Wockhardt Hospitals Blog

Dr. Latha Venkataram specially qualified and trained in OBG and Medicine, has an extensive experience in Medical disorders in Pregnancy (high risk) both in United Kingdom and Bangalore, India. She is currently the senior OBGYN specialist and Chief Co-coordinator, Department of OBGYN, Wockhardt Hospital, Bangalore.

She has held many executive posts including President, Bangalore Society of OBGyn and she is presently the secretary for Bangalore RCOG trust.

She is associated with several organizations both rural and urban projects promoting quality care, targeting Maternal Mortality. She is actively involved in establishing the efficacy of Yoga and other Alternate systems of medicine in the treatment of OBGyn related problems. She has to her credit papers published in International indexed journals. Currently she is guiding Doctoral candidates in the field of Yoga and pregnancy.

She has special interest in Obstetric intensive care and emergency Obstetric care and has treated many patients who are critically ill. Her main interest in the field of Gynaecology is vaginal surgeries and has skill and experience in removing large Uteri vaginally.

Wockhardt Hospitals, Kalyan successfully performed a revolutionary minimally invasive spine surgery - Percutaneous Endoscopic Lumbar Discectomy (PELD) on a 49-year-old man suffering from severe backache.

Truly a minimally invasive spinal surgery, the procedure known as PELD was performed with a single 0.6 cm incision using a technically evolved Yeung endoscopic spine system (YESS) method under local anaesthesia. The PELD Technique is known to be an innovative spine procedure that can help appropriately screened patients recover faster without scars or stitches and more importantly, helps patients walk immediately after the procedure without any pain.

The patient, Sunil Ghag, was suffering from acute back pain as a result of prolapsed inter-vertebral disc, more commonly known as slipped disc. With the severity of the pain only increasing with time, conservative treatment with non-steroidal anti-inflammatory drugs (NSAID) and intermittent pelvic tractions was of little help, forcing him to seek surgical intervention.

An MRI confirmed the prolapsed disc, revealing disc degeneration. "The patient had two options," recalls Dr Vikas Gupte, consultant spine surgeon, Wockhardt Hospitals. "He could either opt for the conventional open discectomy, or the minimally invasive PELD under local anaesthesia." The patient was convinced about going for it as the chances of root injuries were minimal with PELD, promising immediate normalcy and discharge from the hospital.

As Dr Gupte explains, "In the PELD procedure, the patient is made to lie prone on a special operation table and the exact entry point is mapped on the patient's body using image intensifier x-ray system. A long spinal needle is then passed from the side of the back which goes into the disc directly by-passing other bone and ligaments. Through this needle, a guide wire is passed and after making a 6mm incision under local anaesthesia, a dilator and working cannula are passed through the incision. The camera and the monitor are attached to an endoscope that is passed through the incision and the prolapsed part of disc is removed under vision. Advanced instruments like radio-frequency and laser machine are used for such surgery. The surgery lasted for 40 minutes and the wound was closed with a single stitch."

Dr Deepu Banerjee, Neurosurgeon, Wockhardt Hospitals points out that the instrumentation using YESS technique consists of a 6 mm scope that facilitates direct view of the disc fragments in the spine thus minimizing muscle, ligament and tissue damage, while alleviating chances of nerve root injury. "Even the nerve roots are clearly visible through the powerful camera of the Yeung endoscope," he added.

Post-op, the patient was able to walk without any pain and was discharged after 24 hours. According to experts, PELD with YESS technique is the ultimate form of minimal invasive spine surgery in appropriately screened patients.

This Post is in response in connection with the story of Rashmi BT's experience at Wockhardt hospitals. While we are firmly behind her at this time of extreme grief as an institution we thought it appropriate to bring it to the public domain our version of the real story at wockhardt Hospitals and what we believe actually happened The below post gives you the complete details of the case and the facts have been clearly explained down before everyone

However in case anyone of you does not have the time to go through the same in detail we would like to let you know that Wockhardt Hospitals had followed all the necessary medical protocols that any reputed institution across the globe would have followed. We have always tried to question the limits to which medical science can progress and have been also largely responsible for the positive changes that the Indian healthcare industry has been witnessing in recent years. It is but unfortunate that certain risks in medicine cannot be completely mitigated how much ever one might strive.

