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Why the court should not go overboard while fixing the compensation for medical negligence

It is often said that 50 per cent of the practicing lawyers at any given time are delinquents because they work against truth and justice and try to build a fort of lies to win a case (assuming that only one can be right in a dispute) unlike doctors who have to search for truth in every case to win that. Sometimes the lawyers bend the thin twig of law so much so that they could make it touch their side of the fence even though they are wrong.

Dr Kalyan R Kone

This malady has spread to the Supreme Court judges too nowadays. Some of the judges are venting their personal prejudices in the judgments instead of staying above prejudices while pronouncing judgments. But this is not complete death of court — as for every Ajit Nath Ray, there was a H R Khanna (During Emergency in 1975) and for every Altamas Kabir there is an A R Dave (during NEET Verdict). But their voice is getting weaker day by day.

The first fiasco happened few months back with the NEET Exam where the verdict surprised everyone including the judiciary. It didn’t require extreme degree of intellect to interpret what went behind the scenes and why the judgment was leaked.

The second fiasco pertains to the exorbitant fine imposed by the court. The judges had taken the existing knowledge about the condition and fixed the fine for a problem that happened in the pre-internet and communications revolution era. The doctors were definitely guilty — no doubt about it — but the amount of compensation is way too heavy.

Hypothetically, it is true that every life is priceless and we cannot measure its value. But for practical purposes while announcing compensation, the court has to take into consideration the social impact of its verdict. The court definitely knows that if a social price is fixed, it will never come down in the future. This will also embolden the lower courts to put hefty fines in the future. After all, most of the people are greedy and will try to find loopholes in the treatment, not out of love for the patient but for the love of the money in connivance with or coerced by the lawyers — the classic American malady.

The indemnity insurance costs will increase along with the distrust between the doctor and the patient, which will indirectly be passed to the patient. Under the CPA (Consumer Protection Act, 1986), there is no cap on the amount of compensation — it is the earning capacity and hence the loss to the consumer, which is the deciding factor. So, no small hospital can afford rich patients and only big hospitals can afford them and they will also increase the fee citing the Supreme Court ‘tax’.

I am not trying to protect the doctors but only trying to emphasize the fact that the fine imposed was outrageous because the court increased the fine by almost 1100 per cent (the last highest amount was 1 crore rupees) because it would have widespread social ramifications. Society would not notice gradual changes but sudden changes are definitely noticed. The sudden drastic increase in fine will make doctors more defensive and the patients’ attendants greedier. Every action of a doctor would be scrutinized under microscope, which would not augur well for the doctor-patient relation.

Normally courts follow precedents to fix the compensation. We need to compare the present case (which happened in 1998) to a similar but more ghastly incident — the Uphaar theatre fire tragedy (June 13, 1997) in which 59 people died of severe burns. I had personally treated some of these patients when they arrived in the AIIMS casualty and I was outraged at that time (it was the nearest movie theatre to AIIMS and we used to go there frequently). For the administrative negligence, the court awarded Rs 6.5 crore compensation for the 59 people dead and 103 people injured. How different were both incidents? Why the compensation differed in both incidents?

The Supreme Court lost a great opportunity to act in a responsible way and chose the easy way out by putting a hefty fine, which is more than an honest doctor can acquire in his lifetime. We cannot go back to the days of Hammurabi for fixing the fines. No doctor is God and every doctor including honest people must have made at least one mistake unknowingly — sometimes it is called complication and sometimes it is negligence. Many times, there is a very thin line of separation between a complication and negligence. The only doctor who can confidently say that he didn’t commit a mistake is the one who stopped medical practice.

The court said that this would improve the medical care of the patients. This is a ludicrous statement because the court itself tried to promote mediocrity in medical field by quashing the NEET exam. The government is also trying its bit to promote mediocrity by selling medical seats for money by colluding with private medical college establishments.

The court said that “Failure to use due skill in diagnosis with the result that wrong treatment is given would be negligence”. The honourable court should note that the human body is not a fixed circuit like a machine. We are still miles away from deciphering the human body and human code. Although we found out the genetic code, it’s on and off switches and its interaction with the environment is not fully known. For many diseases, there is no single ideal approach. Even evidence based medicine talks about statistics but not what is required for an individual patient. Ultimately the burden of choosing the treatment falls on the patient and the doctor acts only as a facilitator. When a patient survives, they praise medicine as a noble occupation and if the same doctor makes a small mistake they burn his reputation at stakes.

