#RTH-AGITATION- Rajasthan – Sadly doctors are fighting for their genuine rights and dignity against all. No one is with them – media, judiciary, Government and not even patients whom they have saved.
Aspiring doctors should know the reality and introspect- why they wish to be a doctors in such circumstances?
Smaller hospital and individual doctors’ clinics are backbone of the health care system in India. Their contribution towards public health can’t be ignored. Be it Covid care or treatment of daily ailments, they are actually helpful to the public and indispensable in real sense. Their contribution to society is huge especially in view of broken public health care system.
They provide health care near to public near their residential area at affordable cost. From an another angle, they generate employment to the workers as well as small businesses associated with their small hospitals.
In a populous country like India, strengthening these smaller hospital is a desirable step. To strengthen the health care, Government can actually do well to support these hospitals and achieve health care to all. Supporting them will require a fraction of resources, as compared to the money needed in case Govt has to provide to public itself.
It will be a short-sightedness of the Government policies, if instead of supporting them, Govt wishes to exploit their resources to give free health care to public.
But administrators and bureaucratic system has failed on both fronts. Neither they were able to develop a dependable health care system for public, nor they tried to support smaller health systems. What they tried to do was akin to the ancient story of ‘ the farmer and the Golden goose’. The Greedy farmer wanted all the golden eggs instantly without feeding the bird and therefore killed the duck. Government with its short-sighted bureaucracy is killing its golden health care and not realizing the real potential and benefits.
In the present day, ebbed from all sides, doctors need to earn back the dignity of profession and resist oppression. The phenomenon of oppression of doctors in the name of regulation is a global issue. The populist oppressive schemes in the misleading names like #RTH-Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Acquiring kind of skill , the years of passionate, merciless, excruciating medical learning is placed at the disposal of administrators, who themselves have failed to develop a good health care system in real sense.
#NO-TO-RTH-AGITATION is a movement , the result of failure of Government to create public health system, but it has potential to fail the existing private doctors’ system as well. Smaller hospitals are already on verge of closure, will be forced to shut down. It carries the risk of extinction of neighbourhood friendly doctor and hospitals.
The basic problem is the intentions for the task of developing a good health care system. The agenda of administration is to control the health care workers rather than developing a good health care system for citizens.
What NO-TO-RTH-AGITATION is actually doing? It is a cry for survival of the smaller hospitals- not only for themselves but for Indian Health care system, if short-sighted bureaucracy can understand the real problem.
It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medicolegal sword. There is no day that passes when system does not perpetuate negativity against medical profession. Doctors, ebbed from all sides, have lost the dignity and independence. Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
The complex medical skill, the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense. Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.
All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.
Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers.
In todays’ era there has been bullying of doctors by administrative systems, new unreasonable laws, which use pressure tactics on medical professionals to get their own way – no less than enslavement.
Problems faced by doctors are not only innumerable but are also so exceedingly complex that they are difficult to be analysed. Doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession.
Medical courses are comparatively lengthy and expensive study course and difficult training with slave like duties. “enslavement of doctors”.
Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialize. Because of lesser seats in post-graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice.
Hostile environment for doctors to begin: Suddenly young and bright children complete training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
Difficult start of career: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
Blamed for all malaise: The society gets biased because of the media reports and some celebrity talking glib against medical profession. The blame for inept medical system, administrative failure and complexity of medical industry is conveniently loaded on doctors. These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
Personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
Risk doctoring himself: Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.21 occupational risks to doctors and nurses
Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative every day is enough to spoil the mood for the day.
Retrospective analysis of doctor’s every action continues all the life. It could be by patients and relatives every day in the form of “ Why this was not done before?” Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. If unfortunately there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
The decision taken in emergency will be questioned and in retrospect they may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight with luxury of time, may be labelled as wrong if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for lawsuit and punishments. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation would be full and almost permanent.
