FRIDAY, APRIL 19, 2024
Sujay Gupta
There are human rights stories. And there are human rights stories. Some stories are perhaps more "human" than others. Some deeds of giving are worth their weight in gold. Stories of crores of rupees of individuals' contributions to COVID relief by celebrities are covered like a crazy day at the stock exchange. And there are stories of doctors, health care workers, pushing every muscle in their system, and the biggest one of them, all hearts, to care and cure COVID patients
But this is a story not of care, but of possible abject neglect. And this isn't a COVID related case, it happened at a time when Goa was 'green' but the country was reeling with cases. But the story needs to be told because even in a season of masks, some truths should be masked. This story also needs to be told because much as it is a deep personal tragedy, which will cause lifelong scars to the souls of the loved ones of the victim of this tragedy, it is also a larger story of neglect of our health care system. And this may, and often may not be linked to the integrity of the profession of doctors.
The gloves and the masks need to be off. In the garb of health care, health care institutions are becoming shops and trading houses. And even this trade isn't fair. Many private hospitals and nursing homes are either real estate projects cloaked as health care ones, or crude factories of loot and scoot, where patients are looted and the hospital simply scoots off with abject and unfair bills and money charged under appalling heads. Funnily this isn't a new story but yet another one.
Wrapped in a soiled bandage, hardly covering the wounds of hurt, anger and grief, the stench of neglect wafting through all the lies and cover-ups of some health shop or the other, this is another India story. And a Goa story.
In one the most beautiful villages of North Goa love bloomed between a boy who gave up his life abroad working in the oil industry and came home to restore his ancestral home into a joyous homestay for folks to come and soak in the sun. He and his beloved, a girl who went to school in Mapusa, not only made a home for themselves but explored their passion, love for animals, and the need to give them homes too. And then the stork arrived and she was expectantly waiting for her little one to arrive.
She was taken to one of Goa premier hospitals and it would be a matter of time when the newborn would arrive. Something terribly went wrong. During her delivery, she started losing a lot of blood needing transfusions. Her child was born but was critical. The baby had to be rushed from this hospital to another one of those posh private ones. The mother battled briefly but bravely. And on the day she become a mother she lost her life even as her infant battled in the neonatal unit of another hospital.
Let’s pause here; Let's assume at all points of time that the bleeding and her death was due to a sequence of unfortunate medical occurrences and the doctors and the system at the hospital did their best to save her life and that of the child.
The big ask is that why doesn't society, the media, and the legal system ask questions when a young healthy woman dies shortly after delivery of her baby. And these questions must be asked not just within the confines of an internal hospital inquiry but a public one. While there is much that doctors have to be proud of, institutions must open themselves for scrutiny especially when they are committed to saving lives with the best possible care. This will also help the institution to wipe off taints if they are clean.
Indeed, a young shattered father, trying to nurture and be the mother to a newborn, will have neither the energy nor the will to ask questions. A form he signed in a hurry essentially absolving the hospital from liabilities in the event of an unsuccessful surgery or health-related complications, gives him a very little legal foundation to fight. The only way we can bring accountability to this system is to ask questions when each of these cases happen because this is no longer a personal tragedy. Here are a few questions a) What led to a healthy young woman delivering a child to succumb in this manner b) Did the obstetrician do his/her best to handle the situation c) Did the support team like midwives, other doctors team up to give their best possible shot to save the life of this young mother. d) When the newborn was critical, why did the family and close friends take the call to rush the infant to another hospital? Or did the hospital where the mother was admitted ask for the just born baby to undertake a road journey with a possibility of getting an infection, to another hospital? If so, why? e) Did the doctors meet the father, calm him down and explain what happened to his wife and the efforts that they had put in, either during the period when they tried to save her life or after her passing away. This is an extremely vital question and if the doctors did not meet the father, it underscores a principle sign of negligence - not meeting and taking the family into confidence at such a tragic time.
While we park these thoughts, let’s look at another story from another hospital. This is not about death but about daylight robbery emanating from another five-star hospital. A well-known media personality had to undergo surgery and was asked to report at 8.30 am for a surgery which began at 3.30pm. When the bills arrived the family found that for a two-day stay they were billed for three days because the total number of hours the patient spent in the hospital was beyond the cut off for two days. In one of the heads, the anesthetist’s professional fees were billed at Rs 9000. This too would have been reluctantly accepted except for the fact that another Rs 4000 was billed for the anesthetist's consultancy charges. The ‘best’ is yet to come. After the operation, the nutritionist advised the patient against having any wheat-based products including chapattis. But the dinner, (the very next meal) served by the hospital consisted of three chapattis.
This isn't trivialising. It juxtaposes the manner in which money is sought to be extracted from patients, with no coordination, when it comes to crucial aspects of care like diet
Speaking to doctors, across Goa, one does understand that the fraternity doesn't deserve to be tainted. Doctors, especially in the government sector but with gems in the private sector too, have endeared themselves to their patients. Trouble invariably brews when they get into "medical institutions", an ecosystem where those without scruples exist side by side with those who do. Most refuse to break the system but some bend, transforming from doctors to pure salespersons, meeting targets for tests and operations referred to as 'cases'.
Are they beyond scrutiny? Can't they be touched or even nudged because of the backing they have or the funds of the powerful parked with them?
The rights protection of patients is non-negotiable. Much as protecting the rights of the doctors etc are
The Supreme Court's is steadily backing naming health as a fundamental right. The problem is that common law principle relating to negligence, vitiated consent, and breach of confidentiality are applied whereas the boxes that need to be ticked are whether the medical facility has breached its duty of care and If the patient has suffered an injury and trauma of any kind, resulted due to the conduct of the doctor.
But identifying this neglect cannot ever happen if patients families don't have the will or the means, or if hospitals hide behind the indemnity provided by patients at the time of admission or prior to a procedure or if the state and society are unwilling to take suo-moto action and probe all such cases.
The much-loved village doctors of the Portuguese times who were friends, philosophers and guides are a dying breed. Old-timers say these doctors themselves were medicines. In reality, they were all healers. Goa needs more of them. Much more.
Today’s stories are all about lacerating wounds, not healed ones.
