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.
The issue of patient safety has been gaining increased traction year on year and the issue is in right direction. Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety. Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.
There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel. There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies, have insight looking at life and death situations directly, know that comparing both would be just an oversimplification of the real basic issues.
At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.
It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does. But , the kind of comparison that some health care safety leaders make in which they compare the mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front line health workers at any point of time, but still pretend to pioneer the quality in health industry. For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be really effective.
Aircrafts are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients are in the worst shape when they enter the emergency of the hospital.
Medicine is by nature, a much more risky work than flying along with vulnerability to death always.
The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.
But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part. For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.
In other words, doctors have to fly crashed planes always on every day basis,something that never happens even once in aviation industry.
Has any Pilot ever tried to fly a plane in which engine power is only 25 percent of normal with other systems are functioning sub optimally and the fuel tank is leaking? What will be standard procedure (SOP) for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional. Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air. Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.
Obviously the comparison is a bit overzealous.
What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.
By a simple common sense, are two situations comparable?
Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.
Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.
Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.
A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients, should be always be the first pillar of promoting a culture of safety.
Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities. Patients are not aeroplanes, and hospitals are not production lines.
Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.
Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.
In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons. Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.
Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation, still it will be required to be carried out in a diligent manner, a task which is different from mechanical task of mere check list of other industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.
Merely completing protocols mechanically and excessive documentation will result in decline in quality actually. Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely reduced to a number to the satisfaction of so called ‘pioneers’ of quality.
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?
Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.
Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.
Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.
Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also need to be careful about how courts may interpret the medical processes. What doctors think is a correct medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight, which everyone is flushed with as an after event.
Large compensations against medical profession are the single important factor can increase the cost of healthcare and demoralize medical profession. Doctors are always on the receiving end in case of an adverse outcome. Medical problems are very complex and sometimes it is difficult to judge the future course of disease as well as court interpretation of medical science, especially with retrospective wisdom by courts. Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.
Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of lawyers. Law industry has been benefitted enormously because of consumer protection act at the cost of doctors.
Strangely doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.
New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies. Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint. The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for the treatment and purchase of limb prostheses. The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses. As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”. But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist. He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.
A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other lifesaving equipment. This was despite the fact that the committee constituted by the District Surgeon to verify the allegation of medical negligence in its final report has said there is no negligence on the part of the accused during the performance of the LAVH surgery and also shows *how the accused have tried to save the deceased.”*
What is worrying for the doctors is that every death during medical treatment can be a blame against the doctors. If the courts were to impose criminal liability on the hospital and doctors for everything that goes wrong, the doctors now should be more worried about their own safety than giving all the best treatment to their patients. Both Government and Private small hospitals carry out thousands of routine surgeries every day. Occasionally complications may arise in simplest looking procedures – for example even in normal deliveries; what to say about routine surgeries. How many hospitals (Government and private) in districts, town in peripheries are equipped with a ventilatory support system? Perhaps they are too less, although an honest count would be some interesting data. Still, surgeries of the type mentioned are conducted routinely in almost all of these small centres.
So based on one incident of this kind, the thousands of surgeries done in such areas are going to be affected. In other words, doctors will not dare to conduct surgeries in peripheries. As per the verdict of the court, many of the surgical speciality’s doctors in periphery are indulging in blameworthy activities every day in their routine work. Why should they risk their lives and profession in such circumstances? That raises another question , as many Government Hospitals are also without ventilators in the periphery. Should Govt doctors also refuse surgeries without an ICU setup? Any Surgery or even normal delivery in rare circumstances can get complicated and the patient may require ventilator. Usually anaesthetist use Ambu-bag for an emergency situation and transport the patient to other facility. So absence of a ventilator is not life threatening in a real sense. In peripheries, a large number of deliveries are conducted by ANMs, and nurses, and complications may arise occasionally. So what are the facilities expected and available at a sub-centre? In reality almost nothing is available. Merely having a ventilator does not solve the problem and is not enough . The hospital requires much more arrangements to keep a patient on ventilator. Do all Govt hospitals where surgeries are being done have ventilator and trained doctors and support staff to operate those ventilators? It needs round the clock trained doctors and nurses, ABG machine, portable X-ray , bed side Echo dialysis etc. Doctors in ill-equipped Govt centres are forced to conduct deliveries. What should be the SOP in such circumstances? A real and honest data would be an eye opener and interesting.
Doctor need to ponder over the issue of saving themselves before they save the patient.