There was a statement about Mr Manmohan Singh few days back in The Hindu Editorial — “Guilty on many accounts but not corrupt” which applies absolutely to the current medical profession. Many people started treating medicine as business since the Supreme Court judgment 20 years back. But most of us didn’t treat it like business. Otherwise, the situation would have been much worse. Millions of doctor-patient interactions happen in our country every single day. Out of them, even at this very moment, some may go wrong either because of the doctor or patient’s illness. Some of them are definitely because of the doctors, but one should observe the fact that they are very few, not even 0.01 per cent. The public should note the fact that there are more good people than bad men in our profession.

We agree that we are all not good men. We reflect the current society because we are drawn from it. When the society goes bad, the doctors also go bad. But don’t forget one thing – doctors in comparison to other professions are the last people to go immoral because of the ethics inherent in their profession and if it is happening, it shows the society’s direction. But one thing is sure — we, doctors, still draw inspiration from an occasional patient living against all odds because of our efforts and an occasional patient saying, “Thank you very much, Doctor”. Sometimes, these simple words remind us of our noble profession and arrest our moral slide.

Most of us lost our youth studying those immense books and diseased patients. Most of us became indifferent after seeing death from close quarters but never lost our empathy and humanity. Most of us lost our family lives and pampered our kids because of the limited time we have for them because of our profession. Most of us feel happier when a patient recovers from a complication than when our own children are cured from illnesses. Most of us stretched our limits when patients put complete faith in us. Most of us even when we are sick attend to the patients with a single thought — “what would happen to the patients if I am not there”. We don’t embody higher spiritual goals and sacrifice lest we be sages and live in Himalayas but most of the time what drives us is the noble cause because after some time, money won’t drive us.

Let’s go back and examine the case and learn from the mistakes instead of committing them because the sequence of events even though 15 years old can happen to anyone if they are not careful enough.

1) The accused doctor was the most reputed and leading doctor according to the complainant, which I think could not have been achieved with pure luck. Sometimes this works like a double edged sword — the more reputation and patients one gets, the less reliable the treatment becomes over a period of time because the time spent on each individual patient drastically reduces and he/she does not get adequate time to update him/herself. It is better to restrict the practice than spending whole time in the clinic/hospital. Even a senior and intelligent doctor like him could not diagnose the condition (the dermatologist could diagnose the condition later but by that time the condition was full blown). This shows that every new case teaches new things and one should be willing to learn throughout one’s life. This also shows that future doctors should see sufficient number of patients during their training, should have a reasonable intellect and should update them constantly throughout their lifetime. But nowadays people are buying medical seats with money and not being trained sufficiently during their stay at the colleges — the number of disputes will definitely increase in the future.

2) Why the doctor prescribed high doses of steroids, the particular preparation and the dose — whether he by mistake gave that particular dosage or whether he had already treated a similar condition with the given dosage of Depo Medrol 80 mg twice a day is only known to him. In medicine presumptive treatments are used sometimes when the diagnosis is not obvious. The mistake the physician had done was not seeking a dermatologist’s opinion in the early stages of the disease and using long acting preparation instead of short acting ones. Whether the patient would have survived or not with or without steroids is a different question altogether. This episode indirectly shows the dependence of practitioners on medical representatives for their education (because Depo Medrol comes in 3 different dosage forms – 20,40,80 mg, the doctor must have gone for the higher dosage). This also reveals the limitation of knowledge even a senior physician can have beyond his field. Medicine is getting branched into specialties and subspecialties nowadays and when in doubt or not able to precisely identify the problem, it is better to include other specialists in the treatment process to avoid litigation.

3) When the patient was sick in the hospital, the treatment was not recorded properly — there was no notes, no vital signs recording for days. The supportive care was not given properly or not recorded properly. No IV line was started because of the fear of introducing infection when the patient was already in sepsis. There is a peculiar term in medicine called VIP syndrome — the more you treat a patient as VIP, the more mistakes you do. I think that’s what exactly happened to the patient — the more they treated her as VIP, the more she deteriorated. There is also a famous adage — “Everyone’s patient is nobody’s patient”. When the main treating physician left for US, there was nobody leading the treatment because there was not a proper note by any treating doctor. The importance of recording all the parameters (Vitals, Drugs etc) and doing the necessary investigations cannot be overemphasized with this episode.

