Tag Archives: medical negligence

Negligence cases deserving severe punishment.

Negligence cases deserving severe punishment.
© Dr. Rajas Deshpande

A police sub inspector in civil dress, his wife and three kids aged 8, 5 and 1 were brought to casualty. All profusely bleeding. My job as an intern was to secure IV line and stop bleeding. As the CMO questioned the PSI, we all realised as suspected from the stink that the police officer was drunk. He had run into a braking truck from behind. One kid and the wife died the same night. He created a ruckus in his drunk state, threatening to kill everyone in the casualty. “If my wife dies, I will see to it that your life is ruined” he threatened to the CMO. The CMO kept on doing his duty, stressed and hurt. We were all real scared next few days. Everyone sympathises with such a loss. No one will aid or enjoy anyone’s death in a hospital.
Then why this curse of blames?

“This happened due to that doctor’s wrong treatment” : common words now heard in many clinics daily. Who causes maximum deaths due to negligence? Can only a doctor cause medical negligence? No.

These medical negligence cases must be punished too, with bad press, crores of rupees in fines, and public humiliation. You be the judge who is guilty:

Teenager son of an MLA. Played with wild snakes as a hobby, proudly encouraged by this MLA. Bitten by a cobra, landed in icu critical. A patient on ventilator was ‘shifted out early’ to accomodate the MLAs son.

Doctor advised a blood thinning medicine to prevent clots after diagnosing clotting disorder,. Patient went with her husband to a quack, took unknown herbal medicine and stopped blood thinner. Developed strokes, now in a vegetative state.

Patient advised to quit alcohol,,as it caused fits. Counselled with family and friends. In a week had alcohol with same friends, had fits, died in casualty.

Diabetic, told to control diet, continued to binge-eat sweets, lovingly cooked by wifey. Landed in coma due to very high blood sugars.

Pet dog, unimmunised, bit many on the same day, the dog died in three days. One diabetic patient bit by this dog died of sepsis / infection (not rabies). Immense horror among the ten-odd families of bitten members till date after a year.

Kid aged 14, parents allowed him to ride two wheeler on road without licence, killed on spot colliding with a truck. Toddler unwatched on the road died, run over by a truck.

60 year old Mother has giddiness for three days, son and daughter in law not free till fourth day to take her to hospital. Dies in casualty due to stroke.

Patient advised not to fast as it may increase chances of having fits. Fasted and landed in ICU with status epilepticus (a series of continuous fits).

Traffic police at a crowded junction busy with his “routine” away from his spot. Head on collision, two dead.

Unfortunately, in almost all above cases, the treating doctors were beaten up, casualty staff and hospitals vandalised, doctors sued, bad press judged an entire profession almost like a criminal, for not saving the victim.
© Dr. Rajas Deshpande

Often the relatives refuse to take patients to higher centers, expecting “big, advanced treatments and impractical outcomes” from low-cost, small nursing homes not equipped with specialty facilities, then end up vandalising or blaming such set-ups upon inevitable disappointment. Missed medicine, overdose, unobserved children, helpless neglected elderly parents, smoking, alcohol, traffic accidents all cause millions of deaths. So do delayed admissions, some herbals and “unknown” medicines, hunger, poverty, stress at home and workplace.

But it is the “death in hospital” that alone matters, and by default the blame is pinned upon the doctor!

Some actors can kill, rape, go naked, smoke, drink, race, gamble, pee in public, set records for drunken misdemeanours on and off screen, knowing that most illiterate and immature populations imitate them blindly. But they will tell the nation how the medical profession (for which they themselves did not opt in spite of excellent merit in school or in some cases even college) should behave and treat patients!

The few honourable judges who have now realised the “blackmail potential” of medical negligence cases, have fortunately started referring these cases to panels of medical experts before concluding and fixing charges. The only maturity issue that remains is about local goons and politicos with flitting loyalties looking for publicity at the cost of the harmless and intellectual population of doctors. These goons turn the helpless frustration, panic reaction towards tragedy and poverty of our society into anger against doctors and hospitals. As long as there are sane people in the responsible media, there is good hope.

Doctors must start recording without bitterness, any hostile tendencies, lies, deviation from duties towards the patient, advised and declined tests and treatment, neglect and avoidance patterns to provide adequate care for the patient by the relatives. Also the exact circumstances of onset of the problems (patient was drunk / drugged / under medication effect / fasting / missed medicine) etc. and relevant past that may have contributed to the event. This will minimise the allegations and misrepresentation of facts.
© Dr. Rajas Deshpande

Ofcourse the doctors must also discharge their duty with the highest standards of practice possible in their set-up. They must communicate well and explain the condition atleast once to the concerned relatives. They must behave courteously, sympathetically and try to understand and forgive the panic states of relatives within the sphere of civilised behaviour. We all love our patients. But like in every other relationship, we fail to say it aloud and make it clear with our behaviour, thanks to heavily stressful and inadequate lives we lead. Let us make an effort on our side to take one more step in the direction of kindness and understanding, in a hope of saving this profession from defamation at the hands of middlemen.

