POST TIME: 5 March, 2018 00:00 00 AM
Coronary care units during night shift
Nadim Ashraf

Coronary care units during night shift

The medical profession is one of the noblest professions that ensue for the practitioners of this field to possess a particular level of knowledge, skill and expertise, and to maintain a reasonable degree of "care and caution", while performing their duty.

Inherent to the nature of the medical service, patients are one of the most important classes of consumer. Unfortunately they are also the most neglected class of consumers. The current medical industry and its system has bred physicians as entrepreneurs, or as employees in an entrepreneurial enterprise, enmeshed in competition driven primarily by financial KPIs. The toll has taken on quality and service to healthcare. Such shift in priority has resulted in increase in hospital malpractices, where every day in Bangladesh, people suffer and sometimes die because of medical negligence.

Medical negligence is professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. It is a breach of duty by a doctor to perform his or her job as required by their duty. In this regard, due to the nature of outcome and the brevity in time to respond, medical negligence with grievous consequences occur when dealing with cardiac emergencies.

Any patient with cardiac emergency is rushed to emergency coronary care units in hospital or clinics, which are expected to provide with skilled personnel with sufficient training and experience with readiness to provide life-saving medication or intervention procedures.

However, most emergency Coronary Care Units in Bangladesh do not operate with full functionality during overnight. Although they remain open and admit patients, however they are run with inadequate resources in the form depleted, overworked, inexperienced medical personnel, and absence of specialized intervention cardiologists, which lead to delay and omission of appropriate medical treatment causing irrecoverable damage and death.

Patients with cardiac emergencies during night are left without routine standard operating procedures and left to chance for survival till the units are fully functional in morning.

Medical Negligence: A personal case

It is not the aim to punish medical practitioners for all their mistakes, but only to those which are committed out of negligence. Mistakes occur, but which occurs from carelessness and negligence needs to be made accountable. It is the responsibility of every individual, whether a patient, a general civilian, or even a doctor to come together; raise a collective voice to seek our right - our right to life and wellbeing.

Omission and/or delay of appropriate medical treatment is prevalent in these cardiac care units during night shift, and constitute for the case of medical negligence by these institutes based on the following criterion:

1.    Duty: A legal duty exists when a hospital, clinic or health care provider undertakes patients to its emergency coronary care unit to provide emergency cardiac care of the patient that is commonly practiced in the medical field. This duty to provide emergency cardiac care is equal to all without prejudice of gender, age, or religion and is also expected to be equal irrespective of time of admission.

My father, a medical physician himself, was admitted in a well reputed Cardiac Center at the heart of the city on the 2nd of February at 11:50 pm with chest pain.

2.    Negligence: During night shifts when emergency coronary care units are run understaffed and in absence of due expertise (such as intervention cardiologists, etc), it diminishes their capacity to properly administer medical treatment and are unable to execute their expected services, which violate their duty to take reasonable care.

In these cases the hospital, clinic or health care provider are responsible for not allocating resources to execute their services and are liable for the damages resulting from the delay or omission of medical actions. This constitutes to Medical Negligence.

Following the admission of my father, the cardiac care unit was unable to provide him with following healthcare services as is expected and commonly practiced for emergency care of cardiac patients.

(i)    No intervention cardiologist was present in the unit, which is otherwise present during day-time.  

(ii)    Despite having the adjacent facility of Cath-lab, the unit was unable to conduct intervention angiogram-angioplasty, a commonly practiced procedure to mitigate artery blockage and manage cardiac emergency.  

(iii)    Around 2am on 3rd February, the health personnel at the coronary care unit, without any consultation of cardiac specialists, concluded that situation was improving, and chose not to administer Streptokinase, a clot dissolving medication, which is commonly administered medication to manage patient in absence of invasive interventions.

3.    Causation and damage: The inadequacy of the coronary care unit during night shift contributed to health care professional's breach of the standard of care causing irrevocable harm to the patient.

Due to ill-preparation and omission to provide commonly practiced medical procedure and medication, at 2:20 am on 3rd February, my father suffered another cardiac attack and after effort to resuscitate, he passed away after 20 minutes at 2:40 am.

Other Examples of Medical Negligence

Dhaka University teacher Dr. Mridul Kanti Chakrobarty died as his treatment started around an hour after he had been admitted in a well-known private hospital with diarrhea related dehydration. High Court Division passed a verdict and found the Hospital’s negligence.

Professor Abu Nasser M Saleh, a professor of Physiology Department of Rajshahi University died at another hospital without treatment as he was ‘wrongly diagnosed’ at the emergency department of the hospital where he was taken with chest pain and referred him to the respiratory unit instead of cardiology department.

Celebrity Manna died by heart attack at popular hospital in Dhaka, where family members reported that no specialist doctor were in the hospital to treat after he was rushed there with chest pains and he died prematurely because of the negligence of doctors.

These are only but few instances, many such cases are also documented of such medical negligence cases.

Legal Right for Healthcare Receivers:

The Constitution of Bangladesh being the supreme law of the country provides the right to health of its citizen. The right to health can be recognized as a branch of “Right to Life” which is guaranteed as fundamental right of a citizen under Article 32 of the Constitution. Even the Supreme Court of Bangladesh is willing to perform its Constitutional duty to give remedy under constitutional law for medical negligence claims. Furthermore, the fundamental principle of State Policy obligates it to ensure the "basic necessities of life, including food, clothing, shelter, education and medical care”.

Also the Medical Practice and Private Clinics and Laboratories Ordinance 1982, Section 9,  makes it obligatory to health institutes for “availability of all the essential equipment, adequate supply of life saving and essential medicines, required number of full-time registered medical practitioners, nurses and other staff and specialists for the operation, treatment and supervision of patients”.

Finally as patients are receiving services from doctors or hospitals, and are consumers, the Consumer Rights Protection Act, 2009, section 53 allows medical professionals to be held liable if their negligence cause damage to money, health or life of service receivers. This provides same sanctity of protection and enforcement of rights of patients and can institute a suit under this Act that have been filed and accepted by the courts.

A Collective Action

The intent of this modest write-up is to generate collective interest to raise public consciousness to prevent medical negligence by coronary care units providing inadequate emergency care and treatment during night shifts.

All coronary care units that provide service to cardiac emergency patients must have sufficient staff with specialist cardiologist and personnel to perform intervention procedures and treatment as per standard practice, at all times of the day, and equally during night shifts.

Judicial review can be considered as an effective remedy for medical negligence litigations. It allows filing by any person, being aggrieved and having no other efficacious alternative remedy in the form of Public Interest Litigation.

One can also institute a suit under the Consumer Rights Protection Act, 2009, as a medical patient is considered as a consumer and the medical institutions or professionals are as service provider under section 2.

Medical professionals are expected to know about the legal consequences of their medically negligent performances and are expected as always to maintain their professional dignity. People’s unwillingness to bring legal action against medical professionals, are allowing negligent activities to go unchecked.

It is not the aim to punish medical practitioners for all their mistakes, but only to those which are committed out of negligence. Mistakes occur, but which occurs from carelessness and negligence needs to be made accountable. It is the responsibility of every individual, whether a patient, a general civilian, or even a doctor to come together; raise a collective voice to seek our right - our right to life and wellbeing.

This effects each and every one of us, whether directly to oneself or to someone dear in the family. We need to start this discourse, have this dialogue, make this conversation, but most importantly we need to raise our national consciousness to serve with sincerity, only then we can expect to seek for a change.