73-yr-old Alappuzha man with chest pain collapses & dies during treadmill test in hospital; family files plaint

Kochi: The death of a 73-year-old man after he collapsed during a Treadmill Test (TMT) at a private hospital in Pathanamthitta has triggered allegations of medical negligence, with his family accusing the hospital management and the doctor of gross clinical errors and a subsequent cover-up.

Pankajakshan Unnithan, a native of Noornad in Alappuzha district, died on May 25 after collapsing during a TMT conducted at Christian Mission Hospital (CMH), Pandalam. His family has since lodged a formal complaint with the Pathanamthitta District Medical Officer (DMO), Health Minister and the Chief Minister seeking action against the doctor and the hospital management.

According to the complaint filed by the deceased's daughter, Jyoti Sree Unnithan, Pankajakshan had reached the hospital around 10 am with chest pain that had persisted for a week. He was examined by Dr Ampady Sreedhar before undergoing Electrocardiogram (ECG) and Echocardiogram (ECHO) examinations at around 10.30 am. 

The family alleges that the ECG and ECHO revealed severe abnormalities, but despite the findings, they claim the doctor advised a treadmill test.

According to the complaint, during the eight-minute TMT, the patient's heart rate rose from 122 beats per minute (bpm) to 132 bpm before reaching 144 bpm and then suddenly dropping to 44 bpm, following which he collapsed. The family alleges that the physical stress of the test caused a free wall rupture of the heart, leading to irreversible cardiac damage.

Speaking to Onmanorama, Jyoti Sree Unnithan alleged that the doctor knowingly subjected her father to a risky procedure. “The doctor and everyone else involved know very well that such complications can arise. Yet, they intentionally made him get on the machine,” she said.

She further alleged that the family was treated disrespectfully when they questioned the doctors after the incident. “When we went to talk to the doctors about it, the doctors told us, ‘Why don't you all just go sit idly at home? We don't have time to entertain you like this. We have a lot of work to do,” she claimed. 

Jyoti also accused the hospital of altering medical records to shield the doctor. “Because we are cross-questioning them like this, they have explicitly mentioned in brackets in the report provided by the hospital that the patient did not have chest pain when he arrived at the hospital, and that it was only one day prior. Therefore, this is a conspiracy. The entire CM Hospital supported this report to hide the doctor's mistake," she alleged.

Jyoti also questioned the decision to continue the TMT after the patient's heart rate increased. “After the initial check-up, when he was taken in to undergo the TMT, his heart rate became 122. Normally, for a person who is 73 or 74 years old, the heart rate should not cross 120 or 125 during a TMT. In such a situation, it was 122 at first, then it became 143...137, and they ran it for 8 minutes. They pushed the heart rate up to 144. Then he collapsed right there on that machine itself. Actually, he was already in a deceased state there. Then they administered CPR to revive his breathing and got his pulse beating again. It took around one and a half to one and three-quarter hours to transport him to Parumala, and by the time they reached, they declared him dead,” she said. 

The complaint also accuses the hospital of mishandling the emergency response. The family claims the hospital lacked facilities to immediately handle such emergencies and took nearly an hour to arrange a private ambulance from Adoor.

They further alleged that instead of shifting the patient to hospitals in nearby Adoor or Chengannur, he was taken to a private hospital at Parumala, around 28 km away, causing a delay of nearly two hours. The complaint also alleges that the ventilator was disconnected prematurely by the ambulance doctor before the patient was formally handed over at the Parumala hospital.

Hospital rejects allegations
However, the hospital has rejected the allegations, maintaining that the incident was an unpredictable medical complication and that established medical protocols were followed.

Resident Medical Officer Dr John Varghese said the patient's ECG and ECHO findings were not suggestive of serious heart disease and that the TMT was recommended based on clinical assessment. “His ECG and ECHO reports were normal. The chest pain was only muscular pain.  Pre-test probability—before conducting the test, the chances of having heart-related complaints were very low, and that's why a TMT was done. But while doing the TMT, it happened. And the patient didn't provide his proper medical history,” he said.

Responding to allegations of delayed transfer, Dr Varghese said the patient first had to be stabilised before transport. “When a patient goes into arrest, we take time to resuscitate them. We cannot do anything immediately; resuscitation needs to happen. Otherwise, what if something happens on the way? We resuscitated him, put him on a ventilator, and after the BP stabilised and the patient became stable, we shifted him,” he said.

Defending the decision to shift the patient to Parumala, he also said the hospital was chosen because of its specialised cardiac facilities.

Health department orders inquiry
Pathanamthitta District Medical Officer Dr Anitha Kumari confirmed that an official inquiry will be initiated after receiving the family's complaint. “This complaint was received here only the other day. We will initiate an inquiry into it,” she said.

According to the DMO, a special committee will examine the complaint and scrutinise the medical records to determine whether there was any clinical mismanagement. The family has already filed a complaint with the Pandalam police. Police sources said that the complaint has been forwarded to the DMO. “We cannot register a case until the report from the DMO is received,” a police officer said.