In June of 2015, a 35-year-old Malaysian business consultant named Nur Muhammad Tajrid Zahalan suffered what happens to far too many people, acute pain in his mid-back region. Today, he is a quadriplegic who believes that layer upon layer of Malaysia’s medical fraternity has abandoned him and left him to rebuild his life through his own devices.
In addition, Tajrid – who has filed multiple complaints with both the police and medical governing bodies and made statutory declarations available to Asia Sentinel in a bid to back up his case – charged in an extended interview with Asia Sentinel that the medical profession in Kuala Lumpur is so intertwined that the regulatory agencies to which he appealed have direct connections to the institutions and physicians that caused him his problems in the first place.
It is a disheartening statement on a government –whose prime minister and deputy prime minister are both physicians — that took power in 2016 with a mandate from the voters to clean up both inefficiency and corruption in the bureaucracy that little or nothing appears to be happening.
The Malaysian Medical Council has conducted a three-year investigation into the affair, which took place at Prince Court Medical Centre in Kuala Lumpur, cross-examined 12 doctors and referred charges against four physicians. So far there has been no conclusion to Tajrid’s case.
Tajrid, the subject of a November 20 story in Asia Sentinel, was taken by a friend to the Prince Court Medical Centre in Kuala Lumpur for treatment, where he was initially seen by a physician, Ramesh Kumar, who recommended an MRI and nerve conductivity tests. He was diagnosed as having a slipped disk in the thoracic region and multiple problems in his neck, or cervical region of his spine.
Tajrid says Ramesh told him the entire process to treat these problems would be easy, with a hospital stay of no more than two to three days and that he would be back at work as a director of his own consultancy company, within a fortnight. The physician, Tajrid said, told him he had three options – to live his life in a wheelchair, to hope the pain would go away by itself or to agree to an operation.
Other medical authorities say treatment normally focuses on physiotherapy and exercises to strengthen the back and strengthen the muscles in the area, according to what Tajrid says he learned later. Drugs can relieve the pain and assist in muscle relaxation. If after a period of weeks these conservative treatments don’t work, surgery may be an option to either remove a portion of the disk with a microdiscectomy, or remove the disk and replace it with an artificial one.
Hospital’s lawyers deny culpability
Asked for a response to a long series of questions posed by Tajrid and his associates over what he charged was a botched operation, Lilian Wong, a lawyer with the firm of Shearn Delamore & Co. in Kuala Lumpur, responded: “Our client is precluded by Malaysian law from providing the requested information. Allegations of improper conduct are to be established in the appropriate forum and with the requisite proof.”
Wong threatened a lawsuit against Asia Sentinel, saying “Publication of allegations which are unsupported in fact will give rise to claims in defamation. Kindly refrain from such publication. If Asia Sentinel insists on publishing unsubstantiated allegations against our client despite our client’s objection, kindly publish our client’s objection to the same.” Three physicians involved in the matter have also threatened lawsuits against Asia Sentinel, which stands by its reporting.
In fairness, however, it should be pointed out that – in Malaysia if not elsewhere – medical malpractice is notoriously hard to take to court. Once a consent form is signed, for instance, and the doctor can prove he has told the patient of the risks, he has legally covered himself. Tajrid signed such a form.
“It is unfortunate that Tarjid is in this situation, but medical negligence is a complex field of law, one that I am very familiar with having handled many cases in the past for plaintiffs,” one lawyer told Asia Sentinel. “Of 10 cases, I used to throw out nine. Patients become disgruntled after having to pay lots of money and not getting the results they hoped for. I’m not saying this is what Tarjid is doing but my experience leads to a certain amount of skepticism. On the other hand, there are rogue doctors out there.”
Tarjid alleged he was initially prescribed physiotherapy. However, he said, Kumar abruptly ordered a stop to the treatment. His medical file status, he said, was also changed from intermediate to urgent by the administration staff. Kumar allegedly told him his only option was immediate surgery, which was described as minor and would cost no more than RM 10,000 and he was asked to sign a consent form.
The surgery didn’t go as expected. For unexplained reasons, according to documents provided by Tajrid, the surgeon removed 14 cm of his rib, apparently severing his thoracic nerve. He awoke in severe pain and was hospitalized for six days, he said. He was discharged in a wheelchair, unable to walk.
Still in severe pain, Tarjid said he returned to Prince Court Medical Centre where he was told a simple spinal fusion operation would fix him. He awoke to discover iron rods and screws had been used to replace the disk that had been removed. He was kept in hospital for a week after surgery but was discharged when his insurance cover ran out. He was later to discover that orthopedic surgeon Deepak Singh was listed as one of the participants in the surgery and collected fees from the insurance company although he had not taken part in the operation.
Today, Tajrid and his friends say, his life is dominated by medical treatment, with medication to control muscle spasms, and daily rehabilitation sessions which are often interrupted by periods of illness, infection or depression. In good times he makes progress, he said in the interview, but when the memories of what has happened and the days of waiting for help that does not come overwhelm him, his progress stalls and he starts from square one again.
