DOCTORS IN THE DOCK

A recent incident in an Indian hospital: A baby is declared dead, stillborn, and after several hours, discovered to be alive. The doctor in charge was the one who saw the baby in the early hours of the morning, and saw signs of life. The nurse in charge had declared the baby dead the night before. Incidentally, no resident had seen the baby. The doctor in charge was apparently unavailable on phone till the morning. The media had a field day, roasting the hospital and the doctor alive for the ghastly event. The hospital has stood behind the doctor.

In another episode, a doctor gave the wrong cancer drug into the spinal canal of a patient, resulting in paralysis and a possible death. The doctor was told by the nurse that she was giving him the correct drug.

In the second case, the doctor was hauled over the coals, while the hospital concerned tried to shift the onus entirely on the doctor, as if all it did was provide the four walls and roof for the doctors and patients.

Obviously, in both the cases there is likely a strong element of human error or negligence on the part of the physicians concerned. However, it is a disturbing sight to see a hospital put the doctor in the dock and try to absolve itself entirely. This is one of the many instances where corporate hospitals and doctors find themselves in conflict. Recently, a corporate honcho berated a famous doctor blogger (one you may possibly know) for writing allegedly adverse comments about it, even hinting at legal action.

What do you think?

16 responses to “DOCTORS IN THE DOCK

  1. It’s good to hear a doctor openly criticize his own fraternity as in the case of this post. I am not at all surprised about the hospital trying to cover up for the doctor though.

  2. The hospital must support the doctor completely. How can doctors take necessary risks if they can’t be assured of a safety net? That said, there is no excuse for negligence.

  3. This is one of the many instances where corporate hospitals and doctors find themselves in conflict. Recently, a corporate honcho berated a famous doctor blogger (one you may possibly know) for writing allegedly adverse comments about it, even hinting at legal action.

    It’s clear Doc: A corporation can never do evil and is never wrong, since it is fulfilling Rand’s directive. 😉 :p

  4. I liked that post of yours and shared it with many of my friends as an appreciation of your forthrightness. Instead of contemplating any legal action, the Hospital should be thinking about furnishing every bit of information on the procedure, costs and alternatives available and let their clients make an informed choice.

  5. The corporate hospitals are paying huge salaries to the doctors and in order to be viable to the company the doctors have to work more than they are capable of. The hospitals cannot escape accountability in this situation. If the doctor starts at 9 in the morning and is performing 20-25 surgeries and other complicated procedures in a day, I guess the chances of human error increases.
    In the first case the pregnant woman must have been registered with the hospital and it is the hospital’s responsibility to provide her with medical care any time she needs. If there is no doctor available, the hospital is to be blamed.

  6. I’d say doctors get blamed more because they are the most visible part of a patient’s care, and an easier target than a hospital.

    But most patients also don’t know where a doctor’s responsibility ends and the hospital’s takes over.

    I would also like to have something like a hospital bill of rights. What are the things I should expect from a hospital – how frequently do nurses/ residents check on patients? How many residents are on call? How experienced are the nurses..and so on.

  7. doc
    coroprates have deep pockets and a dedicated legal team – u dont

    but isn’t anything written down ? no terms of service agreement and rules of engagement etc

  8. Nita:
    Thanks.
    Marc:
    I agree with you completely. In cases of negligence, it is not always possible for the hospital to defend the doctor. In such cases, at least they should take their own responsibility in the event. That, however, doesn’t always happen.
    Amit:
    Crap! 🙂
    Arun, Lekhni:
    There is actually a Bill of Rights for patients that could be implementable. I had written on it a long time back, but don’t have it now.
    Prerna:
    Corporate doctors hardly do that many cases, and errors are often the result of a less than dead-serious (pun unintended) approach to the patient.
    Prax:
    Not that I am aware of (no TOS, except in terms of clinical practice, money, etc.).

  9. @ R-Doc:

    Hospitals are legal entities; mistakes are committed by people (doctors, nurses) employed by those legal entities. A propos Prax’ comment, there has to be a contractual agreement between the two without which the relationship cannot be proven, without it looking like a case of Lars and the Real Girl.