When we examine the case closely, we would definitely find many lapses in the treatment. But before examining the case with 2013 X-rays, let’s go back to 1998 and take time to compare the medical infrastructure situation in 1998 and 2013. Most of the hospitals were just looking to upgrade their infrastructure in 1998. There were few specialists and most of them treated patients with their hunches and experience rather than EBM (Evidence Based Medicine), which was just being talked about in institutes. Writing notes was not considered important those days. Last 15 years had seen major changes in the medical field in India. The importance of infrastructure, EBM and daily notes are all recognized now. For a patient who returned from US in 1998, every thing must have looked horrific that time. But there was a definite time gap between the adoption of medical advances between US and India, which is only getting narrowed nowadays.

I am not trying to protect the doctors but only trying to emphasize the fact that the fine imposed was outrageous because the court increased the fine by almost 1100 per cent (the last highest amount was 1 crore rupees) because it would have widespread social ramifications. Society would not notice gradual changes but sudden changes are definitely noticed. The sudden drastic increase in fine will make doctors more defensive and the patients’ attendants greedier. Every action of doctor would be scrutinized under microscope, which would not augur well for the doctor-patient relation.

The sad thing is we lost half of our credibility when money entered the system blatantly — money for degree scheme (which was started by politicians) which corrupted the production of doctors (Even in Medicine, 50 per cent used to belong to the bottom half of the class and as money entered the system blatantly, the number will rise to 90 per cent in a short time) and the other half because of the kickbacks we receive from the diagnostics and pharmaceutical industries which corrupted the conduct of the established doctors.

It’s sad that the Supreme Court is also trying to corrupt the system first by scrapping the NEET Exam and later by increasing the fines exorbitantly. I hope the government and court would look into the matter and make correct decisions. The Indian Medical Association (IMA) and the Medical Council of India (MCI) should take a lead in representing the interests of doctors to the executive and judiciary.

Dr Kalyan R Kone

35 Comments

  1. Titto Idicula M.D, Ph.D, FABPN Titto Idicula M.D, Ph.D, FABPN Sunday, December 1, 2013

    Thanks Dr. Kone for such well-rounded article. I appreciate that you judge the issue in a very critical manner. As a person who writes opinion articles myself, I feel that this article demonstrates how an issue can be approached in the most impartial way. While I disagree that increasing the compensation would worsen the doctor-patient relationship, such compensation to a patient who belong to high-class of the society would not benefit either the doctor community or the patient rights. From my experience as a doctor who worked in India, US and Norway, I feel the worst thing ever happened to medical community in India is the introduction of money into the system, I mean buying seats with capitation. Even in a capitalistic country like US, they don´t let people directly buy a medical seat (there are indirect ways of course….. like a rich person able to send kids to reputed schools and colleges which would eventually let them into medical schools). The second important issue is obtaining degrees based on years of study (and not number of cases seen and treated). You cannot compare an M.D degree from AIIMS with that of an M.D which can be bought in a sub-standard medical college. In many Western countries a surgeon won´t be specialized without performing certain numbers of various surgeries. Lastly, IMA is deplorable in doing nothing to gain the trust of people. Doctors, politicians and prostitutes are one and same in people´s eyes today, sadly because of the misdeeds of very few corrupt doctors and lack of any corrective measures from IMA:

  2. M C Gupta M C Gupta Saturday, November 30, 2013

    The issues raised by Dr. Kone raise the following questions:

    1–Has the court acted as per law or in violation of law while pronouncing the judgment? [Obviously, it has acterd as per law].

    2–Has the medical profession / IMA ever tried to get the law amended by demanding, by way of a legally drafted representation / PIL that a cap should be placed on the maximum compensation payable? [Obviously, the answer is in the negative.]

    3–Has the medical profession / IMA ever tried to get the law amended, by way of a legally drafted representation / PIL, that by demanding that, at least to a certain extent, compensation payable for deficiency / negligence in service should be linked with the consideration paid for service ? [Obviously, the answer is in the negative.]

    We should desist the temptation to blame the judiciary. Judges have to act as per law made by the law makers. If laws are deficient or defective, the medical profession should demand proper enactment / amendment rather than blame the judges.

