01  ·  THE LEAD
DOCTORS

The residents asked for four things. The letter came back with two committees.

Dr Rajnaresh Yadav, a junior resident in anaesthesiology, was posted in theatre at AIIMS Jodhpur on 22 September. He went on his break at about one and did not come back. Police suspect suicide. No note has been recovered, the phone and the scene are with forensics, the post-mortem is awaited. Until that report lands the cause of death is not established, whatever your WhatsApp groups have already settled on.

By 24 September his colleagues were on indefinite strike. Routine OPD and elective surgery shut; emergency OPD, emergency theatres, ICU, labour room and blood bank kept running, and they put that in writing before anyone thought to ask them for it. Residents say they were repeatedly worked 36-hour shifts. Thirty-six hours is easier to feel than to read: in at eight in the morning, out at eight the following evening.

The reply came the same day, from an anaesthesiologist writing a condolence letter about an anaesthesiology resident. Executive Director Dr Goverdhan Dutt Puri offered condolences and two committees. The ₹5 crore for the family, the accountability, his own resignation, recognition of the association: not one of the four is answered. And while he was warning that a strike would hamper care across the region, the Medical Superintendent signed the order shutting routine OPD and all elective surgery, same date, opening line "in view of the prevailing circumstances". It does not use the word strike once.

If you or a colleague needs to talk to someone, Tele-MANAS is free, open round the clock and available in multiple languages on 14416.

WHY IT MATTERS
  1. Puri sits on the Supreme Court's National Task Force on doctors' safety, the body that told the court in November 2024 that a separate central law on violence against healthcare workers was not required. That is the official now asking his own residents to resume duty urgently.

  2. Emergency services never closed. Keep that handy for the moment someone in your group forwards a post about patients being abandoned.

02  ·  DOCTORS

Punched in his own ICU, then told the FIR had to carry his name

A 66-year-old man died at AIIMS Nagpur on the morning of 22 September, after days in which his family withheld consent for intubation and asked for an MRI instead. By nine o'clock four or five of them were inside the ICU. The resident who had been treating him was taken by the collar and punched repeatedly on the back, with three senior faculty and security staff in the room. Hospital sources say the group was about to slam his head against a concrete slab before the guards got him out. FAIMA says he was also told he would be shot outside the hospital.

Four relatives are booked under the Bharatiya Nyaya Sanhita and the Maharashtra Medicare Service Persons Act: cognisable, non-bailable, up to three years and ₹50,000. Nobody has been arrested. Police say action follows the funeral rituals, so a law written to be non-bailable is currently waiting for a cremation to finish. AIIMS tried to lodge the complaint in its own name and was told it could not. The man punched in his own ICU that morning had to put his own name on an FIR against the sons of a patient who had just died under his care.

03  ·  MEDICOLEGAL
Medicolegal
 

Struck off for choosing the wrong operation. Thirteen years later, quashed.

A patient in coastal Maharashtra had a narrowing of the urethra that kept coming back. He blamed two surgeons and complained to the Maharashtra Medical Council, which took three years over it and cleared both of them. He appealed to the MCI. In August 2013 its Ethics Committee reversed that and took both men off the register, one for three years and one for six months. Off the register means you stop practising.

They went to the Bombay High Court, got a stay within weeks, and then waited thirteen years with the negligence finding sitting on them. When the court finally read the file, here is what was in it. The MCI could not show it had ever sent the doctors a copy of the appeal. Two of the committee’s three meetings were held without them. No reasons were written down for overturning a clean chit. And the panel judging a urology case had no urologist on it.

The MCI’s answer on the missing reasons was that an Ethics Committee is not a court. The Bombay High Court, which is one, called the hearing perfunctory and hurried and quashed the whole order on 22 September. On the medicine it was short: choosing one recognised operation over another is not negligence. What actually saved the general surgeon was paper. His 1984 to 1989 syllabus showing urology was part of it, a college letter confirming the syllabus has not changed, his own cystoscopy logs, and an RTI reply he filed himself asking a district hospital what MS General Surgery doctors there do every week. If you operate at the edge of another specialty, that is the file.

Nobody gets a rehearing. Under the NMC Act only a doctor can appeal a State Medical Council decision, so the route the patient used in 2012 has been closed. He complained in December 2009 and got his answer in September 2026, and the answer is that there is nowhere left for him to be heard.

03  ·  RESEARCH

The theatre size with the most infections was not the one surgeons predicted

11,163 orthopaedic operations across 78 theatres. Raw infection rates climbed with room size: 0.7% in the smallest rooms, 1.3% in medium, 1.8% in the largest. Adjust for the patient and the case and the large-room signal disappears, leaving medium theatres of 400 to 549 sq ft as the independent risk. Size still ranks below spinal fusion, long operating time, ASA above 3, and emergency and trauma work. Every theatre in the study had laminar flow, positive pressure and at least 20 air changes an hour, so read it as well-ventilated rooms measured against other well-ventilated rooms.

Three in four healthy Indian teenagers just failed a lung test they should have passed

4,175 healthy, non-smoking schoolchildren aged 11 to 14 in Delhi, Mumbai, Bengaluru and Mysuru, scored with GLI-2012, the equations most spirometers ship with. 74.6% landed below the lower limit of normal on FEV1, where about 5% is expected. Mumbai was worst at 82.2%, Bengaluru best at 61.9%, and even the obese group, the least affected of all, sat at 67.5%. GLI-2012 has no South Asian category and never did.

04  ·   ELSEWHERE

An 81-year-old ENT surgeon in Ahmedabad prices his consultation at one per cent of your monthly income

The chart on Dr Nandlal Manseta's wall runs at one per cent. Earn ₹1,000 a month and the fee is ₹10. Earn ₹10,000 and it is ₹100. Earn ₹1 lakh and it is ₹1,000. Earn nothing and there is no fee. No income certificate is asked for and nothing is verified; patients put the money in a small donation box on the way out.

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