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Doctor, negligence and death

About four months ago on October 29, 2007, when Bangladeshi software engineer Masum P. Mohammad, flew back to Bangladesh to see his ill father struggling for life at the Central Care Unit (CCU) of LabAid Cardiac Hospital, he was in shock.

‘I saw my father lying on a bed, full of blood. I asked the nurse to show me where he was operated, and I was speechless to see the unhygienic condition he was put in. I stood there for the longest moment, not knowing what to say,’ he alleges. ‘That was when, I took out my cell phone and recorded the bed and the blood on which my father lay unconscious.’

‘My family was wrong to believe in the so-called expertise and skill of the hospital,’ says Masum, on the phone from his resident in Wollongong, Australia. ‘Today, I sit here, miles away from home and regret that I had not taken my father abroad for treatment and relied on the ailing healthcare system in Bangladesh.’

Masum’s father Late A.K.M Fazlum Haq was admitted at LabAid on October 25 under the treatment of Dr Prof. Baren Chakraborty, after he was struck by a sudden chest pain.

After Haq had a massive heart attack on October 26, he was given injection and later a ring was put around his heart on October 27. Later that week, Haq’s chest x-ray revealed dark areas over the lung, after which Prof. Ali Hossain was involved for the lung treatment. ‘On November 2 that day, Hossain told us, food was stuck in my father’s lung and he wants a Bronchoscope immediately.’

After the Bronchoscope Prof. Hossain provided cough samples for the Tuberculosis (TB) test in two different diagnostic centres-one in LabAid, and another in Monowara Diagnostic, at Panthopath, Dhaka. Three days later the result was completely different in the two hospitals.

‘LabAid results showed that my father does not have TB, and the Monowara Diagnostic test result showed that the report was actually positive!’ he alleges.

Masum explains that later they also learnt that his father had suffered from massive brain injury right after being admitted to the hospital, which was not detected by any of the doctors. ‘When he had a heart attack earlier, blood was stuck in his brain. So, he was not being treated for his brain injury during all these days. My father’s TB test was sent on November 3, 2007. My question is, why did it take so long to send the TB test for diagnostic, and why did it took so long to detect this TB? Even the TB diagnosis result was wrong,’ writes Masum in an email to New Age.

‘After he was given a medication, my father could not recognise us anymore. At that time we requested Prof. Chakraborty to call a neurologist to check my father’s brain, but again he did not bother to listen to us. Two days later, on November 11, my father was announced dead,’ he says fighting back tears.

‘Masum’s story is nothing exceptional,’ says Dr Quamruzzaman who heads the Dhaka Community Hospital in Malibagh and has himself been a victim of medical negligence through which he lost a perfectly-functioning kidney. ‘We have countless other cases of medical negligence and ignorance. But, it is important to realise that one of the biggest flaws of our health care system is that we have no accountability what so ever.’

Indeed, Masum’s case is not an isolated one. According to an investigation of a Dhaka-based NGO, Ain-o-Shalish Kendra, between January to October 2007 alone, there were over 76 death cases reported to be caused by medical negligence.

When Shafiqul Islam’s one-and-half year old baby Afia, under went an endovascular atrial septostomy at LabAid Cardiac Hospitals- an operation through which a catheter is passed into the heart to make the hole bigger so that it doesn’t close up completely, he was relieved. After the successful operation on December 25, last year, Afia was moved to Labaid Specialised Hospital and kept at the Neonatal Intensive Care Unit (NICU) under a ventilator machine as she had also contracted pneumonia.

‘I knew we would have to go for further treatment and I began to prepare papers for India,’ said Shafiqul to Banglavision Channel, which telecasted medical negligence victims last month.

But, two days after the operation, on the 27th, the ventilator machine at the NICU stopped working, alleges Shafiqul. He was asked by the hospital authorities to immediately shift Afia to another hospital with a ventilator machine. He went to two hospitals where he was turned away because their ventilator machines were not available and finally he found it in Salahuddin Hospital and Shafiqul went back to LabAid to take his baby. But he was further delayed for bill payment and when they finally arrived at Salahuddin in a Labaid ambulance, Afia was already dead.

Malpractice cases are numerous, and even affect some of the country’s senior-most and reputed doctors because they see scores of patients daily, giving each little time or thought, points out Dr Zaman. ‘It’s just the whole system that needs to be fixed.’

While an alarming number of cases go unreported and the issue of accountability is hardly in the agenda of health care sector in Bangladesh, Masum’s case has been exceptional in the sense that, he was the first to have raised his voice and reach out so far.

In the past three months, Labaid’s foundation and the health care system’s foundation has been shaken to a great extent, say the health sector insiders. ‘Nothing much is really going to change. But at least, for a change we a have sense of threat and perhaps we can expect at least the slightest degree of accountability,’ says a doctor at a Dhaka-based private hospital.

In the past three months, Masum has reached out not only the Bangladeshis but also an international community through emails, the recorded video of his father’s state released on You-tube and also a blog titled ‘LabAid’s real face’ which has had more than 11,000 visitors till date and also groups on social sites such as facebook. ‘Somehow, whether his allegations are true or false, it has triggered the health sector seriously. More and more patients are now speaking up,’ says a LabAid official, preferring anonymity.