    –M C Gupta, MD, LLM
    Advocate (Former Professor of Medicine and Dean)
    mcgupta44@gmail.com

  3. Drs.k.singhal Drs.k.singhal Friday, November 29, 2013

    now there is increasing demands for so many new laws ,to complicate laws,……..and to increase severity of penalties eg life imprisonment and hanging till death ………probably this will increase profit of big law firms in higher court as more cases have to reach in higher courts……..so may be their business interest of these firms …..and sponsoring these demands of new laws …..and to increase amount of penalties and punishments which may affect clients tremendously ….and so have to spend more money fight against punishment in higher courts

  4. justiceseeker justiceseeker Thursday, November 21, 2013

    Dear Bloodseeker,

    Thanks to understand my point.Medical profession is on the top of 10 most respected professions in the world.But to remain on the top , you have to introspect your self and improve your processes to reduce the errors and blacklist those black sheep who brings disrepute to this highest noble profession.Corruption is prevalent in every area of society but still our country survives because all are not corrupt.A common man still believes in honesty and a corrupt man still prefer to employ an honest man.but MCI and state medical councils have not played their role effectvely. so such black sheep openly throws chalenge to victims of medical negligence that they will be not penalise by their regulatory authoritiesby .Once a victim approach these regulatory authorities in hope of justice, he find that judgment is fixed and guilty doctors are roaming scot free without any punishment.even in some cases victims itself are blamed for death of their near and dear ones.Then he has no option except to initiate a legal case in search of justice.Still it is a distant dream for a medical negligence victim to get justice for want of an expert doctor opinion in his favour in writing though many doctors agree to medical negligence charges orally.Dr Saha was able to get justice after long battle of 15 years because he himself is a highly qualified doctor and able to get highly reputed experts from abroad.Now you can imagine a case of indian medical negligence victims who can not pronounce the disease correctly.Whether your conscience medical community will support such kind of honest medical negligence victims who are fighting for justice and set up a seperate cell to take up these kind of cases to cleans your own rotten system.Its a litmus test for your conscience.

  5. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Thursday, November 21, 2013

    I think we are in agreement. The ‘black sheep’ fortunately is a minority ~ perhaps 1 percent or even less. It is this minority who harm patients. I believe the 99 percent of doctors do a great job who should be appreciated.

  6. bloodseeker bloodseeker Thursday, November 21, 2013

    Dear justiceseeker,

    I hope you include the terms like “black sheep” when you make statements. You initial statement was too general and my response was commensurate (taking it personally). I am with you and against these “black sheep” myself – they’ve made a mockery of the profession and made our lives a living hell.

  7. justiceseeker justiceseeker Thursday, November 21, 2013

    Dear bloodseeker

    I am thankful to you for giving this link but it really surprised that you have misunderstood my comment and not taken it in right perpective.FirstlyThe link provided by you have not mentioned any case wherein SC has confirmed criminal negligence conviction and I am referring only about SC judgment on criminal negligence by doctors .Secondly no one blamed entire medical community.I am talking about those kind of Dr Deaths(As quoted in India Today Nov 13 issue) who bring disrepute to this noble profession and regulatory authorities like MCI & State medical councils are moot spectator and actively trying to shield Dr Deaths by exonerating them from charges of medical negligence at initial stage which force a victim to approach courts as evident from WBMC decision in Dr Saha case itself.

    I am also not against medical community in general and have a lot of friends who are doctors.But now time has come wherein willful negligence by doctors for extraneous considerations as echoed by other doctors on this forum should not be tolerated .Our govt should also enact laws on line of British govt legislation which proposed 5 yrs imprisonment for willful negligence .

    Now responsibility lies with MCI & state medical councils to put own house in order to secure confidence of medical negligence victims by taking appropriate punitive actions.As we seen in medical negligence episode of SATYAMEV JAYATE by Aamir khan that MCI has not permanntly cancelled medical registration of any doctor till date since independence.

    So I request you to kindly awake your conscience and stood up against prevalent medical malpractices otherwise days are not far way when honorable SC will also change its persective about medical negligence just like it changed its perspective on drunken motor accident cases and now cases are regularly tried and confirmed by honoble SC from sec 304A IPC(death by negligence) to Sec 304 IPC(death by willful negligence)

  8. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Thursday, November 21, 2013

    The profession of medicine is a noble one. Therefore, I appeal to all doctors to condemn the black sheep in their fraternity in terms of Section 1.7 of Code of Ethics Regulations, 2002: “Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession”. Sadly, we do not find this anything. When self regulation is ineffective external regulation is necessary. If doctors harm a patient, apart from civil liability doctors should be charged with criminal liability also. An error of judgment does NOT amount to negligence. Law should protect the interests of all citizens of the country, and not of any one profession. I believe right minded doctors will agree with me.

  9. blood seeker blood seeker Wednesday, November 20, 2013

    Dear justiceseeker,

    Do a few Google searches and you’ll find many that have been jailed – all kinds including the MBBSes you so vehemently hate (who would probably save your life one day).

