Millennium Post

Apathy diagnosed

Hospitals run by governments are not only bearing the burden of treating the poor, who do not have resources to care for their health, but are also dealing with complicated and critical cases where chances of survival are too bleak, writes Yogesh Kant.

Corruption is ingrained into the private healthcare system to such an extent that the government urgently needs to formulate strict rules to cure the malady or else it will produce numerous more cases of medical apathy. Recently, a shocking incident of a pair of premature twins – being allegedly declared dead by an upscale private hospital and wrapped in a polythene bag to their parents who realised that one of them was alive only when they were on way to perform the last rites – shocked the nation. Eventually, after five days the newborn succumbed to the negligent practice of private health care system.

What is more appalling is the replay of a similar medical negligence and apathy in form of Adya's death, just before the premature twins' incident, who lost their lives owing to the negligent behaviour of medical practitioners at a private hospital.
Adya — a seven-year-old girl's family, was over-charged with a whopping amount of about Rs 16 lakh for a 15-day stay by Fortis hospital in Gurugram, at the end of which the girl died.
The itemised bill, which ran 19 pages long, shows how Fortis charged the parents for 661 syringes and 2,700 gloves, among other things, that were supposedly used during the treatment.
The father, Jayant Singh, who lives in Dwarka, had paid the amount upfront but accused the hospital of inflating the bill and imposing arbitrary costs. Despite the high cost, he said, the doctors paid little attention to Adya's health.
In another shocking case last year, a private hospital in Paschim Vihar in the national Capital allegedly refused to hand over the body of a PhD scholar of Centre of West Asian Studies of Jamia Millia Islamia, Prahlad Gouro who died of dengue, for seven hours until the victim's kith and kin coughed up Rs 35,000 out of the Rs 60,000 bill for the "futile" 36-hour treatment of Prahlad in the hospital. Incidentally, these cases are just a few examples which have come to light, among several others.
These incidents have exposed the growing commercialisation and disintegrating ethics in the world of healthcare. It also exposes the audacity of the reputed private hospitals and their insolence towards the Government laws. Hence a few questions need to be answered: For whom are these hospitals made? What are the forms of corruption in healthcare and medicine? Why did the parents commit suicide? Who is responsible for the tragic incident?
Rising cases
Cases of medical negligence are on the rise because people are becoming more aware of their rights and are raising a voice against suspected malpractice.
Sometimes, mistakes can be fatal. Gross medical negligence is a serious offence and punishable under the law. "Complaints of medical negligence have increased by 30-40 per cent over the past five years and each case takes at least a few years to be investigated," says Dr Girish Tyagi, Registrar, Delhi Medical Council (DMC), which has the mandate to probe medical negligence cases. It gets 20 to 25 complaints every month. "Of these, five or six are accepted for review, based on evidence," says Dr Tyagi.
Moreover, complaints against negligence are on the rise all across India. Bihar Medical Council (BMC) has received 91 complaints since 2010, of which 47 cases are still pending at the hearing stage. Of the 268 cases filed with Andhra Pradesh Medical Council, action has been taken in 38 complaints only. In Kerala, the situation is better with 225 out of the 267 cases having been acted upon.
Legal row
Only less than 10 per cent of doctors charged with the offence is proven guilty. The complaint is put before an executive committee, and if there is merit, another panel including experts from the field to which the case relates, looks into the allegation. The second panel collects proof like patient records and scans. In DMC, once the complaint is submitted, the case is likely to come up for hearing only after two to three years. "If the committee feels that there is a case of negligence it is referred to the disciplinary committee. The disciplinary committee then has a hearing with the complainant, the hospitals and the doctors involved, after which it passes a judgment. This judgment then has to be approved by the general council of all 23 DMC members," Dr Tyagi adds.
Doctors who are proven guilty usually get off lightly, with the punishment ranging from a strict warning to permanent cancellation of license to practice (which has not happened so far). In the history of medical negligence cases, the highest compensation of Rs 5.96 crore has been awarded to Dr Kunal Saha in 2013 by the Supreme Court of India, for which he had to fight for about 15 years.
A senior doctors-cum-administrator at a government-run healthcare system said that the problem of corruption in health care is multi-dimensional. Hence, one needs to analyse corruption in public and private hospitals from different perspectives. In public hospitals, corruption is involved not only in the construction of health centres/hospitals, purchase of instruments, the supply of medicines and goods but also in the appointment of healthcare professionals. Another facet of the problem is the involvement of multiple parties, such as policy-makers, ministers, economists, engineers, contractors, suppliers, and doctors, which give rise to infinite covert and besmirched dealings among various stakeholders.
"Often public assets and instruments in government hospitals are deliberately damaged to make them unavailable to patients, with the ulterior motive referring to the services of private clinics in return for financial incentives or "commission." Absenteeism has been another major concern in government hospitals," said a professor at a medical college in Delhi.
He further said that whereas the allegations against private hospitals are of different natures, physicians working with private hospitals, in general, have contractual obligations to admit a fixed number of patients to allotted beds and prescribe a number of laboratory investigations, even if unnecessary to generate revenues. Hence, the patients are not only charged exorbitantly but are also made to undergo numerous tests. Taking advantage of the ignorance and helplessness of the patients, the corporate medical sector cheats people.
Dr Vijay Kumar Malhotra, Delhi Medical Association, President, said, "We have to differentiate between the hospital and the doctor. The doctor is not even one per cent part of the hospital, and they are only scapegoated. We are not shielding any doctor found guilty of medical negligence. If it is a crime, it is a collective crime. But the hospital (in case of Max) washed its hands off the case by sacking the doctors."
Better regulation
It is an urgent need to regulate India's pluralistic medical landscape, especially when about 80 per cent of the country's healthcare delivery system is managed by the private sector. Experts are of the opinion that regulatory bodies should be held accountable.
"It is mostly the state councils that hear cases, and the Medical Council of India (MCI) comes into the picture only when the accused challenges the verdict or the state medical council is sitting over a verdict for long, which rarely happens," said an MCI official.
A former MCI official said, "Regulatory bodies have got diluted over the years and it is high time that these are revamped. As the public is becoming more aware, these bodies should be stricter in order to create a mechanism and confidence among people." With the loss of faith in regulatory bodies, people are moving to courts for justice. "More than the backlog, it is also the prevalent belief that the investigation won't be impartial because doctors are part of the investigating team and that is driving people away. To avoid that, one should try to have these bodies chaired by some ex-judge, or someone from the social sector or some ex-public servant with a social standing," he added.
Hospitals run by governments are thus not only bearing the burden of treating the poor, who do not have resources to care for their health, follow dietary advice, buy medicine and get necessary tests done to detect the problem, but are also dealing with complicated and critical cases where chances of survival are too bleak.
Hence the success ratio of private hospitals remains impressive whereas despite giving best efforts in the treatment the success ratio of Government hospitals goes down.

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