Is he getting the care he needs?
In the recent past, there has been a number of high profile unexplained and unexpected deaths in health care in Bangladesh, with parties involved blaming and counter-blaming. This is not a unique phenomenon applicable only to Bangladesh, though the standard processes involved in resolving such issues are not in place.
In the UK, analysis of inquest files over a 10-year period from coroners’ offices has demonstrated a three-fold increase in complaints by relatives to coroners and the police about standards of medical treatment. It may not be very surprising as relatives of the deceased are likely to search for accountability in potential “avoidable patient death” cases.
In the UK, coroners and the police are now more likely to see it as their duty to consider whether a criminal act may have taken place, and invoke the necessary steps to allow further investigation.
This process can include laying charges of “gross negligence manslaughter” against any number of health care professionals involved in a patient’s death based on the guideline set by House of Lords, that states whether the conduct and breach of the care by the doctor was so bad in all the circumstance he or she was placed as to constitute a crime.
In an attempt to clarify matters, the concept of recklessness has been introduced to define what may be considered gross negligence.
Recklessness is having an awareness of the consequences of an action, inaction, or omission, but continuing regardless. While this concept may be helpful, it remains for a court to decide whether the events go beyond a matter of compensation for the victim and constitute a crime.
In Bangladesh, the allegation of death and serious disability due to medical negligence is rather common. According to Ain O Salish Kendro, at least 50 cases of death allegedly due to such negligence are reported in newspapers in the country every year.
A recent study by the University of Dhaka demonstrated that almost 95% of patients attending health care facilities researched allege of negligence, up to 75% of the patients felt that the negligence had led to a worsening of their condition, and half of the patients felt that the doctors providing care were negligent of their responsibility.
Many of the victims of medical negligence, particularly resulting in death, may seek compensation under civil law, and gross negligence may be made criminally liable under certain penal codes in Bangladesh.
However, the process is long drawn, expensive, adversarial, unfriendly, and non-co-operative to both doctors and patients.
Though health professionals should not be exempt from the criminal process, and proper application of law is imperative to safeguard both patients and the medical profession to prevent serious untoward incidents and to save lives, criminal law can be a very blunt instrument when applied to such a complex field as health care.
In the UK, the number of cases of criminal prosecution against the medical profession is very small indeed, and the Crown Prosecution Service treats these cases very differently from most other criminal cases, and has specialist units set up to assist.
Most doctors accept the burden of civil litigation and are indemnified either by the National Health Service or by long-standing indemnity organisations such as the Medical Protection Society or the Medical Defence Union.
The possibility of criminalisation, however, is taken very seriously by the medical profession, which self-regulates in the UK and is extremely keen to provide the best health care possible with dignity, as a successful prosecution even in a single medical manslaughter can have significant ramifications for doctors and health care.
In recent weeks, I have tried to emphasise on the issue of health care human resource development. The demand for health care services exceeds supply by many times over.
We know that the country lacks adequate and appropriate health care human resources and hardly have one-fiftieth to one-hundredth of the required medical specialists.
Is it, then, unusual to find doctors working beyond their ability of physical, social, and psychological endurance, exposed to error, malpractice, and criminal negligence.
Trust in medical care has hit rock bottom. But an atmosphere of hostility between the public and the health profession undoubtedly is detrimental to both.
This situation must, by all means, be circumvented through initiation of due process, otherwise the mistrust of the public on the medical profession would continue to rise, making good doctors feel alienated, unvalued, and frustrated.
This unfriendly situation will only encourage and benefit those who wish not to respect the profession’s honour and continue to practice immorally and unethically.
The greatest tragedy for patients, and equally for dedicated and devoted health care professionals, is the very absence of ways to distinguish between system failure, individual error, or frank negligence, and this is due to the absence of established processes of governance both clinical and corporate, accountability, and a regulatory framework that would help doctors to understand their strengths and weakness, ways to improve their care, and fulfil their very objective that led them choosing a medical career, the noblest of professions.
And hence, we must now engage in robust debate with politicians, law-makers, and health care management bodies such as the ministry and DG health on medical negligence to ensure patient safety, transparency, and best practice, and safeguard the competent, dedicated, and hard-working medical practitioners.