11. Physical assault, routine instances of verbal abuse and threat are common for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. Recently, even female doctors have not been spared by mobs. Silence of prominent people, celebrities and society icons on this issue is a pointer towards increasing uncivilized mind-set of society.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: zero fee and fixed commission ads on television by lawyers in health systems are a common advertisement to harass doctors. They lure patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.
14. Overall, a complex scenario for doctors: There is increasing discontentment among doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult.
In this era, a thought is gradually getting prevalent-‘Is choosing medical career or becoming a doctor is a mistake?
In the present era, Doctors are ebbed from all sides, need to earn back the dignity of profession and resist oppression. The phenomenon of oppression in the name of medical- regulation is a global issue. The oppressive schemes in the misleading names like #RTH Rajasthan (RIGHT TO HEALTH) are prevalent everywhere globally in some form or another.
Doctors and nurses have been reduced to no more than moral and economical slaves either by industry or administrators, not infrequently pulled by legal bridle in their noses.
Doctors in Rajasthan India have shown first of its kind revolt, that is just waiting to happen globally at some stage.
It is not easy to practice as doctor these days. Media full of doctors bashing, credibility crisis and regulators perpetually hounding doctors, who are forced to work under imposed medico-legal sword. There is no day that passes when system does not perpetuate negativity against medical profession.
By certain laws and Acts like RTH, an effort is on to place medicine under State control. Acquiring kind of skill , the years of passionate, merciless excruciating medical learning is placed at the disposal of administrators, who themselves have already failed to develop a good health care system in real sense.
Doctors have become soft targets for populist attention mongering and transforming social nuisance into messiah of the deprived by administrators -by sprouting the fraudulent generalities.
All the calculations that usually precede the enslavement of medicine, everything gets discussed by administrators and industry – except the well-being of the doctors and nurses.
Doctors have often wondered at the smugness with which administrators assert their right to enslave them, to control their work, to force their will, to violate their conscience, to stifle their mind. Irony is that while administrators do this, still they depend on the same doctors for saving lives -whose life they have throttled, who resent the treatment meted out to the health care workers. Like the failed medical system, administrators have failed to realize that all the negativity perpetuated against doctors, who are working with the burden of mistrust under medico-legal sword is going to make them less safe.
Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publicly insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize the medical profession for their popularity gains. Being so distant from the ground reality, their role should not have been more than facilitators, but they have become medical administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses.
Slow or acute revolt is long due. Doctors have only two ways- either to persist, fight or perish. Silently quitting their beloved profession is going on for some time all over the world. Even in developed countries, there has been a fading enthusiasm to be a doctor. But doctors of Rajasthan have shown the way. The way to persist and resist the indignity handed over to medical profession. The have shown that the struggle was not that difficult that it looked to be. They have chosen the correct path of struggle for Independence (Professional). That makes them global leaders without any doubt.
In the new ‘ Right to Health- Bill- Rajasthan’, because of government inability to provide basic and essential services, private hospitals are dictated to render services. As services at Government hospitals are inadequate and have failed to provide facilities to handle the emergencies. Since the patients cannot be left without treatment, provision for emergency services should be made available to country’s population. That is the Government’s duty which the administrators have failed to fulfil. Therefore co-operation from private sector is expected, but it should be sought as help rather than an imposed dictate. This act, though may have a noble intention in mind, should be analysed by all stakeholders in an objective manners.
• Will government render some support in any manner to private health organizations, which they may need genuinely in order to do this difficult task, as the Government itself has been unable to do in so many years?
• In order to provide these essential services especially emergency and lifesaving, is government asking the private players for help for this noble cause or does this act simply dictates its wish onto the private players bulldozing their genuine concerns in doing so?
Will Government increase its’ own responsibility and accountability and shoulder more responsibility towards ‘Health to All’ or it is only for private doctors to provide?
• Will government provide physical and legal protection to doctors and health establishments on the issues arising from the act?
