eMedinewS5th November 2013, Tuesday

Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at
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From where the figure of Rs.6,08,00,550/- came?

Other break ups of the compensation In Kunal Saha Case

Break up by the court
1. Loss of income of the deceased: Rs.5,72,00,550/-
2. For Medical treatment in Kolkata and Mumbai: Rs.7,00,000/-
3. Travel and Hotel  expenses at Mumbai: Rs.6,50,000/-
4. Loss of consortium Rs.1,00,000/-
5. Pain and suffering Rs.10,00,000/-
6. Cost of litigation Rs.11,50,000/-

Total amount of Rs.6, 08, 00,550/-

Calculation of loss of income of the deceased

Diseased was a US citizen and permanently settled as a child psychologist. One has to take into consideration the status and standard of living of the deceased in U.S.A. to determine just compensation under the head of loss of dependency.

For calculation of the award the court relied on
a. The case involving death of a 47-48 years old US citizen in a road accident in India, in United India Insurance Co. Ltd. & Others Vs. Patricia Jean Mahajan & Ors where this Court had awarded compensation of Rs.10.38 crores after holding that while awarding compensation in such cases the Court must consider the high status and standard of living of both the victim and dependents.
b.  The claimant brought US based Prof. John F. Burke through video conferencing in May-June, 2011 for calculation of the loss of income. Prof. John F. Burke stated that direct loss of income of the deceased on account of her premature death, would amount to 5 million and 125  thousand dollars. The loss of income on account of premature death of the claimant’s wife was calculated by the said witness who is an Economist in America and he has also deducted one-third for her personal expenses out of her annual income which is at par with the law laid down by this Court in number of cases including Sarla Verma’s case.
c.  It is the claim of the claimant  that loss of income of multi-million dollars as direct loss for the wrongful death of the deceased may appear as a fabulous amount in the context of India but undoubtedly an average and legitimate claim in the context of the instant case has to be taken to award just compensation.
d. He has placed  reliance upon the judgment of this Court in Indian Medical Association’s case wherein the  Constitution Bench has stated that to deny the legitimate claim or to restrict arbitrarily the size of an award would amount to substantial injustice.

The court said that the deceased was earning $ 30,000 per annum at the time of her death, a fact not challenged by other parties. She would have earned lot more having regard to her qualification and the job for which she was entitled to.

The court relied on the evidence on record for the purpose of determining the just, fair and reasonable compensation in favour of the claimant. The court said that “It would be just and proper for us to take her earning at $40,000 per annum on a regular job”.

The court further relied upon the paragraphs in the cases of Sarla Verma and Santosh Devi , to hold that  30% should be added towards the future loss of income of the deceased.

Also, based on the law laid down by Supreme Court 1/3rd of the total income is required to be  deducted under the head of personal expenditure of the deceased to arrive at the multiplicand.

The multiplier method was used for the final calculation.

The court estimated the life expectancy of a healthy person in the present age as 70 years. The court therefore was inclined to award compensation accordingly by multiplying the total loss of income by 30.
The court also fixed the dollar rate at Rs 55/- per $.
Final calculation
($40,000 yearly income + (30/100 x 40,000$) - (1/3 x 52,000$) x 30 x Rs. 55/-) = Rs. 5 ,72,00,550/-.

Reference

SUPREME COURT OF INDIA, CIVIL APPEAL NO.2867 OF 2012, Dr. Balram Prasad  Vs.  Dr. Kunal Saha; CIVIL APPEAL No.692 of 2012 AMRI vs  Dr. Kunal Saha; CIVIL APPEAL No.2866 of 2012 Dr. Kunal Saha vs Dr. Sukumar Mukherjee & Ors; CIVIL APPEAL No.731 of 2012 Dr. Baidyanath Haldar vs  Dr. Kunal Saha and CIVIL APPEAL No.858 of 2012 Dr. Sukumar Mukherjee vs  Dr. Kunal Saha: V. Gopala Gowda, J.

Medical treatment: 7 laces

For the medical treatment in Kolkata and Mumbai an amount of Rs.23 lakhs was claimed. However, he was able to produce the medical bill only to the extent of Rs.2.5 lakhs. Assuming that he might have incurred some more expenditure, the National Commission had quantified the expenses under this head to the tune of Rs.5 lakhs. The Supreme Court considered this amount as insufficient in the light of the fact that the deceased was treated at AMRI Hospital as an in-patient for about a week and enhanced the compensation under this head by Rs.2 lakhs thereby awarding a total amount Of Rs.7 lakhs.

