I have some really alarming developments to share with you.
As some of you may know, the Indian police have a sinister and notorious reputation for killing 'inconvenient' undertrials and prisoners by staging 'encounters' in which the person concerned can be reported as being killed while allegedly attempting to attack the police or escaping from custody. Times without number, these encounters were later revealed to be fake, and the prisoner was simply killed by the police (there is even a video record which an Indian national TV channel once published last year). Yet these encounters have become quite common, and instead of being identified and reviled as state criminals, 'encounter specialists' enjoy a special public cachet now as heroes of the war against terrorism.
I have just received a letter from Binayak's wife Dr. Ilina Sen which makes clear that Binayak fears for his own life. The circumstances are that while the court is considering allowing him to proceed for treatment of his advanced heart condition to a hospital of his choice, in accordance with the law and precedence in the case of another political undertrial in the same state of Chhattisgarh, the police is obstructing his being moved for treatment to Vellore, where Binayak wishes to be treated. It appears from the correspondence released on a Right to Information appeal filed by Ilina, that Dr. Ashish Malhotra, Binayak's cardiologist, has been put under pressure by the police to have Binayak treated locally. The jail authorities have complained that Binayak himself has refused treatment in writing, which is true. But that's only because he does not trust the police to keep him alive while he is in a local hospital under their control , and fears that they may attempt to stage a 'medical encounter'.
Here is Ilina's letter circulated to friends and family, slightly edited for errors of language (obviously it was written in a perfectly justified state of alarm and tension).
How are we expected to repose trust in a state agency that has so many times expressed through its actions utter contempt for any notion of law, order or justice? Murderers and politicians who express hate and violence in speech can be released on bail and parole. But a doctor who has spent almost his entire professional life treating the very poorest of our benighted land, and never thrown a stone in anger, is seen as such a grave threat to public order, that he cannot even be released to seek treatment at a hospital of his choice.
Reflect on this and despair.
I am writing to share some extremely distressing information that has just now come to light. We now have clear proof that the police in Chhattisgarh are actively interfering with Binayak’s need for health care. I will just go over the facts with you.
Binayak, hypertensive for many years, was diagnosed in 2003 with angina upon stress after he underwent cardiac assessment tests with Dr Ashish Malhotra, Raipur’s only doctor with a DM in cardiology, who practices in a private facility. The drug regime that he was on in 2007 and later was suggested by this doctor. He began to feel chest pain upon exercise, tingling in the left arm etc. sometime in Decembr of 2008 and in January-February of this year, when in prison. He informed the prison authorities of this, and when nothing concrete was done about it (the jail hospital anyway has no facilities), he informed the court about this. An application was filed I court on his behalf on 17.2.09, requesting that he be allowed to go for treatment to a properly equipped hospital of his choice, preferably CMC Vellore, citing section 39A of the Prisoners Act of 1894, according to which the jail Superintendent is empowered to send him for treatment to a facility of his choice, subject to the the prisoner or his family executing a bond and abiding by such conditions as the Superintendent may prescribe. On 20.2.09 the judge (11th additional district and sessions judge BS Saluja who is trying the case) ordered the jail authorities to get the opinion of a medical board on Dr Sen’s cardiac condition so that an appropriate decision on his application could be taken.
Binayak was taken to the Raipur district hospital at some time between 20.2 09 and 17.3.09, where the doctors who saw him suggested that he needed an ecg and echocardiography.
On 17.3.09 Binayak complained to the court that no action had been taken on his request for treatment, and was quite emotional when he said that it did not seem to matter to the court whether he lived or died. The judge who had built up this impressive correspondence was equally upset, and I personally met him after the evidence was over and the accused taken back to jail to convince him that a medical situation demanded something more than just creating records. The judge seemed mollified and on the 18th of March, asked Binayak in court which doctor he wished to see in Raipur who could determine whether or not he needed an onward referral to Vellore , and upon Binayak naming Dr Ashish Malhotra, passed an order asking the jail to have Binayak shown to Dr Malhotra in order to obtain a clear opinion about whether such referral for further investigation was needed.
Binayak was shown to Dr Ashish Malhotra on March 25. On the basis of the court order of March 18 the jail superintendent requested the police for providing security guards to take Binayak to see the doctor. Accordingly, an impressive busload of armed police took Binayak to see Dr Malhotra around 10 am, and I got a call from Dr M around 10.30 asking me to go there along with the old records. I proceeded to do this, and thus was present for most of the consultation. On the basis of the letter from the jail superintendent asking for a clear opinion on whether onward referral to CMC Vellore was needed, and on the basis of an ECG, Echocardiograph and treadmill test, he concluded that Binayak had Coronary Artery Disease (CAD), and referred him to VMC Vellore for Angiography for further assessment, to be followed by Angioplasty/ Coronary Artery Bypass Surgery (CABS). I kept a photocopy of the prescription for my own records, since I was asked to pay for the procedure.
