Kerala CM's angioplasty remarks trigger debate over unnecessary procedures

Kochi: Remarks by Kerala Chief Minister V D Satheesan, alleging that financial incentives may be influencing decisions to perform angioplasty, have sparked a debate among doctors over unnecessary procedures and patient care. 

“If 10 angioplasties are performed, the doctor will get (commission) for two. Even if the patient asks permission to go home and think about it, some never allow it,” the Chief Minister said, urging doctors to avoid unnecessary angioplasties.

The remarks drew strong criticism from the medical community, with the Kerala chapter of the Indian Medical Association (IMA) expressing concern that such generalisations could undermine trust between doctors and patients.

The IMA state president, Dr M N Menon, said, “Every profession has a few black sheep who bring disrepute to others, and medicine is no exception. However, making a generalised statement about all practising professionals cannot be encouraged”. 

While disagreeing with the generalisation, doctors acknowledged that commercial interests in healthcare need to be examined, particularly with the growing corporatisation of the sector. They stressed that the decision to perform angioplasty should be based on the patient’s clinical condition and the need for intervention.

However, when angioplasty is advised as a planned procedure for a patient without significant symptoms, doctors said there may be time to seek another opinion.

Indian College of Cardiology Kerala (ICCK) president Dr Rajesh T also stressed the need to distinguish emergency procedures from planned interventions. “In cases such as ST-elevation myocardial infarction (STEMI), a severe form of heart attack, time is critical. Restoring blood flow at the earliest can save heart muscle and, in many cases, the patient’s life,” he said, reports TNIE. 

A senior cardiologist at a government medical college also supported seeking another opinion when the need for an invasive procedure is unclear. The medical college sees around 500 to 600 patients in its outpatient department every day, but fewer than 15 angioplasty procedures are performed there, the doctor said.

Doctors also noted that chronic stable angina, which causes chest pain during exertion or stress, can in some cases initially be managed with medication, depending on the patient’s condition.

The debate comes as Kerala has expanded access to advanced cardiac care through government hospitals. Official data showed that the number of hospitals equipped to perform percutaneous coronary intervention (PCI), including angioplasty, increased from 18 to 103 over the past decade.

Doctors have called for stronger oversight of the growing corporatisation of healthcare, while stressing that angioplasty decisions should ultimately be guided by medical need and the patient’s condition.