The most common complaint received by Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) and Bhutan Medical and Health Council (BMHC) are of health professionals being rude and medical negligence. The complaints were received through email, written down on paper, verbally made in person, and even posted on social media.
This is even though most Bhutanese don’t know about such a facility for lodging official complaints.
In 2019, BMHC has received five complaints of medical staff not attending the patient on time, taking up wrong responsibility and not responding to the calls on duty hours, but they have not resulted in any fatality or death.
BMHC as well as JDWNRH use corrective measures rather than penalizing the health staff for their negligence unless it is the case of gross medical negligence. A few nurses and doctors in JDWNRH and district hospital have been reprimanded due to their complacency and negligence.
Registrar General of BMHC, Sonam Dorji, said the most common medical negligence is the medication errors, where wrong medicines were given. There are also clinical errors.
There are cases when a wrong patient gets operated. BMHC normally terms the error as medical negligence. Registrar General of BMHC said only the doctors cannot be held responsible.
“The patients have to be identified and one has to go through all those checks and balance from the nurses till the operation theatre (OT), and sometimes there are lapses, and it can be because sometime we are busy, overworked and when there is a rush, it happens. So that is where we are trying to sensitize especially when you are busy and to be careful,” he added.
Registrar General said, in the Bhutanese context, the biggest complaint BMHC gets is that the health professionals are rude with no empathy, compassion, and it is either the doctor or nurses that they are scolding them.
He said all the doctors and nurses are being sensitized to maintain a professional attitude and act according to professional ethics. A patient or patient’s party can always report to BMHC or administration in JDWNRH if they have any complaints regarding the medical negligence.
BMHC is also advocating on the need for quality care, as in not only giving the best medicines or doing the best surgeries, but actually being caring and understanding towards the patients and making them comfortable. “We are trying to put it into practice by all our medical professionals to reduce the complaints,” he said.
There are also complaints that health workers are not available at the right time and in the right place when the patients are in pain or patient’s condition is deteriorating. Such incidences are reported to BMHC and investigations are carried out.
Registrar General said that sometimes the infrastructure itself is the problem. Nurses have to eat, and for that the nurse-on-duty has to go to some other place to eat, and are not found at the duty station, causing much problem when the patients’ attendants come looking for the nurses. “So these are the emerging issues. BMHC has even warned some of the nurses or doctors,” said the Registrar General.
He also said sometimes doctors-on-call keep their phones switched off, BMHC has received such complaints too, and corrective actions have been taken.
“Another challenge is our own beliefs which come into conflict. Sometimes, they (the attendants) take patient to their house to conduct ritual, and the health staff does not know what the patients has taken while they were away from the hospital and becomes serious. Sometimes the patient dies,” said the Registrar General.
At times, the patient’s family does not allow the nurses or doctors to inject or give medication unless the ritual is over. BMHC has been sensitizing the medical professionals on how to handle such situations and make them understand rather than scolding them, he added.
So far, BMHC has not received any cases or complaints with regard to malpractices. It was pointed out that underlying diseases that a patient suffers from could contribute or result in death. “Nothing is intentionally or unprofessionally done,” said Sonam Dorji.
According to BMHC, all complaints are evaluated, and the genuine ones are entertained and followed up with investigation. “The doctors will never operate next time so these are certain cautionary thing we have to be careful. So in the end, the patient will suffer. We have to balance it professionally. Not taking side of the patient and neither the medical professionals,” said Sonam Dorji.
BMHC also disseminates information on corrective measures and action in every hospital to minimize the complaints, and streamline the system right from the hospital heads to ward boys and girls.
“In case of gross medical negligence, where the doctor has wrongly operated on a patient, the council will try to find out whether it is because of the system error or the professional himself as one doctor is not responsible for everything,” said BMHC.
The Quality Assurance Service Division (QASD) in JDWNRH is responsible for analyzing such incidences, and report to BMHC on what went wrong and the course of action and accountability.
“We have no errors or negligence that has gone to seriousness which could result in suspension or rebuke of their registration till date,” said Sonam Dorji.
The Ministry of Health is proposing to put a grievance unit in every hospital where people can freely put up their complaints by writing in or by calling a toll free number as well. The ministry also has its website and combs through complaints or comments on the social media.
“People are more conscious about their health and they want more and better services, whereas the system and health care is not equipped with adequate human resources to give that expected services to people. Even though the health care is free but the government has to pay for it. So, there is always an issue of inadequate resources, medicines get out of stock, the recruitment policy restrict number of human resources. So there are lot of factors influences,” said the Registrar General.
Medical Superintendent of JDWNRH, Dr Gosar Pemba said if the patients or their party want to complain, in regard to medical error or anything to do with treatment, they can always come to hospital administration or BMHC.
Even quarrels between patients or some patients’ attendants and health staff are entertained and investigated within 24 hours, said Dr. Gosar. JDWNRH’s QASD has to investigate on the events that led to the situation mentioned in the complaint.
Cases of medication error are common and instead of fault finding, the investigation looks at factors that led to the event and work out a way to prevent it from happening in the future. It is called adverse event reporting.
“This is happening because sometimes the nurses giving the medicine mistakenly give the wrong medicines as it comes in a small container, and sometimes the nurses do not understand doctor’s handwriting, and the same name and age of the patients. So these are the issues that leads to wrong medication,” said the Medical Superintendent.
JDWNRH receives one or two cases of wrong operation in a year, but it has never being a big case, said Dr Gosar
Identification bands are now worn on patients for correct identification and to avoid wrong medication or operation. Even though there is lot of check and balances, errors do occur and JDWNRH keeps a record of all medical negligence that happens.
The health professionals are reminded to be more careful, and if the same health professional repeats the same mistake then action is be taken. In case of grievous mistakes made by health staff, their license is cancelled and they cannot practice medicine. Usually the management tries to correct the system, using analysis and corrective measures to control errors and prevent them from occurring in the future, said Dr Gosar.
“If the administration starts taking action on every mistakes and starts penalizing staff then they will not report. Best action is try to see what led to mistakes and then improve the system rather than taking actions, unless it results in death or grievous injury to the patients,” said Dr Gosar.
“If there is such case where it has led to death of a patient then the patient party can report to BMHC or to us and then there will be necessary investigation and penalize accordingly,” he said.