• Although the RTH looks like is a democratic action, but is it democratic to doctors and private health players as well? Are their genuine problems and views addressed and accommodated?
• What are government’s plans in the long term to improve such services? Does it plan to continue forcing the private setups (without ant help to them) or are there any plans to improve the government health facilities in future to a level commiserate with the need of the hour.
Imposing such dictates will definitely force the aspiring doctors to think, whether to choose medical career or not.
The Rajasthan government’s proposed right to health bill has landed in deep controversy due to objections from the private healthcare sector, which is dishonouring as a part of the protests the provision of cashless treatment under existing state-run schemes. The draft bill has been criticised as a hasty job that overlooks ground realities and suffers from lacunae that the Ashok Gehlot government is apparently resisting taking note of.
Chief minister Gehlot, on February 17, urged private hospitals to end their boycott of the Chiranjeevi scheme and the Rajasthan Government Health Scheme (RGHS), which provide mostly cashless treatment to private individuals and government employees, respectively, terming it improper on humanitarian grounds. “The private sector has a role to play in making Rajasthan a model state in healthcare, and we will clarify all doubts of private hospitals about the right to health bill,” Gehlot said. It remains to be seen if his appeal has any impact, given that private doctors’ associations have accused the government of intimidating private hospitals to end the boycott of the bill.
Social activists backing the bill have opened a separate front by criticising private hospitals for opposing the proposed legislation. The moot question is this: Does right to health only include private healthcare, which the bill aims at, or also things like potable water, clean air, unadulterated edibles and quality roads? In short, factors determining a healthy life but excluded from the ambit of the proposed law.
The bill has been in the pipeline for some months now. It was tabled in the state assembly in September 2022 but referred to a select committee subsequently because the Opposition and doctors’ fraternity wanted it be debated thoroughly. On February 15, the select committee deferred its scheduled meeting as private doctors threatened to step up their stir against the bill. Earlier, the state government had expressed its resolve to push ahead with passage of the bill.
A key contentious point in the bill is that no medical facility—whether government or private—can deny a patient ‘emergency’ care. The bill, however, falls short of defining ‘emergency condition’ and how the cost of treatment is to be reimbursed to private hospitals. Private doctors and private medical institutions feel the bill will give extraordinary powers to designated government officials to enter their premises and harass them.
Rajasthan has been witnessing a sharp rise in patient-doctor conflicts, both in government hospitals where doctors are accused of negligence as well as private medical facilities, which are accused of charging patients exorbitantly. Critics of the bill say it fails to address the concerns of doctors. Initially, private doctors had protested against the clause to compulsorily provide ‘emergency’ care to patients. They cited various aspects of their concern, such as someone with even a minor injury demanding emergency treatment at a hospital or a person suffering a heart attack approaching a hospital or nursing home that lacks facilities to deal with such a case.
As details of the draft bill emerged, there was also apprehension in the private healthcare sector that the bill may become a tool to bring ‘inspector raj’ into the medical sector. “Once you give officials open access to enter our premises, it is bound to be misused. The bill is a ploy of bureaucrats to control the private medical sector,” alleges Dr Vijay Kapoor, secretary, Private Hospitals and Nursing Home Societies, Jaipur. Highlighting ‘discrepancies’ in the bill, Kapoor points out that while a person who wheels in an accident victim to a hospital is entitled to a reward of Rs 5,000, the bill is silent on how the hospital would be reimbursed for treating the patient. “The bill
Private hospitals have been the backbone of the Gehlot government’s flagship Chiranjeevi scheme, under which beneficiaries are entitled to free treatment worth up to Rs 25 lakh in government and affiliated private hospitals. The scheme has been hit by the alleged refusal of many private hospitals to admit patients—as a symbol of protest against the right to health bill.
The Chiranjeevi scheme allows private hospitals to bill patients for certain costs incurred so as to partially compensate for the high cost of diagnostics and treatment. Private hospitals expect a similar consideration in the right to health bill, besides widening the scope of factors determining ‘healthy life’.
