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Dr. Kunal Saha, M.D., Ph.D. Asst Professor College of Medicine

 

The NRI's Love Story with tragic end
Anuradha never left the soil of her motherland again to get back to their dream house in Columbus. From a simple skin rash, she eventually died in India because of the rash and grossly negligent medical therapy by three senior Calcutta doctors

Los Angeles, May, 11, 2009
Karen/Gary Singh

This story is like a fairy-tale and like most memorable love stories; it also has a tragic end, at least in this world. Anuradha Saha was born in Calcutta in a middle-class family, only daughter with two other siblings. A rare combination of angelic beauty and simmering grace. Anuradha was also an exceptionally intelligent student. After graduating in the top of her class from the Modern High School in Calcutta, she got a scholarship to study in the USA – a rare feat for the Indian students. She left India at a very young age soon after finishing high school to achieve the best education and build a productive career in the Home of the Braves and Land of the Free.

Kunal Saha was also born in a middle-class family at Halisahar, a suburb of Calcutta. With 11 siblings and a doctor-dad, “education” was the central theme of his family. But Kunal was one of the most gregarious and jovial member in his large family with an impeccably open minded for the outside world. Six feet tall with a typical TDH (tall-dark-handsome) look; Kunal was also a fanatic cricket-lover and an astute student with remarkable ability to overcome academic challenges. He graduated from a local high school as a “National Merit Scholar” and was offered admission in almost all top academic institutions in India including the IIT-Kharagpur, Birla Institute of Technology, Presidency College, Jadavpur University and even the Pune Film Institute. But he eventually followed the foot-steps of his father and elder brother to study medicine and joined the NRS Medical College in Calcutta to become a doctor.

The way this love-story between Kunal and Anuradha started would astound even a frequent watcher of Yash Chopra’s romantic Hindi films. As Kunal completed his medical education at NRS in the mid-1980s and was all set to join most of the rest of his family who had already migrated to the USA, Anuradha came to Calcutta after graduating from the Southern California University to visit her parents. Kunal was supposed to go to Delhi on the first week of January 1985, but missed his train for the first time in his life as he got trapped in one of the famous traffic jams on Mahatma Gandhi Road. Anuradha was supposed to return to California the very next week. They would have never met, had that horrendous traffic jam in Calcutta, for once, not played the role of Cupid and forced Kunal to miss his train to Delhi to stay back in Calcutta.

Frustrated for missing the chance to go to Delhi, Kunal returned to House-staff quarter at the NRS Hospital. To compensate his loss of fun in Delhi, Kunal and some of his close doctor buddies promptly arranged a picnic the very next day at Kunal’s family house – a gorgeous bungalow near the Ganges some 50 kilometers from Calcutta. Anuradha also had a school friend, Madhumita, who was a dental student at the R. Ahmed Dental School and was also a common friend of Kunal. Madhumita was invited for this picnic at Kunal’s family bungalow. Having heard that her school friend was visiting from USA and would return to America next week, they also invited her to join the picnic. Sunday, January 6, 1985 is a red letter day for Kunal and Anuradha. This was the day of the picnic when the eyes of Kunal and Anuradha met for the first time and this “love story” began. Was it love at the first sight? Kunal always said, “Anu (abbreviated name of Anuradha that Kunal used to call her) you are more than just a love for me - you must be my angle. Otherwise, how I could have ever missed the train for Delhi only to meet you”. Anu quipped, “I had to be with you, Kunal. I am right in your center. Look at K-U-N-A-L; A-N-U is right in the middle. Our names were chosen at our birth by our parents. How could they put me right in the middle of you when we were born?” Kunal and Anuradha always celebrated January 6, 1985 as their true “anniversary” day even though they actually did not get married until 27th July, 1987 (see below the anniversary wishes written by Anuradha on January 6, 1989).