Travel and Hotel expenses at Bombay: 6.5 lacs

The claimant had sought for compensation to the tune of Rs.7 lakhs for travel and expenses for 11 days he had to stay in Mumbai for the treatment of his wife. However, again he failed to produce any bills to prove his expenditure. Since, his travel to Mumbai for the treatment of his wife is on record, the National Commission has awarded compensation of Re.1 lakh under this head. The Supreme Court found it fit and proper to enhance the compensation by Rs.50,000/- more considering that he had also incurred some unavoidable expenditure during his travel and stay in Mumbai at the time of treatment of the deceased. Therefore, under this head, the court awarded a compensation of Rs.1,50,000/-. 

However, with respect to the claim made under  the cost of chartered flight, a sum of Rs.5,00,000/- was already awarded by the National Commission and the Supreme Court did not interfere  with the same in absence of any contrary evidence.

Non pecuniary damages: Rs One lac

The court said that “We may therefore, revisit the practice of awarding compensation under conventional heads: loss of consortium to the spouse, loss of love, care and guidance to children and funeral expenses. It may be noted that the sum of Rs. 2,500/- to Rs.  10,000/- in those heads was fixed several decades ago and having regard to inflation factor, the same needs to be increased.  In Sarla Verma's case, it was held  that compensation for loss of consortium should be in the range of Rs. 5,000/- to  Rs. 10,000/-, In legal parlance, 'consortium' is the right of the spouse to the company, care, help, comfort,  guidance, society, solace, affection and sexual relations with his or her mate. That non-pecuniary head of damages has not been properly understood by Indian Courts.  The loss of companionship, care and protection, etc., the spouse is entitled to get, has to be compensated appropriately.

The concept of awarding pecuniary damage for loss of consortium is one of the major heads of award of compensation in other parts of the world more particularly in the United States of America, Australia. English Courts have also recognized the right of a spouse to get compensation even during the period of temporary disablement. By loss of consortium, the courts have made an attempt to compensate the loss of spouse’s affection, comfort, solace, companionship, society, assistance, protection, care and sexual relations during the future years. 

Unlike the compensation awarded in other countries and other jurisdictions, since the legal heirs are otherwise adequately compensated for the pecuniary loss, it would not be proper to award a major amount under this head. Hence, we are of the view that it would only be just and reasonable that the courts award at least rupees one lakh for loss of consortium.”

The claimant had claimed Rs.50 crores under this head before the National Commission without giving any break up figures for the amount.  Before Supreme Court however, the claimant reduced the claim to Rs.31, 50, 00,000/- under three different heads. 

1. Rs.13,50,00,000/- for loss of companionship and life amenities
2. Rs.50,00,000/- for emotional distress, pain and suffering of the husband- the claimant
3. Rs.4, 50, 00,000/- for pain and suffering endured by the deceased during her treatment.

Suffering by the patient

The claim of Rs.4, 50, 00,000/- by the claimant was thought to be excessive since it goes against the amount awarded by this Court under this head in the earlier cases. The court acknowledged that the deceased had gone through immense pain, mental agony and suffering in course of her treatment which ultimately could not save her life. The court was not, inclined to award more than the conventional amount set by this Court on the basis of the economic status of the deceased.  Therefore, a lump sum amount of Rs.10 lakhs was awarded to the claimant following the Nizam Institute’s case and also applying the principles laid in Kemp and Kemp on the “Quantum of  Damages”, under the head of ‘pain and suffering of  the claimant’s wife during the course of  treatment’.

Suffering by the husband

Regarding claim of Rs.50,00,000/- by the claimant under the head of ‘Emotional distress, pain and suffering for the claimant’ himself, the court denied the same since this claim bears no direct link with the negligence  caused by the appellant-doctors and the Hospital in treating the claimant’s wife. 

Compensation formula

Why hue and cry about the compensation.
Everyone should know the formula
Its Annual yearly income + 30% for future hike in income – 33% for personal expenses multiplied by 70 minus the age of the deceased at the time of death.
For example a 40 year old doctor is getting an earning of Rs 2 lac per month and his compensation need to be calculated.
1. Number of years left is 70-40 = 30
2. Yearly income: 24 lac
3. 30% added for future increase in income: 24+8 lacs = 32 lacs
4. One third deducted for personal expenses:  App 21.3 lacs
5. Compensation = 21.3 lacs x 30 = 6.4 crores

This much compensation will be expected from the forums in future as a routine. 

