The increasing tendency of negotiations, re-negotiations and settlement for a corpse somewhere inside a hospital’s dark room does not sound commonsensical. It has affected the overall health sector.
Bhisha Kafle/ Janak Timsina: Centre for Investigative Journalism-Nepal
The government on 2nd Asoj 2074 directed the Ministry of Health to prepare an act that ‘requires attending doctors to compensate’ in case of patient’s death’ out of doctor’s negligence. Irated with the decision, doctors immediately disapproved the instruction and closed all hospital services except for the emergency for nine days. Consequences: Thousands of patients were left high and dry.
The gathering of people after the death of nine years old girl at the premise of Kathmandu Medical College, Sinamangal.
This move brought to surface two motives. First, the government’s intention to prepare the Act haphazardly. Second, doctor’s demand of a provision of “jail without bail’ (to ensure that doctors can deliver services without fear). The doctors agreed to resume their services following government’s agreement to fulfil their demands, including the ‘jail without bail’, a provision that provides an instant arrest of miscreants manhandling the doctors or those involved in vandalizing hospital property.
This episode helped to bring into open some devious issues, which has been practiced subversively in the hospitals.
What could that be?
A patient died in a hospital in the course of treatment. Cause of his death? Natural (usual), doctor’s negligence, or delayed treatment? Family members accept natural deaths and carry out final rituals. However, if anyone assumes the death is caused due to doctor’s negligence, there is always room for a legal battle.
However, 23 out of 35 such cases that came to limelight in the last four years, instead of opting for legal battle were ‘negotiated’ and ‘settled’ clandestinely on the basis of “give and take” across the country, including Kathmandu. While the victims’ party prefers to remain silent with the ‘compensated money’, the other party or the hospital prefers to compensate fearing consequences and repercussions of legal procedures. Eleven such incidents have contested legally. One among such instances of “monetory negotiation” is the case related to the death of Kamal Bhattarai at Om Hospital, which, however, both the parties deny.
Om Hospital in Chabahil, Kist Medical College in Gwarko, Norvic Hospital in Thapathali, and Bharatpur Hospital in Chitwan were dragged into controversy following patient’s death due to doctor’s negligence in the last two months. While investigation process into the case of Norvic Hospital reached upto the ministry, reliable sources claimed Om Hospital’s case was settled on the basis of “give and take”. However, other two similar cases have been ‘dismissed’.
The question is: why do parties engage in haggling of corpse instead of opting legal means? Victim’s sides prefer to settle the case either out of society’s fear or discomfort, or to avoid unnecessary legal hassles, or out of the uncertainty of getting sufficient compensation from the hospital. On the other hand, the hospitals or doctors prefer to settle the case to avoid unnecessary legal hassles, defamation, fear of paying heft compensation, among others. As a result, the elusive trend of negotiation in a dark room is on a rise to get rid of hassles and lengthy legal procedures.
Only 35 death cases reportedely related to doctors’ negligence have been made public in the last four years. Experts say there are more cases that have been settled surreptitiously. It has been revealed that among 10 cases, victims have so far received compensation worth Rs one crore 32 lakhs. There have been nine instances of protests against the hospital administration. However, the amount that the victims’ side received as compensation by protesting has not been revealed. If this tendency of providing compensation is to be calculated, hospitals so far should have handed over not less than Rs 1 crore 18 lakhs 80 thousand to the victims’ side. It has been revealed that the agitating party has so far claimed a compensation and insurance worth Rs 1 crore 5 lakhs in three such cases. Only one among these chose legal means and is under investigation. It is evident that the other two parties preferred to ‘negotiate’.
Eleven such cases of hospitals in Kathmandu are under consideration in the compensation committee. Among them, nine victim’s parties have claimed a compensation worth Rs. 20 crores 50 lakhs 64 thousand 658. In the last four years, the Kathmandu district administration office has settled only one of these cases so far. The compensation committee has decided to provide Rs. 20 lakhs 36 thousand out of Rs 30 lakhs demanded by the victm’s family on the death case at the Civil Hospital, Minbhawan.