The love between Anuradha and Kunal flourished in a spectacular manner despite a huge physical distance in America. Anuradha went back to California to join a new graduate program (she initially wanted to become a lawyer in the USA) and Kunal started his new life in USA, first as a research trainee at the Lousiana Medical Center in Louisiana and then as a graduate student at the University of Texas-MD Anderson Cancer Center in Texas. Although Anuradha had been living in the USA long before she met Kunal, she had a tough existence as a young, Bengali student without any family around, trying to build a career in the hustle and bustle in an exotic place in a foreign land, the city of the Angles (Los Angeles). Kunal was living in the deep South trying to cope up with the drastically different life style in America even though he had the support of other family members who were already settled in America. But the distance of more than 3000 kilometers between California and Louisiana was hardly a barrier for these two young lovers who always felt that their match was made in the paradise. Anuradha would drive on the busy highway in California or stroll on the glistening beach of the Pacific Ocean and block out all sounds except the sound of the waves as she engaged in an endless imaginary conversation with Kunal who was living thousands of miles away. Anuradha was blissfully happy by falling in love with Kunal as she wrote in one of her numerous enchanting love letters to Kunal, “If I ever make you, a fraction as happy as I was today, I will say, “Koonal, you are one lucky guy!” Couldn’t I stay, that way, for a long, long, time, perhaps even for ever?”

Their love story soon had a happy turn of event - Kunal and Anuradha decided to return to Calcutta and get married. They eventually got married on 27th July, 1987. Despite a difficult situation as a young couple with limited money and an uncertain future, they enjoyed every minute of their life together as a married couple (pictures below).

Marriage of Kunal & Anuradha, 1987

But the difficult journey towards the “American Dream” started soon for Kunal and Anuradha. While Kunal returned to Texas to resume his medical career, Anuradha had to stay back in India for almost two years before she could return to the USA because of the regular waiting period for visa as the wife of a permanent resident of USA. Anuradha eventually joined Kunal in USA and took the LSAT (entrance test necessary to get into law schools in the US) and prepared herself to get into a law school. She obtained high grades in almost every test that she took and was offered admission from many top law schools in America including a full scholarship at the Baylor Law School in Houston. In the meantime, Anuradha was also working with abused children at the “Texas Department of Children’s Services”. While working for the abused children, she was shocked to find the unscrupulous ploys routinely adopted by the lawyers (mostly in custody battles for the children). She was tormented to find the mental pain and suffering of the abused little children. She changed her mind to become a lawyer and instead, she wanted to be a Child Psychologist to help the hapless children of child abuse. Anuradha applied for graduate programs in “Child Psychology” and was accepted by “Columbia University”, the prestigious Ivy League school in New York City. In the meantime, Kunal also completed his study at the University of Texas and was offered a lucrative fellowship from the “Aaron Diamond Foundation” for conducting HIV/AIDS research at the Columbia University Medical Center. They moved to New York City in 1993. Life was still a busy and hectic struggle. While Anuradha was a studying as a full time graduate student at the expensive Columbia University and also working part time for the children at the Archdiocese of New York, Kunal was busy with his AIDS research at the Columbia Presbyterian Medical Center in upper Manhattan. Despite a very busy life and hard struggle in New York (as most young couple must go through to reach the American Dream), love between Kunal and Anuradha only grew stronger everyday. With little time and money in hand, they still tried to extract time for fun activities in the New York City and often drove long distance to see the rest of the beautiful country of the United States of America