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."


VIP’s on CPR 10 Mantra Video
eMedinewS
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

The science behind Bhai Dooj

sprritual blog
  • Bhai Dooj is celebrated two days after Diwali.
  • Like Raksha Bandhan, it is a day dedicated to the sacred love between a brother and sister.
  • Both Raksha Bandhan and Bhai Dooj fall in Chaturmas; one at the start and the other at the end of the four months of negative state of mind. The Jagannath Yatra (another festival of love between brother and sister where Krishna is worshipped with his sister Subhadra) is also held in Chaturmas. All three festivals signify purification of mind, getting it lust free and reminding the people a sacred relationship between men and women.
  • The festival is known as "Bhau-Beej" in Marathi and "Bhai-Tika" in Nepal.
  • On Bhai Dooj sisters pray for the wellbeing and prosperity of their brothers by putting tika/tilak (vermilion spot) on their forehead and offer sweets (healthy) and perform a ritual of taking their ’Aarti’. The brother offers gifts as an expression of love. Some sisters may fast on this day; gifts often involve rice, new grass, aab’ (a length of flax, knotted into a circular shape and dotted with sugar batashas) etc. In Bihar, the ritual starts with the sister cursing her brother, before asking for his forgiveness.
  • Rice in mythology symbolizes the fulfilled desires and the ritual on this day signifies a non lust based sacred relationship between a man and a woman.
cardiology news

A little engine was employed in a station yard for doing small little pieces of work such as pulling a few cars on and off the switches. One morning it was waiting for the next call when a long train of freight - cars asked a large engine in the roundhouse to take it over the hill. "I can't that is too much a pull for me," said the great engine built for hard work. Then the train asked another engine, and another, only to hear excuses and be refused.

In depression, the train asked the little switch engine to draw it up the grade and down on the other side." I think I can." puffed the little locomotive, and put itself in front of the great heavy train. As it went on the little engine kept bravely puffing faster and faster, " I think I can, I think I can, I think I can."

As it neared the top of the grade, which had so discouraged the large engine, it went more slowly. However, it still kept saying. "I -think -I- can, I- think- I- can," and indeed it could. Because of its hard work and determination the little engine achieved what much bigger engine could not. As it went down the slope of the hill, the engine’s heart swelled with joy of achievement. "I thought I could, I thought I could," it said.

Take away: This is a very famous story that is quoted all the time for its diehard grit. Don’t you just love the image of the brave little engine puffing its way up the steep mountain with nothing but its courage and self -belief to keep it going? No matter how young you are, you too can be like the little engine by simply believing in yourself.

News Around The Globe

News

  • The US FDA may soon reclassify hydrocodone combination products such as Vicodin (AbbVie Inc) from Schedule III to Schedule II, further increasing controls on these opioid painkillers, with a potentially huge impact on providers and patients. "By early December, FDA plans to submit our formal recommendation package to HHS US Department of Health and Human Services to reclassify hydrocodone combination products into Schedule II," Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research, said in a statement posted on the FDA Web site October 24.
  • The US FDA has approved obinutuzumab (Gazyva, Genentech) for the treatment of patients with previously untreated chronic lymphocytic leukemia (CLL). The drug is indicated for use in combination with chlorambucil in this setting. Obinutuzumab is a glycoengineered antibody, which means that specific sugar molecules in GA101 were modified to change its interaction with immune cells.
  • People at high risk for caries can safely protect their teeth by applying their own gels, pastes, and rinses with prescription-level concentrations of fluoride, the American Dental Association (ADA) said in its first-ever guidelines on these products. The recommendation was included in guidelines on prescription topical fluoride products that the ADA updated for the first time since 2006. The guidelines were published in the November issue of the Journal of the American Dental Association.
  • In poorly controlled diabetics, glomerular filtration rate (GFR) will likely be overestimated by standard formulas, according to a new research from Japan.
  • Metabolic syndrome is associated with a greater chance of pulmonary complications after bariatric surgery, especially respiratory failure and acute respiratory distress syndrome (ARDS). Among more than 158,000 bariatric-surgery patients, the study authors found that 21.5% of patients with the metabolic syndrome experienced pulmonary adverse events postoperatively compared with only 12.6% of patients who did not have this collection of cardiovascular risk factors.

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Rabies News (Dr. A K Gupta)

Is observing the dog for 10 days without initiating treatment risky or justifiable?