    I hope you know how to use this : http://www.google.co.in/search?q=India+doctor+jail+negligence

    That puts an end to your malicious propaganda for now, I hope.

    P.s.: Please remain within civilised limits. Don’t denegrate religious symbols for the sake of specious and motivated arguments (holy cow is holy). Your comment highly is repugnant.

  10. justiceseeker justiceseeker Wednesday, November 20, 2013

    Dear ‘blood seeker’,
    I will be happy to know some criminal conviction cases confirmed by honorable SC since independence except a poor homeopath doctor and a Hakim.It appears from your comments that a person who holds MBBS degree has a valid license to kill his patients or indian doctors are infallible and holy cow.

  11. blood seeker blood seeker Monday, November 18, 2013

    dear “justice seeker”,
    you seem to be woefully misinformed. criminal conviction have taken place – please talk to your ambulance-chasing attorney. going on the kind of which hunt you propose, would be the deathknell of the profession. such bloodseeking vengeful attitude is what the supreme court has consistently thrown out. I am sure your nefarious ideas would not materialize.

  12. justice seeker justice seeker Saturday, November 16, 2013

    After reading a lot about doctors comments on supreme court judgement , it appears that they are not ready to digest this judgement easily though it is really a pity sum considering human life value and time span .Even SC has not paid any significant amout towards lifelong pain,suffering,mental agony and loss of consortium to Dr Saha.Medical community should thank SC which shielded them from any kind of imprisonment due to criminal negligence till date.So far SC is more focussed on civil negligence but now time has come when honorable SC should also focus on criminal negligence aspect of medical community.It is really an irony that since independence, no allopathic doctor was sentenced for criminal negligence by honorable SC , whereas in developed countries like UK & USA , a number of doctors sentenced to prison.How it is possible that no patient has died due to criminal negligence of doctors for last 66 years.It may be due to our religious sentiment which link every good and bad things in life to wish of god.But GOD never does harm to any human being.It is some semi god i.e. some notorious doctors who harm to their patients in lust of money and brings disrepute to entire medical community .Now It is challenge to medical regulatory authorities in INDIA to take exemplary punishment to such kind of notorious doctors who are facing criminal charges by deleting their name permanently from IMR .After media report about a recent allegation of sexual exploitation by a retired SC judge which shaken confidence of common man in highest judiciary .Otherwise days are not far away when such kind of doctors should face imprisonment for medical murder in wake of public awareness

  13. Rajagopal Rajagopal Wednesday, November 13, 2013

    There is a diference between medical errors and negligence. If all errors are penalized then these would be hidden and would cause harm to patients in the long term. Negligence should be penalized and not errors.

  14. Dr Amitabh Dr Amitabh Tuesday, November 12, 2013

    well said but probably this will act as a deterrent to both young generation pursuing medical profession and also already malpractising doctors. Though I agree about the quantum of punishment was given on basis of earning capacity in US and not in India. Also there were multiple doctors involved other than hospital. Difficult to justify what is wrong or right but yes among us we need introspection as to where we are leading our noble profession with all these corporates and money minting machines.

  15. n.s.dhaniwala n.s.dhaniwala Thursday, November 7, 2013

    Very apt article with practical analysis.Let the judiciary be aware of the long lasting effects its judgement is likely to have.

  16. Dr. Amlendu Nagar Dr. Amlendu Nagar Tuesday, November 5, 2013

    The article is very well written by Dr. Kone.
    Who will save people of this country if they are enslaved by greedy lawyers, insurance diktats, and litigant patients. Large sum of ruppes can be awarded as compensation to a patient for getting so called wrong treatment in the hands of qualified physicans at well equipped hospitals.
    How much an unfortunate healthy person should get in case he was killed in accident and how much compensation courts are awarding to patients in case they die of faulty treatment in the hands of quack.
    Recent supreme court judgement is an eye opener, should doctors charge their fees according to the age and the potential earning capacity and also add a contingency fees for litigation.
    Unfourtunately in this country majority of the doctors do not make 1 crore saving in their entire life time.

  17. ApperhensiveDoc ApperhensiveDoc Tuesday, November 5, 2013

    One should also realise that doctors do not even make up 1% of the population but treat “the top ten killers in the world” and then some. All “patients” who die, die in the care of a doctor. Not all errors are negligence and people need to understand that in high-risk situations (like medical practice) errors are inevitable. Lack of knowledge of understanding is no excuse. To convert preventable deaths into a money-making industry would do more harm than good.