The script of this scintillating love-story looked almost picture perfect towards the end of 1997. Anuradha completed all requirements for becoming a “Child Psychologist” from Columbia University while Kunal finished the fellowship from the Aaron Diamond Foundation for AIDS Research and published his HIV research in the top medical journal “Nature Medicine”. As Anuradha and Kunal planned all along, they were now ready to start a family of their own. They decided to move to a new place because despite the glitters and fun of New York City, both thought that this was not an ideal place to raise a child. Anuradha would take a break from study and practice for a couple of years to raise the child. Kunal also got the “First Innovative Grant for AIDS vaccine” from the National Institute of Health (NIH) and was offered faculty position from top universities across the country. Eventually they chose to accept the offer from the Ohio State University (OSU) and Children’s Hospital in Columbus because of its peaceful location and mid-western tradition. Both Anuradha and Kunal visited Columbus at least four times before making the final decision to move there. They applied and obtained a joint mortgage to purchase their first house - a beautiful lake-front mansion compared to their apartment in New York City. A big, new “house” in USA for the first time after years of hard struggle together – a house with big back yard and front lawn with plenty of space and of course, a very large kitchen with all the modern amenities (Anuradha’s special wish for many years for her love of cooking). She also decided to buy a new car – a Mercedes sports utility vehicle because she thought a regular car is not suitable when you have a family. Kunal signed a lucrative contract to join OSU from June 1, 1998 as a regular tenure-track assistant professor. They packed all their belongings from the New York apartment and shipped it with the movers for Columbus.

One final wish Anuradha also had – to collect the blessings of her mother in Calcutta before she starts this new phase of their life. So, Anuradha and Kunal planned for a short trip to India just before starting their new life in Columbus. They landed at the Calcutta Airport on April 2, 1998 – the happiest couple ever to land at the DumDum Airport. But they could hardly wait to go back to their new, dream home in Columbus, Ohio. Destiny willed otherwise!!! Anuradha never left the soil of her motherland again to get back to their dream house in Columbus. From a simple skin rash (as allergic reaction to some drugs), she eventually died in India because of the rash and grossly negligent medical therapy by three senior Calcutta doctors, Dr. Sukumar Mukherjee (Medicine), Dr. Abani Roychowdhury (Medicine) and Dr. B.N. Halder (Dermatologist). The next chapter of Kunal-Anuradha love story started with the incomprehensible death of Anuradha as Kunal raged an unprecedented legal as well as social war to bring justice not only to his beloved wife but also for the thousands of defenseless patients who are dying everyday in India only because of medical negligence and an absolute lack of regulation over the practice of medicine in India.

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Anuradha had severe skin rashes and some fever- died from an act of gross medical negligence.

Dr. Sukumar Mukherjee who first treated Anuradha in his chamber at Nightingale Diagnostic Center in Calcutta in the evening of 7th May, 1998 when Anuradha had severe skin rashes and some fever. Dr. Mukherjee’s choice of “Depomedrol” was his selection of its astronomically high “dose”.

  • He injected Anuradha with 80 mg “Depomedrol” straight away in his chamber (“stat”; as written in his prescription) in the evening of 7th May, 1998 and asked her to continue the same injection at 80 mg twice daily for the next three days.
  • The maximum recommended dose of “Depomedrol” for any clinical condition is 40-120 mg at least 1-2 weeks or longer intervals

