75-year-old visits 3 hospitals, dies after confusion over cancer diagnosis in Mumbai

MUMBAI: A 75-year-old security guard battling cancer died on Wednesday morning after facing delays in receiving treatment at Mumbai's Tata Memorial Hospital (TMH) due to multiple reasons. The patient, Rajendra Joshi, couldn't be put on chemotherapy at TMH three days earlier due to an inconclusive diagnosis and the absence of a reliable caregiver to accompany him through the initial side-effects of chemo, said doctors.

Joshi first sought medical attention at KEM Hospital on Feb 20, where doctors suspected hematolymphoid malignancy, a blood-related cancer. Lacking the facilities to treat cancers beyond breast cancer, KEM dean Dr Sangeeta Rawat said the hospital referred him to TMH. However, on his arrival at TMH, doctors requested that he procure biopsy slides and tissue blocks from KEM for a histopathological review before treatment could begin.

His daughter, Kavita Joshi, who had accompanied him on medical visits, said the need for additional biopsy materials was never explicitly communicated to her. According to Dr Lingaraj Nayak, a medical oncologist at TMH, it's standard practice to avoid subjecting patients to repeat biopsies if prior samples exist. "Without reviewing slides, we do not begin chemo based on a provisional diagnosis, as an incorrect treatment could have serious consequences," Dr Nayak said.

Joshi's case grew urgent. On Feb 26, he visited TMH again but was unable to provide the biopsy materials. A PET scan was recommended, suspecting malignancy. Due to long wait times at TMH, doctors advised him to undergo the procedure at the Advanced Centre for Treatment Research and Education in Cancer in Kharghar. The earliest available appointment was on March 6—the day he died.

Joshi's complaints of swollen leg, breathlessness increased. Vikas Bali, chairman of Vijay Tower CHS, Andheri, where he worked, arranged for an evaluation at Seven Hills Hospital. There, he was diagnosed with Non-Hodgkin's Lymphoma. Despite this, when Joshi returned to TMH on March 3, he was again unable to provide biopsy slides from KEM—this time he had an unknown attendant paid for by Bali.

Asked if the hospital could have asked KEM to provide them slides or blocks needed, TMH medical superintendent Dr Sandeep Sawakare said the hospital has no such provisions as in most cases patients are able to bring them to hospital.

It's possible to start a patient on pre-phase chemo without histopathological confirmation. This is a small dose which can be also provided to eldery patients to assess tolerance and improvements. "These treatments carry risks, including severe vomiting.

If there is no one to ensure the patient returns in time for follow-up care, the situation could become life-threatening. The attendant sent was unreliable and said he could not guarantee he would be the one accompanying again," said Dr Manju Sengar, a hemato-oncologist at TMH.

Kavita Joshi maintains she informed hospital staff she would be available by evening of March 3. But TMH doctors say this was not conveyed to them. Dr Sengar said treatment decisions were based on ethical considerations and patient safety. "There is a significant difference in treatment approaches for low-grade and high-grade lymphoma," she said. "We cannot administer chemo without a confirmed histopathological report. These are difficult choices but made in the best interest of the patient."