Friday, 17-Sep-2004 5:16 PM

BACKGROUND INFORMATION TO THE ANWAR IBRAHIM HEALTH PROBLEM

In November 2000, Anwar Ibrahim was admitted into the Kuala Lumpur Hospital (HKL) due to a spinal injury. Prior to that, Anwar was made to shuttle daily between the Sungai Buloh Prison and the HKL. After almost a month, when his condition did not improve, but was in fact getting worse, the government doctors insisted that Anwar be admitted into hospital for proper medical treatment. Clearly, the outpatient treatment and the daily shuttling to and from hospital were doing more harm than good.

At first the prison authorities did not agree to this, but then, when the hospital declared that the prison would have to bear responsibility in the event Anwar becomes paralysed, the prison had no choice but to reluctantly agree to Anwar being admitted into hospital.

The Malaysian government is denying Anwar Ibrahim the right to medical treatment of his choice

Anwar may be a prisoner. However, this does not mean Anwar no longer has any rights. Medical treatment is not a privilege but a right. And being a prisoner does not mean Anwar loses that right.

According to the United Nations Resolution 45/111, “Basic Principles for the Treatment of Prisoners”, adopted and proclaimed by the United Nations General Assembly on 14 December 1990 it states that:

1. All prisoners shall be treated with the respect due to their inherent dignity and value as human beings. 

2. There shall be no discrimination on the grounds of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. 

5. Except for those limitations that are demonstrably necessitated by the fact of incarceration, all prisoners shall retain the human rights and fundamental freedoms set out in the Universal Declaration of Human Rights, and, where the State concerned is a party, the International Covenant on Economic, Social and Cultural Rights, and the International Covenant on Civil and Political Rights and the Optional Protocol thereto, as well as such other rights as are set out in other United Nations covenants. 

9. Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation. 

22. (2) Sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals. 

57. Imprisonment and other measures which result in cutting off an offender from the outside world are afflictive by the very fact of taking from the person the right of self-determination by depriving him of his liberty. Therefore the prison system shall not, except as incidental to justifiable segregation or the maintenance of discipline, aggravate the suffering inherent in such a situation. 

60. (1) The regime of the institution should seek to minimize any differences between prison life and life at liberty which tend to lessen the responsibility of the prisoners or the respect due to their dignity as human beings. 

The Malaysian government’s approval for Anwar Ibrahim to seek foreign medical assistance

After two months of haggling, the Malaysian government finally allowed Anwar to seek foreign medical treatment. This was achieved after constant and persistent pressure from Anwar’s family and friends, plus pressure from the foreign community.

Anwar was then asked to sign a letter releasing the hospital of all liability in the event something goes wrong with the operation. Anwar, however, refused to sign the letter on the advice of his lawyers. While Anwar can accept liability in the event the fault lies with the specialist Anwar chooses, there is no way Anwar can accept liability if the fault is on the part of the hospital.

What happens if there is a power failure and the standby generator does not kick in? Is Anwar also to blame for this though this is something totally out of Anwar’s control and has nothing to do with the fact that it is a foreign specialist who is treating him?

14 days for Anwar to get foreign medical treatment

Anwar was given approval for foreign medical treatment with a 14-day deadline. With this approval, though, was a condition that the specialist must first apply for a Temporary Practicing Certificate (TPC). The TPC application form, however, states the application must be made one month prior to it being required.

When asked why the 14 days deadline, the hospital replied, because Anwar’s condition is very serious therefore action must be taken within 14 days or else there may be permanent and irreversible damage. If this is so, why did the authorities take five (5) weeks to reply to Anwar’s application to bring the foreign specialist to Malaysia?

Anyway, Anwar did not delay the process of applying for the TPC. The lawyers received the letter from the hospital on 29 January 2001 and it was immediately sent to the German specialist clinic (Herrn. Drs. Dekker & Hoogland of Munich) who looked at it and said they will need more time to comply with the terms of the application. Requirements like proof where they went to school would involve the German specialists going back to their old schools for the relevant documentation.

