Aamir Khan's show - Does Healthcare Need Healing? - (Medical malpractice) - Must Watch

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Re: Does Healthcare Need Healing? - (Medical malpractice) - Must Watch

Medical malpractice in Pakistan

By:Muhammad Shafiq Dogar Wednesday, 9 May 2012 9:17 pm

Medical malpractice occurs when a physician turns away from the accepted standard of care for the medical community and caused physical injury or caused or increased a mental illness to the sufferer. Clinical negligence, also known as medical negligence may take place from delay or failure to identify a disease, delay or failure to give the correct treatment to a certain condition, a treatment that goes completely wrong, provided wrong treatment, or failure to obtain consent.

A patient must establish all four factors of the tort of negligence for a successful medical malpractice claim, that is, firstly a duty was owed, a legal duty exists whenever a hospital or health care provider undertakes care or treatment of a patient; secondly a duty was breached, the provider failed to conform to the relevant standard care; thirdly the breach caused an injury, the breach of duty was a proximate cause of the injury; and fourthly, the doctor caused the damage due to failure to live up the required standard.

Medical wrongs are done to citizens by the health care professionals (these include physicians, surgeons, dentists, therapists, and nurses etc).

Medical errors or to be more appropriate medical malpractices also happen in Pakistan, most common of which are the clinical negligence like, birth injuries to babies, birth injuries to mothers, improper use of forceps, caesarian, complications, incorrect medication, incorrect/failure to diagnose, negligent surgical treatment, anesthetic overdose, poor hygiene, misuse of instruments, etc. These claims may be against doctors or hospitals.

Giving the wrong drug or (wrong patient, wrong chemical, wrong dose, wrong time, wrong route), giving two or more drugs that interact unfavorably or cause poisonous metabolic by products, transplanting organs of the wrong blood type, incorrect record-keeping, duty of care of receptionist at general practice, failure to advise of risk of HIV (duty to patient's sexual partner), failure to warn of material risks of various medical procedures, etc are all examples of medical malpractices.

Apparently, it is the responsibility of the Pakistan Medical and Dental Council (PMDC) to initiate disciplinary action against doctors as and when a complaint is received for professional negligence or misconduct.

The radical reforms in the health care systems in the United Kingdom after the highly publicized scandal of case of “Harlod Shipman” are an example to learn lessons in the last few years. This case refers to a single doctor’s malpractice and killing of few patients which has resulted in various reforms in the healthcare proviso of the country. Under the reforms, which builds on “good doctors, safer patients”, doctors will have their skills and competence checked every five years. Doctors who fail the revalidation process will be accepted to take further training.

In Pakistan, the PDMC needs to update its policies in the light of recent significant changes all around the world. The concepts like “good medical practice” and “good doctor, safer practice” of General Medical Council of UK should be considered to be adopted and modified according to local needs. The definition of a specialist needs redefining and the recognised experience of the health care professionals should be incorporated in this equation. Competence, education, and training of doctors are necessary elements to polish the doctors in true meanings.

Medical errors happen worldwide. In Pakistan, at present, a doctor with a postgraduate qualification is considered as a specialist by the PDMC. But in the past decade, it has become very clear that a postgraduate qualification on its own right does not make a doctor a specialist. Proper recognised training is essential to call a doctor a specialist in developed countries like USA, UK and Ireland. Achieving a complete training and a certificate of completion of training (CCT) or certificate of complication specialist training (CCST) is not considered sufficient now.

However, PMDC has got no means or policy to revalidate a doctor’s fitness to work in Pakistan.

When due to the fatal negligence committed by the doctor the deceased had lost life due to wrongful acts, gross negligence and carelessness committed by defendants/ doctors in their professional duties. Defendants were liable to pay damages in sum of Rs 10 million each and pay Rs one lac each to legal heirs of deceased and lady doctor also liable to pay Rs 3,65,000 as medical expenses to deceased husband. (PLD 2011 Kar 117) master Abdul Basit and another vs Dr Sadeeda Anwar and another (P 124, 128 to 132) B to K, M, O, R, S & U.

The information regarding doctors should be made public to earn their confidence. If required, the matter should be taken to the national parliament for an open discussion and wider public involvement, to which the council is accountable.

Pakistan needs a system which should be compatible with the modern delivery of a safe health care where patients and public can have confidence on the professionals and also on their regulations. A safe and high-quality medical care is a basic human right. The health professionals should be accountable for its delivery within the available resources.

Courts always insisted in the case of alleged criminal offence against doctor causing death of his patient during treatment that the act complained against him must show negligence or rashness of such a higher degree as to indicate a mental state which can be described as totally apathetic towards the patient. Such gross negligence alone is punishable. (PLD 2010 Kar 134) (P 142).