Some doctors wonder if a separate bill like this was necessary at all since right to health was enshrined as a fundamental right under Article 21 of the Constitution. Moreover, private doctors say they hardly have any representation in the various committees proposed to implement the provisions of the bill, grassroots level up.
Social activists like Nikhil Dey of the Rajasthan Soochna Evam Rozgar Adhikar Abhiyan and Kavita Srivastava of the Peoples Union of Civil Liberties (PUCL) are dismissive of the opposition to the bill. “It cannot be acceptable that the life of a rich individual is saved but not of a poor for want of money,” says Dey. Srivastava adds that while some objections of doctors could be genuine, the bill cannot be rejected outright.
Private doctors claim schemes to provide healthcare through the private sector under insurance coverage by the state government have been marred by corruption. “Hefty bribes are sought for empanelment of hospitals under these schemes, reimbursement of claims and settlement of complaints if any,” alleges Kapoor.
With more and more private hospitals allegedly refusing cashless treatment to private individuals and government employees under state-run health schemes, patients are suffering. Besides, given the accusation that officials demand bribes and some government doctors patronise certain private hospitals, Gehlot’s right to health bill appears caught in rough weather, all the more since it’s perceived as been hastily drafted.
In a reverse trend and one of the rare instances where a patient asking for 25 lakhs of compensation was penalized by NCDRC for frivolous complaint.
In present era, when patient is no more “patient” and defined as consumer, doctors’ status has been reduced to merely a service provider in lieu of little money. With Medical Consumer Protection Act has acquired roots, the whole system of medical delivery and healthcare has changed. Most striking is this entire fiasco is the “Us and Them” syndrome that seems to afflict all the stake holders. Doctors are pitted against every one- versus administrators, patients, managers, society and lawyers.
There is no dearth of such patients, relatives and lawyers who are ready to try their luck, sometimes in vengeance and sometimes for lure of huge money received in compensations. This encouragement and instigation of lawsuit against doctors has become a major disadvantage for medical profession.
Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements.
The patients’ right activists, media, administrators, managers and lawyers have made their career and wealth out of it. Doctors know the truth that complications are not preventable beyond a point and are part and parcel of treatment. The line separating errors or natural complications is really blurred and arbitrary. The doctors who work in life and death situation know it well that even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.
It becomes an unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.
Zero fee advertisements and fixed commission ads on television by lawyers in health systems in certain developed countries is an example of instigation against medical profession. They lure patients to file law suits and promise them hefty reimbursements.
A mere perusal of the prayer clause of the Complaint shows that on the face of it itself an exaggerated claim was made without any justification given.
14. The OP is a qualified Radiologist, having post graduate degree, MD (Radiology), and having extensive experience in performing USG of abdomen. There are certain limitations in USG. Sometimes the renal calculi are not visible due to intestinal gases shadows in the abdomen, sometimes stones even pass out through urine. Even the best of Radiologists cannot be better than the machine used for the USG, he cannot improve on the technical soundness or advancement of the machine available at his command. The more advanced a machine, the more precise is its report. However, not every hospital can afford the latest state of the art machines. And the Radiologist has to function with the machine available to him. Pertinently, an advanced Apollo Diagnostic possesses USG 730 (GE) Machine having Advanced Live 4-D Voluson, which has more precision and accuracy, was used in the USG cited at (c) in para 11 above, in which left lower ureter stone was detected.
15. The State Commission appears to have hastily arrived at its findings of medical negligence on the part of the OP, without examining to the requisite depth, the limitations and technicalities of USG, and without taking independent expert opinion on the subject where experts in the field could have thrown light from standard medical literature and brought forth limitations of the level of advancement of the machine used for imaging. As such its appraisal cannot sustain.
On the basis of the entire material on record and the critique made hereinabove no negligence is attributable to the OP Dr. Hulesh Mandle.
