Weighing the incident on grounds of clinical ethics, whether these deaths were a result of infection or complications emanating from overdose of medicines, or just an offshoot of carelessness of doctors, this is a serious negligence issue in medical jurisprudence. And somebody should be held liable for all this, perhaps the hospital management or doctors on duty. [break]
In yet another case, four infants died within 24 hours of being administered DPT and measles vaccines in Doti district. Were their deaths a result of poor quality of vaccines or sheer callousness of health professionals who did not hesitate in injecting expired vaccines? Who should be held accountable for these deaths—the government itself which supplies free vaccines or the health professionals who deliver services in remote areas? These two incidents speak volumes about the degree of medical negligence and quality of public health services in Nepal.
Corruption and commissions in procurement of drugs and equipment has a multi-dimensional impact on the quality of health services. National Vigilance Center’s inspection report on Bir Hospital last year had revealed mismanagement of at least Rs. 50 million in hospital accounts. A senior physician at Tribhuvan Univeristy Teaching Hospital (TUTH) had to resort to a fast-unto-death to put an end to political interference in high-level appointments at his institution. Our heath service has also long suffered the malaise of funds not reaching local facilities. As poor services and medical negligence are interlinked, they can be attributed to corruption, mismanagement and political highhandedness which continue to plague our public health institutions.
MEDICAL NEGLIGENCE
Increasing cases of medical negligence are a grim reminder of the extent to which our public and private healthcare systems are vulnerable to malpractice, error and misconduct.
Last year, more than a dozen incidents of medical negligence hit headlines and were a grim reminder of the extent to which our public and private health care system is vulnerable to malpractices, errors and misconduct. A pregnant woman underwent surgery at Om Nursing Home but had her premature baby delivered with its stomach being split open resulting in death. A patient who was supposed to undergo a thyroid operation at BP Koirala Memorial Cancer Hospital in Chitwan was operated upon, but had her uterus removed instead. In another case, a doctor in Chitwan Medical College removed a kidney from a 75-year old patient who was admitted for surgery of an internal blister.
An increasing number of cases of medical errors and negligence have also been a challenge in medical jurisprudence globally. The latest report of Australian National Health and Hospital Reform Commission states that hospital errors kill 4,550 people each year, equivalent to 13 jumbo jets crashes killing all on board each year. The Canadian Medical Association says 24,000 people die annually due to medical errors in Canada.
However, unaccountability is more endemic in Nepal where prosecution of clinical negligence still remains a low-key issue in medical jurisprudence. Such cases are outside the ambit of legal jurisdiction and most patients don’t know that they may have been victims of clinical negligence. Even if they do know, they are reluctant to pursue the matter because medical malpractice claims can be complicated, time consuming and expensive. There are few lawyers and victims in Nepal willing to devote the time and money it takes to legally tackle such claims in the absence of strong laws and mechanisms.
Until now, acts of medical negligence and errors in Nepal have not been explicitly brought under the ambit of legal jurisdiction. The Consumer Protection Act (CPA) has tried to address this issue under the purview of definition of ‘service’. But this doesn’t capture all aspects of the issue. Thus, existing legal and institutional lacunae are actually boosting the confidence of perpetrators of medical negligence.
While dozens of cases of medical negligence do surface annually in Nepal, none of them get adequately investigated and prosecuted. In the history of Nepal’s medical jurisdiction, Srijana KC’s case was perhaps the first in which the victim was compensated with a high amount as ordered by the Supreme Court in February 2011 for medical negligence. She received Rs 6 17,119 as compensation from Dr Dinesh Bikram Shah and Blue Cross Nursing Home for wrongly prescribing epilepsy medicine during treatment of a normal ailment in her left eye. But it took 12 long years to settle the litigation.
Without free support from some non-governmental organization, victims like Srijana KC would not have been able to get justice. Therefore, the prime onus lies on the state itself to enact strong laws and ensure effective mechanisms through which victims of medical errors can get speedy justice in a cost-effective way. For instance, health professionals in Canada are legally required to obtain medical liability insurance to pay medical negligence claims. Such insurance is made available through the Canadian Medical Protective Association.
Similarly, the United Kingdom has a separate Clinical Negligence Scheme for Trusts program which is administered by the National Health Service Litigation Authority (NHSLA). The NHSLA is responsible for managing the legal side of claims through panel solicitors and pays for any damages or legal costs to the claimants of clinical negligence. Counties like Australia have a separate entity called Medical Practitioners Tribunal with a mandate to investigate, hear and penalize cases of medical negligence. Medical Injury Compensation Reform Act in California is considered the perfect model with a cap of US $ 250,000 as non-economic damages in medical malpractice cases. Likewise, National Consumer Disputes Redressal Commission in India deals with acts of medical negligence under the purview of clearly-stipulated provisions in the Consumer Protection Act and Indian Penal Code.
To err is human but mistakes by medical professionals which result in death of a person or permanent impairment can never be forgiven or justified. Thus, unless the government shows it is capable of initiating required legislation and mechanism to regulate acts of medical negligence to ensure a patient’s right to quality treatment and safety, our health sector will not be able to move towards professionalism, integrity, accountability and the spirit of serving.
pbhattarai2001@gmail.com
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