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A panel that probed the circumstances leading to former Chief Minister J Jayalalithaa's death in 2016 indicted V K Sasikala, the late leader's close confidante, medical doctor K S Sivakumar, former Health Minister C Vijayabaskar and the then Health Secretary J Radhakrishnan and recommended a probe against them.
The Tamil Nadu government, which tabled the Commission of Inquiry's (CoI) report in the Assembly on Tuesday said it would initiate action after getting legal opinion.
The Justice A Arumughaswamy Commission of Inquiry said, they "have to be found fault with and investigation is to be ordered." Sasikala is indicted considering several aspects, it said. K S Sivakumar is her relative.
The government said that it was decided to initiate appropriate action against "certain individuals," after obtaining the opinion of legal experts. This is in view of the CoI's recommendations in its report.
The panel recommended investigation against former State Chief Secretary Rama Mohana Rao and two medical doctors, Dr YVC Reddy and Dr Babu Abraham. It however, did not specify if it found "fault" with them or not.
It said that the government may, "decide and investigate" the matter against Dr Pratap C Reddy, chairman of the Apollo Hospitals, where she was treated.
The CoI's Terms of Reference (ToR) was to inquire into the circumstances leading to Jayalalithaa's hospitalisation on 22 September, 2016 and subsequent treatment provided in the hospital till her demise on 5 December, 2016.
The report assumes political significance as it appeared to blame O Panneerselvam (OPS), who is expelled from the All India Anna Dravida Munnetra Kazhagam. OPS now supports Sasikala.
On a plea to cross-examine AIADMK interim chief and former Chief Minister, Edappadi K Palaniswamy, the panel said the applicant has not adduced sufficient reasons.
The panel also has pointed the finger at hospital over the timing of her death, on not choosing a recommended surgical option and on not backing her treatment abroad.
As regards the first part of the ToR, on circumstances leading to her hospitalisation, the Commission said it, "has not found anything abnormal or unnatural" in the conduct of people including Sasikala. Adequate care was taken to shift Jayalalithaa to the Apollo Hospitals promptly without delay, it said.
On the other aspect of the ToR, which is on treatment, the CoI indicted four persons including Sasikala and Vijayabaskar. The CoI, in its 475-page report, goes into allegations of conspiracy against Jayalalithaa by Sasikala and her relatives.
The panel said that it was very clear that, "only on strong suspicion," Jayalalithaa sent Sasikala out of her Poes Garden residence (from November 2011 to March 2012).
Subsequently, after getting a letter from Sasikala that she would not interfere in politics, Jayalalithaa allowed her back into her Poes Garden residence and the leader kept her "at a distance."
Citing depositions of witnesses, the panel said that it is "inferable" that due to some strained relationship, Jayalalithaa would have asked Sasikala and her relatives to leave Poes Garden.
During Jayalalithaa's hospitalisation in Chennai, a cardio thoracic surgeon from USA, Dr Samin Sharma, recommended a life saving cardiac surgery in view of vegetation in her heart.
Sharma examined her in the hospital on November 25, 2016 and discussed it with Jayalalithaa and she was conscious and gave her consent to the surgery.
It was, however, not performed after a UK doctor, who was an intensivist, gave an opinion that a cardiac surgery was not needed. When Dr Sharma was confident to perform the angiography procedure, what was the necessity to bring an intensivist into the picture, the panel wondered.
Therefore, the commission said it concluded that the hospital doctor "played a trick" to bypass performance of angiography to convince "some power centre," and the intensivist gave an opinion that surgery can be postponed.
Sasikala was the one and the only person consulted by doctors, more particularly the doctors of Apollo Hospitals on the course of the treatment and only upon her consent they proceeded, the CoI said.
On the time of death, the CoI said it assumes significance and has far reaching consequences. There is an official description of time of death fixing it at December 5, 2016, at 11.30 PM.
"There is gross variation," the panel said pointing to the version of paramedical personnel.
The unequivocal and unambiguous version of nurses, technicians, and duty doctors was that she suffered a cardiac failure before 3.50 PM on December 4, 2016 and that there was no electric activity in her heart and no blood circulation.
The Cardiopulmonary Resuscitation (CPR) was performed belatedly and is claimed to have been commenced at 4.20 PM.
This would, ultimately prove that she passed away on December 4, 2016 at 3.50 PM itself and the CPR and sternotomy exercises were futile and these have been used as a ploy to explain away the delay in the official declaration of her death.
O Panneerselvam was all along an insider and a part of the inner circle and whatever transpired was within his knowledge. On her demise, he assumed the office of Chief Minister of Tamil Nadu without any loss of time.
He positioned himself as the successor of Jayalalithaa which is not a "fortuitous" happening. "The new found position did not last long, due to the mysterious machinations of the power centre, who overthrew him aiming towards the crown, but failed. The infuriated and disillusioned Panneerselvam launched a Dharmayutham (against Sasikala) in February 2017 with a view to achieve political mileage," the CoI said.
The Chairman of Apollo Hospitals, Dr Pratap C Reddy, gave interview to the media on November 12, 2016 that Jayalalithaa would be discharged any time. "In the meeting held in his room he mentioned that sepsis had occurred and she had infection in the blood. It has been mentioned in the press release by Dr Reddy that sepsis was under control. But he has not mentioned about vegetation and perforation. The reason is not known."
Reddy, though he is the person bound and authorised to state true facts, he issued a false statement to press that she could be discharged at any time.
"Secondly, he has issued briefings in his room often without disclosing the real fact regarding the heart ailments and the treatment to be given to the late CM. It is for the government to decide and investigate the matter."
On Rao, the CoI, citing procedural aspects, said it "finds criminality against him." Dr YVC Reddy and Dr Babu Abraham treated her all along and invited doctors from Mumbai, UK and USA and received their opinion from them.
Though angio/surgery was suggested, they "successfully threw it to the wind on the pretext of postponing it, to achieve their aim under some pressure. Hence, investigation is to be ordered."
Dr Babu Abraham contacted Dr Stuart Russell of USA and he suggested angio-procedure but it was also not done. The Apollo hospital, its doctors Dr Babu K Abraham and Dr YVC Reddy, the then Health Minister and the then Health Secretary, Dr Sivakumar, were all against taking her abroad for treatment. "...they gave certificate to the hospital, rather than shifting late CM abroad for treatment."
The panel submitted its report to the government on 27 August this year and it was taken up for discussion in the Cabinet meeting held on 29 August 2022.