Monetary negotiation and case settlement
The tendency of agitating against the hospital for a patient’s death reasoning ‘doctor’s negligence’ has been rising in recent times. Surprisingly, probe committees formed to investigate into such deaths do not publicize the reports. Instead, both parties opt for settlement on the basis of “good deal” negotiation. Some examples:
- Nine-year-old Balika Basnet died while undergoing treatment at the Kathmandu Medical College Teaching Hospital, Sinamangal on 23rd Shrawan 2074 BS. She was brought to the hospital when she fell from her bed. Doctors said she had a fracture and discharged her by prescribing painkiller. The other day she was rushed to the same hospital due to the medicine’s ‘side effect’ and was admitted at the ICU where she breather her last in a little while. Relatives demonstrated and alleged the doctor of negligence. The case, however, was settled after the hospital agreed to pay a compensation of Rs. 5 lakhs.
- 54-year-old Nanda Kumari Lamichhane, who underwent gall-bladder surgery in Om Hospital on 20th Shrawan 2074 BS died the next day in ICU. Doctors, who shifted her to the ICU after “successful” surgery, argued that her death was due to cardic arrest, not due to doctor’s carelessness. Aggressive relatives demonstrated against the hospital. A hospital authority later disclosed that the case was settled in the evening after the hospital paid Rs. 17 lakhs as compensation.
- 38-year-old Usha Basnet of Dolakha died while undergoing treatment at the Civic Community Hospital in Gatthaghar on 6th Asar 2074 BS. Relatives protested, accused the doctor of negligence and vandalized the hospital. The stir calmed down after the hospital agreed to provide Rs. 5 lakhs as compensation. The hospital had earlier settled a similar case by providing Rs. 3 lakhs to the victim’s family.
- Roj Kumari Shrestha of Lalitpur was admitted at the Midat Hospital in Lalitpur with complaint of lower abdominal pain on 15th Jestha 2074 BS. The next day, Dr. Ranjana Shrestha and Dr. Binay Rajbhandari operated her uterus. However, her lower abdomen showed signs of swelling. An ultrasound report showed that her intestine was slightly wounded during surgery. Dr. Manish Shrestha, after re-surgery, referred to Patan Hospital ICU. However, she died on the way. Relatives and family demanded Rs. 60 lakhs as compensation and later settled on Rs. 30 lakhs.
There are quite a lot of examples of sensible people and hospitals making devious dealings. KMC Hospital, where Prof. Dr. Chanda Karki (also a member of Nepal Medical Council) is associated, too has been involved in such malicious agreements. For instance, KMC Hospital settled a case of 9-year-old Basnet by paying Rs. 5 lakhs to the victim’s family. Dr. Karki claims that the hospital was compelled to make the deal after some hooligans, rather than victim’s family, took to vandalism. “We have not made any written agreement. We paid the amount on the basis of humanitarian grounds,” Dr. Karki said.
Health experts raise concern saying that such a tendency would defame and damage the hospital’s credibility and reputation, and encourage delinquencies. Settling a health-related sensitive issue on the basis of “give and take” by diverging from legal solution will generate confusions and chaos. This will neither prove or disapprove a doctor’s negligence nor substantiate the victim family’s allegations. Sucha tendency will weaken the state’s initiatives to resolve a problem through legal means. “This will merely encourage and inspire hooliganism thereby discouraging doctors’ professional commitment,” said senior Doctor Prof. Bhagawan Koirala. “Hooliganism has been overpowering the rule of law. This has affected both the doctors and the victims’ side.”
Chairman of Nepal Doctors’ Association, Dr. Mukti Ram Shrestha opines this practice will doom the future. “We have been repeatedly insiting on resolving the issue on the basis of legal means, not negotiate. However, hospitals settle the issue hastily. This not only diminishes hospital’s reputation but also raises a question mark over doctor’s performance,” Dr. Shrestha added.
Middleman setting
Keshab Sapkota, younger brother of deceased Nanda Kumari, was seeking stern action against the doctor until 4 pm. However, with some new faces entering the scene, the agitation got violent. At 7 pm, the case was settled. Hospital sources said the negotiation was made by paying Rs 17 lakhs as compensation to the victim’s side. This described the trend where victim’s side prefers to keep quiet after getting compensation. Therefore, negotiations will not only complicate the situation but will make it difficult to comprehend whether the patient’s death was natural or due to doctor’s negligence.