Please do read our version and if you find it convincing forward the same to whoever you might think appropriate.

Reputations take a lifetime to build, is it right to destroy them without understanding true facts and make a hospital and its doctors look inhuman?


Ms. Rashmi B.T. was under the care of a senior gynaecologist in Bangalore for her second pregnancy. She made a conscious decision to shift under Dr. Latha Venkatram’s care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an option and wanted to select that option for her second delivery. She had collected information that Dr. Latha Venkatram was one of the senior gynecologists in the city who offered this option to her patients. From the OPD records filed by Dr Latha Venkatram it is evident that Rashmi was counseled and given ample information about the procedure and the risks associated with it and she took an informed choice to select this procedure.

Vaginal Birth after Caesarian Section (VBAC) is the term used when a woman gives birth vaginally, having had a caesarian delivery in the past. Worldwide VBAC, if possible, is being recommended and preferred over repeat C-Sections as its advantages substantially outweigh the disadvantages. According to the Royal College of Obstetricians and Gynaecologists patient information guideline 2008 “Birth after previous Caesarian Section”, overall three out of four women with an uncomplicated pregnancy would give birth vaginally following one caesarian section delivery. The short-term and long term complications inherent in a C-Section make it preferable that a woman is offered the choice of a VBAC. The US Federal Government in its healthy people report 2010 proposed a target for VBAC of 37%.
Repeat Caesarian Sections are associated with:

o A possibly more difficult operation
o Longer recovery period
o Possibility of injury to bladder or bowel
o Possibility of blood clots developing in legs and pulmonary thrombosis
o Breathing problems for the baby. Higher in C-Section than in VBAC
o Serious risks increase with every Caesarian delivery
o Higher chance of infection
o Future complications for the mother who has had repeated opening of the abdomen
o Higher costs

VBAC has a shorter stay in the hospital, faster recovery as well as lower cost for the patient. There is a risk of uterine rupture but this risk is approximately 0.5%. In spite of this risk the benefits of VBAC far outweigh the risks.

As in all medical procedures there is no way to predict which patient would fall under the 0.5% risk of uterine rupture or any way by which this rupture can be prevented. A VBAC delivery is more demanding of the gynaecologist, as it takes 6-8 hours as compared to a C-Section, which in a planned fashion would be over in less than 40-45 minutes. Also the mother and child need close monitoring it is estimated that one will have to do as many as 200+ unnecessary C-Sections to prevent the occurrence of 1 uterine rupture. In most cases a uterine rupture is not fatal. However in the best interest of Ms Rashmi, Latha Venkatram gave her both the choices and Ms Rashmi chose to opt for the VBAC option.

Ms. Rashmi B.T. was a fit candidate for a VBAC. She had a breech presentation (where the legs of the baby present itself first instead of the head at the time of delivery) in the earlier pregnancy which required a C-Section. A breech presentation in the earlier pregnancy which necessitated a C-Section is in fact an indication to offer a VBAC to the patient in the subsequent pregnancies.

An age of 35 is not a contraindication to a VBAC. The fact that she was 5 days past her due date was also not a contraindication to a VBAC because less than 5% of patients deliver on their due date.

During her antenatal visits to Dr. Latha Venkatram, Ms Rashmi B.T. was explained in detail about the pros and cons of VBAC and she agreed to undergo the procedure. The OPD case records have these notations. She was also clearly informed by Dr. Latha Venkatraman that she works along with Dr. Prabha Ramakrishna as a team and either of them would be present during her delivery. Doctors particularly in the area of obstetrics frequently prefer to work as a team since many times an emergency may hold one of them which would make it possible for the other team member to attend to the delivery as the date and time of delivery cannot be predicted. In a VBAC considering that a consultant needs to be around for most of the labor period it is prudent that a team takes care of the patient. Both Consultants of the team Dr. Latha Venkatram and Dr. Prabha Ramakrishna are Fellows and Members of the Royal College of Obstetricians UK respectively.

Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. She was connected to monitors for a close monitoring of both maternal and fetal parameters. She was visited by Dr. Latha Venkatram soon after admission. An experienced nurse and a fully qualified gynaecology registrar were monitoring her constantly. The Consultant Dr. Prabha Ramakrishna was also available on the same floor and repeatedly examined her. She was kept informed about the progress of the labour.

The labour progressed normally until 1.50 p.m when a sudden decrease in the fetal heart rate was noted (fetal bradycardia). The tracings before 1.50 p.m were normal. The moment fetal bradycardia occurred, the consultant Dr. Prabha Ramakrishna who was on the same floor was called in by the gynecology registrar. When Dr. Prabha Ramkrishna examined Ms Rashmi, the baby’s head position was a little high. She was asked to push to see if the baby’s head would come to +2 position in which case she could do a forceps in the labor room itself and deliver the child. When the baby’s head did not descend as required she asked for the patient to be shifted to the Operating room. After this Ms.Rashmi was not asked to bear down any further.

Shift to the OT was rapid since the dedicated Operation Theatre for Caesarian sections is situated within the labour room complex and this theatre is not used for any other procedure. Within 7-8 mins the patient was in the theatre. The anesthetist had a choice of going in for an emergency general anesthesia which has inherent risks for a pregnant woman or to go in for epidural anesthesia. Since the patient was already receiving pain medication (epidural analgesia) it was decided that for the safety of the mother increasing this analgesia to achieve anesthesia was the preferred option. In the OT the fetal heart rate was recorded as 180 b.p.m on the Doppler. On the OT table an examination was done and it was found that the head had receded and a forceps delivery was not attempted. An immediate emergency C-section was then performed.

The anesthetists, Neo-natologists and the surgical nursing team had assembled in the theatre within a few minutes of the emergency being declared. The hospital has full- time anesthetists, Neo-natologists and a surgical nursing team working round the clock to attend to all kinds of medical emergencies.

At the time of birth the baby did not have a heart beat or respiration. Resuscitation was started and the heart beat started about half a minute later. The child was immediately shifted to the Neonatal ICU and put on the ventilator. The baby’s weight at birth has been recorded in the NICU as about 3 Kg. The only reason an exact weight could not be taken in the NICU was that the child was already attached to various lifesaving equipments and the neonatologist had to make the closest estimate. However it must be noted here that a birth weight of 4 Kg is not a contraindication for a VBAC.

In the neonatal ICU the clinical team met the family on a daily basis and kept them informed about the status of the baby and the prognosis. The poor prognosis was explained to the parents on the 2nd day itself. An opinion from an external eminent neonatologist was also sought who concurred with the poor prognosis. All decisions regarding further care were made only after extensive discussions with the parents of the baby. Dr.Prakash Vemgal our Neo-natologist is not only highly experienced but has also gone through some of the highest training in Neo- natology in high patient volume and reputed international centres.

The doctors and the management (including senior management personnel) of the Wockhardt Hospitals group spent long hours with the parents understanding and trying to address their concerns. As is the normal practice in such a case a complete internal review was done. The family sent to us a detailed list of areas they wanted us to look into during our investigation. We did go into each of these areas and sent them a detailed reply addressing most of these issues including taking the opinion of two leading and senior external gynecologists of the city who do substantial VBAC work. It is unfortunate to note that inspite of providing her all clarifications Ms Rashmi has been projecting an extremely poor image of Dr. Latha Venkatram and the hospital.