It is apparent that the instant Complaint was filed by the Complaint with wrong current address of the OP, beyond limitation, with highly inflated claim. The same, being bereft of any substance, being frivolous and vexatious, merits dismissal with cost of Rs. 10,000/- contemplated for such Complaints under Section 26 of the Act, 1986, to be deposited in the Consumer Legal Aid Account of the State Commission within six weeks from this Order.
NEW DELHI: The Supreme Court on Tuesday modified its 2018 order on passive euthanasia to make the procedure of removal of (or withholding) life support from terminally ill patients less cumbersome for the patients, their families and the doctors by limiting the role played by government officials. While the requirement of setting up two medical boards — one primary and other review — to examine the medical condition of the patient has been retained, the SC has done away with the rule mandating that the district collector set up the review board. The court said both boards will be constituted by the hospital and there would be one nominee doctor of the district medical officer in the review board. The medical boards must take a decision on such cases preferably within 48 hours, it added.
While the current rules state that the consent of the judicial magistrate is required for conducting passive euthanasia, the new order by a five-judge bench of justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar says the magistrate just needs to be informed. While making the procedure for passive euthanasia less cumbersome, the Supreme Court on Tuesday also simplified the process of making a “living will”, an advance directive by a person wishing not to be put on artificial life support. While the earlier rule stipulated that a living will had to be made in the presence of two attesting witnesses and countersigned by the jurisdictional JMFC, the new order says such a will can be attested by notary or a gazetted rank officer. The process prescribed in2018 was onerous as it not only involved family members and doctors but also a judicial magistrate and collector as well as setting up of two medical boards before removal of life support systems and there was no prescribed time period for medical boards to give their opinion. As per 2018 guidelines, in the event a person became terminally ill with no hope of recovery, the treating physician had to ascertain the authenticity of the case from the JMFC. If the physician was satisfied, the hospital then constituted a medical board consisting of the head of the treating department and at least three expert doctors with 20 years of experience.
If the medical board certified that life support system could be removed, the hospital had to inform the collector who then had to constitute another medical board comprising the chief district medical officer and three expert doctors. If the review board allowed withdrawal of treatment, it had to convey the decision to the JMFC. The JMFC then had to visit the patient and, after examining all aspects, decide on whether the euthanasia directive could be implemented. Modifying the order, the bench said that medical practitioners with five year of experience can be part of the medical board. The court also agreed with the petition that there was no need to involve JMFC in the process of preparation of the living will. Times View: The new guidelines have been issued because the earlier guidelines were proving to be unworkable. It is good that the apex court has taken a relook on the subject. It is entirely possible that even these new guidelines may need to be revised in future. But the principle must be about making things easier for consent-givers without increasing the risk of misuse.
NEW DELHI: The Supreme Court on Tuesday decided to “tweak” its 2018 verdict on passive euthanasia to make the procedure and guidelines fixed by it workable, and said that it may fix a time frame within which medical boards would have to submit reports to remove life-support systems from a terminally ill patient. Admitting that the procedure prescribed by the apex court in 2018 was very onerous and time consuming, a five-judge constitution bench of Justices K M Joseph, Ajay Rastogi, Aniruddha Bose, Hrishikesh Roy and C T Ravikumar sought suggestions from the Centre and senior advocates Arvind Datar and Prashant Bhushan to make it workable without compromising with the safeguards put in place by the court four years ago while legalising passive euthanasia. The process prescribed in 2018 not only involves family members and doctors but also judicial magistrates and collectors. Besides, two medical boards need to be constituted before life-support system can be withdrawn. The verdict said the living will, or advance directive for not putting a person on artificial life-support system, has to be made in the presence of two attesting witnesses and countersigned by the jurisdictional judicial magistrate of first class (JMFC). In the event of a person becoming terminally ill, the treating physician shall ascertain the living will’s authenticity from the JMFC. If the physician is satisfied, the hospital shall then set up a medical board consisting of the head of the treating department and at least three expert doctors. If the medical board recommends removal of life support, the hospital shall inform the collector, who shall then constitute another medical board comprising the chief district medical officer and three expert doctors. If the board allows withdrawing treatment, it shall convey the decision to the JMFC before allowing life support to be withdrawn. JMFC shall visit the patient and, after examining all aspects, may permit implementation of the directive.
