Health practitioners: Above the law?

From the media we learn of the lone cancer hospital with no drugs or therapy, we learn of diarrhoeal deaths in the districts while stool culture reports fail to reach the health complexes, we note how patients are crammed into the verandahs or storerooms like sardines, we see how stray dogs share hospital premises with patients as they hang around the food trolleys (perhaps for a sneak lick), we see pictures of the blood bank at DMCH and shudder, we read reports of at least 10-15 cases of wrong treatment every month and that the doctors responsible go unpunished: that claim made by the Bangladesh Medical and Dental Council, and we remember how Hosne Ara lay for three days at DMCH with a sharp object lodged in her right eye waiting for a doctor to remove it.

From casual conversations with the unfortunate, we further learn of the amputation of the wrong limb, the administration of drug doses that have driven patients to or near death, the prescription of wrong drugs to patients, the needless cross-referencing of patients to "friends" in the profession, the piling of diagnostic tests to be conducted at "specified" diagnostic centers, the nursing of patients in private clinics not by trained personnel but by janitorial staff who have no business handling patients, the delays in admitting patients in serious coronary conditions leading to their expiry, and of doctors coming late to assist with a delivery that was fatal because of bleeding during the long interlude.

These are but a few examples of what goes on in the zone of disaster, otherwise known as health care centers. The unbearable suffering of the patients must also be endured in near equal measure by another group: their families and near and dear ones. They are also made to pay dearly -- physically, emotionally, and of course financially until they are at their wit's end.

When one person goes down with a health problem, the suffering begins for many in this utterly mismanaged sector. And because of inadequate and deficient service provision by the so-called health care practitioners, it is not difficult to understand the rage one feels at their insincerity and incompetence. That rage is accompanied by a sense of helplessness that there is very little recourse when negligence or serious errors committed by the service providers end up as life-threatening, life-debilitating or life-ending.

Yet, seemingly, you cannot penalise these health care providers. Not yet!

According to the reports of a human rights organisation, "Nearly 90 percent of the complaints go unheeded because in most cases the victims are unable to provide required evidence against the doctors." And now, according to a report in a local daily, a bill that was passed by the cabinet to punish private clinics and their healthcare personnel for negligence leading to death, serious and sustained mental suffering, or loss of limb, has been withdrawn. The proposed punishment included cancellation of practitioners' licence, 10 years rigorous imprisonment, and/or a penalty of Tk.10 lakhs. Not surprisingly, there was a hue and cry from the practitioner community, with serious reservations against punitive measures.

The fact is punitive measures are essential to establish accountability and to exert some form of control over medical practitioners who cause unbearable suffering to their clientele. These measures must be vigorously enforced under the prevailing circumstances in Bangladesh to bring about behavioral changes among the practitioners. Otherwise, the pitiable and sordid plight of the patients will continue. Unfortunately, the health care providers seem reluctant to change their ways as they have sought representation of powerful lobbies with strong enough influence to have the bill withdrawn, to be watered down substantially.

What are some of the consequences of not having this timely bill implemented immediately? Primarily, a section of the care providers will continue on their merry way, coming late to work or not at all (74% do not show up according to a World Bank study), slashing and gashing patients wherever and whenever they please without being held accountable, overdosing them with whatever brand they were "persuaded" to administer by the drug companies, sending them to their "partner" diagnostic centers and "friends" in the profession, behaving as rudely as ever for making them work, and so on. And for these practices they do not have to account for or be subject to penalties!

A second consequence is that of sending the wrong message to other constituencies and lobbies. We already see some semblance of this, especially how teachers, transport workers, and fourth class employees have seemingly become untouchable and who are so powerful that the government is out to placate their slightest whims -- right or wrong. Soon, others will create their own powerful lobbies to make accountability an obsolete word. Thereafter, we will subject to the laws of the jungle. It is not as if we are too far from it anyway, given the daily dose of crime, corruption, and audacious behaviour across the land that we confront and, sadly, endure each day.

A third consequence is economic: Exonerating health care practitioners from being penalised or watering down these penalties would drive more patients who can afford it to seek treatment alternatives in other countries. I know of someone who recently had a mild heart attack. The individual flew immediately to a neighbouring country for a check up and advice. Apparently, he has been advised to return for a follow-up and he intends to do so when it is time. On a grand scale, if patients begin to flock out, en masse, the burden on the nation's foreign exchange resources is yet to be estimated.

It may be mentioned that customers seeking health care abroad have been known to suffer collateral miseries associated with travel, meals, accommodation, and related needs. For any major mishap necessitating a longer stay than originally planned, these inconveniences could easily be magnified several-fold. That would mean the use of more money "there" instead of "here", impoverishing the nation further in its ability to combat problems in other sectors. Clearly, if health care providers could be "goaded", under threat of penalties, to deliver what they are supposed to deliver in any case, this outflow of resources could not only be stopped, it may even be possible to reverse it. It is difficult to surmise why health care providers fail to understand this point and work collectively to upgrade the entire sector and bring back people's trust and confidence in them. It is time they engage in some introspection about the prevailing conditions and their Hippocratic Oath. It is also time for people to know how one might seek redress for practitioners' failures.

When healthcare providers make health conditions unbearable for their own mistakes, they must be subjected to laws that are supposed to protect the well-being of the citizenry. Being held accountable and being subjected to the laws of the nation is even more important in their case because when dealing with human lives, incompetence is a crime, negligence is a crime, charging exorbitant sums for something patients cannot evaluate is a crime, recommending unnecessary procedures and tests is a crime, and partnering with "friends" in the profession to boost revenues is a crime. All of this and more must be reluctantly borne by mute patients and those who care for them, day in day out, because they have few alternatives and no recourse.

It would, however, be irresponsible not to acknowledge that there are good providers in the system who care, work hard, and try their very best to save lives. But it is debatable whether that can be said for the large majority of health care providers, both public and private, who seem to be solely inclined to make windfall gains instead of following the Hippocratic Oath.

The withdrawal of the bill after being passed by the cabinet is a singularly thoughtless act that demands an explanation. There must also be a national debate on this issue once the watered down bill is re-introduced because giving health care providers an easy way out is certainly not the answer. It is time for the leadership to establish accountability in this sector. That means difficult choices must be made; but that is what leadership is about. If the people of the land feel they are represented by an ineffective leadership -- emasculated by the various lobbies or by the powers that be -- what can they (the people) expect of such leadership? And if this leadership favours the powerful minority over the weak majority, the sense of injustice can be debilitating for the nation as the powerful will continue to exploit the weak. That, to the citizens, is unacceptable!