Good morning. Four of today’s five stories turn on a document, which is not the sentence I expected to write either. An operation note that ran to seven lines. A prescription rule the chemist’s counter still ignores. A file covering ₹450 crore of machines nobody switched on. And a written order that interns refused to go back to work without.
The fifth one is a stopwatch.
— DR. ADITYA SETH, EDITOR-IN-CHIEF
01 · THE LEAD
MEDICOLEGAL
A medical board cleared this surgeon. The consumer court still held her negligent.
She was told she would be home eight hours after a laparoscopic cyst operation. She went home ten weeks later with the colostomy still open and 17 kg lighter, after sepsis, dialysis, a tracheostomy and 48 days in the CCU. The cyst wall had been stuck to the rectum, Stage IV endometriosis, and a tiny rectal perforation was found when she was reopened on day four. Nobody in the case ever claimed that bowel injury in difficult endometriosis is always avoidable. A seven-member government medical board read the file and found no negligence.
Two consumer commissions declined to accept that. The surgeon’s affidavit said the operation was done “with all due precautions”. The operation note itself ran to seven lines: anaesthesia, operators, findings, cyst punctured and aspirated, saline wash, patient withstood the procedure well. Nothing on the dissection, the cautery, or what kept bowel out of the way. Neither side had filed any literature, so the Puducherry bench read a textbook and three electrosurgical safety papers on its own and measured those seven lines against them. ₹9.35 lakh with costs, affirmed on appeal sixteen years after the operation.
WHY IT MATTERS
A known complication is defensible. An empty record is not.
“All due precautions” is a phrase, not a record. Cautery settings, the state of the planes, what protected the bowel: written on the day, or it does not exist.
A board’s clean chit is evidence, not a verdict. A consumer forum can set it aside, and the Supreme Court authority letting it do so is settled.
02 · CLINICAL
Every topical steroid in India has needed a prescription since 2018
Tinea in Indian OPDs no longer looks like tinea, and the reason is usually a combination cream containing clobetasol, the most potent topical steroid, mixed with an antifungal and one or two antibiotics. The steroid suppresses inflammation, so the itch settles and the scaly ring loses its edge while the fungus keeps spreading underneath. India banned the clobetasol combinations in September 2018 and, from 1 November 2018, brought every topical steroid under Schedule H, so a chemist can only sell one against a prescription. The ban works one combination at a time, and the three-molecule cream most of these patients are actually using does not appear in any notification we could find. Enforcement sits with state licensing authorities, and reviews as recent as this year still describe these creams being sold over the counter. The part that is ours is the prescription itself: ask what the patient has been applying, stop the steroid, do a KOH mount, and prescribe a single antifungal with no steroid in it.
03 · POLICY
Kerala has ₹450 crore of hospital machines that nobody switched on
Kerala’s health department has told its ministry that about ₹450 crore of medical equipment is sitting unused in government hospitals: 1,252 idle machines across 215 hospitals, and another 222 that were delivered and never installed, some still in unopened cartons. The list includes ventilators, dialysis machines, digital X-ray and mammography units, which are close to the tests those same hospitals have been sending poor patients to private centres for. The count came days after the state ran short of essential medicines. Health minister K. Muraleedharan says most of it was bought over the last ten years and has ordered an inquiry. Nothing is proven yet, and the explanation is either negligence or something worse.
04 · ORTHOPAEDICS
A partial hip replacement in 2 minutes 45 seconds now holds a world record
World Records India certified it in April and put the certificate out this month: a bipolar hemiarthroplasty under local anaesthesia, done in 2 min 45 sec. The certificate adds that the patient “reportedly” tolerated it well, a word nobody wants attached to their own operation.
The awkward part: the hip fracture evidence says almost nothing about how fast the surgeon moves, and a great deal about how fast the patient reaches theatre. NICE wants the operation on the day of admission or the day after, and the audit data put the mortality penalty beyond that. A surgeon in our comments went to the other question: if the clock stops when the implant goes in, who put the muscle layers back?
05 · DOCTORS
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Doctors
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India’s lowest-paid interns went from ₹12,300 to ₹25,000, and kept striking after they won
The Chief Minister approved the hike on Tuesday. The interns in Jammu and Kashmir stayed out anyway, on the view that an approval is not an order, and went back only when the Health and Medical Education Department issued the written order the next day, backdated to 1 October. MBBS, BDS and FMG interns all move to ₹25,000. The figure had not changed since 2019.
₹25,000 was not a new number either. It had already been recommended, on paper, years ago. The reason four states have arrived at the same figure from four very different starting points is the part nobody is reporting.
06 · AIR QUALITY
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Air quality · 22 Oct, 10:30 PM The worst air in the country is not in Delhi | ||||||||||||||||||||||||||||||||||||||||
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Everything above 200 is Poor on the CPCB scale, where breathing discomfort starts turning up in people with no lung disease at all. Worth knowing before you tell the 62-year-old with COPD that a morning walk will do him good. CPCB bands: 0–50 good · 51–100 satisfactory · 101–200 moderate · 201–300 poor · 301–400 very poor · 401+ severe. Live city readings, AQI.in, 22 October, 10:30 PM IST. Some trackers label the same number differently. |
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