Seeking modification in the procedure, lawyers contended that time was crucial for terminally ill patients and the whole purpose of passive euthanisa was defeated due to the time taken by the process. That was the reason why there has not been a single case of passive euthanasia in the last four years despite it being legalised, they added.
Agreeing with their contention, the bench observed that dying in peace was dying with dignity, and suffering of a patient should not be prolonged due to the lengthy process. It said that the court could set a time limit for completion of the two-tier procedure without delay and also consider that a living be prepared like normal will without the mandatory presence of a judicial officer. The bench sought response from the Centre on whether it intended to frame a law for its regulation as the court had said in 2018. Paving the way for passive euthanasia, the apex court had in 2018 said, “It has to be stated without any trace of doubt that the right to live with dignity also includes the smoothening of the process of dying in case of a terminally ill patient or a person in PVS (persistent vegetative state) with no hope of recovery. A failure to legally recognise advance medical directives may amount to non-facilitation of the right to smoothen the dying process and the right to live with dignity.”
NEW DELHI: Amidst divergent opinions evading consensus on various points to make 2018 verdict on passive euthanisa workable on ground, the Supreme Court on Wednesday agreed in principle to keep judicial officer and district collector out of the process for making living will and setting up of medical board for removing life support system for terminally ill patients. Facing the onerous task to tweak 2018 verdict without modifying it and to continue with the safeguard put in place four years back, Justices KM Joseph, Ajay Rastogi Aniruddha Bose, Hrishikesh Roy and Justice CT Ravikumar are exploring ways to build consensus among parties, including the Centre, to make the process of making and executing living will or advance directive practical and less cumbersome for the patient. As the petitioner, represented by advocate Arvind Datar and additional solicitor general KM Nataraj, agreed that there was no need to involve judicial magistrate of first class (JMFC) in the process of preparation of will, the bench agreed that the living will can be attested by notary or a gazetted rank officer. As per 2018 verdict, the living will or advance directive, for not putting on artificial life support system, has to be made in the presence of two attesting witnesses and countersigned by the jurisdictional JMFC. The court also in principle agreed that collectors be kept out of the process and will take a call on who should be entrusted with the task to constitute secondary medical board.
Medical Negligence case- Noida (death due to Covid -19) is an example that should force the aspiring doctors needs to think whether they should put themselves in such a situation- akin to catching a falling knife. A case which shows that in difficult situations, legal compulsions have potential to affect the treatment, without realizing what is good for the patient or actually required. In difficult circumstances, while treating diseases with naturally poor prognosis, they can be still held responsible for the situations beyond their control. Doctors can be harassed for just being in a peculiar situation and for being the only one on the bedside of patient. Everyone wants some human factor to blame for the loss, which was at the best God’s wish in real sense.
While treating emergencies patients, there is an eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil, just because of an unexpected poor outcome. Due to misfortune of the patient, the randomness of the tragic tale imposed on the doctor becomes difficult to fathom.
No one can forget the dreadful times of Covid pandemic and the sacrifice of doctors. There was severe scarcity of beds, drugs, and even oxygen, a scary situation no one even imagined. There was no one inside Covid ICU’s, none of the relatives to support their patients, except doctors and nurses.
