Are doctors above accountability?
In the wake of the deaths of Mahbuba Rahman Akhi (on June 19) and of her newborn (on June 10), resulting from a botched C-section performed at the capital's Central Hospital, the issue of deaths due to medical errors came under intense scrutiny. The incident received heavy media attention. In response, and perhaps to maintain calm, the hospital fired two negligent physicians. They were arrested by police on June 15. Unfortunately, in protest of their imprisonment, doctors across the private sector launched a two-day strike on July 17, demanding the immediate release of their coworkers, knowing that their actions would possibly jeopardise more lives, exacerbating the issue of negligence that their fellow doctors had been accused of.
In Bangladesh, we are accustomed to the covering up of wrongful deaths and are less committed to accountability, leading to fewer complaints. We must adopt medical professional liability insurance for physicians to address medical malpractice.
The strike was shocking. Demanding an improved work environment, less workload, and even more benefits, and salaries are all part of acceptable civil discourse. However, the incident is beyond the pale. At the time of the protest, when Khulna Medical College Hospital was treating 1,500 patients with a capacity of only 500 beds, according to a report by this daily, such an action by our doctors was outrageous. They reacted as if they were immune to medical malpractice and that their unprofessional conduct shouldn't be questioned. In fact, by going on strike, they threw the importance of transparency and responsibility out the window. Disappointingly, the protesting doctors' demand did see fulfilment when, on July 18, the two physicians were granted bail.
However, very little is known as to what actions will be taken to compensate Akhi's family and hold to account those responsible for the death of her and her newborn. Also, what short- and long-term policies are the authorities going to adopt to stall future occurrences of such negligence? The lack of reporting on the case recently indicates that investigation will slow down and eventually languish in a legal quagmire.
Akhi's death reminds me of the twelve elderly patients who died in nursing homes in Florida in the aftermath of 2017 Hurricane Irma. Extremely high temperatures in the facilities from the loss of electricity were found to be the cause of their deaths. The very next year, the Florida legislature passed a law compelling all nursing homes and assisted living facilities to install generators sufficient to keep the temperature at 27 degrees Celsius or below and provide power for at least 96 hours. With something like this as an example, we must also pursue legislative actions to put a stop to ill-fated deaths in our healthcare facilities.
The drama of arrests, protests, and bails does not help the victims and their families at all. After allegations of wrongful deaths come about, the proper course of action is the dismissal of the accused, the opening of investigations, and repatriation to jobs or punitive measures for the subjects, depending on the findings. Physicians going on strike to interfere with the normal course of proceedings is simply unbecoming of their profession.
Errors are inevitable, even for the best medical professionals in the most ideal environment. But that cannot spare them from accountability for negligence or intentional harm. According to a recent report, every year, 371,000 people die and 424,000 sustain permanent disability in the US due to medical errors. One might think this number is staggeringly high for a country with the best doctors and technologies. However, the US has twice the population of Bangladesh. Plus, the country encourages investigations into complaints, contributing to these astonishingly large numbers. In contrast, in Bangladesh, we are accustomed to the covering up of wrongful deaths and are less committed to accountability, leading to fewer complaints.
We must adopt medical professional liability insurance for physicians, like in the US, to address medical malpractice. Such insurance will shield providers from financial losses from lawsuits and investigations. In the US, for those in high risk facilities, 99 percent of physicians face lawsuits by the age of 65. Regular recertification and training are commonplace solutions to reducing errors and improving efficiency. If caregivers in Bangladesh claim immunity from wrongful deaths at their hands, they should not pursue this noble profession.
The anarchy in our health system seems to be on autopilot; corruption and irregularities have plagued it from the top to the bottom. Hospitals have become places you go to to get even sicker and for the unnecessary loss of life. Deaths are often forgotten as collateral damage. All this means that it is high time we passed comprehensive legislation to address medical malpractice in Bangladesh.
ABM Uddin is a healthcare consultant at the Florida Agency for Health Care Administration. Views expressed in this article are the author's own.