According to Dr. Shrestha, there are some ‘professional’ goons in Kathmandu who reach the hospital as soon as they hear about a case and start vandalizing the hospital. These people, according to Dr. Shrestha, make an ‘all-inclusive’ deal with the hospital management. Hospitals hesitate to take legal means due to fear of being vandalized. DIG Chabilal Joshi, who has already assumed the post of Chief of the Kathmandu Metropolitan Circle said he has not received any “evidence” of involvement of professional goons in such cases. “They claim to be brothers or a close family member.”
However, an official at the Ministry of Health has a different view. Chief of the Doctor’s Division, Dr. Bholaram Shrestha says the government cannot interfere in the agreement between the victim’s side and the hospital management. He puts it this way: “Negotiation, which has been deep-rooted in the society is sure to further escalate. We, unfortunately, lack such a law to curb down such deals.”
Private nursing homes and hospital operators’ association have their own view. Senior vice chairperson of the association, Kumar Thapa says, “The practice of bargaining and vandalizing hospitals is on a rise due to lack of security in the hospitals. This can perhaps come to an end provided that the government guaranteed security.”
Lack of justice
Twenty-seven-year-old Manish Poudel of then Kapan VDC (now Budanilakantha municipality 3) registered a case at the district compensation committee on Falgun 10, 2067 BS citing “father Sushil Poudel’s death because of doctor’s negligence” at the Ganga Lal Heart Center, Bansbari. He claimed Rs 79 lakhs 60 thousand as compensation while registering the appeal against Dr. Yadav Bhatta, Dr. Jwatendra, Dr. Rabindra Timila as well as the hospital. It has been more than five years, but the case has not been decided yet.
Likewise, one among the several cases pending at the district compensation committee is the case filed seeking a compensation of Rs. 10 crores against the death of Sudip Bista. This is the largest amount claimed so far as compensation. Sudip, a resident of Tilot of Rupandehi, and temporarily staying in Greenland, was admitted to Grande Hospital on Kartik 3, 2073 BS. after complaints of severe chest pain. After examining him thoroughly, the doctor attending him referred to normal ward noting “nothing serious” and prescribed some medicines of grastritis. The next morning at 7 am, he died of cardiac arrest. Blaming the doctor of negligence, his family members filed a case against the doctor and the hospital demanding compensation. However, the hospital denied any negligence in the case.
Similarly, Gopal Raj Pokhrel of Kathmandu reached Medicare Hospital in Chabahil to treat a ‘dog bite’ on his hand. Doctors stitched his hand, which later paralyzed. Soon after, he claimed a compensation of Rs. 52 lakhs and registered a case at the committee. However, no decision has been made so far.
The case, filed by Butwal’s Yubaraj Karki against Grande Hospital claiming Rs. 47 lakhs, is still pending. Other cases, which are still pending at the committee are cases filed by Mohanlal Kadauri and Rajan Raj Pathak against Bir Hospital and TU Teaching Hospital respectively. Likewise, two separate cases filed against B&B Hospital at the Lalitpur Compensation Committee claiming Rs 5 crores and Rs 1 crore are still pending. The district compensation committee is formed under the chairmanship of chief district officer. According to Paras Pokhrel, district administration legal officer, nine such cases are gathering dust at the Kathmandu compensation committee in the last nine years.
The case registered at the Nepal Medical Council by Ahmad of Nawalparasi Jahada is still gathering dust. He registered a case on Asar 29, 2073 BS against Bharatpur Hospital for negligence while operating his father Kamaruddin Churiharal’s eyes. However, the NMC is yet to decide on the case. Ahmad is displeased with the lack of what he said, ‘effective investigation’ being carried out. Meanwhile, NMC Registrar, Dr. Dilip Sharma says, “We cannot say outright. There have been several violent activities in hospitals. There are numerous examples of settling the case on give and take basis.”
