OBJECTIONS ON MUSHARRAF MEDICAL REPORT

پرویزمشرف کی میڈیکل رپورٹ پر اعتراضات

پرویزمشرف کےخلاف سنگین غداری کامقدمہ چلانے کےلیے بنائی گئی خصوصی عدالت نے پرویزمشرف کےقابل ضمانت وارنٹ گرفتاری کرتےہوئےانہیں سات فروری کوپیش ہونے کاحکم دیاہے ۔سابق صدر کی میڈیکل رپورٹ عدالت میں پیش کی گئی تواس پر پراسیکیوٹرنےتیرہ اعتراضات داخل کیے جن کی بناپر مشرف کی رپورٹ پربددیانتی پرمبنی قراردیاگیا یہ اعتراضات کیا تھے اس کی تفصیل آپ نیچے پڑھ سکتے ہیں

Before the Hon’ble Special Court, Islamabad

Established under the Criminal Law Amendment

(Special Court) Act 1976

Misc. Application No. ___________ / 2014

In

Complaint No. 01 / 2013

Federal Government of Pakistan

Versus

General (R) Pervez Musharraf

OBJECTION TO MEDICAL REPORT DATED 24.01.2014  IN RESPECT OF ACCUSED, ON BEHALF OF PROSECUTION

Respectfully Stated:

PRELIMINARY SUBMISSION:

1.    That this Honourable Special Court vide its order dated 16^th of January, 2014, directed the constitution of a Medical Board comprising of senior doctors of Armed Forces Institute of Cardiology (AFIC). It is pertinent to note here that the purpose of constituting this Medical Board was to verify the state of health of the Accused in light of his continuous non-appearance before this Special Court.

2.    That this Honourable Special Court further, framed following specific questions for the Medical Board which are reproduced as under:

i)             How precarious is the health condition of the accused which restricts his movement so as to prevent him from attending the Court?

ii)            Has the accused undergone any surgery or other medical procedure during his stay in the hospital or any surgery or medical procedure is planned to be undertaken during his hospitalization?

iii)          For how long the accused has been advised for further hospitalization?

3.    That pursuant to order dated 16^th of January, 2014, the Medical Board so constituted has submitted a self-styled report to which the Prosecution takes the following Objections as under:

OBJECTIONS:

a)   That the instant medical report, with respect to any outcomes, is virtually a duplication of the previous medical report dated 7^th of January, 2014, which had concluded in its paragraph 7 as under:

“Coronary Angiography is required to optimize the management and to ascertain the possibility of further interventions, like coronary artery bypass surgery”.

The findings on 7^th of January, 2014, were that a diagnostic test (Coronary angiography) is required to conclusively ascertain the condition of the Accused and the finding in current medical report dated 24^th of January, 2014, in its paragraph 3 (a) are as under:

“A coronary angiogram is required urgently to ascertain the need for further interventions like coronary artery bypass graft surgery, to optimize the management”

b)    That the medical report reveals that no further tests have been carried out on the Accused, since the submission of the last medical report. That the previous report revealed that a multislice CT coronary angiography was done which revealed:

“5 (a). densely calcific triple vessel coronary artery disease including left main stem disease”.

In the present report which has been submitted after a gap of sixteen days the same diagnosis is reiterated in paragraph 2 (d), that:

“his multi-slice CT coronary angiogram has revealed densely calcific triple vessel coronary disease including left main stem  disease. The presence of disease in the left main stem is of grave concern due to its very location, as detailed in Annex A.”

That in the instant report the Board has come to an entirely new conclusion on the same data as before that this disease is of “grave concern”. That if such a grave concern was present as is alleged, then the question arises as to why this concern was not either shown in the first report or why no further diagnostic testing been carried out.

