Experts divided over medical negligence during Covid care

Allegations of various lapses during treatment of Covid patients have been on the rise in India and elsewhere

AMID concerns raised by Fr Frazer Mascarenhas that late Fr Stan Swamy was vaccinated at JJ hospital when he had all the symptoms of Covid and a media report saying non-medicos were allegedly treating Covid patients at Goa Medical College hospital, health experts have offered differing opinions. Few feel these alleged lapses should never go under the wrap, while others say the doctrine of negligence cannot be applied to an elusive disease like Covid.

Despite much respect and honour for healthcare workers, Dr Subhash Hira, Professor of Global Health, University of Washington-Seattle, said, "There are some aggrieved people who also see the glass is half-empty. "There is no doubt that where there are life services being delivered in a state of national pandemic, and many care providers are seeing bizarre conditions for the first time, there will be some slips." He said many forget "over 728 doctors have died so far this year in India with Covid acquired during their work".

Explaining the condition of the stressed workers, he said, "I read a note from a colleague doctor working in an African hospital stating that she was alarmed to speak with her department junior doctor, who was exhausted and worn-out after 18 hours of non-stop work and still tried to consult her. Such stories abound on medical bulletins across the globe."

During a pandemic health systems get overstretched. To overcome this challenge, he cited the example of a model that evolved in the Indian Army's medical services under the leadership of Lt General Kanitkar. "An alert relative is quickly trained to protect himself from Corona using PPE dress and provide care in the ward to his loved one. This removes the demand on the doctor's time to explain the status of the patient to relatives sitting in an information vacuum. If there's a will, there's always a way to make services more transparent."

Dr Wiqar Shaikh, Professor of Medicine, Grant Medical College and Sir J.J. Group of Hospitals, said there has been a rise in cases of medical negligence in several countries, including India, UK, Hong Kong, Indonesia, European nations and US. He said a local politician had moved the Bombay High Court and as many as 11 cases of medical negligence over Covid were part of this hearing. The court directed the Maharashtra government to clarify its stand on compensation to the families of Covid victims for alleged culpable negligence. He said two out of five doctors in the UK are implicated in such cases. In the USA, the Freedom of Information Act disclosure revealed 48 cases of Covid negligence filed between January 1, 2021 and February 16, 2021.

Dr Shaikh suggested solutions to minimise cases of lapses in India. They include transparency and regular interaction with patients' relatives; allowing kin with protection to meet patients; relaying CCTV footage from critical care units to a place where patients can be seen by their relatives. He said near and dear ones should be allowed to speak to the patient at least twice daily.

"Doctor-patient relationships are always built on trust. In Covid pandemic, since relatives were /are not allowed to meet patients, some patients and their relatives are raising concerns about transparency of medical treatment given to them and they are also raising concerns about medical negligence," said Dr Santosh Bansode, Head of the Department- Emergency Medicine, Wockhardt Hospital, Mumbai Central.

Differing viewpoint

"Since Covid is a totally new entity, there was no information on the disease processes and treatments. As yet there is no standardised treatment protocol. The trial-and-error approach continues to be the deciding factor. The entire saga is still in a grey zone of medicine. Therefore, the doctrine of medical negligence cannot be applied to this elusive disease," explained Dr Ketan Vagholkar, Professor of Surgery at DY Patil Medical College.

He said only experience and scientific evidence correlated to the clinical course of the disease can only help in standardising treatment though not fully and reliably.

But due to the emergence of mutant variants this has become a difficult task, he said, adding, "Therefore, each doctor continues to treat patients based on his experience which is variable across cities and countries. And hence, medical negligence in the context of Covid treatment is yet to be defined."