Medical Negligence
By Limana Solaiman Mridha
Healthcare is a basic human right, enshrined in our constitution as well the United Nations Charter. But in a country where shortage of medical facilities and inadequate number of doctors and nurses are pressing matters, cases of medical negligence usually go unnoticed or are just not reported.
Most patients are not even aware of the standard of healthcare they are receiving or do not have the knowledge or ability to gauge the situation. Quack doctors or religious hacks still provide primary healthcare in many parts of the country, and negligence by such unqualified practitioners is often overlooked. However, recent tragic incidents in Faridpur and Chittagong _ where newborn babies were pronounced dead but were actually alive _ were widely reported in the media, causing quite an uproar among the general people.
On September 22, Naznin Akter, a lawyer, gave birth naturally to a baby girl at Dr Jahed Memorial Paediatric Hospital in Faridpur. The baby, named Galiba, was born four months premature and declared dead shortly after birth by the attending doctor. The babys grandfather, Abul Kalam Mia, took her to the local graveyard for burial that very night, but was asked to wait till daybreak, so he left her there in a carton box. Just before she was to be buried in the morning, little Galiba cried out from the box and started moving. With the help of a generous benefactor, she was rushed by helicopter to a hospital in the capital, where the three-day-old lost her fight for life on Sept 25.
In a telephone conversation with the Weekend Independent, Abul Kalam Mia said: I have testified in two separate investigations that have been carried out here in Faridpur. It was such a traumatising experience for us. When we took Naznin to the hospital, she was admitted but the doctor refused to attend to her and my daughter-in-law gave birth without the presence of any doctor or midwife/nurse. Then when we requested the doctor to attend to the mother, she refused and asked us to take her elsewhere. When we protested that she was unconscious and needed care, she was checked, but the baby was declared dead. We took the little soul to the graveyard for burial and you know the rest of the story.
I really hope that this type of unfortunate incident does not happen to anyone else and I am expecting that the doctor in question will face her due punishment. I have faith in the Almighty. We have not lodged any case yet as investigations are being carried out and tomorrow, I will go to the DC (district commissioner) office to find out the update, added Kalam Mia, whose son Nazmul Huda, a cricketer, is the babys father.
The grandfather called back and informed this correspondent on Oct 13 that the investigation report, which found the doctor involved guilty, had been submitted to the health secretary in Dhaka.
Barely a fortnight after the Faridpur case, a similar incident took place in Chittagong on October 4 at the CSCR (Centre for Specialised Care and Research) Hospital. Dr Ridwana Kawser, a dental surgeon, was taken to the labour room and two hours later, her prematurely-born baby girl was pronounced dead and returned to her in a packet, along with a death certificate. However, upon opening the packet, the mother noticed that the baby had chest movement and was gasping for breath. She immediately took her child to the neonatal unit, where they again insisted that the child was dead, without even heeding its movements or going through the routine checks before declaring a person dead. The baby was then rushed to another hospital where they resuscitated her, but due to shortage of space in the neonatal care unit, she had to be moved to another hospital, where she died the next day.
When questioned about the negligence of the doctors, Dr Salauddin Mahmud, CEO of CSCR Hospital, told the Weekend that investigations were underway, and in the meantime, the doctor in question had been suspended. The inquiry report will be in the office of Directorate General of Health Services (DGHS) soon, we are aghast by the incident itself, Dr Mahmud said.
The Chittagong Civil Surgeons Office has also formed a three-member committee to probe the incident, local media reported.
When contacted, the babys father, Dr Nurul Azam, who is also a doctor, said: Our child is no more and we havent decided yet on whether to press charges or not. We are both doctors and are extremely busy most of the time. Investigations are being carried out thoroughly and we have received apology for the oversight.
The Weekend magazine then caught up with Dr Aminul Haque, deputy director (hospitals) at DGHS, to learn about the status of the reports.
The reports prepared by the authorities in Faridpur and Chittagong are yet to reach the office of the Directorate General of Health Services (DGHS), Dr Haque said.