Anuradha was admitted in the AMRI Hospital in Calcutta on 11th May, 1998 in a serious condition at the advice of Dr. Sukumar Mukherjee. But after Dr. Mukherjee left for America later on the same day, Dr. B.N. Halder (Dermatologist) and Dr. Abani Roychowdhury (Medicine) jointly took over the charge for treatment of Anuradha (although after the criminal case was filed, Dr. Ro chowdhury has claimed that he never knew or treated Anuradha). Dr. Halder first examined Anuradha on 12th May, 1998 and correctly diagnosed TEN. He also wrote a prescription (in consultation with Dr. Roychowdhury) which was basically followed during Anuradha’s entire stay at the AMRI hospital. Although Dr. Halder stopped the long-acting “Depomedrol” which Anuradha had already received for the past 7 days at 80 mg twice daily dose, he added a different, albeit “quick-acting”, steroid (“Prednisolone”) without considering the devastating residual effect “Depomedrol” which was already pumped into the body of Anuradha. More importantly, Dr. Halder did not advise any of the mandatory treatment, i.e. “supportive therapy” which is essential for TEN patients. There were absolutely no specific instructions Dr. Halder/Dr. Roychowdhury for any IV fluid administration, care of the skin wounds or monitoring for any developing infection (through regular blood and swab tests) which are crucial for proper care of TEN patients. In fact, Dr. Halder and Dr. Roychowdhury advised not to “prick any needle” to Anuradha (with an obsolete and baseless fear that needle pricking might introduce infection) thus, totally ruling out possibility of administration of any IV fluids or blood tests. The hand-written prescription of Dr. Halder as present in AMRI hospital record is (shown in the next page) is a glaring example of gross medical negligence. First, Dr. Halder has not recorded a single clinical feature (e.g. pulse, respiration, physical description etc.) of the patient. Anuradha was very sick at this stage with large portion of her skin becoming loose or peeled off resulting in the loss of tremendous amount of body fluids through the denuded skin surface like in a “burn” patient. And there was absolutely no specific direction for replacement of the lost body fluid or monitoring of evolving infection. In fact, this same mode of therapy was basically followed for Anuradha until she became completely moribund and was shifted to the Breach Candy Hospital in Mumbai on 17th May, 1998.

Evidence of reckless practice of medicine

Being a physician born and raised in India, Kunal was well aware about the seemingly impossible task of bring the doctors who were responsible for the untimely demise of his beloved wife to justice. All of Kunal’s close doctor friends in India were also of the opinion that despite an absolute brazen act of medical negligence that took Anuradha’s life, there is no chance to bring justice for these “top” doctors responsible for Anuradha’s death. Although Anuradha was an India-born naturalized US citizen, the case for medical negligence had to be fought and won at the scene of the alleged crime – the City of Joy where this angelic love story between Kunal and Anuradha started almost 13 years earlier. Even though legal provision for “criminal prosecution” of a doctor causing death of a patient through reckless treatment (“manslaughter”) exists in the Indian Penal Code (IPC) for almost 150 years (under IPC Section 304A), not a single registered, allopathic doctor has ever been convicted under this law in the history of Indian medico-legal jurisprudence until 1998. Kunal started this “crusade” for justice against the negligent doctors in Calcutta by contacting the very top medical experts in different countries in the relevant fields (dermatology and pharmacology) for their opinions about Anuradha’s treatment because opinions from medical experts play a crucial role for establishing a case of “medical negligence”.

The reckless therapy that eventually killed Anuradha started with Dr. Sukumar Mukherjee who first treated Anuradha in his chamber at Nightingale Diagnostic Center in Calcutta in the evening of 7th May, 1998 when Anuradha had severe skin rashes and some fever. Dr. Mukherjee immediately injected her with 80 mg of “Depomedrol” and advised that she must continue the “Depomedrol” injection at 80 mg BID (twice daily) for at least the next three days. He diagnosed Anuradha’s condition as “Angioneurotic oedema with allergic vasculitis” and also prescribed some other medicines. This was the beginning of a therapy unheard of in the annals of medical science that eventually snatched the life of young woman. As discussed previously, “Depomedrol” is used as a steroid therapy only in some “chronic” clinical conditions like “asthma” and “arthritis” because of its “long-acting” role. Patients with “chronic” conditions do not have to take steroid everyday since one injection of “Depomedrol” lasts in the body for up to one month.

For “acute” clinical conditions where steroids are recommended, only “quick-acting” steroids like “Decadron” or “Solumedrol” are used for its fast action and quick elimination from the body. This is why “quick-acting”, and not the “long-acting, steroids can be repeated daily or even several times a day. Frequent injections of long-acting steroids like “Depomedrol” would cause a devastating adverse effect (“suppression of natural immunity”) in the body by accumulation of the drug to a very high level. So why did Dr. Mukherjee choose to use “Depomedrol” as a steroid to treat Anuradha on 7th May, 1998 when she came with an “acute” skin condition? Dr. Mukherjee could not answer this question when he was asked during his examination in the court.