Our internal review involved discussions with our own team of gynaecologists, meetings with two external gynaecologists who practice VBAC and the entire clinical care team. Our findings after this detailed internal review are summarized below.

a. Ms Rashmi BT was a fit candidate for a VBAC. She would have been offered this procedure as a first choice by any gynecologist or hospital which practices advanced obstetrics anywhere in the world. Her age or the week of pregnancy were not contraindications to go in for a VBAC.
b. She had made a conscious and informed decision about going in for a VBAC. She had changed her senior gynecologist whom she was consulting until the 35th week of her pregnancy primarily because that gynaecologist was not in a position to offer VBAC.
c. The OPD case notes of which she was given the duplicate copy recorded that she was willing for VBAC and she was informed about all risks of her decision.
d. Both the mother and the child had been monitored carefully right through the labour
e. All medications used for progressing labor were prescribed agents and safe for use in VBAC
f. She did have a uterine rupture which in VBAC carries a risk of 0.5%. This rupture could in no way be predicted or prevented. In spite of the rupture the gynecology team was able to save the uterus for future child bearing.
g. The Operation theatre was ready at the time it was required.
h. All the staff were present in the Operation Theatre within a few minutes of the emergency being declared
i. While the baby was in the NICU Dr.Prakash Vemgal the head of Neo-Natology met up with the parents at regular intervals and kept the family clearly informed about the status and prognosis. All major decisions were taken only after discussion with the parents.
j. Senior management of the organization met up with the family on multiple occasions to understand and address their concerns

A minute by minute account of her story as is being spread through the various emails circulated by various people who were neither physically present during her admission to the hospital nor were involved in her care process exhibits to us a determined effort to harm the reputation of the gynecologist and the hospital without having any understanding of the clinical facts of the case.

Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?

We do understand the pain and suffering of Ms Rashmi BT. As a hospital every life is precious to us but we are also are in the world of medicine where unfortunate rare complications can be counteracted but every procedure cannot be made risk free. There are many lives which we save each day when all has been given up and each such case teaches us that to pursue medicine is to pursue the limits of the unknown but does that mean that we become victims of public misinformation

We have taken all necessary care and followed every medical protocol that any reputed institution across the globe would have followed. However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails to use a redressal system that is purposely harming the reputation of Dr Latha Venkatram, Dr.Prabha Ramakrisha and our institution.We will not stand to be mute spectators to this form of intentional disreputation.

The case can be subjected to analysis by any competent authority.

According to a recent editorial in New York times "Overseas Under the Knife" Wockhardt Hospitals has been featured as one of the alternative medical tourism destinations abroad. Commenting on the rising healthcare cost coupled with the long waiting times for critical procedures and surgeries,It lists Indian Hospitals as one of the most traveled destinations by US patients

"One consequence of the high cost of medical care in the United States has been the rise of medical tourism. Every year, thousands of Americans undergo surgery in other countries because the allure of good care at half the price is too good to pass up.

"Average total fees at well-regarded hospitals like Apollo and Wockhardt in India are 60 percent to 90 percent lower than those of the average American hospital, according to a 2007 study by the consulting group Mercer Health and Benefits (where Dr. Milstein is affiliated). Even compared with low-cost American hospitals, the offshore fees are 20 percent to 50 percent lower"

Typically, they are people who have either no health insurance or meager coverage. Though not poor enough to qualify for Medicaid, they cannot afford a good health plan. But lately, even some people with good coverage have been encouraged to take advantage of cost savings abroad.

A few pioneering American insurers like Blue Cross Blue Shield of South Carolina and self-insured employers like the Hannaford Brothers supermarket chain sent American doctors to evaluate foreign hospitals. Favorably impressed, they now offer payment for travel expenses and cash incentives as high as $10,000 for choosing offshore hospitals.

For very costly operations like open heart surgery or hip joint replacement, savings far exceed these payments. That is not to say that offshore surgery could substantially lower health care costs. Less than 2 percent of spending by American health insurers goes to the kind of non-urgent procedures that Americans seek overseas. "

Read the full story here

69 year old Mr. Ramgopal Mundhra who underwent bilateral knee replacement at Wockhardt Hospitals 10 months ago, completed 5 kilometer Majja Run in the recently concluded Bangalore Marathon. Mr. Mundhra, a businessman from Bangalore, was suffering from pain in both his knees for the past 20 years and in the last two years had lost complete mobility and was unable to even complete the simple chores of daily life without assistance.

