Clean slate for doctors on medical negligence?

With no data on incidence of medical errors and no authority tracking cases of medical negligence, one might be forgiven for imagining that the over-8 lakh registered doctors in India are perfect professionals who never make any mistakes. 

Recently, the parliamentary committee on health and family welfare expressed concern over the fact that there is negligible prosecution of medical negligence cases in India. But the committee's observation draws attention to an even more shocking fact — there is no centralised collection of data on negligence cases filed in India or their outcome. 

Since developed countries track such data meticulously, there are constant efforts to bring down the incidence and curb the consequences of medical errors. 

In response to repeated questions in Parliament regarding data on medical negligence cases, health minister Ghulam Nabi Azad came up with a rather lame reason — health being a state subject no such information was maintained centrally and no data was available on deaths caused by medical errors in the country. 

State medical councils and the Medical Council of India (MCI) are supposed to maintain registers of all complaints filed against doctors, their status and the outcome of such complaints. But till today, the MCI has not bothered to put together regional data to build a central database for the nation. This means that the magnitude of the problem of medical negligence remains ignored in India. 

Anyone looking for data on the subject in most is likely to run into a wall since it is not made available in the public domain. The parliamentary committee's recently submitted 73rd report on the Indian Medical Council (Amendment) Bill 2013 has drawn attention to the increasing incidents of negligence on the part of doctors. 

"All members of the MCI are medical professionals and whenever any complaint of medical negligence or violation of code of ethics is brought before the council, such cases are decided by the medical professionals themselves. There are reports that the medical professionals probing into the allegations of medical negligence are very lenient towards their colleagues guilty of negligence and none of them is willing to testify another Doctor as negligent," stated the report adding that the impact of this arrangement was that the prosecution in medical negligence cases by the MCI is dismal. 

"In other countries, non-doctors like patients and social workers are mandatorily made members of the medical council and they are known as 'lay members' and on occasions they may even lead the council as was the case with UK's General Medical Council," pointed out the report recommending that the new, revised legislation ought to make it mandatory to have such members on the council. 

In many state medical councils, the disciplinary committee hearing complaints against doctors does include members from the lay public as is the case in the Delhi Medical Council (DMC). However, a closer look at the composition and working of the committee shows how easily this safeguard is subverted. The disciplinary committee comprises three doctors including the chairperson of the DMC and one expert in the field of medicine related to the complainant and three non-doctors — a lawyer nominated by the DMC doctors, an MLA nominated by the state assembly speaker, and one eminent person nominated by the Delhi government. In the case of DMC the eminent person nominated by the government is Dr Prem Aggarwal, yet another doctor. DMC secretary Dr Girish Tyagi admits that the MLA, being very busy, hardly attends any disciplinary hearings. The quorum required for the hearings is just three. Hence, complaints against doctors end up being heard by just other doctors despite the rule. 

According to People for Better Treatment (PBT), which was started by Dr Kunal Saha (he recently won the record settlement of over Rs 6 crore by the Supreme Court for the death of his wife due to medical negligence), hardly any doctors are found guilty by state medical councils. 

For instance, PBT's RTI enquiry found that just 515 cases were filed against doctors for either medical negligence or ethical violation in one decade (2001-10), barely four cases a month. And action was taken in just 9% — 15 doctors were removed from the council's list of registered practitioners and 30 let off with a warning. In 91% of cases, either the case was closed or the accused let off. 

Azad claimed last Tuesday that 97 doctors were penalized by the MCI in the last three years. But Mihir Banerjee, vice president of PBT, counters that these include doctors who were let off with a warning. 

"State medical councils mostly comprise doctors and most are not even functioning properly. The ones that function do not reveal any data on the complaints or their outcome," says Dr Amar Jesani, editor, Indian Journal of Medical Ethics. In Maharashtra the medical council was not properly functional for two decades. From 1990 till 2011, it remained mired in controversies regarding malpractices in the election of council members. 

"We had a tough time trying to get data from the different state medical councils. Even with RTI, they give vague information. There is no price to be paid when council members shield doctors in cases that come before them as the public will never know what happens," says Dr Saha.