But even more shocking than Dr. Mukherjee’s choice of “Depomedrol” was his selection of its astronomically high “dose”. He injected Anuradha with 80 mg “Depomedrol” straight away in his chamber (“stat”; as written in his prescription) in the evening of 7th May, 1998 and asked her to continue the same injection at 80 mg twice daily for the next three days. The maximum recommended dose of “Depomedrol” for any clinical condition is 40-120 mg at least 1-2 weeks or longer intervals. On Dr. Mukherjee’s advice, “Depomedrol” was injected to Anuradha 160 mg everyday (80 mg twice daily) for the next 7 days (Dr. Mukherjee repeated the same prescription after Anuradha on 11th May, 1998 at after Anuradha was admitted at AMRI hospital, see his second prescription in the next page). So, Anuradha basically received a dangerous steroid preparation (“Depomedrol”) at 20-50 times its maximum recommended dose as prescribed by Dr. Mukherjee. As shown below, a plethora of other documentary evidences including written experts’ opinions and direct testimonies were presented in this case to establish the brazenly wrongful and reckless use of “Depomedrol” by Dr. Mukherjee. On the contrary, not a single expert’s opinion, either as a written statement or as a witness in the court was produced in this case by any of the accused doctors suggesting that “Depomedrol” at 80 mg twice daily as Dr. Mukherjee prescribed could be given to any patient under any clinical condition. A brief summary of the evidence showing reckless use of far too excessive “Depomedrol” by Dr. Mukherjee is presented below.

  • Depomedrol” can only be given maximum at 120 mg at an interval of at least 1 week.
  • Opinion by Indian manufacturer of “Depomedrol”: Pharmacia is a US-based drug company. “Depomedrol” is circulated in India by the Indian branch of Pharmacia company. They were contacted for their opinion about the use of Depomedrol at “80 mg twice daily” dose as prescribed by Dr. Mukherjee. The Medical and Regulatory Director of Pharmacia in India, Dr. S.P. Bindra submitted a written response in which he has categorically stated, “Package insert of Depomedrol does not recommend the twice daily dose of injection Depomedrol 80 mg in any clinical condition”.
  • Opinion from US manufacture of “Depomedrol”: The original Pharmacia company in Kalamazoo, Michigan, USA was also contacted for their opinion about the “80 mg twice daily” dose of “Depomedrol”.
  • Opinion from world-renowned Pharmacology experts: Dr. Philip Walson is a world-renowned clinical pharmacologist and associate editor of the United States Pharmacopiea- Drug Index (USP-DI), most commonly used drug index book by world-wide doctors. Dr. Walson has evaluated the treatment given to Anuradha with 80 mg twice daily dose of “Depomedrol”. His written opinion has been filed in the court in which Dr. Walson has categorically stated, “In my opinion, the late Mrs. Saha received excessive amount of corticosteroid for her TEN, including the dose (80 mg BID) of long-acting corticosteroid “Depomedrol”. The daily use of intramascular long-acting corticosteroid “Depomedrol” was not justified for any TEN patient and was also excessive for any clinical condition……………there is no doubt in my mind that the improper use of corticosteroid caused or significantly contributed to Mrs. Saha’s ultimate death from “sepsis”.
  • Opinion from India’s top expert in Dermatology: Dr. J.S. Pasricha is the ex-head of the department of Dermatology at the All India Institute of Medical Sciences (AIIMS) and probably the most well-known Indian dermatologist today. Dr. Pasricha has also examined treatment of Anuradha and provided written answers to questions asked by Kunal’s attorney. When asked, “Is the treatment given by Dr. Mukherjee correct?”, Dr. Pasricha answered, “……The chief parameters of my approach include, 1) controlling the reaction within 24 hours by using a large dose of corticosteroid. Use of Depo-preparations (“Depomedrol”) at this stage will be incorrect. In fact, Depo-preparations (“Depomedrol”) are used for chronic diseases and not for acute diseases like TEN. Secondly, Depo-preparations are not to be used twice a day”

