Cost Burden of Medico-legal Tangles

Legal costs always have an adverse effect on an organisation’s balance sheet. They also have an adverse effect on the reputation of the hospital. The second panel discussion on Day 2 of Healthcare Senate 2016 focussed on the ‘Cost Burden of Medico-legal Tangles’. Moderated by Mahendra Bajpai, Advocate, Supreme Court of India; the panel comprised Manpreet Singh Sohal, CEO, Global Hospitals, Mumbai and Hyderabad; Dr Vivek Jawali, Director, Fortis Hospitals, Bengaluru; Dr Suganthi Iyer, Deputy Director, Legal & Medical, P D Hinduja Hospital & Medical Research Centre, Mumbai; Dr Alexander Thomas, Executive Director, Association of Healthcare Providers (India) and Dr Nikhil Datar, Founder President, Patient Safety Alliance, and Medical Director, Cloudnine Hospital, Mumbai.

Bajpai began the session by citing the controversial case of Dr Kunal Saha v/s Dr Sukumar Mukherjee and others and how it stirred the entire healthcare fraternity. He said, “The compensatory structure of medico-legal cases in India has changed. Previously, the
compensations for medico – legal cases would not be more than Rs 5 lakhs, but today the compensation scenario has changed tremendously where patients are being compensated in crores.” He stressed upon the fact that the rising compensation structure for medico-legal cases has adversely affected the entire healthcare delivery system. Leading the session further,  Sohal pointed out, “Most doctors and healthcare providers believe that ignorance of law is a bliss. They believe that since they provide healthcare to the masses they are above the law.” He stressed on the need for hospitals to be more aware of the laws of the land and implment measures to ensure compliance with them. Bajpai asked the audience if they were aware of a written law in India that regulates the conduct of the doctors. He went on to say  that this law clearly mandates  that a practitioner should maintain medical records of their patients for a certain number of years, the methods to be adopted by a doctor while prescribing medicines, so on and so forth.

To the panel’s dismay only a few doctors knew about these provisions in the law. Bajpai then agreed with Sohal’s view that many in the medical profession were ignorant about legal matters. He further informed that the above mentioned regulations were part of Indian Medical Council Professional Conduct Ethics Regulations 2002.

Dr Jawali opined that every hospital should maintain a transparent line of communication with their patients and relatives to avoid medico-legal issues. Moreover, he recommended establishing a crack team that comprises doctors from within the hospital and lawyers. The core responsibility of this team is to inspect all legal aspects of a hospital. In times of medico-legal cases, this team has to check for very bit of information, legal documentation even at the ward boy level to ensure ethical implementation of medico-legal strategies, he advised.

Dr Thomas intervened to say that documentation is not the most important thing. He stressed upon preventive measures to avoid getting entangled in such cases. He agreed with Dr Jawali that communication plays a pivotal role in better patient management and patient care. He referred to a study made by a member of the Harvard University that stated, India has around 5.2 million medical errors every year. Of these, medical errors have costed the lives of around 5-10 per cent patients. He further said that said that the major reason for medico-legal burden is not lack of core competence but poor communication. Addressing  hospital administrators present at the conference, he said that hospitals lose upto two per cent of their revenue to medico-legal tangles. He also highlighted that NABH, CAHO, MCI and various other bodies within the healthcare sector have felt the need to ensure healthy communication and have introduced training programmes for nurses, doctors and other support staffs within hospitals. Dr Thomas also emphasised that accreditation has proven to reduce medico – legal tangles within hospitals. He advised, “We, doctors, need to regulate ourselves. There is a dire need to include ethics in the curriculum. Medical education is totally commercialised today. Therefore, once a doctor completes his/ her education the only motive they have is to recover all the money invested. This is why they resort to kick-backs, cuts etc. We need medical reforms that can ensure a change in this area.”

Key takeaways

• Communication at all level is key to reduce medico-legal errors
• Ignorance of law is not bliss. Hospital administrators and doctors need to have a basic knowledge of the laws associated with their jobs
• Hospitals must take responsibility for medical errors and report them
• Hospitals should set-up a crack team comprising medical director, HODs and lawyers
• Training staff members is a must

Dr Datar drew attention towards understanding of medical complications and medical errors. He also underlined that out of the overall medico-legal cases recorded worldwide, the actual cases of negligence is only around 5-10 per cent, the rest is poor communication, medical complications, high costs etc. He further said, “We need to have a policy in place that defines medical negligence and deficiency of services. “

Adding to this, Dr Jawali reminded the audience that any rise in cost burden to a hospital results in rise of healthcare costs which adversely affect the patients. This also results in trust deficit among patients,  a bigger loss to the hospital.

Picking up lessons from what Dr Datar spoke, Bajpai asserted that there is a need for Indian hospitals to take responsibility for medical errors and report them. Identifying medical errors and reporting them will minimise errors and reduce medico – legal tangles.

Dr Iyer brought to light that courts today are taking inflation into consideration while declaring compensations to patients. She also pointed out another important medico – legal issue that concerns the sector — the involvement of  third party insurance players. However, she also pointed out that often doctors and nurses become victims of misplaced anger. Raising her concerns on the same, she called them as  malicious acts done with the intention to exhort money from doctors and hospitals. She summed up by saying, “Employees at different need different kinds of training in communication to bring down medio – legal errors and reduce the such cost burdens on a hospital”.

Sohal once again brought up the issue of ignorance of law and spoke about the furore cause by the recent organ donation scandal and sex detection scandals that have caused many medical practitioners to lose their reputation and employment. The moderator summed up the session with a word of caution that medico – legal tangles have far-reaching effects. The panel advised hospitals to have a sound strategy in place to deal with these sensitive and crucial issues.