Frequent medical incidents and doctor-patient conflict
Need for a co-ordinating body consisting various stake-holders

Dr Th Suresh Singh *

JNIMS Teachers Association launched cease-work in protest on 19 July 2014 :: Pix - Deepak Oinam

Recently, as well as in not so distant past also, our state has witnessed loss of many valuable lives in the hospital care delivery system. Majority includes new inborn and expected mothers. Analysis of the various reports show that majority of these incidents are avoidable. Who is responsible for these avoidable incidences? As a doctor and as an Ex-Director of Health Services, I am deeply concerned about this. Hence, we need to go a little farther length in this crisis.

What a ghastly experience it is to hear that, in the most recent incident, the death body was kept at the entrance of the supposedly wrong-doing doctor; and the concerned hospital (JINIMS, Porompat in this case) heating back with closure of the OPD for 2 days. Both these incidences are condemnable, as such showings/doings cannot bring any solution to the otherwise complex problem. Though majority of such incidences occur in the field of child delivery related cases, it is also seen in many other related cases of surgery.

What are the principal causes for this happening?

The following can be listed from what I gathered; but this is not exclusive :
i) in-experienced hand - many doctors, though holding PG degrees, are found to be lacking in their practice/experience
ii) in-experienced anaesthetist – many anaesthetists happen to be junior ones lacking to handle complicated cases
iii) a nonspecialist MBBS doctor practising a major operation
iv) negligent post-operative care – this is one of the major causes, one can equate it to a criminal charge
v) no proper attention by the treating doctor while he is attending dual duty to the Govt. Hospital and the private clinics as well
vi) lack of supervision on the part of the senior doctor while his junior operated on the patient
vii) unnecessary prescriptions of costly medicines leading to loss of valuable pre-operative time
viii) time-gape while referring to the next referral hospital
ix) bad condition of the patient at the time of bringing to the hospital
x) patient party's un-ability to purchase costly medicines or purchase of the same in late stage
xi) hidden/undetected diseases in the patient. This can occur in spite of many costly pre-operative investigations by the treating doctor
xii) unavoidable death due to serious drug allergy- this also can occur in spite of full precaution by the hospital staff, and lastly
xiii) certain communication gap between the patient/patient party and the treating doctor/ the staff.

After effects : all these are leading to un-wanted and un-warranted incidences. These, again, can be summarised as below :
i) various violent hit-backs from the patient party leading to loss of hospital structure/ property
ii) physical assault to the doctor/staff
iii) compensation demands running into lacks of Rupees to the doctor/concerned hospital
iv) compensation demand to the Government, and
v) appropriate punishment demand of the concerned doctor/hospital. These are from the patients' side.

From the doctor/ hospital side : vigorous denial of any wrong doing stating that the unfortunate death is due to development of sudden unforeseen complications, mostly sudden bleeding and drug allergic. Mind you, it is not easy to establish a case against a doctor while treating. There are many many Supreme Court rulings favouring the doctors.

Having heard directly in the Dias from 6/7 family victims in one of the seminars at the Press Club recently, it was really found an unbearable scene. Further, opinion from the many doctors in the same seminar gave an opposite view. What I am worried is that, both parties, instead of giving serious attempt to prevent such occurrences, had solved majority of the incidences by paying huge amounts running into Lakhs to the patient party by the concerned doctor/ hospital. Is life so cheap that it can be purchased and negotiated by a few lakhs of Rupees? My worry is even more strengthened after hearing both the parties in the said seminar.

This situation cannot be allowed to continue. It has to be stopped. In recent months, these conflicts are only increasing, and not diminishing. What I fear is that, latter on, the doctors may refuse to touch a simple ailment for fear of illegal compensation. He may refer the case to the next referral hospital stating that facilities are not available at the present one. This will only lead to unbearable burden to the have-notes and the poor. I can definitely visualise a chaotic situation in future. Hence, other punitive actions have to be explored.

What are these other options? To the doctors/staff :
i) prevent the Government doctors to practise in private clinics
ii) another option is – abolish NPA and allow intented doctors to work in the private hospital with strict Govt. supervision
iii) develop a proper mechanism to investigate such incidences
iv) give punitive action, if found guilty, to the concerned doctor as per the Indian Medical Council Act
v) Give punitive action to the concerned doctor/staff, if established properly, as per the various criminal procedures of the land.

To the patient party : give severe punishment for destruction of hospital property
ii) give severe punishment for physical assault to the doctor/ other staff as per the law of the land.

Formation of a 3rd neutral party : a 3rd party i.e a co-ordinating body consisting of the various stake-holders be formed to negotiate with both the parties. Public health specialists, leading lawyers, journalists and civil society organisations can be accommodated to this. It will be better if the state Government form this. As it is unlikely to expect any response from the Govt. side, it has to be oriented from the people's side.

The scope of this supposed body can be enlarged latter on to include hospital inspection, patient welfare, various illegal practices going on, various conflict situations etc., the sooner the better. In short, it can be an excellent people's body to improve the overall health care delivery system. Is there any one to listen to this?