‘We operate a huge system and we are truly dedicated to delivering the best possible health care service,’ explains an official of the LabAid Consultant management, preferring anonymity. ‘Mistakes happen and we work everyday to fill up the gaps and move to provide better services.’

In an e-mail to Masum, following the nationwide response and also six other negligence cases brought forward in a press conference, the LabAid consultant management wrote, ‘We are all aware of the unfortunate incidents you faced at Labaid which was basically the work of a few of our worst kind of employees and does not in any way reflect our service standard or customer service and behaviour.’

‘We, including our Managing Director, sincerely apologise for the incidents that occurred in your case and we hope we can now move forward. We have investigated the whole situation and have already taken administrative measures against those responsible. We sympathise with you and hope that you will also accept our official apology,’ reads the e-mail sent to Masum two months ago.

‘Afia’s case was also exaggerated. She was in a critical state already,’ explains Mesbah Aajad, Media Coordinator, the LabAid Group. ‘As for Masum’s case, mistakes do happen, but you do not take it that far and add more dimensions to it.’

According to Dr Mohammad Saiful Islam, Paediatric Surgeon and Dean of Faculty of Surgery, BSMMU, one of the biggest flaws in Bangladesh’s medical system is that there is no monitoring mechanism which checks whether doctors are administering wrong treatment which results in patients’ deaths. ‘The organisation that is to oversee such cases of negligence, the Bangladesh Medical and Dental Council, is now dead.’

‘In other countries there is a system in place which requires doctors to resit exams every five years or so as a way to reappraise his skills,’ says Dr Zaman.

Dr Zafrullah Chowdhury, the chairman of Dhaka’s Ganashasthaya Nagar Hospital echoes these concerns. In an interview with New Age, he says that the Bangladesh Medical and Dental Council should be responsible to investigate such cases but this doesn’t happen because of a ‘medical mafia’ that forbids doctors from testifying against their fellow professionals. ‘In Dhaka, certainly, you will not be able to find a case where even one senior doctor will be willing to testify to a gross malpractice by another,’ he says.

‘The question of a doctor’s negligence is intricately related to whether he is seeing more patients on a given day than he can handle,’ says Dr Zafrullah. ‘There are good and bad doctors just like there are good and bad architects or lawyers, but a good, skilled doctor can still give bad treatment because he prescribes medicine without giving a patient enough time to tell him the problem in detail.’

‘And make no mistake,’ he stresses, ‘that is negligence.’

Then why not lodge a case against such negligence?

As much as LabAid officials regret the cases and deny further allegations that has been born following the incidents, they ask why was not a case lodged against them, if they had been unfair to such extent?

‘The reason is that the law does not support Masum or anyone else’s case and this is a reality for the healthcare in Bangladesh,’ explains Obiadur Rahman, Co-odinator, Legal Advocacy, ASK. ‘Under the existing law, it is impossible for patients and their families to successfully take doctors to task for negligence or oversight.’

According to Obaidur, Masum had in fact approached ASK and they had sent a letter to the civil servants in the health ministry and an enquiry committee led by Dr. Mumtaz Uddin Bhuiyan was also formed to oversee the case. ‘Officially, we do not know if anything has actually been done, as of yet.’

In the eyes of the law, medical negligence typically comes under the ambit of Tort laws, since it is a civil offence as opposed to a criminal offence, says Bangladesh Supreme court lawyer Faustina Periera, in an interview with New Age.

The concept of Tort applies to an act which is a ‘wrong’ or ‘breach of duty’ as distinguished from a crime. The idea is that the doctor has a duty towards a patient who entrusts his health to the doctor’s care with the reasonable expectation that he will get a certain standard of treatment, even though there is no specific contract between them.

The Penal Code in Bangladesh allows a victim of negligence to file a case if the doctor involved did not possess the educational or professional degrees he claimed he had, or if he failed to take the patient’s consent before operating on him, as well as a slew of other fraud scenarios, explains Dr Pereira.

‘The doctor has an escape clause in Section 88 of the penal code which exonerates him from wrongdoing if his act was done in good faith with the patient’s benefit in mind,’ says Pereira. And that escape hatch of ‘good faith’ lets doctors off the hook in many cases, she explains.

Moreover, the concept of a civil offence is intricately related to the idea of whether the law sees the act of administering treatment as a service which a patient is purchasing, and if so, whether there are minimum standards of the quality of this treatment that a doctor has to meet, say legal professionals.

‘The monitoring system that is supposed to ensure that doctors and clinics are up to par are so riddled with corruption that it is surprising the health system works at all,’ says Rahman. ‘We file medical negligence cases under the same act that applies to reckless driving, imagine that,’ he says.

‘We need to enshrine a Consumer Protection Act that will detail the responsibility that a doctor has towards his patient, or any other service provider has towards a consumer,’ says Pereira. ‘Without an umbrella act, victims don’t have faith in the system, and we don’t have the confidence to tell them that they will get justice.’

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