Observing the dog for 10 days without initiating treatment is risky and not at all justifiable. It is mandatory to start treatment soon after exposure. The vaccination must be started immediately irrespective of the status of the biting animal. Improper treatment to animal bite victims may lead to rabies death and litigation under Consumer Protection Act (COPRA). According to Consumer Protection Act, the animal bite should be considered as "medical urgency" and treated with due care.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Only about one in five patients undergoing elective angiography in the Department of Veterans Affairs (VA) system had normal coronary arteries, a smaller proportion than that seen in other studies of non-VA hospitals, a study found. Overall, 21.4% of the veterans included in the study had a normal coronary angiography, defined as <20% stenosis, as reported by Steven M. Bradley, MD, MPH, of the VA Eastern Colorado Health Care System, and his co-authors online Oct. 30. in the Journal of the American College of Cardiology. That compares with a 2010 study of 400,000 patients -- 90% of whom were at private or community hospitals -- without known coronary disease who had been referred for an elective coronary angiography. That study found that just 38% had obstructive disease, while 39% were essentially normal.
  • Taking a more conservative approach to deciding which coronary lesions need percutaneous intervention did not harm patient outcomes. In a randomized trial, the 1-year rate of all-cause death, myocardial infarction, and any revascularization was 7.3% when stenosis of greater than 70% was used as the deciding threshold and 6.8% when stenosis of greater than 50% was used, according to Hyeon-Cheol Gwon, MD, PhD, of Samsung Medical Center in Seoul, South Korea. The difference met criteria for noninferiority (P=0.0055). The trial was reported at the Transcatheter Cardiovascular Therapeutics meeting.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • The global Expanded Programme on Immunization established in 1974 increased global coverage with the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3) to 83%, but further improvement is likely to require new strategies, public health experts report in the November 1 issue of the Morbidity and Mortality Weekly Report. The researchers report similar problems in achieving global coverage with 3 doses of hepatitis B vaccine, 3 doses of Haemophilus influenzae vaccine, rotavirus vaccine, and pneumococcal conjugate vaccine. Data gathered by researchers from the World Health Organization (WHO), the United Nations Children's Fund, and the Centers for Disease Control and Prevention on global vaccination coverage in 2012 showed that 22.6 million children did not receive the recommended 3 DTP doses during the first year of life. They also found that, more than half of these children lived in just 3 countries (India, Nigeria, and Indonesia), nearly 10 million children started but did not complete the 3-dose series, and 12.6 million did not receive even the first DTP dose.
  • The US FDA has approved vigabatrin (Sabril, Lundbeck) as add-on therapy for the treatment of refractory complex partial seizures (CPS) in children aged 10 years and older who are refractory to several other treatments if the possible benefit outweighs the risk for vision loss with this drug. Vigabatrin is already approved as adjunctive therapy for adults with refractory CPS, but it is not indicated as a first-line agent for this indication. It is also approved for use in infants from 1 month to 2 years of age with infantile spasms, again if the possible benefit outweighs the potential risk for vision loss.
cardiology news

Remember the health windows

The window for the deadliest form of heart attack, called ST–elevation myocardial infarction (STEMI), ideally is within 30 minutes for clot–dissolving drug treatment, and within 90 minutes for angioplasty. Window means the period before which the specific treatment should start.

Thirty percent of STEMI patients do not get clot–busting drugs. Twenty percent are not candidates for clot-busting drugs and, of these, 70 percent do not get angioplasty.

The window period for a patient with paralysis to receive clot–dissolving drug is also 3 hours. The earlier definition of transient ischemic attack (or mini paralysis) "focal neurologic symptoms of ischemic cause that last less than 24 hours" has now changed to "a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than 1 hour, and without evidence of acute infarction." The paradigm shift is so that more and more number of cases can get clot–dissolving drugs.

For a victim of road traffic accident, the window to shift the patient is 10 minutes, called ’Platinum Ten minutes’ and for the victim to get basic resuscitation is one hour called ’Golden Hour’.

cardiology news

Total CPR since 1st November 2012 –71933 trained

Media advocacy through Web Media

Long term use of painkillers can cause kidney cancer

A study published in the journal Archives of Internal Medicine has shown that people who regularly take painkiller drugs like ibuprofen or naproxen are 51 percent more likely to develop kidney cancer. There is no increased risk from taking aspirin or paracetamol, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India.