There is no liability in negligence unless there is a duty to take care. This establishes the necessary link between the claimant and the defendant. Such duties are widely recognised. In cases of doubt the modern test is whether there was forcibility and proximity and it was fair just and reasonable to impose the duty.
 
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Night_Hawk

Siasat.pk - Blogger
Re: Does Healthcare Need Healing? - (Medical malpractice) - Must Watch

Medical negligence: A growing problem in Pakistan

Muhammad Hanif Shiwani ( Barnsley General Hospital, University of Sheffield, UK. )
Amin A. Muhammad Gadit ( Memorial University of Newfoundland, Canada. )

By definition,[SUP]1[/SUP] Medical malpractice or medical/professional negligence is an act or omission by a health care provider in which care provided deviated from accepted standards of practice in the medical community and causes injury or death to the patient. Clinical negligence is an expression which can be applied to the illegal behaviour of a medical doctor or consultant.[SUP]2[/SUP] Pakistan has witnessed a number of cases related to medical negligence. Using faulty operation techniques, leaving gauze pieces and instruments in abdomen, administration of wrong injections, use of expired drugs, making wrong diagnosis and giving wrong treatment can lead to complications and even death. Media reported a number of cases recently in which an inexperienced doctor administered anaesthesia to a young man leading to partial brain damage,[SUP]3[/SUP] administration of a lethal injection to a Pakistani-American engineer raised a serious criticism on the level of training of Pakistani doctors,[SUP]4[/SUP] it was stated that growing number of cases where people are dying at the hands of ill-trained medical professionals who lack knowledge, competence, professional integrity and commitment. Under these circumstances, WHO\'s standard guideline can easily be adopted but implementation has been a formidable task in Pakistan. Independent inquiries in cases of medical negligence revealed that the concerned doctor was found unqualified for the work he was assigned, many doctors working in public sector hospitals have been running a private practice, showing indifference to their patients\' suffering, which has remained an important cause of medical negligence. It was further transpired from reports that the quality of medical education, lack of professional ethics, concurrent private practice, faulty health policy and non-application of professional laws has much to do with this scenario.[SUP]5[/SUP] Pakistan Medical and Dental Council (PMDC) should have effective authority to curb medical negligence. In a press statement, the then secretary of the council mentioned that PMDC had revised its code of ethics to include modern and religious concepts but was not responsible for all health practitioners such as homeopaths, opticians, lady health workers and quack-doctors.[SUP]6[/SUP]
Medical errors are a problem in health care systems all over the world irrespective whether is a developed country like USA and UK or a developing nation like Pakistan. Researchers believe that between 45,000 and 98,000 fatalities occur every year due to medical workers\' mistakes in US. There are many more that survive but develop severe painful and debilitating conditions.[SUP]7[/SUP]
In UK the NHS (National Health Service) Litigation Authority is responsible for handling claims made against NHS bodies in England. It plays an important role in developing risk management programme and monitoring of human rights law.
In 2004-5 the Authority dealt with 5,609 claims of clinical negligence and 3,766 of non-clinical negligence. About 38% of claims are abandoned by the claimant, and about 43% are settled out of court. In 2004-5 502.9 million was paid out in respect of clinical negligence claims, and 25.1 million in respect of non-clinical negligence.[SUP]8[/SUP]
In a study, 30,121 randomly selected records from 51 randomly selected acute care, non-psychiatric hospitals in New York State were reviewed. It was found that adverse events occurred in 3.7% of the hospitalizations, and 27.6% of the adverse events were due to negligence. It was concluded in the said study that there was a substantial amount of injury to patients from medical management and many injuries were the result of substandard care.[SUP]7[/SUP]
There is no way one can develop a health care system where there are no errors and negligence. Human beings are not perfect and bound to cause some error. However, there is a need to develop a system where the negligence, issues of probability and error can be recognized and the accused whether an individual, a group of people, an organization, a department or the responsible persons who are the policy makers should be identified, accounted for, condemned and penalized. At the same time the victims and their relatives should be provided with the justice and compensation according to the rule of law.
Medical litigation is an expensive, time consuming; complex process requires highly professional skills. The lawyers and doctors do develop such specialized skills after achieving expertise in their profession as generalist. Clinical negligence can overlap with other area like personal injuries, fatalities related to accidents and disabilities caused at work. Therefore a distinction must be made and professional advises are usually require before analysing a case.
In Pakistan charitable organizations have developed services at a large scale e.g. blood banks and ambulance services and have provided tremendous support to government sectors in the delivery of health care. The voluntary contributions of social workers have also developed citizen liaison services in controlling crimes. There is need for an initiative to be taken by doctors, lawyers and social workers to develop a group of people and an organization who can provide a professional service for the victims of medical errors and negligence.
Once the patients and their loved ones will start going through a litigation process, doctors and medical experts would consider protecting themselves by acquiring support from lawyers for their professional defence. Hence, in majority of the civilized countries doctors cannot practice unless they are a member of a medical defence union or a protecting society. In civilized world victims of medical negligence go through the court of law rather than taking law in their hands and similarly medical professionals do the same in their defence. We can only hope and wish to have similar practice in our country.
We also need to look into our health system in Pakistan. There is a need for close monitoring of medical training, regularization of duty hours and work commitment by medical professionals, legal protection to patients and doctors, absolute authority to PMDC, adequate pay scales for doctors, assessment of professional competence at regular intervals and above all open register of medical practitioners registered with PMDC with all details about individual practitioner that can be accessed by general public through the net. This is perhaps the best way to verify the credentials of the practitioner and any associated information about any medical litigation. This can control quackery and will curb medical negligence to a greater extent. What do you think?


