V.K.Kpoor a former IPS and convener of INTECH, Chandigarh wrote poignantly about a cultural event in a jail; a place permeated with the smell of sorrow and a veritable catacomb of darkness and unhappiness. They live ‘between hope and despair of yesterday and fearful tomorrow. The environment in which a doctor works in India is no better. He is on the wrong side of the law if he attends a patient and the outcome is not right. He is punished if he refuses to attend even if he feels he cannot do justice to the patient or his wages are not assured! He is punished if he does not get his clinic registered even if he is not running one. If he has registered as a clinic he is punished if all facilities are not there, even if he is physically or mentally or financially not sound to do that. There is no age of retirement for him, unlike his colleagues in service or other professionals. He is caged and lashed out for the only fault that he chose to get qualified as a medical doctor. Many doctors have either closed clinics or shifted to some other professions.
A report in The Tribune of May 14, 2015 illustrates the point. ‘U T consumer commission has sentenced Dr Sanjay Saluja, orthopedic surgeon, who was earlier practicing in Sector 8, Chandigarh, to undergo simple imprisonment for a period of two years and to pay a fine of Rs 10,000. In default of payment of the fine, he will have to undergo further simple imprisonment for six months’. In July 2014, this doctor was asked to pay up Rs.70 lakh for amputating the wrong leg of a teenager. Dr. S.K.Prabhakar, a leading physician observed in comment on the net: It has to be impressed on the society lawmakers and judges that medicine is no perfect science and no two patient are same. Same is true for doctors. Doctors have to work under lot of stress overtime sometimes continuously for 36 hrs or more taking decision in split second which can go either way but is taken in the best interest of the patient. There is no perfect methodology of treatment and for a particular condition there are so many treatment theories. Yes a basic average competence has to be maintained and there are always brilliant and average medical practitioners more of the latter.
Who will defend the doctor?
Many doctors hesitate to touch serious patients or even disclose their identity as medical doctors, where they could have helped if the fear of litigation was not there. Those involved in lawsuits suffer from depression, burnout, and emotional exhaustion and often become suicidal. What the doctor may do? A middle-aged couple comes to a doctor. The man complains of a burning sensation in his chest right after eating, which radiates all the way to his neck. The doctor diagnoses him with indigestion, suggesting a change in diet and some pills. But the patient and his wife continue to look anxious. The doctor, although convinced that his diagnosis is right, orders a barrage of tests to rule out a heart attack: an echocardiogram, a tread mill test, a homosysteine and lipoprotein test, a 64-slice CT angio scan. The tests cost Rs.15,000 and, although not medically necessary, they protect the doctor in case of any future claims of insufficient advice. Thus a culture of unnecessary tests and medications or refusing patients with critical illnesses as a safeguard against litigation that hangs like a Damocles of sword over the doctors’ heads has set in. While patients are afraid of an uncaring medical system, doctors are terrified of litigant patients. Doctors’ authority and autonomy stands challenged. The trust between doctors and patients has come down and there is no solution in sight.
India today wrote ‘Medical negligence cases involving surgery account for 80 per cent of all cases, of which obstetrics and gynecology (29 per cent) top the list, followed by orthopedics (22 per cent). Of the various reasons for death, negligence of doctors (49 per cent) is cited the most. But medical errors more often than not are ‘system errors’ and not the result of negligence,” says Dr K. Srinath Reddy, former head of cardiology with AIIMS and currently president of Public Health Foundation of India. “In 2030 BC, the king of Babylon, was to chop off a doctor’s hand for making a mistake. This approach may prevent future mistakes but after some time few doctors would be left with hands to operate. India’s current legal position on medical negligence is not vastly different from that,” says Dr Devi Shetty, cardiac surgeon and chairman of Narayana Hrudayalaya in Bangalore. In 2010, the Supreme Court held out a ray of hope for doctors. A bench of Justices Dalveer Bhandari and H.S. Bedi had pointed out the need to protect doctors from “malicious prosecution”: “It is our bounden duty and obligation of the civil society to ensure that medical professionals are not unnecessarily harassed or humiliated so that they can perform their professional duties without fear and apprehension.”
Highest paid medical malpractice cash in 2014
1. $32.8 Million- for delayed delivery causing brain damage & cerebral palsy
2. Strep infection leads to amputation of all limbs-$25.3 Million
3. Delayed delivery resulted in brain hemorrhage-$14.5 Million
4. $12 million -Hernia operation led to coma & permanent injuries
5. $4.5 million –rib punctured artery due to delayed intervention
6. Heart attack misdiagnosed as stomach illness-$4 Million
7. $1.3 Million-Tummy-tuck causes complications &long term medical issues