Saturday, April 26, 2014

A legal system against medical malpractice and rights of patients

M. Serajul Islam

 I was recently talking with a nephew who is studying to become a doctor in the United States where to become one is very expensive and takes away almost a good part of one’s lifetime. We were trying to understand medicine as a profession and health system in Bangladesh in comparison to what these are in the United States. We concluded that doctors in the United States are compensated handsomely after their gruelling efforts. We also concluded that doctors in the United States are never allowed to forget how important human life is because the law makes sure of that.

I told my nephew that there are no worries/problems for doctors in Bangladesh on account of human lives. His eyes almost popped out when I told him that the doctors in Bangladesh are given an unwritten license with the one they are given legally to practice and that the unwritten license is similar to the one James Bond of fiction has been given, the 007 one or the license not too worry who dies in his hands. I also told him that to my knowledge no Bangladeshi doctor has ever been taken to court with a case of malpractice against him or her and that no one is sure whether there are any such laws in the country to take a doctor to court even when a patient dies in his/her care due to his/her negligence or inefficiency. I further told my nephew that hospitals also enjoy similar unwritten immunity from legal hassles.

Doctors and hospitals in the United States are the most heavily insured among professional groups and institutions. Relatives of patients can take doctors and hospitals to court if they think they were responsible for the deaths of their patients due to negligence or wrong treatment. The laws allow such action against doctors/hospitals within a year of the deaths. Doctors and hospitals are taken to court regularly by relatives of patients where, when cases are proven, huge compensations have to be paid by court orders or by out of court settlements. The insurance companies in which the doctors and hospitals are insured heavily make such payments. Similar laws to protect the rights of the patients and insurance to protect the interests of doctors/hospitals are integral parts of health systems where both doctors and patients are stakeholders and not on opposite sides.

In Bangladesh, there is perhaps no family that has not had a member pass away due to negligence of the attending doctor or the hospital in question. Unfortunately, in the country, there is no legal system to take doctors/hospitals to court. In Bangladesh, doctors/hospitals and patients/their relatives are opponents where the former do not see the latter as stakeholders in the apology of the health system in the country. Therefore, the recent incidents in BIRDEM, Rajshahi Medical College Hospital and Dhaka’s Salimullah Medical College/Hospital where relatives of dead patients went on rampage were neither unexpected nor unusual. These incidents were always likely to happen. In fact, many such incidents have happened in the past regularly but did not make news the way the present ones in the three government hospitals have. The current ones have come into the public domain as leading news because the doctors who came under attack retaliated, turning the three hospitals into battleground that can happen only in a nightmare or in an uncivilized country.

The doctors, not satisfied with taking the law into their hands, declared strike to follow upon their most un-doctor like behaviour imaginable. The media added a new element of ugliness to the conflicts when they became victims in the hands of the junior doctors while covering the conflicts and the strike. They were beaten and their professional equipment destroyed/damaged. The private TV Channel, Channel 21, went ahead and filed a case against the interns for beating up its journalists and destroying its equipments. The Home Minister came on the side of the public and the media and warned the doctors that the government would not take their strike lightly. In fact, he was most threatening in warning the doctors.

The conflicts exposed the surreal nature of the health system of Bangladesh. Clearly, there can be no justification whatsoever those relatives of patients would go unpunished where they take the law in their own hands and try to punish doctors/hospitals that they think are responsible for deaths of their near and dear ones. Therefore, the arm of the law must come down strongly and heavily against those who take up law into their hands. Nevertheless, the government and society must also consider that the anger of those who take the law in their hands are not the outcome of any criminal intent but often the result of genuine grievances of negligence of doctors and hospitals that result in deaths that are preventable.

The public perception about the institutions where the conflicts/deaths have taken place is very negative; that doctors there care very little about human lives. Deaths in these hospitals have been occurring with monotonous regularity where relatives of patients have felt the deaths were due to negligence of doctors. The doctors in taking the law into their hands have not done themselves any favour. They have instead helped the nation focus more on their 007 licenses that are now under threat due to public anger. However, the resolution of the problem is not in exposing these occurrences in the media but ensuring that these do not occur. The Health Minister’s description of the doctors who took law into their hands as “terrorists” will not help making the Bangladesh health system civilized. In fact, the Minister’s stand against the doctors was for public kudos and media support that may only quieten things for the moment but the basic problem, that of holding doctors responsible for deaths that relatives of patients think should not have occurred, will not happen.

The answer for a sustainable resolution lies in ensuring what Bangladesh does not have, laws for bringing to court doctors/hospitals for what is known worldwide as malpractice in the health sector. If doctors /hospitals know that relatives of patients can take them to court to make them pay for negligence, then only will they treat their patients and the need to explain to their relatives about their treatment as matters of the highest priority in their professions and relatives of patients would not need to take laws into their hands. Lest it be misunderstood, the medical profession in Bangladesh, the lack of a system notwithstanding, has extremely dedicated doctors and hospitals also render yeoman services. Yet, there exists very deep-rooted perception in the public mind based on personal experiences that doctors/hospitals do not believe that patients and their relatives have any rights except what they decide.

Therefore, the urgent need, something that has been pushed under the table for long and cannot be ignored anymore, is to bring the country’s medical profession under a legal system where those aggrieved by deaths in doctor’s/hospital’s care can easily go to court and get redress. At the same time, laws must also ensure that doctors/hospitals are insured against such cases. Unbelievable as it is, no doctor in Bangladesh insures himself against malpractice cases because he/she and the hospital where they work, the massive services they provide notwithstanding, has also the 007 license that must be taken away from them without any further delay.

The writer is a retired career Ambassador.

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