http://jpma.org.pk/full_article_text.php?article_id=2837
 
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Night_Hawk

Siasat.pk - Blogger
Karachi
The doctor of death arrested
our correspondent
Wednesday, May 25, 2011
From Print Edition
5-25-2011_48905_l_akb.jpg

Karachi

Medicine is a noble profession and doctors who complete their education take a solemn oath to protect lives and provide people with the appropriate treatment. But instead, Dr Masood-ur-Rehman allegedly chose to dupe innocent people into paying him millions in exchange for fake cancer treatment, which resulted in the untimely death of three patients.

The Landhi police took the so-called specialist into custody on the suspicion of providing false prescriptions to his patients. The doctor was accused of causing the death of three patients due to his malpractice.

Ahmed Yar, who was a resident of Landhi, said that he had approached Dr Rehman, also known as Dr General, to treat a relative who had been suffering from cancer. Initially, Dr Rehman demanded Rs1.2 million to perform an operation. Ultimately, Rs600,000 was paid to him, following which he provided his patient with two bottles of what he claimed was medicine.

The doctor instructed Ahmed Yar to give the patient a regular dosage of the medicine and assured that the cancer would recede in a matter of time. However, the patients condition deteriorated after he started taking the medication and a short while later fell unconscious and ultimately died.

Following his relatives death, Ahmed Yar tried to contact Dr General, but the latter was untraceable. He later claimed he was in Lahore.

But Ahmed Yars relative was not the only one to fall victim to Dr Rehmans malpractice. Jauhar Majeeds brother had been suffering from cancer and no cure was in sight until he heard of Dr Rehman.

Once he established contact with his patient, Dr Rehman called the men to a place in the Landhi area and agreed to provide treatment in exchange for Rs300,000. The doctor then prescribed medicines to Majeeds brother.

As instructed, Majeed would give his brother the prescribed dose, but instead of curing the ailment, the medicine made the patient vomit. Worried, Majeed called Dr Rehman, who informed him that the side-effects would go away in a day or so. However, Majeeds brother did not live beyond the next day.

Dr Generals third victim was Mohammad Hussains brother who was also suffering from cancer. Hussain was called to Karachi where he would be given the necessary medicine to treat his brother. He was asked to buy books worth Rs60,000 and Dr Rehman settled at Rs100,000 in exchange for the treatment.

The same medicine bottles were given to Mohammad Hussain, which he took to Lahore and started giving his ailing brother the prescribed dose. Sadly, the patient only lasted

for three days under this medication.

SHO Mazhar Awan said that separate cases had been reported against Dr Rehman for malpractice and the police had started calling him to trace his whereabouts. Cunningly, the SHO called the doctor and pretended to be a cancer patient. When Dr Rehman told SHO Awan to reach a spot near the Landhi Fire Station, the police conducted a raid and apprehended the suspect.

During interrogations, it was discovered the Dr Rehman had some fake degrees in his possession and played with the lives of innocent people.

Moreover, the doctor would frequently change his voice in an effort to fool his patients. In reality, he had no nurse or receptionist.


http://www.thenews.com.pk/TodaysPrintDetail.aspx?ID=48905&Cat=4&dt=5/25/2011
 

Night_Hawk

Siasat.pk - Blogger
Saviours or slayers?
Faiza Mirza | 16th April, 2012





Karachi Press Club, which is a couple of yards away from my office, remains a platform for countless people who desperately want their issues to get addressed by the crme de la crme of Pakistan. Last week, en route to work, I saw a man outside Karachi Press Club brandishing x-rays toward a herd of people. Unable to conceal my curiosity, I stepped out only to discover that the poor man was just another unfortunate victim of medical negligence. The x-rays, he carried, showed a grotesque image of a pair of scissors inside his abdomen, which were left in his body by a doctor during a surgical procedure seven months ago.

