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Mumbai: Holding Deenanath Mangeshkar Hospital, Pune responsible for violating multiple regulations that allow patients to get treatments in emergencies, the Maharashtra government-appointed committee has slapped a Rs 10 lakh fine on the hospital after being found guilty in connection with the tragic death of the mother of twin babies who lost her life after being denied admission due to non payment of Rs 10 lakh advance. 

After collecting the Rs 10 lakh fine, the government will deposit Rs 5 lakh each as Fixed Deposits in the names of the deceased woman’s twin daughters. The girls will receive the money when they turn 18. Until then, the Chief Minister’s Relief Fund will cover all their medical expenses.

The action has been taken against the hospital after the committee, led by Joint Charity Commissioner Rajni Kshirsagar, found that the hospital violated key provisions under the Maharashtra State Public Charitable Trust Scheme by refusing to provide treatment to the woman as her family could not pay the advance deposit, which led to her unfortunate death. 

Also read- Enrollment in Government Health Schemes Mandatory: Maha Govt tells Charitable Hospitals

According to the inquiry, the hospital’s refusal to provide immediate care directly violated Clause III of Maharashtra’s charitable hospital norms. These rules clearly state that hospitals cannot ask for advance payments during emergencies and must begin treatment without delay.

The committee also found that the hospital broke another important law under Section 41AA of the Maharashtra Public Trusts Act, 1950. This law requires charitable hospitals with annual expenses over ₹5 lakh to set aside 2% of their billing for an Indigent Patients’ Fund (IPF). The IPF is meant to provide free or low-cost treatment to poor patients. Investigators found that Deenanath Mangeshkar Hospital did not meet this obligation.

The inquiry committee’s report, submitted to the Chief Minister’s Office on Saturday, noted that Deenanath Mangeshkar Hospital not only failed to meet these legal responsibilities but also contributed to a tragic and avoidable loss of life, exposing serious flaws in the system meant to safeguard underprivileged patients. 

The government has also directed multiple departments, including Home, law and judiciary and the corporation to initiate ‘strong action’ against doctors, employees and administration officials for alleged criminal negligence in the death of 37-year-old Tanisha Bhise last month.

The Indian Express source said, “The Deenanath Mangeshkar Hospital has been subjected to a penalty of Rs 10 lakh as punishment. Of this, Rs 5 lakh each will be kept as a Fixed Deposit for the two girls she gave birth to before she died. The amount will be handed over to the two girls when they turn 18. Till then, all expenditures incurred on their treatment will be borne by the CM Relief Fund. To ensure better planning and monitoring, central planning through the CM charity cell has been recommended.”

Deenanath Mangeshkar Hospital, a registered public charitable trust and multi-speciality facility, failed to uphold its charitable responsibilities when a gynaecologist in the hospital demanded advance payment from the families of the deceased woman before starting her treatment. Instead of providing immediate care during the critical golden hour, the doctor allegedly chose to delay treatment, and she died, leaving behind her two twin babies.

Enrollment in Government Health Schemes Mandatory

Medical Dialogues recently reported that the Maharashtra government has made it mandatory for all charitable hospitals in the state to enroll in government health schemes. These include the Mahatma Phule Jan Arogya Yojana (MPJAY), the Pradhan Mantri Jan Arogya Yojana (PMJAY), and the National Child Health Programme.

The new GR mentioned that the updated information regarding the Indigent Patient Fund (IPF) account of charitable hospitals should be updated regularly on the charity commissioner’s website. All charitable hospitals must immediately treat a patient coming to the emergency ward, including pregnant women seeking medical attention.

The GR also stated that many charitable hospitals transferred a major source of their income to external sources like pharmacy and diagnostic tests (pathology, radiology or microbiology). As a result, the main hospital’s income appeared lower, and less money was going into the Indigent Patient Fund (IPF), which is meant to support poor patients. To fix this, the government has now said that even outsourced services must contribute 2% of their yearly income to the IPF. Under the charity scheme, a hospital has to reserve 2% of the annual gross bill for the IPF account.

Why no arrest till now?

Even though the Pune police registered an FIR against the gynaecologist, who resigned from his position two weeks ago, no arrests have been made so far in connection with the case. 

The Pune police took this action following a recent report submitted by the Sassoon General Hospital committee, which confirmed that the attending doctor had been negligent in handling the woman’s case. The report stated that the doctor had deliberately delayed her treatment, and this lack of timely medical intervention led to complications that ultimately caused her death.

While the doctor has been booked, he cannot be arrested now since the BNS does not mandate an arrest, said a senior police officer. Therefore, the police took a record of his detailed statements and launched an investigation in this regard.

Also read- FIR against Gynaecologist in pregnant woman’s death case

A new study published in Diabetes Technology and Therapeutics showed that one of the main causes of postprandial and nocturnal hyperglycemia in hospitalized inpatients is delayed insulin delivery after meals and snacking before bed without insulin administration.

For those with diabetes, controlling blood glucose levels is essential, and timing insulin boluses during meals and eating before bed are important factors in this process. Better decisions about insulin dosing and glucose stability at night are made possible by continuous glucose monitoring (CGM), which offers real-time insights into glucose changes.

