Thousands of patients die due to medical negligence in hospitals across India, the number steadily rising. SHALINI SAKSENA speaks to the families of the dead who say that there is an urgent need to revamp the healthcare system. Doctors, on the other hand, are ruing the fallen doctor-patient trust which they say is the lowest today
I want to file a case against the doctor who operated upon my father. My father recently underwent a liver transplant that led to fatal complications. To top that, the prolonged hospital threw up an exorbitant medical bill. I saw on YouTube how the surgery should have been done and now that the surgeon erred. Please take appropriate action against him.
The National Accreditation Board for Hospitals Report claims that 98,000 deaths from medical injuries occur in India every year. According to Manupatra, a legal research source, medico-legal cases in the Supreme Court have gone up by 400 per cent in the last decade.
Take the case of Pankaj Arora who has been fighting a case against Medanta-The Medcity in Gurugram for the last five years.
“My son (10) suffered a deranged liver after he had jaundice. In October 2010 when I brought him to Medanta, his prognosis was ‘Auto-immune Hepatitis’. A liver transplant was recommended. I was given an estimate of Rs 15 lakh. I was not in a position to shell out so much and requested the doctor to cut the cost, but to no avail. I approached Haryana Chief Minister Bhupinder Singh Hooda. He urged the hospital to give me discounted treatment in January 2011. Immediately, the transplant was postponed to March 2011. This delay led to post-surgery complications. My son’s body rejected the graft. A medical condition called Cytomegalovirus set in along with hepatic thrombosis. The hospital discharged my son despite these complications because they had already given me a discount of Rs 3.5 lakh,” Arora claims.
On April 4, 2011, he adds, the son was re-admitted. His previous treating doctor prescribed him antibiotics and tests and the family was sent back again. But the condition of the patient deteriorated and Arora rushed him back to Emergency of the same hospital.
“A call for retransplant was taken but no action was taken. I was repeatedly asked to make a payment so for the treatment to start. By April 19, the complications were so high that a re-transplant should not have been done yet they went ahead with it. My 55-year-old mother was the donor. My wife was the primary donor but couldn’t donate again. The surgery was unsuccessful due to complications. My son was on immunity suppressant drug and should have been in isolation but was kept next to a drug resistant TB patient in a sharing ward for a month. He caught TB. Four more drugs were added to his schedule. A liver transplant patient couldn’t handle so many antibiotics. On July 31, 2011, my son passed away due to multiple-organ failure and septis-shock,” Arora said at a recent Press conference in the Capital.
Since then he has been in a running battle with the hospital giant.
“If only, others had decided to fight instead of merely abusing the hospital and returning home to weep in silence, my son would have been alive today. But I will fight till justice is imparted,” Arora said. He finally ended up paying the hospital Rs 30 lakh. This included the amount raised in charity.
Rinku Singh, who hails from Azamgarh, is in a similar situation. His father, Sardar Pradhan Singh (59) was suffering from a kidney problem and advised a transplant by Max Hospital, Saket. Rinku’s mother was the donor.
The family was told that the operation was a success. But it now alleges that doctors neglected the case by not factoring in the high infection levels in Singh. Three immuno-suppressant injections costing Rs 16,500 each to be given before the transplant were never administered. “After the operation when the patient was in ICU and complained of excruciating pain, no senior doctor came to see him till 9 pm. The doctors then wheeled him into the OT again and my father was put on the ventilator. His eyes were taped and there was no movement. He was declared dead four days later, a day after my mother was discharged from the hospital,” he recounted.
Rinku alleged that the doctors were careless and that he was given an additional bill of Rs 3.19 lakh over and above the Rs 6.4 lakh which he had deposited before the operation.
“There were serious lapses in my father’s treatment. You had a patient in the ICU screaming in pain and no senior doctor comes to see him till 9 pm! Why? Then, when they took him to the OT again why were his eyes taped? I think he was long dead but they wanted to build up the bill and also thought they should wait till my mother was discharged,” Rinku said at the Press conference.
He filed a complaint with Delhi’s Health Minister and met his OSD who advised him to complain to the Delhi Medical Council where he submitted all the documents. He also wrote to the Directorate General of Health Services, Delhi, but no action was taken.
After several months, he got a response from the DMC stating that no negligence was found and, hence, no action could be taken against the hospital or the doctors. He was given an option to approach the Medical Council of India. He, instead, decided to approach the Delhi State Consumer Court in September 2016. Since then, seven hearings have taken place. Meanwhile, Max Hospital has filed a case against Rinku for non-payment of Rs 3.19 lakh which he claims had earlier been waived by the treating doctor. The case is in the Saket District Court now.
Advocate Piyush Chhabra who is fighting on behalf of Arora says that the problem in cases of medical negligence is that there is no singular forum where a complaint can be filed.
“Some go to a consumer court and others file a criminal case again the hospital and the doctors concerned with the police. I have written to the Government about how our system is not competent to hear medical negligence cases. Special courts are needed to hear and investigate such cases. Even during a trial, there should be a Tribunal. The Government can do many things. The investigation should be carried out by a special team set up for this purpose at each level, depending on the demand, similar to what we have in economic offence cases. Then a chargesheet should be filed at the special tribunal which understands medical terms. This can have a retired judge, a doctor and a social activist,” Chhabra explained.