Medical Negligence: Karnataka Court Convicts Three DoctorsFor Death Of Woman Operated Without Ventilator Facility & Other Life Saving Equipment* “A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other life saving equipment. BIDAR: Four people, including three doctors, have been handed jail terms and slapped with fines by a local court for a botched surgery which claimed the life of a woman.The II Civil (senior) and JMFC Court judge Abdul Khadar sentenced well-known medical practitioners Dr Rajshree Biradar and Dr Vaijinath Biradar, and Saibanna, to two years imprisonment and fined them Rs 10,000 each. If they fail to pay the fine, they will have to serve an additional six months in prison. Dr Rajshekar Patil was sentenced to six months imprisonment and fined Rs 5,000. He will have to serve additional imprisonment of one month if he fails to pay the fine.The case dates back to October 12, 2014, when Sampavati, wife of Ghaleppa Auradakar, got herself admitted to Sushrut Nursing Home in the city for a hysterectomy procedure. But after a five-hour surgery, she died due to alleged medical negligence.However, without disclosing her condition to the family, she was shifted to Dr Rajshekhar Patil’s Shree Hospital in an ambulance. Dr Patil continued the treatment without disclosing her condition, it was alleged in the chargesheet.
Nursing home was negligent in not having ventilator: Court
Later, it was revealed that Sampavati had died at Sushrut Nursing Home itself due to the lack of ventilator facility. The court, while convicting the accused, observed that the nursing home authorities were negligent in not having a ventilator facility for such a risky procedure.
With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades. Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone. No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new. Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.
Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years. It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome.
One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money. Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.
The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over the system is not robust enough for such a change. To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment.
Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care. Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous, just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the scenario projected. It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.
There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients.
With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs. To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.
Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall inflated cost of health care.
Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.
Medical consumer protection act has increased the anxiety and insecurity among medical professionals. Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.
Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.
Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes. Mutual understanding takes a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity among medical professionals.
The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the doctors by all, including medical industry, law industry and administrators. Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible. The industry has used the protective systems against medicolegal cases to gain maximum benefits out of doctors’ hard work.
In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being a victim of sympathy towards patient or clever lawyering. So taking medical decisions in critical situations is becoming more difficult in view of the future uncertainty of disease.
Windfall profits for lawyers is a strong incentive for law industry to promote instigation of patients by against doctors . One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations.
Consequently doctors are now an easily punishable human link for poor outcomes. Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.
Strangely Medical Consumer Protection Act applies only to doctors, that too selectively. All other professions and services are out of it, not even other constituents of health services. Selective application is what is demoralizing the doctors. Considering the uncertainty and kind of work done by medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult by uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach. The possibility of complex medico-legal situations in doctor’s mind are enough to distract doctors from their primary point of intentions ‘the treatment’.
Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the entire life.
Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides, while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years. Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.
If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult position?
Medical Consumer Protection Act has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run. The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment) are few of the side effects, which will definitely be passed on to the patients inadvertently. After all doctors have to save themselves as well. As a result, now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.
Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses. Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.
The 300-page book contains 20 stories divided into three parts viz – Larva & Pupa Syndrome, Hope & Fear & Medical Lawsuits. The book is available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive etc.
While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts. Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.
His book ‘At the Horizon of Life & Death’ is a Reality Fiction that reflects the sensitivity involved in dealing with patients facing death.
Through the eyes of its protagonist Dr Anand, the book captures significant moments in the treatment trajectory of critical patients. The book tries to create awareness regarding pertinent issues faced by the medical professionals like demoralisation, expensive medical education, the extreme pressure and suicidal ideation, the plight of the nurses and support staff, assaults and violence and the medico-legal intricacies involved in day-to-day practice among others. The author has also taken care to guide aspiring doctors to make well-informed career decisions.
Part One (Larva & Pupa Syndrome)- talks about the expensive medical education, and the issues students face in medical college.
Part Two (Hope & Fears) talks about the beginning of doctors’ professional journey, the disease demons they face while dealing with critical patients, dilemmas of doctors and patients near death situations.
Part Three (Medical Lawsuits) is about how doctors are always working under the threat of medico-legal lawsuits.
While stories are fictional, the scenarios and the problems in them are very real — things that he faced or saw his colleagues facing.
Medical profession has become victim of mistrust generation and blame culture. Everyone keeps harping about the few black sheep in the community, while larger good work of doctors is not highlighted enough.
The stories span from Dr Anand’s initial days in the emergency room and capture his struggles in complex medico-legal scenarios over the next four decades. This book is an effort to bring back focus on the treatment of the patient as opposed to the mistrust, legal frameworks and policies surrounding the healthcare practice.
The book is self-published, available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive etc.
Medical consumer protection act was implemented in 1995. Patients defined as consumers and hence doctors converted to service providers in lieu of some money. Consequently the changed definitions altered the doctor-patient relationship in an irreversible way. Instead of the earlier congenial relationship, now-a day’s doctors and patients are fighting in courts, whereas most of aspects of the law still remain grey after 26 years of implementation. Here in this case even courts differ in the interpretation (among themselves) of the law after more than two decades of its implementation.
The doctors are supposed to treat, provide relief and save lives are the most affected, it is needless to say that the way of treating patients has been altered like never before. Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on someone’s confidence and belief, which takes a lifetime to build.