A patient who comes with 60 % saturation level of oxygen, but wants Remdesivir to be administered. His wish to get administered Remdesivir is taken as a legal contract between doctor and patient. Without realizing that in such situations administration of oxygen was lifesaving but Remdesivir was not. Doctors know the fact but patients are commonly misguided by the media reports. Patients insisting upon Remdesivir, that was not available. But could the doctor refer the patient to some other hospital with 60% saturation- especially in those uncertain times-taking that risk was not a feasible option. What would an average doctor have done? Only option was to manage the dangerous and precariously low oxygen levels. That is a standard medical teaching in critical situations. All drugs are of secondary importance. In this case, as proved by later studies – role of Remdesivir turned out to be doubtful, but oxygen was proved to be of real help.
But patients precondition for admission was to get Remdesivir, a false belief generated more by media than scientific evidence. A false belief hence generated by media gave Remdesivir the status of a panacea and lot of money to the company, who sold it.
But medicolegal compulsions stamped the administration of Remdesivir as a contract between doctor and patient. A contract that needed to be fulfilled, akin to that of constructing a building. But it is actually different to treat critical human ailments from constructing a building. They cannot be treated merely by wish of the patient. Unfortunately, Remdesivir was not available and all the blame for death was conveniently loaded on the treating doctor.
Doctors’ dilemma in present era is generated by conflicting solutions given by medicolegal implications and principles of medical science. Needless to say, doctors will have adopt to defensive practice to save themselves from medico-legal harassments. For example in this case, doctor could have sent patient to some other hospital (in sick condition), according to patients’ wish for Remdesivir. But would that have been a right decision from medical point of view. But legally it would have been safer for doctors.
In other words- the blame -patient didn’t die of Covid-19 but because of lack of Remdesivir. What a sad conclusion for doctors? Non-availability of drugs is not doctors’fault.
To save themselves from such medico-legal predicaments, aspiring doctors needs to think whether they should put themselves in such a situation akin to catching a falling knife.
NOIDA: Five doctors of a private hospital have been booked under IPC Section 304A (causing death by negligence) in an FIR filed on the recommendation from the health department, whose preliminary inquiry found merit in allegations of a “delay” in administering remdesivir to a 22- year-old college student who died during the second wave of Covid last year. The management of Yatharth Hospital here rejected the charge, saying its doctors did their best to treat the patient, who was admitted in a critical state in April 2021. They also pointed to a remdesivir shortage at the time, and subsequent research that says the antiviral drug does not help in Covid treatment. A top-ranking official of the Indian Medical Association, meanwhile, stressed the need for a central law to safeguard doctors against such “violent action”. In cases of negligence against doctors, the health department has to verify allegations before a case is registered by police. In December 2021, Pradeep Sharma had told UP’s Pandemic Public Redressal Committee that his son Deepanshu (22) was not given the remdesivir injection on the first day of his admission to Yatharth Hospital in Sector 110 on April 30. This was despite the family having paid for the treatment, Sharma, a resident of Vijay Nagar in Ghaziabad, alleged. The committee forwarded the complaint to the health department in January 2022. “The preliminary inquiry has found negligence on part of the doctors as a delay was made in administering remdesivir injection to the patient,” the deputy CMO said in the inquiry report. Police said they would now be able to take up the case for investigation. The hospital administration defended its doctors and their line of treatment. “Deepanshu Sharma was brought to us with severe illness. His oxygen saturation was just around 60% and his lungs were affected. During Covid’s second wave, there were a lot of patients and the remdesivir injection was also not easily available. But we managed to arrange the injection for him in 2-3 days and administered it to him,” said Dr Kapil Tyagi, managing director of Yatharth Hospital. Deepanshu was admitted to the hospital for 35 days, after which his family shifted him to a private hospital in Delhi. He died at the facility in June. His father could not be reached for comment on Monday
Treating emergencies and critical patients has become akin to catching a falling knife. There is eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil when exploited by many in the society for the vested benefit- ‘media and celebrities’ to sell their news and shows, by ‘law industry’ and ‘industry’s middlemen’.