Multiple doctors have assessed Tajrid’s condition since his operations at Prince Court and evaluated the tests conducted at the time of his admission. The doctors have unanimously concluded that he should not have undergone surgery – that his condition should have been treated conservatively with physiotherapy and drugs. Experienced surgeons have insisted that they would not have resorted to surgery in Tajrid’s case and said they have been shocked by what happened. They are unable to help beyond offering remedial treatment, for which of course he has to pay.
Costs for the procedures at Prince Court reached RM117,000 (US$28,288) and a similar amount has been spent trying to fix the problems including the damage to his nerves. The costs continue to mount, with weekly physio treatment another RM2,000, according to Tajrid and his friend, Geoffrey Williams.
“Ramesh told me if I didn’t do the surgery I would live my life in a wheelchair,” Tajrid recalled in the interview. “Now because of what he did and because he didn’t help the problem in my neck, I have to live my life in a wheelchair. He betrayed me, took my money and refused to help me.”
Complaints Against Hospital
Tajrid says he took his complaints to the chief executive officer of Prince Court, Chong Su-Lin, and the medical director, Kulijt Singh, who is now a member of the Malaysian Medical Council governing council. According to Tajrid they only offered to refer him to a public hospital and refused him any further help.
“What they did made me [disabled] forever,” Tajrid said. “They took RM100,000 from my insurance. I had nothing left to fix what they did to me. I had to wait nearly one year before my insurance allowance to started again. I was in so much pain and no one at Prince Court would help me.”
Tajrid’s pain and mobility problems continued for many months before he was hit with another bombshell from the hospital.
“Instead of helping me, Prince Court summoned me in the court to get more money [around RM17,600] to pay the doctors who did this to me,” Tajrid continued. “Now we know that they already took money from my insurance to pay Deepak when he didn’t do any surgery. He already admitted it in his SD [affidavit] and at MMC. Prudential [Tajrid’s insurance company] confirmed already that they paid them [Prince Court] even though Deepak did not do anything.”
On the day of the hearing of their claim in the Kuala Lumpur High Court in September, Prince Court withdrew their case after forcing Tajrid to attend the hearing in a wheelchair while recovering from spinal cord injury, Tajrid said. The Court denied them leave to sue for payments from Tajrid again and refused them costs for eight lawyers hired to represent them and the doctors, Ramesh Kumar and Deepak Singh. A demand from one of the law firms, Raja, Darryl & Loh, for RM500 for attending the hearing was also refused by the court.
Medical profession has no solutions
Tajrid himself sought other routes to find a solution through the Malaysian Medical Council (MMC) complaints procedure but he says he immediately hit a wall of bureaucracy that appears complicated by close professional and personal relationships.
His complaint against three doctors at Prince Court, Ramesh Kumar, Deepak Singh and Consultant Neurosurgeon Jagdeep Nanra, was assigned to Preliminary Investigation Committee IV (PIC IV) chaired by Victor Lim, a member of the MMC governing Council and a professor at the International Medical University (IMU) in Kuala Lumpur. Two other members of PIC IV, Alexius Delilkan and Kew Siang Tong, are also employed by IMU.
The CEO of International Medical University is Chong Su-Lin, the former CEO at Prince Court during the time of Tajrid’s malpractice claims. A separate MMC complaint filed by Tajrid’s partner on his behalf cited Chong Su-Lin for malpractice. The first committee hearing this case resigned due to accusations of corruption and the second committee has been under investigation by the police and corruption authorities for their handling of the case, according to Tajrid.
Under Malaysian law, if any of the doctors in Tajrid’s claims are found guilty by MMC of practicing without proper consent, Chong Su-Lin could face criminal charges as the manager of the facility in which the malpractice took place.
“Victor Lim is employed by Chong Su-Lin, so is Alexius Delilkan and Kew Siang Tong,” Tajrid said, “How can they be independent? Of course, they will release Ramesh and Deepak otherwise she will be in trouble too. They already let me down by releasing Jagdeep [Jagdeep Nanra, a neurosurgeon at Prince Court accused of malpractice] without even hearing my witnesses against him. I cannot trust them to be honest in my case.”
Tajrid has applied to MMC to have his case reassigned to another committee but MMC has failed to respond. He has also contacted the Malaysian Anti-Corruption Commission with complaints about conflicts of interest at the medical council that has held up adjudication of the case, and has been assigned a case number, indicating the implementation of an investigation.
Inactivity by Health Ministry
Tajrid’s frustration with the handling of his case at MMC was brought to the attention of the new Minister for Health, Dzulkifli Ahmad following the election of the first Pakatan Harapan (PH) government in May 2018.
“We met with Dato’ Seri [Dzulkifli] in Jalan Cenderasari [Health Ministry Office in Kuala Lumpur] and he told us he would help,” Tajrid says. “He said that things will be different under PH but so far he has done nothing, even we keep him up to date through Dr. Ahsan his Pegawai Khas [Special Officer]. I really want him to help me.”
The Director General for Health, Noor Hisham Bin Abdullah, who reports directly to Dzulkifli Ahmad, is President of the MMC Governing Council.
Attempts by Asia Sentinel to reach Dzulkifli and his special officer were unsuccessful.