NO Bail to Ahmedabad Cardiologist jailed for unindicated cardiology procedures

Ahmedabad: The Gujarat High Court has denied granting bail to a cardiologist, who was accused of performing unnecessary angioplasty procedures to extort funds from the Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme for Khyati Multispecialty Hospital.

While denying the cardiologist's bail plea, the HC bench comprising Justice M.N. Mengdey observed that the material on record indicated a "strong prima facie" case against the petitioner, where his involvement in the alleged offence cannot be ruled out.

The court also agreed with the submission by the prosecution, who argued that this was a case of mere medical negligence but a systematic attempt to "mint more money" under the PMJAY scheme from the Government.

Denying granting bail to the cardiologist, the HC bench observed,

"The present applicant has played a pivotal role in the present offence as in the first place it was the present applicant who had performed the procedure of angioplasty on the patients in question and as observed herein above, in some cases, though not required. The witnesses i.e. the patients in their respective statements have categorically stated that when they expressed their disinclination to the present applicant, there was heavy persuasion by the present applicant for undergoing the procedure by showing the threat of their death. The involvement of the present applicant in the present offence cannot be ruled out at this stage, since the material available on record indicates a strong prima facie case against the present applicant."

Medical Dialogues had earlier reported that last year in November, two patients, who attended a free medical camp organized by Khyati Hospital under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) passed away due to postoperative complications following Angioplasty procedures.

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This incident caused widespread outrage as an angioplasty was performed at the hospital on 19 patients and two of them died while 5 others were kept on ventilation. These 19 people were brought to Khyati Hospital by ambulance for treatment after they attended the free health checkup camp in Borisna village of Kadi taluka on November 10. Around 80 to 90 people were examined at the camp.

Dr Prashant Vazirani was the doctor who reportedly carried out the said surgeries. Following this, he was arrested along with hospital CEO Rahul Jain, marketing director Chirag Rajput, marketing executive Milind Patel, and his two assistants, Pankil Patel and Pratik Bhatt, and directors Rajshree Kothari and Sanjay Patolia.

After Dr. Vazirani's arrest, the Gujarat Medical Council had decided to debar his registration for three years in November 2024. Challenging this decision, Dr Vazirani filed an appeal to the NMC in December 2024, which is still pending. Even though NMC had imposed a stay on the GMC suspension order, it later vacated the stay after the GMC wrote to the Apex Medical Commission in this regard.

Dr. Vazirani, who was booked in an FIR registered under BNS Sections 105 (culpable homicide not amounting to murder), 110 (Attempt to commit culpable homicde), 336(2) (forgery), 340(2)(Forged document or electronic record and using it as genuine), 318(cheating), 61(criminal conspiracy), filed a bail application before the Gujarat High Court.

The counsel for the cardiologist argued that only 7 out of 19 people had been advised to undergo the angioplasty procedure. He refuted the allegations that the patients were forced to undergo angioplasty procedures and submitted that there already was a mechanism in place for approval of angioplasty procedures. As per the said mechanism, if the blockage is of more than 70% in any of the arteries of the heart, then only the approval for angioplasty is permitted under the PMJAY scheme.

It was submitted by the doctor's counsel that the patients who were examined at the medical camp were made to undergo the examination of cardiogram and those who were suspected of having any heart-related issues, were asked to come to Khyati Hospital on the next day. On the next day, those patients were subjected to undergo the procedure of cardiogram and angioplasty, and out of 19 patients, only 7 patients were found to have more than 70% blockage. 

The counsel argued that if the hospital or any of the accused persons wanted to perform false procedure upon the patients for want of more money out of the PMJAY scheme, all the 19 patients would have been subjected to undergo angioplasty procedures. It was also submitted that all the reports of the patients who were subjected to angioplasty were forwarded to the competent authority under the PMJAY scheme for approval and it was only after the reception of approval from the authority under the PMJAY that the procedure of angioplasty was undertaken. The doctor's counsel submitted that the concerned authority had also found substance in the report submitted to it and thereafter permission was granted for performing the angioplasty procedures.

On the other hand, the Prosecution submitted that in this case, human lives were tampered with just to get monetary benefits. It was submitted that the manner in which the offence was committed had shaken the confidence of the public at large on the medical fraternity. The protection submitted that the present offence was a result of a large-scale conspiracy of which the present applicant was also a part. Generally, there would be no direct evidence regarding the aspect of any conspiracy since they were hatched in the darkest corners of the room, according to the prosecution, who submitted that the conspiracy could only be sensed through the circumstances surrounding the incident.