The reality is that neither doctors, nor patients were ready for such a legal relationship, and the system was not robust enough for such a change. To work with weak infrastructure, non-uniform medical education along with legal threats pushed doctors into a shell and forced defensive practice. It caused erosion of doctor-patient relationship and escalated cost of care.
Medical business, insurance and legal industry made full use of the opportunity to have the benefits of changed doctor-patient relationship. Doctors were used as scapegoats for poor infrastructure by administrators and further exploited by law industry.
Justice eluded doctors at all stages.
It is discouraging for medical professionals to note that courts are still clarifying the law even after 26 years of its implementation. What is more disheartening that many more aspects about the medical-consumer protection act are either remain unclear and create difficulty for doctors. To differentiate medical mistakes, poor prognosis from negligence is a very fine line and difficult to judge. Therefore medical profession has become a subject to blackmail by patients, lawyers and sitting ducks for punishments. The consequent insecurity among doctors, practice of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment) are few of the side effects, which will definitely be passed on to the patients inadvertently. After all doctors have to save themselves as well.
Consequently being consumer may be overall a loss making deal for the patients.
The point to ponder is that courts themselves differ on interpretation of law even after 26 years of its implementation.
The Supreme Court has reiterated that service rendered by medical officers on behalf of a Hospital, free of cost, would not fall within the ambit of medical consumer protection act.
KMG General Hospital in Balasinor, Gujarat has to pay Rs 11.23L compensation to patient’s relative after the doctor removed his left kidney after the patient was admitted for removal of kidney stones.
Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, and can have high complication rate. Merely because a Kidney has been removed for stones can’t be negligence on part of surgeon. Doctors need to save themselves while taking decisions in good faith. Natural complications can be easily labelled as medical negligence because of faulty definitions of consumerism applied to complex medical scenarios.
Doctors need to be careful on following points as any adverse event can lead to professional hanging.
Communication-Possibly appears to be the main mistake. Doctor could have communicated the need for kidney removal, instead of doing it in good faith. One should remember the strings of consumerism applied to medical science and not the good intentions.
Informed Consent: Many times, surgical plans change during surgery. Therefore consent has assumed an important role in present era. There was no consent for Nephrectomy, but done in good faith. In absence of consent, Whole blame and responsibility is shifted to the Surgeon. An informed consent will avert untoward aggression apart from legal entanglements.
Performing in suboptimal facility– as newspapers says, Raval was advised to go to a better facility, but he chose to undergo surgery in the same hospital. Doctors should now be careful to operate, if facilities are not available. They should refrain from taking blame for suboptimal infrastructure.
Wrong Projection of the problem by media; As the paper says- “The surgery was just for removal of stone from the kidney and the consent was taken for removal of stone only, but the kidney was removed instead”.
Merely because a Kidney removed for stones can’t be a negligence on part of the surgeon. It is a procedure which is not uncommon.
Medical Opinion of experts: The news report doesn’t tell about the expert medical opinion. How in the given circumstances, negligence is proved? Has any competent surgeon given a report of negligence or it is merely because the patient has died.
KMG General Hospital in Balasinor has to pay Rs 11.23 lakh compensation to a patient’s relative after the doctor removed his left kidney after the patient was admitted for removal of kidney stones, ordered the Gujarat State Consumer Dispute Redressal Commission. The patient passed away four months after the vital organ was taken out.According to the report, Devendrabhai Raval from Vanghroli village of Kheda district consulted Dr Shivubhai Patel of KMG General Hospital in Balasinor town for severe back pain and difficulty during passing urine. In May 2011, Raval was diagnosed with a 14 mm stone in his left kidney.
However, Raval was advised to go to a better facility, but he chose to undergo surgery in the same hospital.
He was operated upon on September 3, 2011. The family was surprised when the doctor after the surgery said that instead of the stone, the kidney had to be removed. The doctor cited it was done in the best interest of the patient.Later on, when the patient began having greater problems in passing urine, he was advised to shift to a kidney hospital in Nadiad. Later when his condition deteriorated further, he was taken to IKDRC in Ahmedabad. He succumbed to renal complications on January 8, 2012. Minaben, Raval’s widow, approached the Consumer Dispute Redressal Commission at Nadiad, which in 2012 ordered the doctor, the hospital and the United India Insurance Co Ltd to pay compensation of Rs 11.23 lakh to the widow for the medical negligence.
The district commission’s order brought the hospital and the insurance company to the state commission over the dispute as to who should be held liable to pay compensation. After hearing the dispute, the state commission observed that the hospital had the insurance policy for indoor and outdoor patients, but the insurer was not liable for medical negligence by the treating doctor. The surgery was just for removal of stone from the kidney and the consent was taken for removal of stone only, but the kidney was removed instead. Thus, it is a clear case of negligence on part of the doctor and hospital, reported Times of India.
Evolution of Medical profession-Extinction of good doctors 