HIGH RISING LITIGATION AGAINST DOCTORS

Doctors in the dock

Doctors are in fear as a storm of litigation hits hospitals. Fuzzy laws and frivolous cases are taking a toll on the profession. Will it change the way medicine is practiced in India?

Open proclamation of 'guilt' against a doctor based on an Internet search? "This will only get worse," muttered the chief of the National Accreditation Board for Hospitals (NABH), India's quality control body for hospitals. He received far too many complaints these days, 50 per cent of all, from disgruntled families and friends of patients. He shuddered at the thought of what the future might hold.

Doctors are in the dock. Lawsuits filed by aggrieved patients are jamming up courtrooms across the country. Their names get splashed day after day across front pages of newspapers, on computer and television screens across the nation. It is the kind of exposure every doctor dreads. Chastened by medical litigation and intimidated by negative publicity, a culture of defensive medicine of unnecessary tests and medications or refusing patients with complex illnesses as a safeguard against future litigation, hangs over our hospitals.

Here's an alarming statistic: 98,000 deaths from medical injuries occur in India every year, reports an ongoing NABH study. Here's another: medico-legal cases have gone up by 400 per cent in the Supreme Court in the last 10 years, according to legal resource, Manupatra. Patients are afraid of an uncaring medical system. Doctors are terrified of assertive patients. Hospital life is under scrutiny, and with it the authority and autonomy of doctors. "Doctors are afraid," says Dr Arvind Kumar, chief of robotic and chest surgery at Sir Ganga Ram Hospital in Delhi. "The trust factor between doctors and patients is slowly coming down and there is no solution in sight."

BLAME GAME

Every day, the headlines get worse, although in reality just 10-15 per cent cases are ever proved against doctors. Check out 2014: in January, a premature baby in Meerut died of burn injuries from an overheated incubator. In May, a hospital was asked to pay Rs 7 lakh after a woman lost her uterus during a caesarean section. In July, a Chandigarh doctor was asked to pay up Rs 70 lakh for amputating the wrong leg of a teenager. In June, a newborn in Coimbatore lost eyesight while in hospital. In July, a Bangalore woman with uterus tumour died of anaesthesia allergy. In August, a patient declared dead by a doctor was found alive when grieving relatives went to collect his body in Malda, West Bengal.

Who is at fault? Ask forensic experts, who ultimately determine if a medical malpractice case has merit. Four such doctors from Mysore Medical College and Grant Medical College, Mumbai, have drawn up a profile of medical negligence cases with the National Consumer Disputes Redressal Commission, this year: medical negligence cases involving surgery account for 80 per cent of all cases, of which obstetrics and gynaecology (29 per cent) top the list, followed by orthopedics (22 per cent). "Hospitals are found to be negligent, along with doctors, in 34 per cent cases," says lead researcher Dr Anand P. Rayamane. Of the various reasons for death, negligence of doctors (49 per cent) is cited the most.

"Negligent doctors need to be punished. But medical errors are also often 'system errors' and not the result of an individual physician's negligence," says Dr K. Srinath Reddy, former head of cardiology with AIIMS and currently president of Public Health Foundation of India. The scientific basis of good clinical practice depends on combining a well-gathered history of illness, physical signs and results of tests into an estimation of probabilities of possible diagnoses, he explains. While medicine is not an exact science, which always gives a 'yes' or 'no' answer, the 'art' of medicine lies in converting scientific evidence to standard management guidelines created by expert bodies, for all practitioners to follow. "Apart from minimising errors and avoiding unnecessary tests and treatments, adherence to guidelines forms the best defence against allegations of medical negligence," he adds.