It was also submitted that the material on record indicated that the applicant had persuaded and forced the respective patients to undergo the procedure of angioplasty by making them understand that if such procedure was not performed immediately, there was all likelihood of them suffering from cardiac arrest, which was the most likely to result into their deaths.

He also submitted that the post-operational protocols were also not fulfilled as regards ant of the patients. Relying on the material on record, the prosecution submitted that the record indicated that there was no requirement for angioplasty in cases of some of the patients, whereas in the other patients, though one stent was required to be inserted, two stents were inserted and the bill was claimed under the PMJAY scheme. He submitted that the records of the case papers of the patients were also manipulated to draw those patients under the umbrella of PMJAY scheme.

The counsel for the victims also submitted that the victims had also opposed the plea contending that the applicant had performed the angioplasty procedure upon the patients who did not require it. The counsel claimed that all 7 patients were made to undergo the procedure only with the intention to grab the monetary benefit under the PMJAY scheme. It was submitted that because of the wrongful performance of the procedure, two patients had unfortunately succumbed to untimely death. Therefore, there was a strong prima facie case against the applicant for commission of the offence in question. 

While considering the bail plea, the HC bench took note of the statements of several patients and recorded the statement of one patient who submitted that "After the angiography Dr. Prashant Vazirani i.e. the present applicant informed him that his arteries were blocked and asked him to undergo the procedure of angioplasty, to which he had denied. Despite the same, the procedure was performed upon him. He was persuaded by saying that he was not required to incur any expense for the same and it would take only 10 minutes for performance of the procedure. He further stated that despite he having denied, Dr. Prashant Vazirani had inserted stent in his body."

Further, the court noted that another patient had submitted in the statement that "Doctor Prashant Vazirani had operated him for angioplasty and prior thereto it was informed that he was having serious heart problems ...He was only suffering from constipation."

Another doctor had mentioned in a statement that "those history forms had been altered by the hospital and the opinion of 2DECHO and cardio reference was added subsequently."

Taking note of these statements, the court observed that these facts indicated that the history forms which were filled at the medical camp at village Borisana, were altered and the advice for some tests were added subsequently.

The court relied on expert opinions from U.N. Mehta Institute for Cardiology & Research Centre and noted that in the case of one of the deceased, "a proper indication for coronary angiogram or coronary angioplasty was not established or mentioned… The discrepancy was noted in CAG report. The report mentions mid LCX 80% stenosis while in angiography video there is 30-40% disease in OM branch which is considered as non-critical… There is no post procedure ECG attached with the file. No post procedure cardiologist note could be found."

"The material available on record indicates that the reports of angiography were prepared in the handwriting of the present applicant. The material on record also indicates that those reports were also changed after the inquiry authority had called the applicant and the other accused for inquiry. Thus, those reports were incorrect and manipulated," observed the Court.

"The present is a case of classic example of the abuse of the scheme floated by the Government for the welfare of the general public. The PMJAY scheme has been in place to provide quality medical treatment to the public at large at a minimal cost. The expenses for the treatment of the patients under the PMJAY scheme is borne by the Government and the same is reimbursed to the hospital concerned by the Government. It is this scheme which has been allegedly misused in the present case for fulfilling materialistic ambitions of a few," observed the HC bench.

Regarding the contention that the expert body of the PMJAY scheme had granted approval for the procedure, the Court noted, "the reports which were submitted to the concerned authority themselves appear to be doubtful. The expert body of the U N Mehta Institute has clearly opined in case of some of the patients that either no procedure of angioplasty was necessary to be performed or only one stent was required to be inserted to the patients who were inserted more than one stent. If the authority who had granted approval for the procedure despite these glaring facts, then their role also requires investigation."

Addressing the petitioner's contention that no ingredients of Section 105 BNS are made out, the Court noted that the "material on record" makes the Court believe at this stage "that two unfortunate deaths were not natural".

Therefore, the Court observed that it was not possible to conclude that "offence punishable under Section 105 of B.N.S. is not made out". With this observation, the HC bench dismissed the bail plea.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/gujarat-hc-cardiologist-286277.pdf

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