Hippocrates could not have seen this coming

Posted on March 30, 2017 by Lali C. Sengupta

A man was brought to Apollo Gleneagles Hospital in Kolkata from a road traffic accident with severe injuries. Unable to afford the cost of care there, he was moved to the Government tertiary care hospital IPGMER where he died within 4 hours of being moved. This piece of news resulted in the government and much of media alleging Apollo had tried to extort money from the patient’s family before letting him be discharged. In February this year, the CMRI Hospital, in another part of the city, was vandalized by local goons and doctors and other staff attacked. Shortly after the Apollo incident, in Medica, another private hospital in the city, a patient had a myocardial infarct, and despite efforts to treat him, died. The dominant media made no effort to explain any other viewpoint, or even the real reason for the death save the most titillating and damning (of the doctors and the hospitals). Any viewpoint of the hospitals or the attending doctors were silenced or not heard at all in the media brouhaha about standards and costs of care in private hospitals. There is much ongoing talk about the allegedly immoral methods employed by these hospitals to extract money from patients.
Doctors are killing people and understand only money.
Private hospitals are fleecing patients
Suddenly doctor-bashing is in fashion and doctors and private hospitals are under attack. Long beleaguered out of their ‘god’ status in this country, a doctor now is the new enemy. As with almost everything, there is a kernel of truth in the perception, but what is missing is a proper understanding of where the blame should lie.
In an unprecedented move to address grievances against private hospitals, the state government is set to rid patients of the liability to pay for treatment, through the amended Clinical Establishments Act. It has also sought to relax penalty provisions against patient parties charged with ransacking of hospital premises. It is a measure of the trust deficit in the doctor-patient relationship that the average man is ready and eager to believe the political rhetoric and lap up the populist mantra.
Access to healthcare facilities and decent schools are essential parts of civilized society and for many years now, political parties and governments in India, and particularly in West Bengal, have abrogated their responsibility to provide adequate healthcare to the people. Instead of improving cover and standards of public healthcare, the government and politicians – across all parties – have consistently tried to deflect public opinion by trying to portray private hospitals as the culprits, out to fleece people. There is little merit in comparing West Bengal or Calcutta with Chennai/Mumbai/Delhi. In the latter, there are government hospitals, which, if not comparable to private hospitals in plushness, offer quality medical care. It has long not been the case in West Bengal. Private hospitals have thus come up to fill that lacunae. But in West Bengal, people have started to feel private healthcare is an essential service, which, however unpopular the view, they are not. That onus should rest on public healthcare. The sense of entitlement they feel is targeted towards private hospitals when it should be against the government. And because people have started to feel private healthcare is a right, they are agitated when it becomes too expensive to afford. Politicians, however, over the years have fanned those feelings to hide their own inadequacies or indeed near-criminal lack of accountability that has almost become the hallmark of politics in the state.
We must understand that no healthcare is free – government hospitals are funded by the tax-payer’s money and are actually more expensive – if you factor in the enormous numbers of redundant staff employed and the consequent disguised unemployment – than a section of private healthcare. Understand also that the public healthcare system is not being brought under the purview of the law, for reasons quite unfathomable to the sane mind, displaying a blatant disregard for even common fair-play, as well as, if you think about it, an utter devaluation of human lives who are dependent on public healthcare. The people desperate enough to avail public healthcare seem not to deserve any of the compensation and quality guaranties.
There already were in place several ways in which patient grievances could be settled, the most logical one being to complain to the medical council who deliberate on the allegations, consult specialists in the field for a proper decision. The patient could go to the consumer court or complain to the government. The police had no role to play in any of these deliberations, and came only if there was criminal negligence. A private complaint could not be entertained unless the complainant could produce prima facie evidence before the court in the form of a credible opinion given by another ‘competent’ doctor and as the complaint got escalated, it would always involve medical experts to provide unbiased and proficient opinion. It can never be possible to cap medical costs despite complications and suggesting that it can be, speaks of a total lack of perspective about what proper medical care entails. Real issues which should be taken up with the corporate hospitals are not being taken up as they are not going to find popularity.
There is heavy irony and it should not be lost, that the current bill, with its layperson’s commission adjudicating on medical matters and deciding criminal negligence ‘shall not be bound by code of civil procedures but have the same power as vested in a civil court under the civil court procedure’. The Bengal government and the commission ‘shall be protected from prosecution, suit or any other legal proceeding’, and ‘no civil court shall have jurisdiction’ over the commission. So in essence the government is bypassing the judiciary with a commission who are neither independent, nor from the judicial system (who by definition would be independent) and are certainly not competent to judge medical criminal negligence cases.
Despite the Supreme Court ruling that all complaints need to first be referred to a competent doctor or committee of doctors specialized in the field related to which the negligence is attributed, the amended Bill deliberately, in a blasé fashion subverts due process of law and provides blanket power to a commission not professionally competent to make any assessment of the medical situation to pronounce judgment. This is a clear pathway for corruption to make immediate inroads. It will also mean that smaller hospitals, which cannot afford to pay the hefty compensations necessitated by this law, will close down, making the patients – who cannot afford corporate hospital care but don’t want to go to government hospitals either – the ultimate loser.
“A consequence of encouraging litigation for loss is to persuade the public that all loss encountered in a medical context is the result of the failure of somebody in the system to provide the level of care to which the patient feels entitled” (actual statement by the Supreme Court). The effect on the doctor-patient relationship is already plumbing depths in this miasma of complete breakdown of trust and will not be to the benefit of the patient in the long run. Doctors, who surprisingly, are humans too, and have families for whom they need to protect themselves, will tend to practice defensive medicine, ordering more tests, which will hike up expenses even more. They will stop taking in emergency patients because of the fear of reprisals if anything goes wrong, and by its very nature, there are huge risks involved in any emergency medical care. Patients sometimes die, despite best efforts. If that is always going to be viewed as the hospital’s (note: private hospitals) unscrupulousness and the doctor’s criminal negligence, it is not level playing field, I am afraid. Many who have been trained abroad and wanted to come back with a genuine wish to work here are already planning to leave the state, and sometimes, even the country.
Also, and I am never sure why nobody thinks along those lines, but if lawyers, architects, interior designers and heck, even beauticians charge hefty fees, it is supposed to be a sign of their professional standing. I know women who would not think twice before spending Rs 3000 to color their hair, complain about doctors’ fees. I know people who go to lawyers who charge by the tens of thousands for a fifteen minute hearing in court, and then they sometimes even lose – but the lawyer is not held by his collar or thrashed because he has lost the case. I know interior designers who charge the earth, and that is a feather in my very expensive cap if I can employ him or her. I am never sure why medicine makes patients feel so democratic.
Meanwhile, our politicians and media will dance around issues when it suits them, but go out of country or state or to these very same private hospitals for their own treatments.

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