Routine inquiries

Investigations ordered by the Appropriate Authority and the State unit of the Indian Medical Association into the kidney trade in Kerala fail to address important questions and hence come up with nothing substantial.

THE inquiry ordered by the Director of Medical Education (DME) into the trade in human kidneys in Kerala (Frontline, October 25) has come to the same `benign' conclusions as those of the official investigations conducted under the orders of Health Minister P. Sankaran. This is the latest in a series of inquiries into the trade in human organs that have come up with nothing substantial.

The DME, Dr. K.A. Kumar, told Frontline that the inquiry conducted on his behalf by the Principal of the Government Medical College, Thrissur, Dr. M. Lily, "concluded" that the hospitals in Kozhikode where the transplants were done "had followed proper procedure and legal requirements for conducting those operations", that no doctors were "involved", and that "there is nothing legally wrong in the records in the hospitals".

The DME, as the `Appropriate Authority' in the State to ensure that no trade in human organs takes place, failed to conduct inquiries and initiate action for over three months after the first reports of a major kidney racket appeared in the media in May. Eventually, in late August, under pressure "to do something" it ordered an inquiry into "whether the hospitals involved had followed procedures while doing the kidney trade-related transplants". For all intents and purposes the inquiry merely meant "another look at the records" and its findings were a foregone conclusion.

After reports about the kidney trade appeared in the local newspapers, the State government, in a show of earnestness, ordered a number of inquiries. But it kept the inquiries separate and independent of one another. The conclusions arrived at by the various departments skirted the important issues and were at best half-baked. A police inquiry ordered by Chief Minister A. K. Antony has been the only comprehensive one so far, but its findings (Frontline, October 25) have not been made public officially.

Now, the government, has asked the police to conduct "further detailed inquiries" to find out whether kidney rackets had existed in other parts of the State. In effect, the Home Department has set the police on a wild goose chase until the issue fades from public memory. This seems to have become the signature response of the Kerala government to controversies in the health sector. Meanwhile, the Appropriate Authority can continue to convince itself that it has done its duty through an eyewash of an inquiry.

THE government's move for another police inquiry, this time "all over the State", seems to have suffered a curious setback. According to reliable sources, the Director-General of Police, K. J. Joseph, has questioned the need for the inquiry when the report of a detailed, comprehensive police inquiry into a specific kidney racket was with the government, without any action taken on it so far. Government sources said the DGP also pointed out that under the Transplantation of Human Organs Act, 1994, the government's directive was not "a practical one" and if a police inquiry was to be conducted the proper way was for the government to ask the Appropriate Authority to register a formal complaint regarding irregularities.

Meanwhile, the much-awaited report of the Ethics Committee of the Indian Medical Association's (IMA) State unit, released in Thiruvananthapuram on October 25, has turned out to be a damp squib. The professional body has failed to address important questions regarding the role of the doctors and the hospitals involved in the transplants and the failure of institutional mechanisms. The report has invited strong criticism from many quarters. A section of the State unit of the IMA has even questioned the capability of an IMA committee to investigate the issue, given the ramifications of the case.

The report of the three-member committee of past presidents of the IMA's State unit listed the following important findings: money transactions have occurred between the donors and the recipients without the knowledge of the management or doctors of all (three) hospitals (in Kozhikode); all hospitals have adhered to various provisions of the Act; there is no evidence to show that the hospital authorities/doctors directly or indirectly influenced the kidney donors to give their kidneys; the Authorisation Committee failed to detect the illegal money transaction between some of the donors and the recipients; there is an attempt on the part of the National Hospital (Kozhikode) and Dr. Rouben George (the nephrologist at the hospital, who conducted the transplants) to show him (wrongly) as a post-graduate degree-holder in Medicine.

Another section of the report lists the "observations made by the committee" during the inquiry. Among the important "observations" were: money transactions have occurred between donors and recipients at all hospitals; two middlemen, Sajeev alias Reji of Kottayam and Viswam of Thrissur, were involved; the donors of Methotti village (in Idukki district) volunteered to give their kidneys for money; many of them were in debt and they chose this easy method ignoring its legal implications; the doctors and management of Baby Memorial Hospital and National Hospital "have not been proved to be involved in the financial transactions that occurred between the donors and the recipients".

Elsewhere, the report points out significantly, that "documentation is very poor in the National Hospital and the addresses of many donors and recipients were not available". It mentions a known instance of kidney-for-cash transplant operation that took place at National Hospital ("the first victim of agent Reji") and points out that the case record and addresses of both the donor and the recipient were not available at the hospital.

Asked about the allegations that the IMA report was highly protective of the interests of the doctors and private hospitals, the chairman of the IMA inquiry committee, Dr. M. Bhaskaran, told Frontline that the committee "had to confine its findings on the evidence available and not base them on assumptions". "The report clearly finds fault with the Authorisation Committee for its failure to detect illegal money transactions, even though the committee's actions were well within the provisions of the Act," he said.

For the State government, the IMA report is one more convenient instrument that strengthens the Health Minister's argument (Frontline, October 25): "Middlemen may have been involved, money may have changed hands, but how can it be proved? They (the hospitals) have all the records required under the law."

The only investigation that goes against the grain of the official arguments so far is the one conducted by the police. The government, however, seems to have decided that its report should continue to be an "official secret".

Opposition Leader V.S. Achuthanandan, at a press conference in Thiruvananthapuram on October 29, described the IMA Ethics Committee report as "an attempt to protect the private hospitals in Kozhikode, the doctors in these hospitals and the Health Minister who enjoys their hospitality". He also demanded that the government publish the police report immediately and suspend the registration of National Hospital, Kozhikode, and the nephrologist concerned. Achuthanandan said that he would write to the Union Health Minister requesting him to direct the Medical Council of India to probe the case.