Dr Hazida Bawa case is of importance worldwide in many ways, an (lost)opportunity for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in treatment, especially in difficult situations , for doctors. At the time of death of patient, a constant and universal last link is only the doctor, that is visible. This visibility of doctor at the time of declaration of death or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, equipment and other innumerable shortcomings of the whole system may not be visible or not given consideration in the haze, as compared to publicity and attention given to only doctor’s faults. This is specially so when the wisdom is applied retrospectively, with knowledge of hindsight, and by the people who have never treated emergencies or have never been in such difficult situations themselves.
Analogy to Dr Hazida Bawa case
Imagine a situation where during a bad sea storm, large number of people are trapped and are in mortal danger. The coast guard on the duty tries his best in the emergency situation with his limited resources and saves a large number of people. There were only a few coast guards present, equipment were inadequate and sub optimal. However the guards manage to salvage the situation by doing the best possible in the circumstances. There were instances, where they decide, act, communicate and document events simultaneously, in an instant. Those who could not be saved were exposed to risk of death as resources allocated by authorities were limited. The near and dear ones of those who died were unhappy and revengeful with the services. Inquiry is done to find out the cause of failure in preventing those deaths. Rather than appreciating the facts that greater proportion of victims were saved in those difficult circumstances, the guards are blamed for those who could not be saved. Guards who are already apologetic for not been able to save the few, are blamed for doing their duty shabbily after careful fault finding analysis of the event. The administrators who are responsible for allocating the inadequate number of guards and equipment, who actually failed in their duty, also participate in pointing fingers at the guards.
The saddest part was that courts also were unwilling to apply wisdom to look beyond the guard faults and reach beyond the fog in present hazy circumstances. Systems and administrative lapses and inadequacy of number of coast guards was not raised as a concern. The responsibility of the deaths is thus fixed on the persons who struggled to save the lives of many. Every one has great sympathies for the deceased, but there is another angle for doctors in such difficult situations.
This is an analogy to Dr Hazida Bawa case, but similar unfortunate incidents are happening to medical professionals worldwide, more so in developing countries. The new regulated system of medicine has an aberrant evolution and chooses to hang their own wounded soldier for not putting up the best fight, rather than accepting the limitations of medical science or errors in the supporting systems. Was she an easy scapegoat for some obviously non- admissible reasons prevalent?
Why is it always necessary to punish a doctor, and conveniently overlook errors of the sub optimal system in cases of unfavorable prognosis, especially in sick patients. Why a sub optimal system or unsafe working conditions like all other registrars were on leave simultaneously, or only one registrar in place of three and that too a trainee. There was no consultant or registrar covering her? Why is a single doctor stuck in a difficult situation not treated as just another human being in an emergency situation, especially in cases of very sick patients? Why administrators or managers are not punishable for putting doctor and patients at risk and unsafe condition ?
If a doctor is supposed to raise concern (may be at cost of his career), then what is the role of managers, management and administration? Are they inefficient or incompetent to anticipate the situation? A new doctor coming on duty can not anticipate the deficiency of system. He will not have time to assess the managerial deficiencies. Therefore raising a concern by doctor on duty is something, which is expected but at the same time not feasible always, in true sense. This expectation to raise a concern may be used to later implicate the doctor as to why he or she did not raise a concern. At the same time it takes responsibility off, from the administrators whose duty was to raise concerns.
NHS is looked upon in the world as one of the better organized health care organization in terms of uniformity. If such an organization has to sacrifice its working hands in the form of scapegoats to prove its quality, deliberately overlooking its system errors, then it is a sad state for doctors all over the world. This would set a precedence for governments and health administrators, world over to be fearless in putting errors of sub optimal system under the carpet by punishing the doctors instead. Since there will always be a doctor in the end who will declare the death, is the last and common link in all deaths. Other circumstantial issues would be overlooked because of sheer unwillingness to do so.
Irony of the situation is that generally people who have been invested with the power to decide on these issues of medical negligence may have never faced such situations themselves. They may be the people in administrative positions who have never treated a single patient, leave aside emergencies. They do not even know, what it takes to deal with emergencies of life and death, that too multiple ones, with limited resources. The court takes years to decide on these issues discussed retrospectively with wisdom of hindsight, on issues which the doctor had to decide in a jiffy. A person who perhaps can only imagine such a situation, or never handle it himself, even in his wildest dreams is the one who decides what went wrong merely based on how the situation is placed and presented before him.
If there is unsaid immunity to governments and administrators for providing a suboptimal systems, then the doctor should be the first person to get this immunity. But unfortunately nobody seems to be willing to find out who is responsible for putting the doctor in such a difficult situation, making everything error prone.
If in such system a doctor is punished, then the administrator, manager or trust should be an automatic accomplice to the doctor’s punishment. Firstly for providing an unsafe and suboptimal system, and secondly for not raising a concern as management . Thirdly for putting it’s doctor in difficult circumstances. If it was an understaffed system, then disaster was bound to happen sooner or later. This is a perfect example how management lapses contribute to death but doctors are the only ones who are entirely blamed and punished in isolation.
Another sad part is the unwillingness of judiciary system to look at the larger picture and the fault in the system, which has led to mass demoralization of the doctors. The doctors are denied the true justice in many such cases. They are being used as sacrificial lambs. Health administrators are obviously at an advantage enjoying the invisible immunity and perks, at the cost of medical professionals. By crucification of the doctors, vengeance of the society is fulfilled and everyone feels satisfied with false sense of justice. But does this give any advantage to the society? Definitely not. In fact the society is thus raising a demoralized force to be their care providers, who under duress, will definitely not perform to their very best. If this is quality of justice for saviours, this demoralized force may also not be available in future.