‘Medical professionals enjoy highest level of impunity’

In an interview with DH’s Akhil Kadidal, Akhila Vasan, member, Karnataka Janaarogya Chaluvali, which is working towards protection of health rights and strengthening hospitals, talks about Karnataka Private Medical Establishment (KPME) Act, its 2017 amendment and various issues regarding medical negligence. Excerpts:

What are some of the worst incidences of medical malpractice you have heard about?

A lot of people who have suffered medical negligence approach us to see what they can do next. Our cases are mostly from Bengaluru, of which we have 68 cases on record, plus one in Davanagere.

We were told of a husband who took his wife to Manipal Hospital at 10 am because she was suffering from terrible stomach pain. The attending doctor ruled out kidney stones as a cause. The doctor put her on an IV line, but when the patient noticed her stomach swelling, she asked the line to be removed. The doctor, however, refused to
comply and yelled that he was the doctor, not she. He instead administered her with a drug. When the husband protested, the doctor grew more agitated, prompting the patient to ask her husband to let the doctor proceed with his treatment. Forty minutes later, she was sent to the ICU. Now, she is in a vegetative state.

There is another case of a 60-year-old man who was given a false HIV positive report, which made him so depressed that he attempted suicide.

How do you hold hospitals and doctors accountable for their mistakes?

The matter of accountability is difficult to pin down, which triggered the 2017 Amendment to the Karnataka Private Medical Establishment (KPME) Act — which requires hospitals to have an internal grievances redressal system. While, the KPME Act offers compensation to patients by bringing them under the Consumer Protection Act, one of the biggest drawbacks of the Act was that even if doctors were negligent in their duties, the case would still have to pass before the Karnataka Medical Council (state unit of Medical Council of India).

There is a clause which says that the consumer forum cannot dispose of cases until the matter is disposed of first by the Karnataka Medical Council. Cases cannot be filed in parallel. This leads to delays.

Are some hospitals complicit in covering things up?

Hospitals sometimes manipulate records. In any other legal situation, the complainant has independent access to documents, but in this case, the offending hospitals possess the records, which are crucial bits of evidence.

Can this situation be fixed?

No, it cannot be fixed as long as healthcare is a profitable service. In fact, what is happening right now is that with various insurance schemes, both private and government hospitals are getting entangled. Now, these agencies are setting targets for government hospitals to treat a certain number of patients — just like private and corporate hospitals. In corporate hospitals, the doctors are assessed based on conversion ratio — which takes into account, how many patients out of the total they see are made to undergo a procedure — a CT scan, an MRI scan and of those, how many went for surgery.

Surgery is what fetches them the money, not consultations or diagnosis. So, the whole language is that of markets. Now, it is so normalised that nobody thinks that it is morally reprehensible that somebody is profiting out of a person’s misery.

The situation is rather frightening...

It is frightening and this model is taken from the United States.

In the United States, patients can sue in the event of negligence. Here, what is the scope for suing?

See, that’s the crucial difference because when people sue, it is not as if they get justice. In fact, there is one particular case which went from the bottom most court to the Supreme Court, where it was dismissed — after 39 years. Medical professionals enjoy the highest level of impunity, because I think there is a kind of social capital that they enjoy. These are the factors sustaining the system. The nail in the coffin is the commercialisation of healthcare.

Would an amendment to the KPME Act bring more healthcare regulations?

During the amendment to the KPME Act, all the private hospitals in Karnataka went on strike for more than a month and they literally held the state legislature to ransom. They refused to be regulated by anyone else. And their self-regulation is a joke.

There was a vicious misinformation campaign saying that doctors would be jailed etc. But these were not proposed in the amendment. There was a kind of mass hysteria among doctors. They didn’t think it was important to read an amendment but they repeated the lines of a misinformation campaign. It was shocking.

The scale of the problem seems staggering.

The legal struggle, the struggle for justice, is an inordinate struggle. So, it is really upsetting. You really need to have nerves of steel. There is a law for all citizens of this country, but those don’t seem to apply when it comes to doctors.