Let us make a greater effort to tell the society that it is only a doctor who will never intend harm. The only reliable rescue from the clutches of death, even a doctor fails sometimes. The effort has to be recognised if not always rewarded, but never suspected.

Negligence, you see, is easy to pin only upon the doctor.
All others are forgiven any number of deaths in all other types of negligence.
© Dr. Rajas Deshpande

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The Grandiose Genius

The KHAMIR poison.
© Dr. Rajas Deshpande

“Doctor, we think that doctor treating my mom is giving her the wrong treatment. She is in the ICU, unconscious, for last three days” said the angry and crying son.
A 55 year old nice farmer lady with epilepsy, well controlled with two medicines, without fits for last three years had suddenly developed many fits / convulsions at home, and was now in ICU, ventilated because of the necessity to paralyse the patient to control fits (a common recommended treatment). Her brain had suffered damage due to lack of oxygen as breathing was compromised during fits.

As per their request I called to talk to the doctor treating her. She courteously explained that the patient was admitted after many convulsions, in an unconscious state, with dangerously low oxygen levels. The management since admission that she narrated appeared the correct one recommended in this case. “We will try to wean the patient off venti tomorrow” she said.

10 days later, the patient visited my OPD with her sons. Having known me earlier, the emotional lady held my hands and cried a while, thanking God for her rebirth.

“What happened on that day?” I asked her.

“Oh I had missed my antiepileptic (fits) medicine for five days.” She said.
“Why?” I asked agitated, as we clearly explain to every patient the importance of taking medicine regularly, in time, and stocking extra too.

“I live in a village. My son sends me this medicine from Pune. This time I told him a month earlier, but he couldn’t send it as he was busy”. Said the ever forgiving Mom.

I looked at the son. He said, semi guilty, “Doctor, I thought four five days of break in treatment would not make a difference. Also some people tell us that sometimes doctors prescribe unnecessary medicines for years, so we were confused whether she should continue. She had not had a convulsion for three years too”.

“Then why did you blame that ICU doctor?” I asked, still sizzling inside with hurtful anger.

“You can understand, Sir, we were emotionally disturbed as Mom was critical. Also, we had to spend a lot for her treatment”.

A case of brain cancer, stage 4. Headache neglected for years. MRI was delayed for months after the doctor advised it for headache. Then done at a free center by long awaited appointment. Multiple secondaries had caused block to the flow of brain water (CSF). Operated by one of the best reputed neurosurgeon, only to restore the lifesaving flow of CSF and obtain biopsy. It proved stage 4 cancer. Patient by now medically unfit for radiotherapy. The relative kept on asking: “Was the neurosurgeon wrong? Was the surgery done correctly?”.

Where do we bring faith and trust from, in this world where even brothers, sisters, parents are killed for money and most couples find it difficult to respectfully trust each other?

The more kindness the doctor shows, the more he/ she is taken advantage of. People look at every chance of not paying or paying less, and if paying at all, expecting a miracle with that payment. From someone they don’t trust.

In the widening valley between patient and the doctor, where trust is paramount, shows like Satyamev Jayate and some other media have further created a rift that has caused severe damage. This “KHAMIR” poison has really caused immense corrosive effect on this beautiful profession of intellectuals. Like other cheap “filmy” philosophies, conclusions by revengeful murders, the whole allegation game neglects the very high standards of education, compassion and sacrifice practiced by 90% Doctors in India and elsewhere.

Of course a logical analysis is not to be expected from someone not well educated. Many celebrities have been victims of the “genius grandiose” that money and fame brings.

The effect of this “Khamir poison”:

Many if not most patients now enter the hospitals with suspicion in their mind, and aversion for the entire process of consultation, paying fees, investigating, admission and taking treatment, all of which is a natural healthy process followed worldwide in all hospitals. Indian patients are unaware of how good the available specialist medical services are, at least in the urban/ semiurban areas, at the lowest costs anywhere in the world. Just because there are a few unfair practices (btw, most of which originated out of the policylessness and “charity for all” expectations from healthcare industry) and few greedy doctors, so many others suffer, doctors and patients too!

It takes 2 years to get an appointment of Joint replacement Surgeon, One year for a Neurologist, One year for a cardiologist, Three months to do an MRI, in most of the developed world. These can be expedited only in emergency, where one cannot have the choice of a specialist. This is mainly because they work 8-5 OPDs. Even senior docs in India work late nights and earn one tenth or less in most cases, to be available for anyone within a day irrespective of their financial / social status.

The notion that everything best in medical care should also be low priced or free is damaging the future of this profession. Add to this the loose talk by middle-school educated celebrities who have great hold on the illiterates / semi-literates, people who are angry at the govt., at their own poverty, unemployment etc., and find the “Intellectual, hardworking and doing comparatively better” class of harmless doctors an easy target to screw for their personal frustrations.

The “Khamir” poison is not a surprise, for it definitely stems from a desperate attempt to use one’s celeb status to cover for the lack of any serious academic achievements and intellect by attacking those who have these. What surprises is the willingness with which both the illiterates and literates swallow it, not knowing how harmful it is for themselves.
© Dr. Rajas Deshpande