In Jaipur, a senior doctor erred in inserting an oxygen tube into his patient’s brain; in a Hyderabad hospital, a man who had come for a routine check-up was inadvertently operated upon and the surgery left him paralysed; in Chennai, a woman went in for a tubectomy and lost her bladder; in Bangalore, a man died during chemotherapy after being injected in the spine instead of the vein; in Mumbai, a baby declared dead was found alive during burial; and the latest in Kolkata, a premier hospital confessed to having lost a part of a patient’s skull! Medical errors have long been a reality. With the absence of a strict law and heavy pendency of medical negligence cases in consumer courts, the respite is seldom in sight. Deebashree Mohanty tells you why action needs to be taken and taken fast
Even after tremendous growth of the healthcare industry in India, there are as many as 98,000 patients succumbing to death every year due to medical errors. More than 20 per cent could have led a comfortable life if not for that one gross medical negligence. Thirtyseven per cent patients were children below 15 years of age while 11 per cent were senior citizens with perfect health conditions. Of these, only 20-27 per cent approached the consumer court for redress. While 12 percent withdrew midway due to the tedious process and time taken for action, 2 per cent hung on to that slim chance of getting something out of the hospital. Only 3 big cases of compensation have been awarded to hapless relatives of patients since 2010
— A study by the National Board of Hospitals and Healthcare Providers (NBH&HP) in February 2014
Rima Nair, an account manager at a popular advertising agency in Mumbai has been pursuing a case of severe medical error which resulted in the death of her younger brother in the Sheikh Sarai district consumer forum. It has been 10 months but the case has not moved an inch. However, it has done enough damage to her wellbeing and finances. “My husband left me in December 2013, as he felt I was getting obsessive about this medical malpractice case that I had filed in New Delhi. We are not divorced, only separated. My boss has been very co-operative and grants me leave whenever the need arises,” Nair, who has also walked the ramp for many NGO events, says. For her, the entire world came tumbling down after two phone calls — one at 5: 30 am on March 21, 2012 and the other at 4: 47 pm on the same day.
“My parents passed away when Rahul was only 11 years old. Since then I was his only support system. A graduate from Pearl Fashion Academy, Rahul was in the Capital to explore options to start his new designer boutique in a posh market in South Delhi. On March 21, he got up with a horrible stomach pain. Thinking it was his appendix giving him trouble, he got admitted to one of the biggest hospitals in South Delhi. The attending doctor informed him that all was well and it was only just a urinary tract infection. There was also a small (.07 inches) growth on the kidney wall which the doctors wanted to examine to rule out any possibility of further health issue. He called me to say that he would be discharged in an hour. The next call I got was at 4 pm by a friend who said Rahul was dead,” Nair recalls.
The senior resident doctor attending on Rahul, who was supposed to conduct a biopsy on the growth in his kidney, had by mistake started an operation on his appendix. The anaesthetist had only administered anaesthesia for the biopsy which would have been for a much shorter period. “We were informed by the nurse that Rahul’s anaesthesia wore out within 15 minutes and he convulsed in pain. By the time the doctor could rectify his mistake, Rahul had started sinking. A series of follies later, he died in the OT,” Nair recalls trying not to sob.
The excuse the doctor and the hospital gave was that there was a confusion regarding the patient chart which said that “the patient complained of appendix related pain”. Instead of looking at the resident doctor’s report, the operating doctor went by the first note. He has been removed from the board of special physicians and has been handed over a temporary suspension by the hospital till his name is cleared. No out of court settlement has been offered to Nair.
“Patients dying on the operating table due to miscommunication between the anaesthetist and the doctor is the commonest medical errors of our times. This could be because in very few hospitals there is a direct line of communication between the doctor and the anaesthetist prior to the operation. It is seen in most cases that the doctor arrives only after all the procedures are dealt with. That is a dangerous route to follow because a patient’s needs can change at the last minute,” Dr KK Kalra, CEO of NBH&HP, tells you. He says that medical errors are a matter of grave concern and are between 2.9 to 3.7 per cent of all admissions in hospitals, of which 8.8 to 13.6 per cent result in death. The safety of patients is still to be indoctrinated among medical practitioners, a point used by lawyers persistently, he adds.
In most cases, the institution furnishes bizarre excuses like: The doctor was sleepy or tired as he had done 10 operations in a week, that there were a lot of surgical procedures being done on that day etc.
Excuses are galore but the recent case of the missing skull from a Kolkata OT is mind-boggling.
Arnab Dutta, 23, had jumped from the terrace of his lake Gardens apartment in January 2013 in a bid to commit suicide after his father passed away. The computer engineering student was rushed to the Ruby General Hospital with severe head injuries and was operated upon for brain hemorrhage. At the time of discharge, the hospital told his family that the bone flap of his skull would be preserved and replaced later, and that they should return after some time. In May, the family asked the hospital for the bone flap but the skull piece was nowhere to be found. Neurosurgeons said, it was no big deal as the flap replacement was done only for cosmetic purposes. However, the hospital has assured the family of compensation.
