Days after the counsel for the Justice Arumugasamy Commission and the Tamil Nadu government attacked Apollo Hospitals and VK Sasikala of colluding to not provide former Chief Minister J Jayalalithaa the best of medical care, documents show that Dr Mathew Samuel Kalarickal, known as the father of angioplasty in India, was not in favour of an angiogram for the late leader.
According to documents accessed by TNM, Dr Mathew Samuel Kalarickal, a consultant at Apollo Hospitals during the hospitalisation of the former Chief Minister at the hospital, was of the opinion that an angiogram was not necessary.
In a deposition dated November 20, 2018, the doctor says, “I saw Amma's (Jayalalithaa’s) case sheet before I went to her room. I wrote on the medical note that an angiogram was not needed then. The reason for me writing as such was that Amma had not experienced any setbacks due to systolic failure (type of heart failure). Using some other criteria like ECG, echocardiogram, DII (dietary inflammatory index), I decided.”
Dr Mathew Samuel Kalarickal’s medical advice is similar to those suggested by several senior doctors who were consulted by Apollo Hospitals-- cardiothoracic surgeon Dr R Girinath, senior pulmonologist Dr Babu Abraham, cardiologist LF Sridhar of Apollo Hospitals, Dr Nitish Naik of AIIMS, and UK-based intensivist Dr Richard Beale- had not been in favour of an angiogram, which is conducted to check the health of blood vessels, in order to determine if there are blockages.
The doctor also agrees with an October 12, 2016 observation by Dr Babu Abraham that an angiogram is not advisable when Jayalalithaa was recovering from sepsis.
His views, the doctor says, were reiterated by a team of AIIMS doctors who arrived on December 3, two days before Jayalalithaa passed away.
His deposition gains significance in light of a petition filed by the counsel for Arumugasamy Commission on December 28 stating that the team of doctors failed to conduct an angiogram on Jayalalithaa despite three senior doctors from various hospitals suggesting the same. Apollo Hospitals’ failure to do an angiogram on Jayalalithaa led to her health deteriorating and subsequent death, argued the Commission’s lawyer.
October 25, 2016
In his deposition, Dr Mathew Samuel Kalarickal states that he went to Jayalalithaa’s room on October 25, 2016 to see whether she needed an angiogram. “At the time, she was answering nature's call. It was 8: 45 am. She said she didn't want to see me that day. The next day I went out of station. The reason for calling me there was to take my opinion on whether an angiogram needed to be conducted on Amma,” he says.
Even as Jayalalithaa refused to meet him, the doctor says he made up his mind against an angio based on her medical records. He says, “I saw Amma's case sheet before I went to her room. I wrote on the medical note that an angiogram was not needed then. Whether Amma was immediately qualified to be performed angio on, I cannot say, since I did not see her. I do not know why critical care doctors asked my opinion. But they asked me in order to know whether an angio was necessary or not.”
In addition to factors such as ECG, echocardiogram, dietary inflammatory index, the doctor said that a mitral valve vegetation (infected growth) on Jayalalithaa's heart could have also been a reason for not performing an angiogram. As reported by TNM earlier, the former CM had a 14mm long vegetative growth on her heart valve since 2015. The growth, which may have impeded the functioning of her heart valve, may have caused a leak in Jayalalithaa’s heart.
“If the doctors had decided that they wanted to perform angio, they could have asked my opinion. They could have thought that. But I said it was not necessary. I knew that Amma had a vegetative mitral valve of 14-mm in her heart. If the vegetation is a problem for the heart, that too is a reason (for not performing angiogram). Because the vegetation was atop the valve, the valve's functioning was slightly impaired. Because of the impairment, the quantity of blood that flows to the other organs will reduce. Other than this, there were no impairments in Amma's heart,” he says.
‘20% risk to life’
In response to a question by VK Sasikala's counsel on the risk to Jayalalithaa's life if surgery to remove the vegetative growth were to take place, the doctor said such surgeries always involved a 20% risk to life.
Dr Mathew Samuel Kalarickal says, “I am a doctor, not a surgeon. Despite this, I am somewhere in between ie I provide treatment to those who have blocks in their heart. If someone has a problem in their lungs, the signs of that can be seen on the right side of the heart. When I saw Amma on October 25, it (the medical note) said that she had perforation. This too is something that increases nature of the disease that affected her heart. On the day that Amma was admitted itself, she had acute LV failure (when the left ventricle, one of the four chambers of the heart, is unable to contract normally). When Amma's age and other ailments are taken together, the vegetation in the heart is also to be considered. If Amma's death is heart-related, that (vegetative growth) too is a reason.”
Stating that he did not pay attention to whether Jayalalithaa's kidneys were in good condition, Dr Mathew says that in order to perform an angiogram, the kidney function and creatinine is tested for.
Dr Mathew notes that although the vegetation may not disappear with medication, its growth can be contained with antibiotics. Warning of the risks of surgery, he states, "The vegetation could burst at any time and go to any part of the body."
During cross-examination by the Apollo counsel, the doctor says that Jayalalithaa was given antibiotics for treating septicemia (a blood infection). “The vegetation also stops growing once the antibiotic is given. That's why that treatment was begun,” he says. Apollo Hospitals’ doctors had also told the Commission that the vegetative growth was being controlled by antibiotics.
Noting that the critical care doctors had not reached a decision on performing an angio when his opinion was sought, he said that diastolic dysfunction was normal for diabetic patients.
Reason for death
The doctor notes that on the day he went to Apollo, the doctors who had treated Jayalalithaa gave him a brief of her condition as well as their opinions. “On a file dated November 29, Amma's heart is noted to be operating properly,” he says.
The doctor further points out that despite the ailment a patient has, they either die because their heart or their brain stops functioning. "On file number 3 and 4 from December 5, 2016, it has been mentioned that the reason for the death is ARDS (Acute Respiratory Distress Syndrome), I was not there then. But that too is a reason.”
It was on December 4 that Jayalalithaa suffered a massive cardiac arrest.
“After Amma's heart stopped functioning, the massage, electric shock given to her, the sternotomy done to directly massage her heart and linking to ECMO-- all these are protocol procedures conducted by the hospital,” he explains.
When Sasikala's counsel asked the doctor why Jayalalithaa's heart had stopped functioning despite an AIIMS report on December 4 stating that she was alright, the doctor reasoned that it could be due to a number of diseases in the body acting up.
"It cannot be said that Amma's death is on account of the 14 mm vegetation. This is unlikely. If Amma's heart had not stopped working on December 4, 2016, she could have been discharged. It cannot be said that Amma's heart stopped functioning because an angiogram was not done. The risk of death during and after a surgery at hospital is inbuilt and inherent. An angiogram is to determine closely if there are any blockages in the heart,” he says.