Apart from these evidences discussed above, many other medical experts produced by the prosecution either as a witness in the “criminal trial” or through written submissions including Dr. Anil Gupta, Dr. Anil Shinde, Dr. Salil Bhattacharya, Dr. Kunal Saha, Dr. Peter Fritsch (Austria), Dr. David Fine (USA), Dr. Gerald Pierard (Belgium), and Dr. J.C. Roujeau (France) have all testified about the wrongful use of “Depomedrol”. In contrast, the accused doctors have failed to produce even a single MBBS doctor to testify on their behalf that “Depomedrol” at 80 mg twice daily could be used on any patient.

1) Prof. J.C. Roujeau from France : Prof. Roujeau is probably the most well-known TEN expert in the world who has published the highest number of scientific articles and major textbooks on TEN. “Your wife was a victim of malpractice. This is much more obvious in the way steroids had been used (and also on the lack of supportive therapy) than on the principle of treating with steroids”

2) Prof. Peter Fritsch from Austria : Prof. Fritsch is also a highly respected TEN expert and the author of the chapter on TEN in the well-known dermatology textbook “Dermatology in General Medicine”. In email communication with Anuradha’s husband, Prof. Fritsch has categorically stated, “It is obvious that (Anuradha’s) treatment has not been appropriate and that it did not conform to the principles that I outlined in my chapter on TEN in the textbook” (see page 35). Prof. Fritsch has also made a detail analysis of Anuradha’s treatment from the AMRI hospital record and found glaring flaws in the treatment as he has observed, “No hematocrit, blood gas analysis or electrolyte values are recorded in the files. Fluid input/output measurements are only recorded for May 12 and 13. Temperature was recorded only on May 12 and 13. Although the last reading (May 12, 10 pm, was 100.80F, there was no further monitoring of body temperature… It is not even clear if a venous line was installed to correct fluid and electrolyte imbalances and to administer IV antibiotics”.

In the case of Mrs. SAHA, the corticosteroid doses were excessively high (in view of her slim body weight; also, it is unclear why slow release corticosteroids (“Depomedrol”) were used). Finally, the hospital records are more than deficient by any standard”

3. Prof. David Fine from USA ): Prof. David Fine is a highly accomplished expert on TEN at the University of North Carolina and like Prof. Fritsch, he is also one of the rare dermatologists in the US who still prefer to use some steroids in the very early stage of TEN. ........“The treatment provided to her (Anuradha) was clearly improper. Indeed, I would view this as gross malpractice based on the considerable medical literature on this subject, ....................……..Although many authorities still use systemic corticosteroids in carefully selected patients with early TEN, the manner in which treatment was instituted in your wife certainly appears to be unprecedented”

Many other supporting experts’ opinions have been produced in the court in the “criminal” case for the wrongful death of Anuradha which are not shown here. In fact, apart from expert dermatologists, the prosecution also produced witnesses in the court during the criminal trial who were experts on “Pharmacology” (e.g. Prof. Salil Bhattacharya) and “Medicine” (Dr. A. Gupta and Dr. F. Udwadia). As mentioned before, Dr. J.S. Pasricha, eminent dermatologist from India also provided his opinion in this case in support of Anuradha’s husband, Dr. Kunal Saha. In sharp contrast, not a single expert’s opinion was produced by any of the accused doctors in support of their treatment of Anuradha either during the “criminal” trial or in the pending “civil” case for financial compensation.
Source; Dr. Kunal Saha/pbtindia.com


 

 

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  • Dr. Kunal Saha, M.D., Ph.D. Asst Professor
    College of Medicine and Public Health
    Pediatrics - Molecular Medicine
    Children's Hospital Research