The report also has not suggested any aggressive management of the disease, which shockingly suggests absence of any cardiac ailment.

c)   That the findings of the medical report are inconclusive and deliberately vague. The report discloses no reasons as to why a patient of such a disease needs constant hospitalization since 2^nd of January, 2014, especially without any progress in his clinical evaluation or management. There are non invasive procedures like E.T.T and thalium scan which are biblically performed before considering the invasive test of Angiogram.

d)   The medical report is unsatisfactory and does not even come close to addressing any of the questions, which the Board was bound to answer in terms of order dated 16^th of January, 2014. It is neither a rational nor a befitting reply to the queries of this Honourable Special Court. As such this Honourable Special Court does not gain anything from this second medical report, rather the time of the learned Special Court has recklessly been wasted at the cost of reputation of our premier institution of cardiac disease. The report does not proceed on any basis suggesting of existence or occurring of the disease during all this time of hospitalization.

e)   The instant medical report has come to an erroneous conclusion regarding the state of health of the Accused. Dr. Ismail Bokhari, MD, an internationally known cardiologist from U.S has, on the basis of the two medical reports, opined as under:

“I reviewed the report on General Pervaiz Musharraf very carefully.  He was presented with chest discomfort with prior history of left shoulder disease and cervical spine disease.  No history of hypertension, diabetes and no prior history of precipitating or relieving factors for chest pain.  His cardiac examination was perfectly normal, heart rate was described at 56 beats/min, which is normal (it was described as sinus bradycardia).  The electrocardiogram and cardiac enzymes were normal.  Echocardiogram is normal, has good ejection fraction, which is most important predictor for good prognosis.  Cardiac CT angiography shows calcifications, no impressive lumen narrowing, especially in the left mainstem.  CT angiogram narrowing is usually less severe on actual coronary angiography.  With this information, on routine practice, patient needs stress test before recommending coronary angiography.  High calcium score without lumen narrowing is not an indication for coronary angiography.  This patient is in the hospital since January 2nd, 2014, and continues to have normal electrocardiograms and cardiac biomarkers.  Chance for serious cardiac disease is very low.  His chest discomfort mostly likely is from cervical spine and shoulder disease.  In my opinion, he is low risk for any serious cardiac event at this time.”

f)     That the medical report refers to the previous report dated 7 January 2014 as being a “detailed medical report on his health status” which is precisely what that report was not. In fact, it was due to the previous report having serious gaps, that this Honourable Special Court sought it appropriate to give the Medical Board precise questions or terms of reference, which have despite these explicit queries remained un-heeded even now.

g)   That such a long hospitalization when no diagnostic process has to be carried out is against the established norms of medical rules. That even in serious cardiovascular interventions, subject to appropriate treatment, the patients are not hospitalized for such an extended period of time.

h)   That it appears that AFIC’s management has housed an unwilling patient who does not even trust the esteemed cardiac center’s expertise in carrying out a relatively common and a routine investigative test performed on millions of patients by the ‘State of the Art facility’.

i)     That the report by a Medical Board comprising of four senior doctors should have contained a factual analysis of the Accused’s disease. Instead the report contains conjectures and hypothetical situations, which are inapplicable to the accused and as such does not deserve a serious consideration.

j)      That there is no place in a medical report of reproducing statements or opinion of the Accused. (see Paragraph 3 (b)).

k)   That the report is inconclusive and makes attempts to thwart the judicial process by urging the Special Court to come to a decision regarding further procedures/interventions without expressing as to whether the pre-requisite tests prior to angiogram have been performed, indicating the necessarily for the same.

l)     That without prejudice to the other objections, even if the Accused needs medical supervision that does not render him unable to make attendance before this Special Court.

m)  That it is now manifest that the Accused is prolonging stay in hospital in order to evade the judicial process. That as per orders of this Special Court dated 16 January 2014, the Special Court was faced with two options, either to presume that the Accused is avoiding to appear before this Court or to verify the state of his health. That the second option was exercised and exhausted, hence resulting in what was a presumption having crystallized into a fact, which is, that the Accused is avoiding appearance before this Special Court.

That in light of the above objections, including the reference of global procedures, this Special Court may kindly pass appropriate orders for the attendance of the Accused as per the mandate of law.

(Mohammad Akram Sheikh)

Prosecutor - Sr. Advocate Supreme Court

On Behalf of the Federal Government