Mr. Mundhra consulted Dr. Sanjay Pai, Consultant Orthopedic Surgeon Wockhardt Hospitals and was diagnosed with Osteoarthritis in both his Knees and was advised to undergo a total knee replacement. He underwent bilateral knee replacement within a span 2 days, post which he went through a comprehensive rehabilitation program. His recovery was remarkable and at the time of his discharge he was able to walk with the help of a walker. Not only this Mr. Mundhra started driving on the 5th week of his surgery and on the 6th week he was able to swim.

Addressing the media Dr. Sanjay Pai, Consultant Orthopedic Surgeon, Wockhardt Hospitals said “Mr. Mundhra stands out as an example to all who are apprehensive of undergoing knee replacements. Osteoarthritis is the degradation and degeneration of the cartilage in the knee. As the disease progresses the cartilage becomes thinner and even in some wears away altogether, necessitating total knee replacement. The surgery greatly improves the quality of life for patients who are in the advanced stage of the disease. The procedure is extremely safe with a high success rate and patients can get back to living a normal life with only a short recovery period”

“Forget the run; I never expected to walk a few steps on my own. The pain which I have gone through over the last two years was crippling. Thanks to the doctors at Wockhardt Hospitals, who reassured me and dispelled my fears of undergoing surgery. I can now run again and I am looking forward to the next marathon in 2010, who knows I may participate in the 10K run” said an overjoyed Mr. Ramgopal Mundhra.

According to Mr. Joseph Pasangha, Head of Physiotherapy, Wockhardt Hospitals, “Mr. Mundhra’s case shows the importance of proper rehabilitative care post surgeries. With proper training and a comprehensive rehabilitative program there can be immense improvement in a person’s quality of life post a surgery. The patient’s attitude goes a long way in speeding up the recovery. Mr. Mundhra is a very positive person and he is always ready to take up a challenge. Faced with adversity he came out smiling.”

He ran 5 kilometers during the Bangalore Marathon on 31st of May 2009 without any hitch, displaying the benefits of bilateral knee replacements and dispelling the fears and myths around total knee replacements.

The Wockhardt Hospitals Bone and Joint Care is equipped to treat all types of musculo-skeletal problems ranging from Trauma Surgery to Minimally Invasive Arthroscopy Surgery. The hospital also specilalises in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation. Wockhardt Bone & Joint Care has complete technology and advanced skills to perform Microscopic Lumber & Cervical Discectomy, Endoscopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decom-pression in the shoulder.

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Our Bone and Joint care at Mumbai and Bangalore has been a center of ,excellence in Joint Replacements and Orthopedic Treatments.Our Bangalore and Mumbai centers are equipped to treat all types of muscular-skeletal problems ranging from Orthopedic Trauma Surgery to Minimally Invasive Arthroscopic Surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation.

Wockhardt Hospitals Bone & Joint Care has complete technology and advanced skills to perform Microscopic Lumber & Cervical Discectomy, Endo-scopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decompression in the shoulder.

1)We were the first hospital chain in Western India to perform Hip Resurfacing or Surface Replacement

2)We are the first hospital in India to perform mobile bearing Hi-flex Uni Knees (Half Knee Replacement )

3) Wockhardt Hospital was among the first Hospital to have performed India's first bilateral knee replacement surgery. In a bilateral knee replacement, both the knees are replaced in the same surgery which is performed on the same day.

4)We are Credited performing the largest number of "tissue preserving joint replacement surgeries".This is a technique where by making a superior incision, rather than a posterior incision, neither the posterior hip capsule, nor the gluteus medius or minimus are dissected. This results in improved post-operative results in the form of less dislocations and better healing.


to schedule an appointment with our Bone and Care doctors,please email us at enquiries@wockhardthospitals.net