Greed and the rise of medical malpractice in India

23 August, 2016

When India opened her doors for foreign investment in the post-1991 liberalization era, businessmen of all hues sensed opportunity. Among them, were those who identified healthcare as a space where India had lagged behind for decades – but was now ready to catch up. At the time, barring Government facilities with certified doctors and good equipment, the healthcare options available to most middle-class Indians were dismal. Private nursing homes existed, but they were largely unregulated and did not offer specialist services that were badly needed. Prosperous neighbourhood doctors usually converted bungalow-style homes into ‘hospitals’, and periodically called in their specialist colleagues whenever a difficult case walked in.

Given this depressing backdrop and coupled with an overwhelming and seemingly endless demand for high quality medical care, the business case for a corporate style hospital was never better. PV Narasimha Rao’s regime opened the doors for foreign players with the technical expertise to join hands with Indian businessmen who knew how to traverse India’s slippery bureaucracy. The goal was simple – you had to make these projects a success. Unsurprisingly, socialist eyebrows were raised when profit was openly recognized as the driving force behind these ventures.After all, how could doctors be allowed to make money?

Doubts were finally assuaged by the belief that Indian patients would benefit the most if market forces were allowed to do their job. The expectation being that the best doctors would be handsomely rewarded for choosing to remain in India. People also assumed that compensation would be commensurate with performance, and that the most successful doctors would finally get their due. In the old days, success was analogous to reputation, and this in-turn was a consequence of a doctor’s ability to diagnose and treat their patient’s condition accurately and effectively.

And what a success story it has been since – or has it?

Unfortunately, today, the reality is different and in some cases tragic. ‘Success’ no longer corresponds to an individual doctor’s reputation or ability; it has transformed into an intangible adjective abused by some corporate hospitals that treat patients as revenue generating clumps of tissue – to be pricked, prodded and cut open at the slightest pretext. Why on earth should a regular cough require an MRI or an ultrasound? However, when goals shift from honest treatment to cold revenue targets, unnecessary intervention becomes the norm.

Cases abound in some hospitals, where caregivers have brought in family members for minor ailments and have been advised to ‘rule-out’ conditions ranging from bone-cancer to tuberculosis. Doctors at prestigious branded hospitals routinely demand extensive blood-work and nuclear-imaging for a lot of their patients – and when everything comes back normal, the patient heaves a sigh of relief and thanks the Doctor for ‘being so cautious’!

The cycle goes on and on, till the unfortunate time a patient actually suffers from a serious underlying condition that needs urgent treatment. Hundreds of tests will be performed. The same diagnostic findings will be corroborated a dozen times, and finally an array of invasive options will be provided to the patient, like a menu card – where perhaps non-invasive options might have been safer and quicker.

The net result, notwithstanding the financial condition of the patient, is that the treating physician and the hospital administration raise astronomical bills. Monthly revenue-targets must be met. Incentives range from kickbacks for needless tests and longer hospital stays, to vacations and luxury sedans for the ‘best’ doctors. Anyone who has had the misfortune of being through the rigmarole at one of these branded hospitals will testify that even a short-stay can mean a massive financial hit. The situation is worse for most folks who cannot afford expensive medical insurance, and are thus entirely at the mercy of the hospital staff.

Sadly, expensive treatment is not even half the story. The real danger from needless medical intervention is avoidable damage to the health of a patient. In the rush to perform as many surgeries and procedures as possible, doctors often neglect their duty to warn their patients about the high risks involved in such procedures. Consent forms are treated as a mere formality, and are often left blank at the time of obtaining signatures from patients or their caregivers.

As a lawyer who deals regularly with medical malpractice cases, I have heard victims of negligence complain about doctors who were very enthusiastic and optimistic prior to the surgery, but when the procedure didn’t have the desired outcome, they became completely inaccessible. Worse, in cases of serious injury or death, some unscrupulous hospitals avoid parting with medical records to shield themselves from liability. Legally speaking, a hospital is supposed to provide records within 72 hours of a request being made. Fat chance that they will actually comply!

It doesn’t help matters that the statutory body which is supposed to monitor these hospitals and enforce compliance of the rules, is itself led by prominent members of the healthcare industry, and they are rightly accused of shielding their ilk. There is simply no accountability. Unsurprisingly, stories of rampant corruption in the functioning of the MCI are legion. Instead of keeping a close watch on existing hospitals and the quality of treatment being provided to patients, the MCI is busier handing out ‘approvals’ and ‘permissions’ to new medical colleges and hospitals. A simple survey on ownership of these medical colleges reveals another story altogether.

Anyone reading this in Maharashtra will know exactly what I am talking about.

In the midst of this mess, the only messiah, so to speak, has been the Indian judiciary. In 2015, the Supreme Court passed a landmark verdict. The Court awarded a young victim who lost her eyesight owing to the incompetence of government doctors in Tamil Nadu, nearly Rs. 2 crores. This decision is extremely important, because for the first time ever, a Court in India computed a realistic figure, which will actually and tangibly impact the quality of medical care a victim will receive. Feminists have reason to rejoice too, because this judgement took into account the victim’s mother’s lost wages, since she quit her job to care for her daughter.

Sadly, gone are the days when you could trust your doctor’s advice with blindfolds. With the unavoidable advent of profiteering in medical treatment – it is now absolutely critical that patients know their rights.

http://blogs.timesofindia.indiatimes.com/the-irreverent-lawyer/greed-and-the-rise-of-medical-malpractice-in-india/