    Unless people accept the reality of life and death and the inherent risks of medical treatment, they should not opt for it – should they? The best way to prevent medical malpractice is to not take medical services. By your own statistics, it would seem like medical errors are exceedingly common. I am being rhetorical, of course. Maybe you’ve hit upon the answer to your own question. Doctors are not infallible. Maybe this is the average rate of human error in this field at this point in time. It can be improved, sure – but to what extent? At that rate, you would end up destroying medicine itself, wouldn’t you? You can’t expect healthcare of 2113 in 2013.

    Doctors who follow the code of professional ethics will be respected till an inadvertent error happens. Even the USA dropped live atomic bombs on their own soil. (Don’t take my word for it). Then these people will have no right to expect that the society will be tolerant towards them, in your opinion. Sorry to say that you’re being extremely unrealistic. Humanity is not yet perfect and neither is medicine. You can either let people correct themselves, or you can “shoot.” I know your choice.

  18. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Monday, November 4, 2013

    One should realize that death due to medical negligence is one of the top ten killers in the world. Doctors who follow the code of professional ethics will be respected. If they do not do so, they have no right to expect that the society will be tolerant towards them.

  19. Dr.Praveen Kumar Dr.Praveen Kumar Monday, November 4, 2013

    Calling a doctor “God” may be compared to calling females “Devi” in our country.

    As far as crime against women is concerned we stand fourth in world.

    Their is no data available regardind crime against doctors ( Unnecessary harassment be goverment officials,NGOs,Lawers ,Quacks etc , Undue criminal cases and cases in consumar courts,Murder Kidnapping and physical abuse ) in this country – however it will be very close to fourth rank.

    We dont want to be called God by this hippocratic society.We will better like to be called ” Insaan” only rather than “Bhagwan”.

  20. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Monday, November 4, 2013

    Dr Nawalakha – do you have any evidence to suggest that Dr Saha ‘fixed’ the judgment and the award? If yes, why should he have fixed the award as a mere Rs 6 crores? Dont you think he would have tried to ‘fix’ the award for a much higher amount ~ Rs 60 crores? Or, are you thinking aloud and casting aspersions without any basis whatsoever on a man who suffered for 15 years with tenacity? A person who has not lost a near and dear one cannot understand the meaning of sentiments and emotions. I would not like anyone to be a victim of medical negligence where a precious life is lost.

  21. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Monday, November 4, 2013

    Though not a doctor, I crave the indulgence of readers most of whom I presume are doctors and invite their attention to Section 1.7 of Code of Medical Ethics Regulations 2002 which reads as follows:
    “Section 1.7: Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession”.

    If grievances of victims of medical negligence are addressed by medical councils and if the esteemed members of the noble profession join hands in condemning the black sheep in the fraternity, there will be a healthier patient-doctor relationship. Dr Saha’s struggle for justice would not have been a prolonged one if the West Medical Counciil would have acted against the doctors concerned for professional misconduct.

    One has to also take into account the countless trips that Dr Saha must have made from the US to India for justice and the number of times that he must have caught the return flight to US disappointed and dejected.

  22. DR.P.L.NAWALKHA DR.P.L.NAWALKHA Monday, November 4, 2013

    The judgement provided substantiation about increasing downhill worthiness of JUDICIARY ,as on today.The verdict is reflecting prejudicial mindset,absolute void of realistic perception and possibility of perhaps,(may be wrong but nothing is impossible in this kalyug,) ‘judgement fixing -insider trading,playing a role. This possibility arose because of fantastic and outragious increment in fine (x 1100 times)

  23. Dr Suresh Rao Dr Suresh Rao Monday, November 4, 2013

    A very good article highlighting the relevant points.

    However, good communication, empathy, professionalism, documentation, and spending time with the patient and their attenders in addressing their queries, discussing the problems with them, keeping them in the loop even if there are complications, and humility, are the only sure shot remedies to avoid litigation most of the time.

    It is important to assume that no patient consults a medical professional to sue him / her. Many a time we bring it on ourselves with our conduct . At least in our country……., still there continues to be great reverence / regard for a committed doctor who rises to the occassion above the call of duty. We should work to preserve this by conducting ourselves well.

    No amount of defensive practice however thorough it may appear could immunize us from litigation as Medical Science and outcomes are inexacting and unpredictable at times. This will only serve to push up the cost of medical care in an already unaffording poulation as has happened in America with total loss of the special doctor – patient relationship.

