LEAD STORY. Question of ethics: protecting patients... and doctors

Late last month a committee of medical professionals looking into ethical and legal challenges facing healthcare sat for their first meeting.

The discussion revolved around medical malpractice, negligence and self regulation. Key concerns for the fraternity as they witness an increase in the number of law suits and compensation amounts, following the historic Kunal Saha verdict on medical negligence.

“There are a few black sheep, but even if they are a small percentage, it is in the interest of patients and the medical fraternity to regulate itself,” says Dr Alexander Thomas of the Association of Healthcare Providers India, giving the backdrop to this introspection. The price of not addressing the problem is high, as it pushes up healthcare costs for the patient, while casting a stressful shadow over even the best intentioned doctors, he points out. Late in 2013, the Supreme Court awarded its highest compensation for medical negligence by directing Kolkata-based AMRI Hospital and three of its doctors to pay about ₹ 6 crore to non-resident Indian doctor Kunal Saha, following the death of his wife.

There has been a 20 per cent annual increase in similar cases, says Dr Jayakrishnan AV, with the Indian Medical Association’s National co-ordination committee of medicine and law. Kerala alone has an average of 3,000 cases before various courts, he says (refer to graph).

Dr SP Joga Rao, professor of healthcare law, agrees that the prevailing climate is of “deep suspicion” between patients and doctors. And the blatant and unethical practice of cuts and commissions (between doctors and drug companies or device companies and hospitals) is just one of the reasons for the trust deficit, he says. Patient-families often complain of hospital procedures, hygiene, training etc not meeting quality benchmarks. (read By Invitation below). And the problem acquires a sinister dimension, as hospital networks grow, but fall short on adequate trained medical and para-medical staff.

Rao insists that patient safety will not be compromised by measures being discussed to protect the medical fraternity from frivolous cases.

In fact, hospitals are being urged to have a patient grievance redressal cell and an arbitration and negotiation unit. Also being discussed are hospital or insurance-driven funds to compensate patients in an untoward event, after the grievance has been investigated by a specialised medical tribunal.

Doctors have approached Government seeking a cap on patient compensation to prevent adding to a stressed healthcare system. In the US, compensations are capped $ 2,50,000, says Thomas, adding that similar practices prevail in Canada and New Zealand too.

Compensation amounts in India have increased from a couple of lakhs earlier to ₹40- 50 lakh and more, says Thomas. The increased insurance-premiums that hospitals pay to insure doctors against law suits is evidence of increased litigation, he adds.

High compensation triggers defensive treatment, where doctors prescribe more tests fearing patient law suits if they miss something. A UK study found that such testing pushed costs up for patients by 18 per cent, he points out.

In the US, doctors refrain from risky complicated cases. Finally, it is the patient who suffers, he explains.

Dr Devi Shetty, cardiac surgeon and founder - Narayana Health Hospitals cautions that litigation would adversely impact nursing homes who deliver most of the country’s babies. An alleged malpractice compensation of ₹1 crore could shut them down.

Hospitals are being held accountable through initiatives including accreditation, says Shetty. “But somebody has to protect small nursing homes, as if they shut down it would be disaster for the country.” IMA’s Jayakrishnan adds that compensation does not in fact punish the doctor. The Medical Council of India can be empowered to act against an errant doctor and stop their practice, if found guilty.

But there lies the difficulty for a patient family - establishing medical negligence. So the framework under discussion must ensure that the aggrieved patient has an easy avenue to register a grievance and not have to run around for redressal, agrees Rao.

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