    However there is another issue here – the expanding role of the nurses in healthcare. In the UK, this growth of responsibilities is limited to primary care; politically it is being linked to their increasing/ increased pay (not that they earn a lot when compared with doctors).

    What is the Indian situation in this regard? What do contracts say? Does it define where the buck stops?

    I must say however I am with Amit on being surprised at this post. Aren’t people all free to do as they please? Why should the law confer more responsibility on the corporate than it does on human employee? What happened, Doc? 😉

  10. Correction: Prax’s comment.

    Thanks.

  11. The doctor is an employee of the hospital. I case of negligence or errors, I guess the hospital should indeed take responsibility.
    I mean that’s how it goes with every company right?
    But going to court challenging medical negligence wouldn’t reach anywhere. As far as I have heard the court wont agree to the patient plea unless another doctor accepts that the case was indeed a human error.
    But none of the docs will talk against their fraternity? What say doc ? 🙂

  12. Shefaly:
    The hospital employs nurses. It is liable for the actions of the nurses. However, in situations as the ones referred to, the hospital may try to pin the blame on the visiting doctor, even though the nurses are also shareholders in the lack of acceptable care given.
    That is all I tried to highlight here.
    Xylene:
    There is much to be gained by going to court on grounds of negligence. In cases like the faulty injection, the legal case is res ipsa loquitor (the thing speaks for itself), where the onus of proof lies on the defendant.

  13. Intrigued by the comments..

    Hospitals need to stand steadfast behind their employees’ negligent actions ? Irrespective of the employer, who does ? And why should they ? If my gross neglect caused my employer significant loss, they would fire my behind before I can bat an eyelid and sacrifice me at the media altar…

    The hospital needs to extend the help it can given the negligence of it’s employees and the associated trauma, but it is doing itself good in making these careless morons take the heat — this was no risky procedure that went awry, this was gross negligence. It sends a message..

    And spare me the doctors work long hours ; who isn’t burning midnight oil these days and for a lot less pay than doctors. Hate to mention it, but it’s about time malpractice insurance debuted in India, if not already..

    Questions :
    1. If you were in a flight that had a drunk pilot , would it suffice if the airline took the heat for it did a quick press release ?

    2. In 2007, a crazy NASA astronaut did a 900 mile trip to her lover’s home in an attempt to kill his wife, with an adult diaper strapped on to ensure no pit stops. All in this 3 way love triangle were NASA employees. Maybe NASA ought to stand behind her diapered behind as well ? One could argue about the rigors of training, lack of social life, close proximity et al and how NASA is a party to it ? (spare me the this did not happen on NASA’s premises, it could well have..)

    3. Virginia Tech shootings of last year — VT stand behind the killer ? No. But he was their student ?

  14. Athreya:
    Nice comment. The hospital, of course, should not defend negligence. However, what one may find is an attempt to deny negligence, merely because acknowledging negligence will mean forking out compensation to patients. It is cheaper to blame the doctor. Of course, this does NOT mean the doctors are not negligent. I am merely saying that hospitals try to use this escape route frequently.

  15. In India at least, I have found doctors to be a fairly dedicated bunch. Generalizations are always untrue, of course. My father had cancer some years ago and though he is a doctor himself, he had to submit himself to another doctor who insisted on treating him in Tata Memorial Cancer Hospital. They treated him well and since it was detected early, managed to cure him completely. I spent a lot of time in TMH, accompanying him and generally playing butler. The doctors really know their jobs, they care for the patients regardless of their station in life and are surprisingly gentle and sympathetic towards patients in an advanced stage.

    I found the non-medical staff a little callous, and had to pull strings to make sure my father was well cared for (one of my friends knew their union leader). But the doctors were amazingly gentle.

    So, from my scant experience with hospitals, I would suppose that most of the avoidable mistakes are usually made by the hospital administration.

  16. Thanks, Naren, for sharing your experience. I agree, on the whole.

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