    God save this country if we are enslaved by greedy lawyers, insurance diktats, and litigant patients. We are heading towards it. Before it becomes a curse, let the medical fraternity introspect and maybe have a “Soft Skills” module in the MBBS curriculum to highlight society’s expectations from a medical professional and how a medical professional should conduct themselves in their practice and in trying situations.

    Kudos to Dr. Kone on his article.

  24. Dr.K.Srikar Reddy Dr.K.Srikar Reddy Sunday, November 3, 2013

    It is a well written article except for the part regarding compensation paid to Dr.Saha. The compensation paid to Dhanaka was 1 crore and Dr.Saha is 6.08 crore. Dhanaka was working in India as software engineer at the time of the incident while Anuradha was working as child psychologist in US. The compensation given to Kunal is quite less when compared to US standards. Moreover, doctors can not generalize that this type of compensation will be given to each victim of medical negligence . If you read the judgment the Supreme Court multiplied the earnings of Anuradha by 55 times (1dollor =55₹) while arriving at the compensation figure. Therefore, Indian nationals working in India will never get such compensation. The worries of doctors are unfounded. At the most, compensation for high skilled people who are victims of medical negligence can expect what Dhanaka has revived as compensation. Normally, the courts until now we’re giving very paltry sum (2-20lakhs) even after 15years of litigation . Most people will agree that if the legal expenses from the stage of district, state, national consumer forum and finally Supreme Court are considered! the victims end up spending more than they actually receive as compensation. The medical community should focus of issues raised in the above articles like CME, medical malpractice etc. most of us are aware that for a medical seat in a private college people are spending one crore and for post graduation up-to two Crores. If we add simple interest by the time he becomes a MD/MS he would have spent 6 Crores on his education. He will be forced to do medical malpractice like seeing more patients in an hour than a normal doctor would see and might result in negligence. If one sees the websites of GMC of United Kingdom and Medical Boards in USA many doctors loose their license for 6 months to 5 years every week. However, only 1-2 doctors per year for whole India put together that to for 3-6 months. Unless the regulatory framework in India is improved, things won’t change with one judgment by Supreme Court. the risk to reward ratio is highly in favor of doctors and they will continue to indulge in medical malpractice which will result in medical negligence.

  25. b.ravikumar b.ravikumar Sunday, November 3, 2013

    The author’s first observation is that the first doctor who saw Mrs.Saha is having a high reputation. To my MIND this is due to rampant use of steroids which gives instant relief in almost all common problems. I do know one Licentiate in Medicine and Surgery who was popular because of his constant use of another steroid called betnesol. I do admit that there are different strengths of the drug but I cannot understand why he prescribed twice daily for three days. Even the duty doctor who was supposed to look after her in the hospital blamed this doctor of ? repute in the court. Another point is he denied that he prescribed depomedrol initially and admitted only later while being confronted with the evidence.
    The next point is about the compromise in the family life which is there in all executive jobs particularly in business. These type of people will be proximate to the family only physically and not mentally. Regarding the risk involved for executives it is definitely higher than 90 percent of the doctors who treat only common ailments which can be treated by trained paramedics. But this is a very touchy issue and the I.M.A. will not budge because of monetary implications.
    This reputed doctor’s knowledge about medication is from the representative who in all probability will be a graduate. There is also a very good chance that this reputed doctor was under pressure to reach the monthly target(hence overdose) of prescriptions since he was going abroad. No one bothered to find out who paid the bill for his foreign jaunt.
    About the suggestion of refereeing the patient to all specialists for a simple headache for example E.N.T.,ophthalmology,neurology and a psychiatrist will only make a patient with migraine worse.
    Off course I do admit that there are a few genuine people in the profession. But the vast majority actions borders on THUGGERY.
    Coming to the negligence aspect I like to bring to your notice about the death of a 24 year old lady on 14/12/2004. Kollam Consumer no 36/2006 awarded 15 lakhs and I.P.C. 304 A is pending for trial at karunagapally no 1675/2011.The most important aspect of the case is the reference letter which is silent about the two culpable drugs recorded in the case sheet and nurses orders. for details contact 9349312325 or ravikumar.bhaskaran1930@gmail.com

  26. dr mvk rao dr mvk rao Sunday, November 3, 2013

    all you have written is ABSOLUTELY CORRECT. But whether any lawer, judge, supreme court judges who have given judgements are reading this?? Are you sending a copy to them? I do not see any result coming out of it.