Recently, I received a complaint from Patuakhali that during the Eid holidays, a patient and his family could not find a doctor. I had the matter investigated and the roaster shows that a doctor was present. Such contradictions are quite common and we are very prompt to look into any sort of protests, he added.
To find out about how investigations are carried out by the Bangladesh Medical and Dental Council (BMDC) once it receives an official complaint, the Weekend talked to Dr Zahedul Haque Basunia, registrar of the regulatory body. This is what he had to say: Usually, when we see a report in the newspaper regarding medical negligence, we stay put until a formal complaint is lodged with us, as it is not possible for us to investigate everything that is printed. When someone lodges a complaint against a health care professional, we ask for relevant documents that would enunciate the nature of negligence stated by the patient. Until we get proper paperwork, email, registration number of the physician/surgeon in question, we cannot go ahead and investigate the matter. Although it is possible to find registered doctors on our website, there is a problem. People often do not update their addresses properly when renewing their registration. Therefore, if you cannot provide the updated address of the doctor you are complaining about, it will be difficult for us to find him or her.
Once we get everything that is required, we write to the doctor and ask him/her to give us an explanation within the next 15 days. When we receive the explanation, we let the patient party know that this is what we have received. If they still pursue the matter, then we have a disciplinary committee that looks into the grievance. But to tell you the truth, if we receive 100 allegations of negligence, in the end there are hardly five we can put forward to the disciplinary committee as most cases cannot provide ample supporting documents. For example, we got papers for a negligence allegation that took place in 2012, now after such a long time, it gets difficult for us to inspect the complaint. Formulation of a law for protecting both doctors and patients is still underway and I have participated in the meeting. In the case of the baby who was declared dead in Faridpur and later woke up in the graveyard, an investigation is being carried out and the report will be at the DGHS soon.
Regarding a recent media report that only one doctor has been punished for negligence in the past four decades or so, Dr Basunia said: So far, a total of four healthcare professionals have faced investigations and have had their licences revoked. The report that states that only one doctor faced suspension is not correct. The surgeon whose name came up as the only doctor to be punished in 43 years _ actually, the surgery he carried out was perfectly alright and the complications that happened afterwards are quite common in surgery patients. But we took away his licence because he performed the procedure in an unregistered clinic. This trend of checking whether a clinic or hospital is registered or not is not an usual practice in our country and therefore, he made the mistake.
Regarding negligence litigation in Bangladesh, Khan Khalid Adnan, a barrister who has dealt with a few such cases, told this correspondent: So far, there is no specific law under which medical negligence cases can be lodged. Therefore, we have to file cases under 304A of the Penal Code that specifies that if a person causes the death of another person by negligent act or rash conduct, then the accused can be jailed for up to five years. We do not have any straight forward law on clinical negligence. My first such case was that of a diabetic patient who was given insulin when she was taken to the hospital for hypoglycaemia. She became comatose and later died in Dhaka. When I filed the case in Dhaka, the accused were summoned in court to explain their conduct and later, the case was resolved with a settlement from the accused.
There are many reasons as to why people avoid filing cases. The major reason being that the person filing the case needs to be present during a hearing and mostly people are not comfortable with the environment of the courts here. Working professionals cannot make time to be present at every hearing, so if a settlement is offered, the wronged party usually agrees to it, the lawyer added.
To make matters worse, people often resort to taking the law into their own hands. We often see media reports about disgruntled relatives of allegedly maltreated patients threatening or assaulting medical staff, or vandalising the medical facility.
Such scenes would not take place with a proper law in place for bereaved families to seek redress. That would protect medical staff, too. And perhaps, a bit more patience from often overworked doctors to listen to patients and their complaints would do good, too, opined Dr Hasina Ahmed, a public health specialist who runs a charity clinic in Dhaka. But we must also remember, in our country, patients are often brought to the hospital when their condition is already critical, and there is nothing much doctors can do. And many facilities, especially in rural areas, lack life-saving drugs or equipment, even there is no water or electricity supply sometimes. That doesnt mean there is dearth of trying or sincerity on our part to save a life, the senior doctor added.
Mollika Wahab also contributed to this report.
Photos: Internet
