SC verdict may push doctors towards defensive treatment

The Supreme Court has left the medical fraternity in India shell shocked. In a recent groundbreaking judgment, it awarded a compensation of Rs11 crore to an American doctor of Indian origin whose wife had died due to alleged medical negligence in a private hospital in Kolkota 15 years ago.

It is the highest ever in this country’s history. This order has sparked intense debate applauding and criticizing it. Some feel it is a stern warning to doctors and hospitals to exercise greater care while treating patients. Others fear inflated medical bills as a result of this judgment. When doctors feel threatened with such colossal amounts of compensation, they may insure themselves heavily and pass that burden also to their patients. Secondly, Indian health care may go the American way of ‘defensive medicine’ where hospitals and doctors are more preoccupied in securing their own safety rather than their patients’. These are complex issues that need serious consideration.

Ever since the Consumer Protection Act was passed in 1986, the doctor-patient relationship has come under scrutiny in this country. It converted the whole process of sickness and medical treatment to a purely commercial proposition, where a patient who pays money for medical care has every right to haul the caregiver into courts of law to be punished for negligence. Although patients have hardly taken this step for fear of losing their case along with the medical care itself. The costs and travails of the legal procedure itself have also been great deterrents. Besides, the Act did not take into account the doctor-patient relationship which is a special and delicately balanced bond that cannot be measured in commercial terms. It is a relationship of trust and faith that both have to respect without the interference of acts of Parliament or the verdicts of law courts.

Poor patients in state hospitals, who are the worst victims of medical negligence, have neither the clout nor the means to hire lawyers and move courts as Dr Saha did for 15 years. Not only did he travel back and forth between two countries to collect medical data and legal opinions from the best lawyers, he even assembled an international panel of medical experts to study the case and to provide valuable support for his legal battle. How many affected patients in India have such medical/legal strengths? Even if they did try to seek justice for medical lapses, they will be fighting losing battles since the final arbiter in the Consumer Protection Act is the Medical Council of India where other doctors will not let down their own fraternity.

Annual interest

So, the Supreme Court’s “hope and trust that this decision will act as a deterrent and a reminder to doctors who do not take their responsibility seriously” sounds too facile. In its generosity and concern, the apex court decreed that the award in the present case should take into consideration the petitioner’s monetary losses including his medical, legal and travel expenses with 6 per cent annual interest added to them. The court has also not questioned as to why he -- a doctor -- agreed to the treatment in the first place when it was done with his knowledge and compliance.

If the “guilty” doctors used a particular drug in a particular dosage, it was their considered opinion that it was the best line of treatment for the victim of a rare life threatening disease, also known for its high mortality rate. Far from being ‘negligence,’ it may have been an error in judgment to which he too sadly contributed. Yet, the highest court in the land thought fit to punish those doctors when tens of thousands of blatant medical lapses go unrecognised.

Doctors face innumerable problems while treating patients. If they order tests and refer patients to specialists in the field, a nexus is suspected between doctors/diagnostic centres/specialists. If they do not resort to these measures, that becomes negligence. A doctor is walking a slippery path all the time. There may be cases when the treatment becomes an act of judgment where doctors themselves tend to differ. For example, one doctor may prefer not to treat a terminal case of cancer in order to avoid further pain to the patient, while another may suggest aggressive remedies for the same. A third may even recommend palliative care.

In the present case, where the patient was suffering from an obviously incurable condition, the doctors administered steroids as a last resort to save her. How did the highest court in the land consider this as ‘medical negligence?’

However, it must be added that facilities in hospitals and attention by doctors do get diluted in a scenario where the sheer numbers of patients seeking relief is mind boggling. Public hospitals with their scarce medical resources and poor infrastructure have become torture chambers for the teeming millions who go to them for lack of alternate solutions. Private corporate hospitals which have been established as business conglomerates are patently commercial ventures. Some are notorious for exploitation and profiteering. Rich patients who visit these mega hospitals have as little access to establishing a close and confident relationship with their doctors as the poor patients in government hospitals.

While sick persons are sadly neglected in one, their treatment is reduced to ‘customer care’ in the other. The Hippocratic Oath is relegated to the back burner in both cases. The much touted Consumer Protection Act becomes meaningless under these circumstances.
If the latest SC ruling is meant to remind doctors and hospitals that they will be punished appropriately if they neglect their patients, legal procedures must be made easy and all cases of medical negligence be treated with the same consideration.