I went to see Binayak in prison on the 26th, and to discuss what the modalities of travel to south India would be. I was shocked when the Jail Superintendent said categorically that Binayak would not be investigated/treated in Vellore but in Raipur. Sensing that something was amiss, I put in an application under the RTI act asking to see all the correspondence between the jail and the doctors regarding Binayak’s treatment. It is this last lot of documents that has just come into my hands.
To conclude the treatment story before I come to this, the jail tried on the 31st of March, to take him to Escorts hospital in Raipur , and according to what we had discussed on my last jail visit, Binayak refused in writing to go there, saying that he did not wish to be treated in any facility in Chhattisgarh as directed by the jail superintendent , as he feared that his life might be in danger. This reply of his with a covering note that Binayak was refusing treatment was presented to the court on the 31st itself, seeking further directions. The court referred this to the public prosecutor asking him to file a reply within seven days. To the best of my knowledge, no such reply has been filed so far. Binayak has started on the new medication prescribed by Dr Malhotra (Atorva Statin) and reports some symptomatic relief.
To come now to the results of the RTI, I have now received Dr Malhotra’s original referral letter of the 25th, but also a second letter addresses to the Jail Superintendent, quoting a query from him and dated 26th March, in which he gives his opinion that the facilities for angiography are available in Chhattisgarh in Escorts, Apollo, Bhilai Main hospital, Ramkrishna hospital and two other places. He also writes that he referred Dr Sen to Vellore because the latter asked him for it. The problems with this are as follows:
• Why was this second query sent from the jail to Dr Malhotra ? If the jail superintendent sent such a letter, who was breathing down his neck to do so?
• This clearly constitutes total disregard for the court. The mandate to Dr M as specified by the court was to give a clear opinion about whether referral to Vellore was needed or not. The court did not ask Dr M about the length and breadth of medical facilities in Chhattisgarh.
• Dr M lied when he said that he had referred Binayak to Vellore because the latter asked him to do so. In any case, what conversation he may or may not have had with his patient is supposed to be privileged information.
• If a doctor not in the public sector payroll in anyway can be intimidated to this extent, what is one to say of doctors in Escorts, Apollo etc which are private medical franchises set up in the medical college (great examples of public private partnership, in which all human resources are public, the brand name and the option of onward referral are private)?
• Under these circumstances, Binayak is absolutely right to fear that his life may be in danger in any facility controlled by the state in Chhattisgarh.
In fact I am now worried that as Plan A of the police / prosecution (discredit Binayak and convict him in the legal case) shows signs of coming apart, they are now trying to resort to Plan B ( bump him off while in hospital in Chhattisgarh by just asking someone to inject air into an IV drip, for example).
I would like to appeal to all friends to ensure Binayak’s physical safety, publicize this matter, write about it, perhaps appeal to higher courts/political leaders. It is urgent.
I want to end by saying that what we are asking for - treatment at a hospital of choice - is not unknown in Indian judicial history. In fact even from Raipur Central Jail, the Shivsena leader Dhananjay Singh Parihar, in jail on a charge of murder, was sent at state expense to KEM hospital Mumbai, Shankar Netralaya, Chennai and three other hospitals for an assortment of ailments in 2003 . The police would like to portray Binayak as the biggest internal security threat they perceive. Are we going to let them get away with this ?
UPDATE OF 212 APRIL 4.35 PM ISTANBUL TIME
I have just learnt from Ilina that Dr. Malhotra has confirmed to Mr. Shailesh Pandey of ETV what Ilina was apprehending in her later. ETV will run the story tomorrow in detail. The police did indeed pay the cardiologist a visit, and "persuaded" him to send the jail authorities or the court a letter detailing that local facilities for Binayak's treatment were available.
But the availability of treatment is not really the issue here. As my younger brother Dipankar has already pointed in an e-mail broadcast: Nobody, but nobody, in his right mind, above all a doctor, would surrender his life to his jailors on an operating table. So, EVEN if Dr. Sen asked to be referred to Vellore he is:
d) there is a precedence of a prisoner being able to choose his doctor, and furthermore
e) the law allows it.