FARZANA Saleem had reportedly been advised surgery for the removal of a cyst from her left ovary. After the surgery, she was told that not only had the cyst been removed, but that her ovary too had been taken out. Despite being given the green signal to return home, Farzana continued to feel severe abdominal pain.
Three days later, her condition was said to have become critical. On the point of death, it was only when she went for a third surgery at another healthcare facility that it was revealed that during her previous surgeries a small yet potentially fatal hole had been created in her large intestine because of the surgeon’s alleged negligence.
For many, the story of Farzana Saleem is hardly surprising. On a daily basis, many average Pakistanis have to face the onslaught of substandard medical services — without recourse to better alternatives.
The state relies on legal remedies to tackle faulty medical services.
The apathy towards the country’s medical services is not surprising when we consider that healthcare spending is only an estimated 0.7pc of GDP, and out of a total of 187 countries, Pakistan is ranked 146 on the UN index of human development.
The lack of investment in healthcare has resulted in a dearth of medical practitioners who would be able to meet those demands. It is the government’s inability to fill such a gap, or even to try to do so, that has allowed untrained individuals to freely enter the field at the expense of the patients’ health.
There is no doubt that a variety of measures should have been and can still be taken to meet the demand for skilled medical expertise, including an increase in healthcare spending. However, in the absence of such measures, the state has and will have to continue to lean on legal mechanisms to stem the provision of substandard medical services.
The PMDC was the outcome of the Pakistan Medical and Dental Council Ordinance, 1962. Amongst its various functions, the body oversees and regulates medical institutions and teaching hospitals, as well as entertains complaints against medical practitioners on grounds of professional misconduct.
However, although there is a functioning mechanism in the PMDC to address complaints pertaining to medical negligence, there are several issues with it.
Firstly, many of the victims of professional misconduct are too poor or ill-informed to file complaints with the PMDC, or do not possess the resources to pursue their claims. Further, the jurisdiction of the PMDC is limited to medical and dental institutions imparting medical training and to teaching hospitals, whereas certain healthcare establishments, small clinics and similar entities are excluded from its purview.
Also, the PMDC only retains effective authority over registered doctors and practitioners, whereas quack medical experts and other so-called professionals, who are a greater risk, are not covered adequately by PMDC regulations or authority.
In addition to taking one’s complaints to the PMDC, aggrieved patients or their legal heirs may also file civil suits for compensation and recovery of medical bills before the competent courts. Alternatively, aggrieved parties may also institute criminal proceedings against medical practitioners they hold responsible for professional negligence.
However, although such remedies are available under the law, their efficacy is often in doubt on account of the prolonged nature of the proceedings, and the inadequate compensation or penalties actually pronounced upon the conclusion of protracted trials. Therefore, many persons with complaints, despite having suffered on account of medical negligence, choose not to turn to the law for redress.
As can be seen from this situation, although legal remedies are available to address complaints arising from cases of medical negligence, their efficacy and adequacy remain severely in doubt. It is perhaps in light of this that at least two provincial governments have established healthcare commissions, namely, the governments of Punjab and Khyber Pakhtunkhwa, whilst the Sindh government, too, is in the process of establishing one.
The apparent purpose behind creating such commissions is to more fully regulate healthcare establishments and services in Pakistan, and to augment the authority and ability of government authorities to ensure quality medical services for all patients. Moreover, the commissions also seek to examine and regulate those areas of the medical profession which are currently outside the purview of the PMDC.
In light of this, and if potential jurisdictional issues between the PMDC and the commissions are addressed, the move may be welcome. That said, only time will tell whether these modest efforts of the government will prove futile, or whether they will actually be the first steps towards the establishment of an effective regulatory framework to govern medical services in Pakistan.
The writer is an attorney at law.
Published in Dawn, August 3rd, 2014