Shaken to the core after witnessing the worst form of violation of the Hippocratic Oath, I kept wondering why the government and other policymakers of Pakistan heed no attention to the rise in the cases of medical negligence in the country. The well-known case of Imanae Malik, a three-year-old girl, who died in 2009 after her doctor administered a lethal dose of anaesthesia, also made no headway and disappeared after a while.
Dr Rahim*, a doctor who has been in the medical profession for the past 25 years and previously, owned a private hospital narrated his experience by saying, “it is all about money these days. Doctors tend to entertain more and more patients every day because that way they can earn more. They run their private clinics and misguide patients.”
“I remember a case of a 19 year-old-boy who was diagnosed with appendicitis and was operated. The doctor even showed him a specimen of his appendix for authenticity after the surgery; however, recurring pain in the boy’s abdomen led his family to consult another doctor, whose diagnosis confirmed colorectal cancer. Moreover, lab reports also revealed that the boy’s appendix was intact, which proves that the doctor only operated on the boy because he wanted more fees,” he added.
The fact that medicine remains one of the most underpaid professions in Pakistan, so much so that a Resident Medical Officer (RMO) gets Rs 8,000 to Rs 10,000 per month for services, can be possibly attributed to this materialistic mindset of doctors. They, who are considered the epitome of humanity and are known to carry the responsibility for alleviating people’s miseries, should not let money drive them.
We all hear about tampered medical and pathological reports, primarily because perhaps it is more ‘lucrative’ to remove a spleen or appendix than to prescribe medicines.
Medical negligence and incorrect diagnosis, which ideally should be considered equivalent to attempted murder, have become a norm in Pakistan because there is no accountability. We hear about cases of medical negligence and the plight of the victims but what we do not hear is the news regarding the fate of the culprit who has either been involved in malpractice or is found guilty of medical negligence. Termination from employment by the government and medical associations is the highest form of punishment for these culprits, without any mention of suspending their license to practice.
Medical negligence, however, is not always deliberate. In government hospitals evidently the constant flow of patients is one of the most important factors behind medical negligence.
Whilst talking to another doctor who works at the Abbasi Shaheed Hospital in Karachi, I came to know that flocks of patients wait outside the outpatient department (OPD) and surgical wards, which is why doctors are always in a rush to attend and discharge as many patients as possible.
“Leaving cotton packs inside human bodies after surgical procedures is not uncommon in government hospitals and generally these mistakes occur because doctors cater to a huge queue lined up for treatment,” said the doctor on condition of anonymity.
“The government should either deploy more qualified doctors or should construct more state-owned hospitals to resolve this issue,” she added.
Regulations and governance framework, setting a ceiling of maximum patients that a doctor can see in a day, among other measures can resolve issues of unintentional medical negligence.
The most underreported and unknown cases of medical negligence take place in pediatric and neonatal wards.
A speech therapist, who works for children with disabilities, said on condition of anonymity that, “it would not be unwise to say that an extremely high percentage of disabilities that Pakistani children face is either because of an inaccurate diagnosis or medical negligence.”
“Many a times, a child is diagnosed with common jaundice, whereas it is later revealed that the child had Kernicterus or Bronze Baby syndrome. I have personally counselled and treated many children who are completely deaf because they were diagnosed with common jaundice when they actually had Kernicterus,” she added.
Kernicterus is a form of excessive jaundice which can cause irreversible brain damage if the patient is not given photo-therapy or the blood is not exchanged, within the early hours of the birth. All it takes is one wrong diagnosis and screening test to deprive a child of a vigorous and healthy life.
Whether we attribute the failings of our doctors and medical system to a lack of conscience, drive to make more money or inappropriate training, it is essential to understand that policies and punishment for non-compliant doctors are the only way to address the issues pertaining to medical negligence.
It is difficult to say when and how the negligent doctors will be reprimanded, however, unless the culprits are identified and extreme judicial precedents are set, we will continue to read traumatising stories about ‘medical killings’.
*Identity concealed due to security reason.



http://dawn.com/2012/04/16/saviours-or-slayers/
 

shannonwells830

New Member
Re: Does Healthcare Need Healing? - (Medical malpractice) - Must Watch

The meaning of medical negligence is the failing to provide care which varies from the conventional approved level; leading to damage, injury or loss of life. The doctor/patient connection in healthcare carelessness situations could consist of the NHS, GPs, dental practitioners, personal treatment centers and also wellness authorities/trusts.
 

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