Anwar then asked for an exemption and it took another two (2) weeks for the authorities to come back with a reply. Anwar acted immediately and without delay but it took the authorities another several weeks to reply to Anwar’s letters sent through his solicitor. As the record would show, Anwar and his lawyer, at all times, acted diligently and at no time did they delay the application process.

Anwar is worried that the operation may be sabotaged if done in a local hospital by local doctors

It is not that Anwar has no confidence in local doctors. Some of the local doctors are quite good and are, in fact, personally known to Anwar. It is more whether these doctors would come under any pressure from the authorities.

As it is, it is already known that the doctors were pressured to certify Anwar fit enough to be sent back to prison in April 2001. The hospital was also under pressure to not give Anwar a copy of his medical records and they declared that his medical files were deleted from the computer. They also refused to hand over the original records saying it is the hospital’s copy.

On checking with other doctors from the hospital, they denied it is the hospital’s policy to delete hospital records, let alone records of patients who are still undergoing treatment and have not fully recovered yet. And the patient’s records can be given to them anytime they request them.

Anwar then instructed his lawyers to sue the hospital after which the hospital settled out of court by handing over Anwar’s hospital records showing that not only did they have the records, but that it is their legal obligation to hand it over when requested.

The local doctors may be good, but would they be allowed to do their best? So far, what has been demonstrated, gives the impression that local hospitals are subjected to political pressure. Anwar, therefore, would be safer in an overseas hospital.

The local doctors cannot guarantee the success of the operation

The local doctors have indicated that the risks involved in conventional open surgery are higher than the newer types of microsurgery. On the percentage of risk, we are getting a wide-ranging figure of between 3% to 30%. The doctors, somehow, cannot be more precise in the percentage and said a 70% to 80% success rate would be a fair guess.

Anyway, whether the risk is 3% or 30% does not matter, as either figure is still too high. On checking with the overseas spine specialists, they have indicated a risk factor of less than 1% - that is, between 0.7% to 0.8%.

The local doctors admit that conventional open surgery is more painful and leaves a scar compared to the newer methods such as microsurgery. The local doctors also admit that the local hospitals do not have too much experience in the newer types of surgery.

The local hospitals are general hospitals whereas the overseas hospitals are spine hospitals. This makes the overseas hospitals more specialised and dedicated to spine problems compared to local hospitals. The local doctors have also admitted they have seen many failures in back operations done locally. They also confirm that the pain from a botched back operation is worse than before surgery. Furthermore, the pain will be there for the rest of your life.

The local doctors indicate that they have had to send victims of failed back operations overseas for a second operation to correct the first one. Many times, even a second operation could not help. Without exception, all the local doctors say that back surgery is risky and the chances of failure are quite high. Also, without exception, all the local doctors admit that it is the patient’s right to decide on the type of treatment he or she wants and where to have it done – and being a prisoner does not take away that right.

In the beginning, prior to being sent back to prison in 2001, Anwar was attended by a panel of seven doctors. One of the doctors, Dr Halili Rahmat, a renowned local neurosurgeon attached to the Tawakal Specialist Center in Kuala Lumpur, had this to say:

Statement by Dr Halili Rahmat:

After many months of non-surgical treatment, Anwar’s condition has not improved. Anwar is clearly in great pain due to pressure being subjected on his nerve. All of us unanimously agree that immediate surgery is required to correct the problem.

But it is not as simple as that. There are different types of surgery that have to be considered. And it is the legal right of the patient and his family to decide on the type of surgery to opt for.

The three different techniques available are the conventional open surgery, endoscopic surgery and microscopic surgery. It is up to the patient and the family to decide on which technique they want. This is their right.

The trouble is, while the conventional open surgery technique is available locally, the other two techniques are still new to Malaysia and we don’t know much about them.

Our professional opinion is we should invite the German expert to Malaysia so that he can examine Anwar and review the situation. We won’t know which surgical technique is best for Anwar until the German spine specialist examines Anwar.