Hospitals sometimes get caught in a mess even if there is no negligence on the doctor’s part. The kidney scam at the Man Mohan Hospital is one such case. Doctors were compelled to take off Shiva Prasad Rimal’s kidney (of Nuwakot) while undergoing treatment of stone in the kidney. However, due to fear of getting involved in controversy, the hospital management ‘negotiated’ with the victim’s family. Later, the investigation report prepared by government and Medical Council showed no fault of the doctor.
In fact, the findings of all reports of cases filed at the Council come in favor of the doctors. Out of the 75 cases filed against the doctor’s conduct in the last two years, 60 cases have been sorted out. Four doctors have been suspended so far. It has been alleged that the council does not easily admit doctor’s errors. Dr. Satish Dev, however, dismisses the allegation saying, “We cannot stop everybody from exercising his/her right to speak. We have been doing our responsibilities without being unfair.”
An example of negligence
On 29th Poush, 2073 BS, intoxicated Uddhav Singh Ayer of New Baneswor fell from the staircase. His wife took him to Civil Hospital, Min Bhawan at 11:30 PM where he was admitted at the emergency ward. He was conscious till the attending doctor advised CT scan of his head. Initially, the patient and family members did not agree to the idea of undergoing a CT scan test. However, later patient’s family agreed after doctor’s advice. Even as the doctors prepared for the CT scan, the patient, who was intoxicated did not cooperate. Therefore, doctors administered anaesthesia “Midazolam” through a syringe. Udhhav lost consciousness. Soon after the doctors carried out CT scan of his head, his oxygen saturation came to a low level. Doctors immediately referred the patient to Norvic Hospital without informing or notifying the use of Midazolam in the referral sheet. The Civil Hospital did not have “neuro surgery consultation”. Udhhav’s health showed no signs of improvement until 12 mignight and went in coma. Later, on 29th Poush, Udhhav returned home from Norvic Hospital after being announced “brain death”. Family members started putting pressure on the Civil Hospital management. He was the sole earner in his family. Civil Hospital also formed an internal probe committee, which in its report said that Udhhav’s emergency treatment and the medicine was administered according to “emergency treatment protocol”. The report prepared on Falgun 2 said that they forgot to mention about the use of the Midazolam while referring the patient to Norvic Hospital hence the cause of the death was unclear.
Nagarik Community Teaching Hospital, Bhaktapur vandalized over 9-year-old girl’s suspicious death.
Dissatisfied with the Civil’s internal report, victim’s family members filed a case at the District Administration Office Compensation Committee in Kathmandu as per the Comsumers Protection Act 2054 BS seeking comprehensive investigation into the case and demanded Rs. 30 lakhs as compensation on Falgun 5. They have, in the case, informed their denial for CT scanning, administration of overdose Midazolam, referral to Norvic Hospital instead of admitting the patient in ICU, among others. A five-member compensation committee was formed under Chief District Officer, Bishnu Panthi. The committee in its report pointed out that the major reason of Udhhav going into coma was because of doctor’s negligence. The decision of the committee said, “Since the Civil Hospital doctors seem to be negligent in Udhhav’s treatment, the committee recommends compensation to his family.”
However, after the vicitm’s family failed to produce the bill of Rs. 30 lakhs, it was decided that the hospital should pay Rs. 20 lakhs 36 thousand 956 (including Rs. 15 lakhs 36 thousand 956 and additional compensation of Rs. 5 lakhs). The committee’s decision demanded Rs. 10 lakhs 36 thousand 956 from the hospital, Rs. four lakhs from hospital’s director Dirgha Raj RC, Rs. 3 lakhs from emergency ward chief, and Rs. 3 lakhs from Dr. Rajib Thapaliya as compensation. Likewise, the committee has in its conclusion said that the hospital should bear all treatment expenses of Udhhav till his life.
Dr. Gauri Shrestha, medical representative, however, deferred during the committee meeting. “The decision to have a CT scan was a right one and Midozolam was given with an intention to save the patient,” he said. Now that, the Civil Hospital has the right to whether to provide the compensation to the victim’s family or appeal the court.