Optimizing glycemic regulation and lowering the risks of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) can be achieved by comprehending how these variables interact. It might be difficult to provide prandial insulin with meals on time for hospitalized inpatients. Moreover, no prior research has examined the glycemic effects of post-dinner snacking, sometimes known as “bedtime snacking,” in the absence of prandial insulin treatment. This study was by Sara Alexanian and colleagues examined the effects of bedtime eating and delayed insulin delivery on inpatient glycemic control.

The In-Fi study, compared Fiasp with insulin aspart (Novolog) in inpatients with type 2 diabetes, was the subject of a post hoc analysis by researchers. The Dexcom G6 PRO continuous glucose monitoring (CGM) device was used to measure the glucose results. A total of 122 randomized participants who finished the primary trial protocol (which involved wearing a CGM for at least 4 meals) had their CGM and insulin delivery data examined. This study assesses the effects of bedtime eating and postponed insulin injection on glucose regulation.

Insulin boluses given before meals (n = 149) had a 4-hour postprandial time in range (TIR70–180) of 48%, while those given more than 5 minutes after a meal had a TIR70–180 of 24%. When controlling for bedtime sensor glucose, eating between 9 p.m. and 12 a.m. was linked to a considerably lower overnight (9 p.m. and 6 a.m.) TIR70–180 and a significantly higher fasting glucose the following morning.

After controlling for initial bedtime sensor glucose, bedtime eating was linked to greater overnight glucose percentage coefficient of variation and higher overnight glucose standard deviation. Overall, one of the main cause of post-meal and nocturnal hyperglycemia in hospitalized patients is the delayed administration of insulin during meals and the consumption of insulin-free snacks before bed. 

Reference:

Alexanian, S. M., Cheney, M. C., Bello Ramos, J. C., Spartano, N. L., Wolpert, H. A., & Steenkamp, D. W. (2025). Impact of meal insulin bolus timing and bedtime snacking on continuous glucose monitoring-derived glycemic metrics in hospitalized inpatients. Diabetes Technology & Therapeutics. https://doi.org/10.1089/dia.2025.0027

A new study published in the Journal of the American College of Cardiology showed that the patients with atrial fibrillation (AF) on oral anticoagulation, which includes NT-proBNP and high-sensitivity troponin outperforms clinical ratings in predicting stroke.

The risk of ischemic stroke is a major factor in stroke prevention therapy recommendations for people with atrial fibrillation (AF). It is known that a patient receiving direct oral anticoagulant treatment today still has a chance of having a stroke, which might range from 0.3% to 0.9% annually.

The true vision for the future was that if patients treated with a direct oral anticoagulant still had a high risk of stroke, they might benefit from additional treatment such as left atrial appendage occlusion [LAAO] devices, or perhaps have a more liberal indication for ablation to eliminate A-fib or lessen the burden of A-fib as a stroke risk indicator.

This was because the risk of stroke still varies during oral anticoagulant treatment. Thus, this study was to assess the biomarker-based Age, Biomarkers, Clinical history (ABC)-AF-stroke risk score. Lars Wallentin and colleagues also created a modified ABC-AF-istroke risk score to predict total stroke and ischemic stroke in AF patients, respectively.

The ABC-AF-stroke score and the modified ABC-AF-istroke score were calculated using data clinical history of stroke, on age, and levels of N-terminal pro B-type natriuretic peptide and troponin in 26,452 AF patients who were assigned to direct oral anticoagulants (DOACs) or warfarin.

There were 756 incidents of stroke or systemic embolism (SEE) throughout the follow-up period, including 534 cases of ischemic stroke/SEE. In comparison to the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) score of 0.632 and the CHA2DS2-VASc score of 0.614, the ABC-AF-stroke score, C-index, demonstrated greater discrimination of total stroke/SEE. With a C-index for ABC-AF-istroke of 0.677 when compared to 0.642 for the ATRIA and 0.624 for the CHA2DS2-VASc score, the outcomes for ischemic stroke/SEE were comparable (P < 0.001 for both).

For both total and ischemic stroke, the ABC-AF-stroke scores demonstrated satisfactory calibration. In the pertinent subgroups, the results were consistent. Analysis of decision curves revealed a net advantage with regard to decision thresholds for stroke prevention. Overall, when it came to predicting total and ischemic stroke, the biomarker-based ABC-AF risk scores were well-calibrated, demonstrated superior discrimination over clinical risk scores, and offered significant decision assistance for stroke-prevention therapies in AF patients.

Reference:

Wallentin, L., Lindbäck, J., Hijazi, Z., Oldgren, J., Carnicelli, A. P., Alexander, J. H., Berg, D. D., Eikelboom, J. W., Goto, S., Lopes, R. D., Ruff, C. T., Siegbahn, A., Giugliano, R. P., Granger, C. B., & Morrow, D. A. (2025). Biomarker-based model for prediction of ischemic stroke in patients with Atrial Fibrillation. Journal of the American College of Cardiology, 85(11), 1173–1185. https://doi.org/10.1016/j.jacc.2024.11.052