No doctor should treat a patient with a bag over his head

It has now come to light that the 14 year-old boy who was tortured by Guyana Police officers at the Leonora Police Station was examined by Dr Mahendra Chand, at the Vreed-en-Hoop Police Station on October 29, 2009, shortly after the abuse occurred. Dr Chand is a Government Medical Officer (GMO) and Police Surgeon.

In response to public criticism of his conduct, Dr Chand attempted to defend his actions in a letter published in the Stabroek News on November 14 (‘Allegations about ‘callous indifference’ to tortured teen completely spurious’). Foremost, it must be noted that Dr Chand said in his letter, “I was called out by the police administration to see a patient about ten kilometres away from my home at 6 pm, a time very much outside my normal working hours.”  The supreme duty of a medical doctor is to help save lives whenever called upon. The doctor should view such responsibility as an honour and commitment to civilization, not as a personal favour. Therefore, if Dr Chand truly believes that seeing a patient at 6 pm in the afternoon is acting beyond the call of duty, then he needs to find a new profession.

Dr Chand made the following claims:

1.  He said, “I was presented with the said patient who was naked except for his head which was covered with a bag… the bag was not tightened at the neck with a string and the patient was breathing comfortably.” No doctor worth his salt should ever treat a patient with a bag over the head. His medical training would have emphasized that in performing a medical examination, it is necessary to obtain a complete history from the patient and to perform a comprehensive physical examination. Obviously Dr Chand did neither. Who did he think he was seeing – an animal? As a human concern, why didn’t he demand that the bag be removed?  The fact that the police had the audacity to present him with a patient in this condition should have insulted his sense of human decency and his profession, and signalled possible abuse unless this in his experience was a normal practice. A bag over the head of an injured person in police custody in itself constitutes cruel and inhumane treatment, which under the law Dr Chand is obligated to report to higher authorities. At no time did Dr Chand say that he questioned the patient. Therefore his conclusion that the patient was “breathing comfortably” is speculative and medically tenuous.

2. Dr Chand asserted that “The injured area was exposed and that was solely my concern and focus.” How inhumane and unethical could Dr Chand be? As an doctor, it is his duty to be “concerned” with the holistic welfare of his patient. To abdicate this responsibility is to indulge in callous indifference to human life. For him to publicly admit that a patient in the custody of the Guyana Police Force, which has a sordid history of abuse and torture, who presented with a bag over his head and severe burns on his genitals, warranted no further concern is abominable.  Wasn’t he concerned that the patient may for instance have had other burns on his head which was covered?

3, Dr Chand further said “On examining the area I concluded that the patient was suffering from 1st degree (superficial) burns of the genital area, upper thighs and lower buttocks (5-9%). I did not see any other ‘areas of brutality’ as alleged by the Guyana Human Rights Association (GHRA).” First, Dr Chand who seems here to acknowledge there had been brutality failed to report the abuse. It has been reported that the child suffered at least second degree and possibly third degree burns. He admitted never thoroughly examining the patient, neither did he say he questioned him to determine how he got the injury and how he was feeling. Neither did he state that he checked his temperature or counselled him on how to avoid such injuries in the future. All of this encompasses the responsibility of a medical doctor and is essential to an informed diagnosis and prognosis.

4. Dr Chand further stated that “Nor did I see any signs of dehydration.” How could he have made this determination? Did he ask the patient if he had access to food or water? Did he ask the patient if he was experiencing abdominal pain which may be consistent with dehydration? Did he remove the bag and examine the patient’s face, eyes, lips, mouth, etc, to conclusively determine the absence of dehydration? If he failed to perform these basic medical procedures, how could he conclude that there was no dehydration?

5. Dr Chand also said, “I did mention verbally that the patient should have been carried to the hospital.” What does he mean by “I did mention verbally?” Did he or did he not direct the police to take the child to a hospital? Given the severity of the injuries, and the fact that the patient was in a jail cell and susceptible to further infection, Dr Chand had a professional duty to insist that the patient be taken to a hospital. As a medical professional, he was duty bound to ensure that his medical judgment prevailed over police procedure and inhumane treatment. He had an obligation to contact the police command to inform them of his medical judgment and recommendation. He also had an obligation to announce the patient to the intended hospital and to follow up with that institution to assure the patient’s best possible treatment and care. His contention that “I left the Vreed-en-Hoop Police Station with the assumption that the patient would have been carried to the hospital as soon as it was possible to do so,” is therefore unacceptable and not in keeping with professional protocol.

6. Moreover, Dr Chand stated that “I had a stamped prescription which I had walked with in anticipation of any medication that needed to be prescribed and I did prescribe antibiotics/analgesics and an antiseptic cream.” However at no time did he state that he interviewed the patient. How therefore could he have prescribed medication for a patient without knowing that patient’s name, address, date of birth and whether that patient was allergic to the medication being prescribed?

7. Clearly, if Dr Chand had interviewed the child and ascertained his age and immediately realized that he was a minor, determined that his injuries suggested that he was subject of abuse and that it was inhumane for the police to hold a child with such injuries in a jail cell, much less present him to a doctor with a bag over his head, he was obligated to  report such abuse and cruel treatment to the Police Commissioner.

8. Dr Chand posits in his letter that “I have always treated patients presented to me with care, sensitivity and concern, whether they be ranks from the Guyana Police Force, detainees from the lock-ups or prisoners. I have never ever knowingly or unknowingly encouraged torture, neither have I ever participated in any cover-up.” The facts in this case do not support his contentions about his professional conduct and ethics. CGID endorses the GHRA’s condemnation of Dr Chand, and considers his conduct justifies an investigation as well as a professional peer review.

Yours faithfully,
Rickford Burke
President, Caribbean Guyana Institute
for Democracy (CGID)