The mechanism through which painkillers could cause kidney disease is the inhibition of prostaglandin synthesis with resulting papillary and tubular injury, and ultimately damage to DNA.

The study analyzed data from 77,525 women in the Nurses’ Health Study and from 49,403 men in the Health Professionals Follow-up Study. The risk was related to the duration of use of the painkillers. There was a decrease in the risk by 19 percent if the painkiller was used for less than four years. There was a 36 percent increase in risk of kidney cancer for people who used them regularly for 4 to 10 years. The risk increased almost three times for those who used these drugs regularly for 10 years or more. The good news is that kidney cancer is uncommon so the risk is small for average users.

Two other important causes of kidney cancer are obesity and smoking. So people on painkillers should not smoke and should also keep their weight under control to prevent kidney cancer.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 71933 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

today emedipics

20th MTNL Perfect Health Mela

press release

Uric acid and endothelial dysfunction

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

A 40-year-old lady delivered a full term baby. On examination of the baby, the neonatologist noted certain urogenital abnormality. He took the the picture. The most likely diagnosis is:

1.Urogenital sinus.
2.Hypertrophied clitoris.
3.Miocropenis.
4.Vulval hematoma.

Yesterday’s Mind Teaser: Decreased glycolytic activity impairs oxygen transport by hemoglobin due to:
1.Reduced energy production.
2.Decreased production of 2,3-bisphosphoglycerate.
3.Reduced synthesis of hemoglobin.
4.Low levels of oxygen.

Answer for yesterday’s Mind Teaser: 2.Decreased production of 2,3-bisphosphoglycerate.

Correct answers received from: DR ABBAS VAKIL, Dr. P. C. Das, DR.A.K.GAJJAR, Narahari Kandakatla, Dr.K.V.Sarma, Dr Sunil Malik, Muthumperumal Thirumalpillai

Answer for 3rd November Mind Teaser: 2.Replacement of glutamate by valine in B-chain of HbA.

Correct answers received from: DR AVTAR KRISHAN, Muthumperumal Thirumalpillai, Dr.K.Raju, Dr Sunil Malik, Shravan Kumar

Send your answer to ijcp12@gmail.com



medicolegal update

Click on the image to enlarge

medicolegal update

Last week I took my children to a restaurant. My six-year-old son asked if he could say grace.
As we bowed our heads he said,"God is good. God is great. Thank you for the food, and I would even thank you more if Mom gets us ice cream for dessert. And Liberty and justice for all! Amen!"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation:: A patient with hiatus hernia developed severe symptoms after eating a ’Paan’.
Reaction:: Oh my God! Why was he given a peppermint?
Lesson: Make sure patients with reflex esophagitis are not given any foods, which can relax GI sphincter.

medicolegal update

Great minds discuss ideas; Average minds discuss events; Small minds discuss people. Eleanor Roosevelt

medicolegal update

Dr KK Aggarwal: A mix of exercise protocol is better http://bit.ly/15Lvpwx #Health
Dr Deepak Chopra: What is the psychological meaning of Cosmic Consciousness? http://tinyurl.com/nvtspuz #askdeepak

Forthcoming events

GFIMS&R

Venue: Gold Field Institute of Medical Sciences & Research, Ballabgarh, Faridabad
Date: November 14, 2013
Time: 2.00 pm to 4.00 pm

Program Details
Floral welcome
Lighting of lamp & Saraswati vandana (Recorded):
Introduction: Dr Jasveer Singh 
Welcome: Dr (Col) Parduman Singh, Principal GFIMS&R       
Blessings: Dr Shashi Adhlakha, Secretary GFIMS &R 
Felicitation: Padma Shri Dr K K Aggarwal and Dr (Mrs) Veena Aggarwal, Dr Gajinder Goyal
Keynote Address on CPR: Padma Shri & Dr B C Roy National Awardee Dr K K Aggarwal, Eminent cardiologist, Moolchand Medcity, New Delhi
Demonstration of BLS of CPR by already trained persons (Medicos & Non Medicos) under guidance of Dr Nirupama Bansal    
Emergency of Cardiac arrest: Dr Gajinder Goyal, DM Cardiologist
Concluding remarks and Vote of thanks: Dr Jasveer Singh    

medicolegal update
  1. Thanks, -Happy Diwali to eMedinews Editor Dr KK Aggarwal and his team. Let the light of knowledge glow and shine bright. Prof M E Yeolekar ,Mumbai.

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medicolegal update

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