Renuka Ramnanan was diagnosed with early-stage breast cancer in late December 2008.
She was 52 years old. Within weeks, she had gone under the knife to remove a lump from her left breast.
She started chemotherapy soon after, completing an aggressive round of chemo treatment in May of 2009. It was tough going; the chemotherapy made her ill a lot of the time — side-effects of nausea, high fevers and hair loss.
With the support of her husband and two children, Renuka battled her breast cancer, willing her body to get stronger for the next round of treatment — radiotherapy.
On June 23, 2009, she received her first dose of radiation therapy administered by a linear accelerator, or Linac machine, which delivers high-energy radiation rays at the tumour, minimising damage to nearby healthy tissue and reducing side-effects.
Att the beginning of July 2009, Renuka suffered terrible pain in her radiated breast, blisters and burning and peeling of the skin. She couldn’t wear a bra and the slightest touch – even the gauze dressing and ointment recommended for her treatment caused pain and extreme discomfort.
She was one of the 223 patients identified last week by Health Minister Dr Fuad Khan as receving higher doses of radiation from the Brian Lara Cancer Treatment Centre (BLCTC) in Port of Spain.
The BLCTC where she was being treated told her she had sensitive skin. By the time her radiotherapy treatment at BLCTC ended on July 20, 2009, Renuka said she noticed a hardening of her left breast and skin discolouration. She attributed the slight hardening of tissue and skin discolouration to the expected side-effects of radiation.
But as the months went by, her breast hardened and the discolouration of skin grew. Three months after her last radiation treatment, Renuka returned to BLCTC for a follow-up visit. She saw Dr Kavi Capildeo, who asked whether she had been contacted by the BLCTC, which is owned and operated by Medcorp Ltd.
Not following his line of questioning, she asked him to explain. “He told me I had been identified as one of the patients who had received an average of 12 per cent more radiation than had been prescribed for me,” she told the Express, in an interview last week.
Stunned by the news that she had received more radiation than had been prescribed in her treatment plan, she asked for a “how” and “why this could happen” explanation.
Dr Capildeo advised her to talk to the centre’s oncologist, Dr Peter Bovell.
Bovell saw her and her daughter Nesha on November 3, 2009. Scared, worried and angry that no one from BLCTC had taken the trouble to tell her that she had been given an excessive dose of radiation, Renuka said she asked for an explanation.
Nesha said Bovell was rude and dismissive of their concerns, asking: “So what is the problem?”
He told the two women that there was nothing to worry about and that while Renuka had received more radiation than had been prescribed for her in her treatment plan, it was within “the acceptable range”.
Nesha said she asked for copies of her mother’s medical records and was stonewalled by Dr Bovell, who, after initially agreeing to make them available, asked that she return the next day.
She received a single page correspondence from the centre signed by Dr Bovell. In it, he indicated that she was treated to 47.92 Gy instead of 42.56 Gy in 16 daily fractions to her left breast and pointed her to the guidelines for tissue tolerances following external beam radiation therapy. According to Dr Bovell, the radiation overdose administered to Renuka was within the “conventional fractionation”.
On January 26, 2011, Renuka was examined by former BLCTC oncologist Dr Anesa Ahamad at Mount Hope Hospital who, in a referral letter to Dr Ahamad Rahman for recommended hyperbaric treatment noted that Renuka was “having a great deal of discomfort in the chest wall and breast with fibrosis, hyper pigmentation and inflammation.”
The Dr Ahamad referral letter clarified the magnitude of the radiation overdose this way: “The medical record that she has been given quoted a reference by Emami which is from pre-3D conformal era and this is no longer the reference standard. The information relates to conventional fractionation which does not apply here because conventional is radiation given at 2Gy per fraction. She received 2.995 Gy per fraction.”
Dr Ahamad said that: “The equivalent dose or radiotherapy is worked out using a linear quadratic equation that considers biological effect of higher dose per fraction. She was given a biologically equivalent overdose to the whole breast of 19.7 per cent.”
Renuka subsequently wrote to BLCTC asking for a full refund of the more than $120,000 spent for the cost of her treatment, compensation for her damaged breast and an acceptance of liability for all expenses for any medical complication arising from the radiation overdose administered by the centre.
She received a terse response from Dr Dinesh Mor, chairman of BLCTC, who reiterated the points made by Dr Bovell.
The Mor letter, dated February 2011 notes in part: “Sometimes, as with any medical treatment, there are possible side-effects that may occur with radiation treatment as a normal consequence of the actual radiation given, even thought the level of radiation dose administered is below the level of toxic intolerance as defined by the Emami Charts.”
Dr Mor concluded: “We are therefore unable to consider the three options stated in your letter. However, we do offer to continue to see you in follow-up gratis and to advise you as to the most appropriate course of action to take in an effort to assuage and mitigate the symptoms that you are complaining of.”
Renuka said she heard nothing from BLCTC until a week ago when a nurse called to enquire how she was doing. That phone call came after the Express newspapers spoke to doctors Bovell and Mor.
Also, the Ministry of Health has issued a Charter of Patients’ Rights and access to their medical record is a right of all patients in Trinidad and Tobago, whether in the public or private sector.
Point 14 of the Patients’ Rights charter says this: “You or your authorised representative have the right to access a copy of your records.” (Trinidad Express)
