Doctors' strike: Is the new proposed bill in Karnataka unfair?

If we ask why the treatment at private hospitals/ clinics is expensive, well, there is no one line answer to it. There are several factors that determine this.

The private hospitals and practitioners went on a strike in Karnataka on Friday to register their protest against a proposed bill which seeks to regulate private medical institutions, including the fee charged and punishment for malpractice.

The Karnataka Private Medical Establishment (Amendment) Bill, which is likely to be tabled in the winter session of the state assembly, seeks to hike the penalties levied on doctors in case of malpractice, to the extent of imprisonment. The bill is also aimed at regulating the amount of money charged in various hospitals and to make the costing more transparent.

If we ask why the treatment at private hospitals/ clinics is expensive, well, there is no one line answer to it. There are several factors that determine this. Here are some of those factors that play a key role.

The cost of medical education:

There are 45 medical colleges affiliated to the Rajiv Gandhi University of Health Sciences, and around 5 colleges are without affiliation. Approximately 15 of them are the government run medical
colleges and the rest are all by private managements.

After writing the entrance exams for MBBS course, 20% of the eligible candidates get into the government medical colleges and the rest all enter the private sector.

“The fees in these private medical colleges is again regulated by a body formed with the government and that fees is in no way approachable for a decently earning human being, ranging from 7 to 20 lakhs per annum. So if the regulation for pricing is done, no private medical college can run nor get admissions in future. The blackest of black money can't help sustain a medical college which can't get enough to even pay the salaries of the workers,” said a doctor who did not wish to be named.

“One smooth wave of the KPME act amendment and all private medical colleges are almost closed,” he added.

The cost of setting up a clinic:

Labour act implies that a skilled labour be paid Rs.14,000 a month and an unskilled labourer be paid Rs. 11,000 a month approximately. A clinic requires one nurse (skilled), one sweeper (unskilled) and
one compounder (unskilled). Just the wages to these 3 will come to around Rs.36,000/- per month. And this holds good even in the villages.

“To make Rs.36,000/- per month, a doctor who is supposed to charge only Rs.50 per patient will have to see a minimum 24 cases per day. And that is just to feed the workers. Now, a 20 bedded basic nursing home would at least require 5 nurses, 2 sweepers, 2 ward boys and a lab and an x-ray unit. The consultation amount is Rs.100/- as it's in a town. But the burden on the wages doesn't change. Runs to a lakh plus. So how many patients should the doctor see then? 100 per day???,” asked a doctor.

The new bill: What are doctors worried about?

The new bill also proposes severely penalising the doctor who errs in diagnosis and treatment. A doctor we spoke to explained how this will instil fear in the minds of the doctors. He also gave us two scenarios to explain what the ground reality is when it comes to treatment.

Scenario-1:

“Albert (name used as an example) comes to the hospital with stomach ache. He has been continuously vomiting and is very much in distress. He needs emergency care. The doctor is seeing another patient and request Albert to wait for a minute. Albert obliges. The doctor, after examining Albert, immediately puts some fluids to stabilise him, then gets an ultrasound scan and blood tests done, identifies it as being probably appendicitis, advises surgery. On opening the abdomen, he finds that the appendix was normal, but it's a case of infection, clears the infection and winds it up. Albert is explained that it was not a case of appendicitis, the actual cause was different and Albert goes home happy”

Scenario-2: (Post KPME act amendment 2017)

“Albert enters the hospital with severe stomach ache and recurrent vomiting and enters the hospital in acute distress. The doctor is seeing another patient and requests Albert to wait for a minute. Albert threatens to complain against the doctor if he doesn't see him immediately. The case being examined also threatens the doctor that he would also complain if Albert was seen before finishing his treatment. Fight erupts and doctor gets hit. Somehow, doctor regains his composure and manages both cases, diagnoses after ultrasound and blood tests that it may be a case of appendicitis. Is about to advise surgery, but thinks twice. In case the diagnosis is wrong? So asks for a CT scan for more evaluation. Inconclusive. Then asks for an MRI. Inconclusive. Ultimately decides to open the abdomen. Alas. Appendix is normal. Infection inside. Now what to do?”

“The doctor relieves the infection and winds it up. Albert is enlightened that his appendix was normal, abdomen was infected and now he is ok. Gives him a bill of twenty five thousand."

"Albert is not happy. How dare the doctor say his appendix was normal? Let's teach him a lesson. He just walks into the nearest panchayat office and complains. Wrong diagnosis. Misled by the doctor. Needs compensation. The doctor is liable for up to 5 lakhs compensation. And that too not in a court. No lawyer to help. In a panchayat office governed by an IAS officer.”

Conclusion:

One may say that both the scenarios describe two extreme ends of spectrum, but then again there is a vast grey area between the two extremes. There are many things that cannot be foreseen, especially when it comes to diagnosis of a diseases. Doctors' skill and aptitude are undoubtedly the most important things to give best possible treatment to patients. But, considering the vast number variables that exist in treatment of diseases, will not a harsh penalty like imprisonment erode the confidence of doctors approaching the patient?

At the same time, patients suffering due to negligence by doctors is also not something that can be tolerated. So, a midway has to be found, just making strict laws will not solve this problem.

OneIndia News