“The most unfortunate part is that consumer claims on medical negligence have the highest pendency in consumer fora. In 2013, 4 lakh such cases were pending. As of March this year, more than 8,000 cases were pending before the national commission alone, many of which were those where the compensation sought was Rs 1 crore or more. The pendency in district forums was 3 lakh and those before State commissions around 50,000. These cases have nothing to do with the pendency in courts which stand at around 4 crore across India in subordinate courts, High Courts and the Supreme Court. This acts as a huge dampener for those who want to file a case. Steps are being taken to expedite this process,” Arun Jain, retired judge of the Pritampura consumer district forum, tells you.
“If the hospital feels it can get away with gross negligence resulting in death or paralysis, they will not be too bothered about it. It is time we strengthen the legalities and make it possible for hapless relatives to file complaints. We need stringent laws to bring erring senior doctors and reputed institutions to the book,” Jain, who now operates as a consumer complaint advisor, says.
But do reputed institutions have it easy in consumer casesIJ “It is a 60:40 ratio. More complaints are against small-time hospitals which go about their surgical procedures in a haphazard manner. About 40 per cent cases are against the big institutes across Delhi. It is seen that the bigger the hospital the more the chances for an out-of-court settlement. If the hospital decides to go all-out and fight the case, it is seen that the complainant withdraws it in a couple of months,” advocate Mihir Mishra, who is pursuing a medical negligence case in the High Court, says.
In 2010, Mishra and his client were rewarded a compensation from Bhardwaj Hospital when the attending doctor administered a drug that had long expired to a 70-year-old patient. The highly diabetic patient had come in with viral fever and was injected with an anti-viral that had expired over a year before. “The patient’s son, Sanjeev Singh did not have the means to go through with the case so we had to make do with an out-of-court settlement in which the hospital paid Rs 2 lakh as damages and his mother was treated for her worsened condition for free at the hospital,” Mishra says.
As for the current case, he is hoping that will see a huge compensation. “It’s a very interesting case. My client’s 15-year-old son was suffering from dengue and required blood transfusion. He was given blood from a different group which resulted in his painful death. The client is a celebrity and is willing to fight the case against one of the biggest medical institutions in India,” Mishra says, not willing to give out any more details.
The case with Government hospitals is more sordid. “It is difficult to give the exact numbers of medical negligence cases in Government hospitals, like AIIMS, but it is huge. Note that the last three cases of huge compensation and settlement have been from AIIMS,” Mishra tells you.
In 2011, advocate CK Mathur filed a petition at the IP Estate district consumer forum against a cardiologist working at AIIMS for gross medical neglect leading to the death of Kishore Bihari Shankar, 68. Mathur argued that the patient succumbed to heart attack in four minutes after failure of a stunt insertion operation. He held the hospital and doctor liable and sought a compensation of Rs 2 lakh with 10 per cent interest as they had been charged for the operation. The hospital went in for an out-of-court settlement.
In 2007, holding the AIIMS guilty of ‘gross medical negligence’, the State Consumer Commission asked it to pay Rs 1 lakh compensation to legal heirs of a patient who lost his voice after undergoing an operation. JS Bedi, a Chandigarh-based doctor, lost his speech six years ago after AIIMS doctors ‘botched up’ a surgery to remove a tumour and failed to take note of the damage to his speech faculties.
By the time the commission pronounced the verdict, he died and the money will now go to his legal heirs. Bedi was operated on August 22, 2001.
Apart from awry surgical procedures, lawyers tell you that doctors amputating the wrong foot or removing the wrong kidney are common gaffes that occur every year. “In May 2013, there was a story of a tragic mix-up. Blood transfusion meant for one patient was given to another at a top private hospital in Delhi as his bed had changed. It caused severe blood reaction and he died. Such cases happen as doctors don’t listen to the patient. A study shows that 90 per cent doctors interrupt patients in the first 20 seconds of their conversation. Besides, in wrong-site surgery, several factors come into play, from a series of small but crucial mistakes by several people who dealt with the patient, to flaws in a hospital’s operating procedures. It is individuals making several mistakes and systems not being able to prevent those,” Dr P lal, cardiologist at the Indira Gandhi Medical College, says.
All said, there are two sides to a coin here too. Doctors feel their entire community is being penalised for the few who don’t take their profession seriously. Ever since the Supreme Court brought the patient-doctor relationship under the Consumer Protection Act in 1995, complaints against doctors have soared. But no one knows how many such cases occur. Also, the law does not clarify the difference between ‘gross negligence’, ‘error of judgement’, ‘accident’ and ‘recklessness’. This, Dr KK Bhansali from Medcity Hospital in Gurgaon, feels worsens the case for diligent doctors.
“Mistake, mishap, mischief, call it what you may, the sacred covenant of trust inherent in a doctor-patient relationship is crumbling. Yes, medical errors are a reality and have to be rooted out of the system. But it is also a fact that in the absence of any strict law, even doctors are being wronged. We need better management and fair law enforcement,” the doctor says. Doctors on the Indian Medical Association board call for strict action taken against doctors who are lackadaisical. But there is dire need to have a fair and just system to rule out phoney redress demands too.
“In our profession, there is no scope for a ‘mistake’. Hospitals across the country are still dependent on 19th century principles of management and it’s time to redesign them,” Dr Vishal Bali, CEO of Forits Healthcare, concludes.
Consumer claims on medical negligence have the highest pendency in consumer fora. In 2013, 4 lakh cases were pending. As of March more than 8,000 cases were pending before the national commission, where the compensation sought was Rs 1 crore or more. The pendency in district forums was 3 lakh and before State commissions around 50,000