  27. G.Saikumar G.Saikumar Sunday, November 3, 2013

    If crores of rupees can be awarded as compensation to a patient for getting wrong treatment,how many crores an unfortunate healthy person should get in case he was killed in accident by negligent driver of bus or train.How much compensation should be awarded to the patient in case he dies of treatment by a quack.What courts should know that thousands of people in villages are dying of treatment by quacks.The only difference seems to be that they they can not afford to hire a lawyer even at district level.This judgement of awarding crores of rupees has opened new opportunity to demand higher compensation from government for deaths due to floods or quacks.

  28. Maj Pankaj Rai (Retd) Maj Pankaj Rai (Retd) Sunday, November 3, 2013

    A very well written article. However, respectfully I differ. In the existing framework, it is virtually difficult to press criminal charges against doctors. In contrast, within a limited time the late Michael Jackson’s doctor was convicted. Compensation is one of the ways for a victim’s family in getting justice. Many doctors feel that the compensation awarded in Dr Saha’s case was high. However, I have a different view. When a retired Supreme Court judge could be awarded damages of Rs 100 crores for what appears to be an inadvertent mistake on the part of the TV channel, the compensation awarded to Dr Saha appears to be peanuts. As a victim of medical negligence where I have filed perjury charges against the doctors, I maintain that Indian doctors are one of the finest in the world and who are concerned about patient safety. However, the grievances of victims of medical negligence is against the ineffective regulatory system which does little to address the plight of victims. I believe a lot will change if the state medical councils in India have the credibility of the GMC of UK. Patients consider doctors next to God and very rightly. That should not change. However, I appeal to the noble profession to respect patient rights and expose the black sheep in the fraternity also. Fortunately, for India the black sheep are a handful only. Jai Hind!

  29. Dr Hitesh Bhatt Dr Hitesh Bhatt Thursday, October 31, 2013

    Agree with the article but few points to ponder
    (1) Can we change or amend CPA to insert CAP on compensation?… In that case court may limit our fees too for a particular treatment
    (2) When CPA entered into medical practice in case of V P Shanth V/S IMA we were not awake, This happens with us always, May it be PNDT or CEA …We Cry over PNDT, but what were we doing when it was enacted? Now also Clinical Establishment Act has been passed …How many doctors know about it?
    Sir , If we are ignorant, if we are careless, if we are educated but illiterate we deserve this kind of judgements….. Still if most of us do not get awake then we; the awakened; must think of doing something else than continuing with medical profession!!!!

  30. ketan ketan Thursday, October 31, 2013

    Still in our country we are governed by rules set before independence.

    It is a foolish rule that compensations of medical issues are governed by motor vehicles accident rules.
    Skills of doctors is compared to skills of any ignorant illiterate driver!!
    IMA and others should take up this and make a change in this on URGENT basis.

    So also doctors should charge as commented by Jayachandra, than only will it make the medical economy balanced in such scenarios. And what should be for saving life in life threatening condition….?. That should not be taken as corruption.

    In our country people take health as taken for granted and suffering as negligent act by doctor!!
    People do not keep a budget for health issues and feel outraged by medical expenses, especially by charges taken by doctor.
    To many patients and relatives when a patient gets hospitalized doctor is looked as “bhagwan”, as patient gets better doctor is looked as “insaan” and while paying bills doctors is looked as “shaitan”!!!

    “Sab ko sanmati de bhagwan”…..

  31. Tony Soprano Tony Soprano Thursday, October 31, 2013

    “We reflect the current society because we are drawn from it”. Amen to that.
    When the whole doggone society is corrupt, why the burden of morality only on doctors then!!..

  32. jayachandra jayachandra Thursday, October 31, 2013

    May be the doctors should charge their fees according to the age and the potential earning capacity and also add a contingency fees for litigation which should be about 500-1000% of the fees. The younger the patient the higher should be the fees. Neonates would be paying the highest fees.
    This should just barely cover the doctors from litigation and costs imposed.
    seriously 90% of the doctors hardy make 1 crore in their entire life time.

  33. Dr Rakeshkumar P Singh Dr Rakeshkumar P Singh Wednesday, October 30, 2013

    Yes. This is going to give birth to new breed of lawyers called ambulance-chasers.

  34. Dr Rakeshkumar P Singh Dr Rakeshkumar P Singh Wednesday, October 30, 2013

    Brave article . True unfortunately .

  35. SocialistCountry SocialistCountry Wednesday, October 30, 2013

    This judgement has give a whole new meaning to the term, “kaun banega karoepati.”

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