We must remember that the risks attached to any type of surgery are always present. Some techniques, of course, have lower risks than others do. And we must also note that the risks with open or conventional surgery are higher compared to the newer techniques.

The purpose of surgery is not only to correct Anwar's spinal problem, but also to relieve the pain associated with the problem. However, in some cases I have seen, the pain after surgery became worse than before surgery was done. I have even seen cases where a second surgery was required, but even that did not help.

In some cases that we could not handle locally and had to send overseas for the second surgery to be done, they could not do anything for the patient. We must remember, once we do surgery and it fails, we cannot undo the surgery. Once it is done it is done. That's it.

If the surgery fails and it results in more pain than before the surgery, the patient will suffer for the rest of his life. There is no guarantee that a second surgery can be done, or even if it can, that it would be successful. That is why the patient and his or her family must decide whether to opt for surgery or not, and what type of surgery to opt for. The doctors cannot make this decision for them.

All of us agree that, if Anwar chooses any of the newer techniques, it would be best that we draw upon foreign expertise that have more experience in these techniques. It is also good for us as our local doctors will also be able to learn from this. We hope we would be invited for the operation and that we would be allowed to ask questions and learn from the experience.

Let us not forget that the whole objective of surgery is to relieve the pain the patient is suffering from. That and only that should be the objective. Therefore, whatever we decide, it must be based on this one objective. If what we are going to do not only does not relieve the pain, but actually makes the pain worse, then why go through the whole exercise?

That is why the final decision must be the patient’s. The patient must decide. No one else should make this decision on his or her behalf. And that too is what the law provides for.

Statement by the Director of HKL:

On 25 April 2001, the Director of the Kuala Lumpur Hospital (HKL), Dr Hj Abdul Razak Bin Hj Kechik, issued a letter saying that if Anwar does not undergo surgery these would be the risks he faces:

1. Persistent or aggravation of back and/or leg pain.
2. Transient or permanent loss of lower limb function (sensory or motor).
3. Transient or permanent loss of bladder and/or bowel functions.
4. Transient or permanent loss of sexual function.

“This list is not exhaustive,” said Dr Razak, “And other less common complications may arise.”

Anwar’s current medical condition

Anwar’s request to undergo surgery overseas was turned down and he was subsequently sent back to prison. The government promised that, once he is back in prison, he would get the necessary medical treatment. However, to date, the promised medical treatment has not been provided.

Anwar is in constant pain and is permanently on painkillers. Due to the side effects of these painkillers, Anwar’s hands and feet are swollen. He is also in a wheelchair and cannot move around unaided.

Clearly, Anwar’s condition has deteriorated and there is genuine concern that, even if the government now allows Anwar to undergo surgery overseas, it may already be too late to help him.

In mid-December 2003, Anwar’s condition took a turn for the worse. His lawyer, Sankara Nair, then wrote to the Ministry of Home Affairs asking that Anwar be admitted into hospital. The Prime Minister, Abdullah Ahmad Badawi, who is also the Home Minister, instructed the Health Ministry to examine Anwar and report back with their findings.

On Tuesday, 30 December 2003, Dr Jayaindran Sinnadurai, the government doctor assigned to Anwar, went to the Sungai Buloh Prison to examine Anwar. That same morning, Dr Jayaindran phoned the Deputy Health Minister and said that Anwar is fine and not at all at risk. The fact that Anwar was suffering excruciating pain and was so doped up on painkillers that his arms and legs were swollen was not reported.

The Deputy Health Minister then reported the same thing to the Prime Minister and Anwar was not sent to hospital as requested.

Anwar has since requested that Dr Jayaindran be taken off his case and another government doctor be appointed in his place. Anwar has also given the government until Tuesday, 6 January 2004, to send him to hospital, after which he will proceed with legal action against all those responsible for denying him his right to be admitted to hospital, in particular Dr Jayaindran. Anwar has been languishing for three years since October 2000 with no sign of the promised medical treatment. He is no longer going to tolerate the treatment he is getting.