The problem faced by the families, he said, was that “hospitals and the doctor have no fear. A forum will make them cautious. A person who is dead can’t be brought back. We just want further negligent deaths prevented,” Chhabra said.
He was critical of doctors who say that being brought to scrutiny ties their hands in treating patients.
“A good doctor has no such fear. Every profession comes with riders, even lawyers. Courts agree that wrong advice can’t be held liable. That doesn’t mean lawyers won’t give advice. The same is true for doctors. But if there is factual and glaring negligence, that can’t be ignored, negligent acts like making a liver transplant patient share a room with a TB patient. A hospital like Medanta has the best facilities. A person goes there because he feels he will get the best treatment. Such a hospital can’t be expected to make such a mistake in the face of clear guidelines,” Chhabra added.
Jayant Singh lost his seven-year-old daughter to Dengue in 2017. He alleged that the Gurugram-based Fortis Hospital charged the family an exorbitant fee of Rs 18 lakh. Singh posted this on the social media which was picked up by the Delhi Health Minister who ordered an enquiry. Charges of medical negligence and over-charging through consumable products, the pharmacy and the path lab were proved. Not only this, the hospital forged Jayant and his wife’s signatures which was also proved.
Singh filed an FIR. A Special Investigation Team was formed on December 10, 2017 and a writ filed in the Supreme Court asking for reforms in the Healthcare sector. The proceedings are going on.
Several families asserted that no doctor had the right to treat a patient based on ‘personal experience’ without the backing of authentic medical literature. Courts, these families said, often exonerated doctors by giving them benefit of doubt after he is able to show he followed a mode of treatment shared by other medicos.
In a vast and poor country like India, only a fraction of the cases of genuine medical negligence actually reach the court or the medical council because of lack of public awareness.
Singh, like Chhabra, insisted that doctors should be open to scrutiny. “Human error is acceptable. But in my case, the investigation found gross negligence. The problem lies in the system. Doctors are given targets by private hospitals. What will you say when a patient with multiple-organ failure is put next to an MDR-TB patient? Human error or negligence? Definitely negligence. The only alibi the doctor and the hospital had was ‘we only have one ICU’. People go to a premium hospital to get the best care. I am willing to pay, why not give me the best? Doctors are not to be blamed, it is the hospitals who make doctors party to the problem,” Singh said.
Dr Anand Bansal, medical director with Delhi’s Sri Balaji Action Medical Institute Hospital, says that the rise in medical negligence cases is because the Internet has information on everything.
“This means that the patient and his family doubt the doctor from the start. The increased awareness that this profession is no longer noble means that we are questioned on everything. There are always chances of human error which does not mean negligence. There is no doctor who will harm the patient deliberately. They go beyond their call of duty to give their best. Just because a patient has come to a hospital doesn’t mean that he will be cured. This doesn’t mean that the doctors are not competent or there is pressure leading to negligence. Most patients want quick results. But we can no longer depend on clinical diagnosis. We have to first prescribe tests. If we don’t they go to court as to why we didn’t do so. The doctor is no longer trusted and that’s wrong. The patient and the families must realise that we are not God,” says Bansal. He feels that this is the worst patient-doctor relationship phase.
“They have no confidence in the doctor; they only see us as people wanting to money. If they go back hail and hearty, the doctor is just doing his job, otherwise we are blamed and taken to court. Therefore, we have to take signatures for everything. Something that we never did a couple of decades back. The problem is that some doctors are unable to communicate, to the family, the critical situation. Most times the doctor is in the right but the patient and the family are not willing to listen,” Bansal explains and says that out of the 1,000 gross medical negligence cases one or two per cent would be based on factual errors.
Both the doctors and families agree that there is no dispute that medical science is not perfect adding two plus two to four. There is a grey area in diagnosis and treatment of many clinical conditions as our knowledge in medicine is changing everyday through remarkable medical research across the globe. Thus, there is every possibility that a doctor may commit an inadvertent error of judgment while treating a patient by not following the latest medical guidelines or by following the least supportive school of thought. But no doctor should be held guilty for medical negligence in this situation.
President of the Heart Care Foundation of India and former president of Indian Medical Association, Dr KK Agarwal, agrees that there is no escape for treating doctors if a negligence is alleged. “But no case should be registered unless a preliminary inquiry proves negligence. Today, this happens only for criminal negligence cases but not with non-criminal negligence cases,” he says, adding that no medical treatment is risk-free.
“No surgery or drug is risk-free. For sudden death or unexpected complications, consent should be taken in every case. Unexpected deaths and complications are a reality but often not explained to the patients,” Dr Agarwal says.
A word of advice for the families by the doctors. The most important aspect to get the right treatment is awareness about the rights of a patient. For example, every patient has a fundamental right (under section 1.3.2 of MCI Code of Ethics & Regulations, 2002) to obtain the medical records of the treatment, both during and after the therapy.
The patient must demand (in writing) these records that are crucial for obtaining a second medical opinion (which is recommended in serious medical condition) and also to fight for medical justice, if necessary.
Unfortunately, from thousands of victims of alleged medical negligence that one has seen, who come to People for Better Treatment seeking justice, after their loved one may have fallen prey to reckless treatment, that they have little, if any, records of treatment given by the errant doctor/hospital.
All patients must demand and obtain all medical records from the treating doctor and hospital. This sends a strong signal to the doctor/hospital that the patient-party is well-aware about his rights. This is enough pressure on the treating physicians to be careful in treatment.
