Medico-legal ‘formalities’ causing avoidable deaths

[Naveed Yaseen]

By Kamran Mansoor
Karachi
It is a growing concern that private hospitals do not take in emergency cases, especially when the cases pertain to medico-legal (ML) formalities, which leads to unnecessary delay in the treatment of patients, in many instances leading to their deaths.

It has been observed that major private hospitals all over the city are clearly reluctant to receive and treat any emergency case without prior completion of ML formalities.

After the bloody incident of Mir Murtaza Bhutto in 1996, the National Assembly in the then Nawaz Sharif government approved a bill requiring all private hospitals to treat emergency cases, however, after giving first aid the hospitals were required to send the patient to the nearest public sector hospital for ML procedure.

It was also specified that immediate treatment of emergency cases would help save lives.

Investigations revealed that the reasons for non-treatment are based on a number of specific reasons - the first one being the cumbersome police procedure.

Police procedure entails a lengthy inquiry system and repeated notices from the police to the concerned hospital administration for the recording of statement and collecting evidence.

According to a senior medico-legal officer (MLO), police formalities are also very lengthy and thus private hospital doctors do not want to take the responsibility in their hands as it eats into their work time.

“Police officials are unnecessarily brash and insulting in their interaction with doctors,” said an MLO, preferring anonymity.

“Another issue is that some police officials also extend repeated threats regarding certain cases, and if their demands are not fulfilled, they threaten to harm the MLO in-charge,” he added.

Moreover, private hospitals do not have any security apparatus unlike government hospitals.

This security is needed, especially after a patient is moved from one ward to another or when attendants become violent in case a patient dies just after arrival, which has literally become a routine at government hospitals in Karachi.

Furthermore, at the court level, repeated summons in a single case cause long waiting periods, wastage of time, and in the end, cases are adjourned for one reason or the other. MLOs often complain of humiliating attitude of the low-grade court staff towards them.

According to the head of an ML department, the emergency ML cases require immediate treatment such as curbing blood loss, replacement of lost blood by infusion of drip, and immobilizing the fractured cervical spine by applying the cervical colour. It is only possible when these and other procedures have been carried out and medical emergency is technically declared to be over following which the case can be referred to any (state) hospital where an ML department exists.

In cases where a patient is in a serious condition, and not in a position to be shifted, the medico-legal procedure should be held where the patient is lying, and complete details may be forwarded to the nearest police station for legal formalities.

If these hospitals provide the space to fulfill the ML requirements then Sindh Government’s Health Department should be requested for the posting of MLOs.

Since the medico-legal departments exist only in the three main hospitals of the city, the mortality rate in ML cases has risen, with patients unable to receive first aid or have to travel a long distance which often results in fatalities, especially en route to another hospital.

Also, ambulance services lack in training, life saving equipment and instruments along with trained staff. Major private hospitals are reluctant to receive ML cases while government hospitals lack the facilities to tackle emergency cases round the clock.

Although these state hospitals are affiliated with reputable medical colleges, such as Sindh Medical College and DOW University of Health Sciences (DUHS), the appropriate number of staff, qualified surgeons and physicians have not been posted at these hospitals.

http://www.thenews.com.pk/daily_detail.asp?id=178193