Whenever there is an anecdotal episode of adverse event or poor prognosis in hospitals, it is aired by media as an illustration to portray whole medical professionals as dystopian community. By theatrically deriding hard work of doctors, the celebrities grabbed eyeballs to be at the centre stage of health care. What remained invisible to all is the fact that every day in hospitals, thousands of lives are salvaged back from the brink of death.
The real hidden agenda is an attempt to project ‘Reel heroes’ as ‘Real heroes’. By self-appointing themselves as custodian of health of masses, ’the film stars’ and celebrities give true meaning to their work of ‘Acting’, that otherwise was no more than a trifling entertainment. When masses worship them as their true well-wishers, they feature in advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.
The intentional unfairness of the criticism is evident, since the delineation of the cleft that separates doctors from the actual overpowering and controlling health industry is not unveiled, ensuring to sustain the prejudice with its dangerous bias towards health care workers.
There is gradual transition of doctor-patient interaction to a business transaction. The pharmaceutical industry, insurance, law industry and administrative machinery remain hidden in the background and have enormously benefitted by the exploitation of doctors and nurses, who have suffered at the front as the face of the ‘veiled and invisible’ colossal medical business.
The evolving system of corporatization and medicine being projected as a purchasable commodity has resulted in an illogical distribution of health care. The resources spent by people in last few days of life, mostly in a futile quest to have few more, are equivalent to thousands of times the food and medicine for the poor, who lose lives for fraction of that expense. Since in this era, medical therapies are perceived as purchasable and patient has become a consumer.
There is persistent fear of getting a raw deal amidst tricks and traits of the law industry, if any doctor has to face a malpractice lawsuit. A brilliant mind gets entangled in a useless clutter and gets engulfed by a strange fear for the imminent misfortune. Just because of an unexpected poor outcome, randomness of the tragic tale imposed on the doctor is difficult to fathom. With element of arbitrariness involved in the medicolegal suits, law industry has got benefitted enormously at the cost of medical profession.
But these utterances against the medical community are not without serious side effects and results in deteriorating doctor-patient relationship. Mistrust resulted in loss of respect for doctors and predisposed them to all types of violence- be it verbal, physical, legal or financial, as if uncountable lives saved every moment in hospitals were of no consequence.
The blame for deficiencies of inept system and poor outcomes of serious diseases was shifted conveniently to doctors, who were unable to retaliate to the powerful media.
Not only such projections shifted and pinpointed the attention to inappropriate issues, but created an unbridgeable gap of trust between doctor and patients. The fear provoked in the patients’ minds would scare patients to seek help from doctors, who they should be trusting.
The sense of gratitude, which doctors deserved from patients, was replaced by the burden of blame. Even a saved life was thought off merely as a duty fulfilled in lieu of some remuneration.
Consequently, more of doctors’ time is being spent on issues, which are assumed to be worrisome but are not, and less time is spent on the issues that really count.
To control the health system, administrators or even legal systems have a tendency to assume that shortcomings in the patient care can be rectified by punishing the doctors and nurses. For doctors, no gain if they succeed thousand times, but agony assured if they fail once?
Reaction to ‘Death’ in this new era of consumerism has become a story of paradox. Massive civil negligence and 141 deaths but there are no punching bags as are doctors for revenge in case of a hospitalized death. Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence to the one hospital death by disease.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease.
Multiple Deaths in healthy people by civic negligence:
Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods etc. The number of people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of negligence here is massive and these deaths are unpardonable. Timely action could have prevented these normal people from death.
Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.
Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.
Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.
The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.
Single Death in Hospital due to disease:
Reaction to single “in Hospital” medicalized death is a paradox. The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault.
In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.
Point to ponder-Misplaced priorities:
Who is to be blamed for the deaths of healthy people which occur because of civic negligence? Here relatives are actually helpless and the vital questions may go unanswered . There are no punching bags as are doctors for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by Doctors.
It is time to check the emotional reactions to single hospital death due to a disease as compared to hundreds of death of healthy people due to civil negligence.