Thursday, September 09, 2010

Man awarded RM1.2m for losing eye during surgery.

I just read this on the on-line edition of NST. I do sympathise with Mr Megat Noor, that he has lost one eye, following surgery, but I cannot agree with the statement that he is alleged to have made ( according to NST ), following the decision of the High Court. He is quoted to have said

"Since the public pays so much for medical services, it is time we raised expectations of the treatment we receive. ". That is shortsightedness ( sorry, no punt intended ).
Firstly ( with all due respect to the Judicial Commissioner ), whether surgery would have saved the eye, or he would have gone blind anyway ( he is suppose to have a retinal detachment ), I do not know. This case was 11 years ago. Retinal detachment, a condition where the retina is detached from the back of the eye, can cause blindness. It appears that the ophthalmologist was trying to push the retina back, but failed ( ? why ), and he became blind. Something must have happened in OT, as the anesthetist was also sued. The OT nurses must have squeal ( whistle blower ).
I was concern ( this article, non cardiac, is for lay public consumption ), that if the public expect every dollar compensation for every " perceived" medical negligence then there will be consequences to the public. Firstly, cost of medical indemnity will rise. As courts award million dollar compensation, the doctor does not pay. The medical professional insurance will pay, and so the medical professional insurance fees will rise. That will result in the specialist either refusing to take on tough cases, because he no longer wish to pay for the hefty insurance cost, or the specialist will just raise his charges, to cover the increase cost of medical indemnity. For example, when I first started to practice as a cardiologist, my annual medical indemnity fees for a cardiologist, then was RM800. This year, my medical indemnity is RM4,000+. The ones paying the most are the Obstetricians ( about RM 30,000+ ). That is why, in USA and even here now, some obstetricians are opting not to do deliveries. They just practice gynaecology ( safer and medical indemnity fees less ). Secondly, if you wish your doctor to be super safe ( as if there is such a thing ), he will be very defensive. The practice of defensive medicine will mean more evaluation tests, more cross specialist consultation for every little thing ( sometimes you see 6 consultants in charge of one case, more cases going to ICU ( intensive care monitoring ), which will all lead to increase medical cost. Is that what the public want?? Even with all these defensive stunts, the patient may still die or suffer morbidity.
What then is the answer?
Looks like, on the medical end, there must be a good level of communication regarding risk of disease and risk of procedure. There must be no super sell to say that I can cure all ills. For surgery, there must be good informed consent. On the patient end, there must be a good understanding of his disease condition and not just to sue to get revenge or to get money. There must be a certain degree of trust in the doctor, otherwise go find someone that you trust. When a surgery turns sour, doctors feel it ( even though it may not be their fault ) and they empathise with the patient. They feel sorry. We only hope that the compassionate part of the doctor is more often seen, and not the money minded part. The human body is a very complex machine, created by God. No human can predict with 100% certainty what can go wrong. I have done thousands of angioplasties in my career. Believe me, I still have the greatest respect for every single lesion that I dilate. Sometimes the simplest lesion is the one that gives the most trouble. The complex ones, you have planned the steps so well, may be the smoothest one to go through.
Human doctors carry out treatment, it is God who decides the final outcome. It is humbling to know that.
Suing for revenge, so shortsighted. Is that what you want?

1 comment:

DOLI said...

Dear Doc,

Warm wishes.

I read the news report too but in the absence of the judgement proper - will reserve comments for the moment.

What intrigued me was the award itself. You would note that our of the 1.2 Million awarded - RM 1 Million was for aggravated damages.

Though i reckon you subscribe to the MPS scheme there are quite a number of doctors in Malaysia who buy Professional Indemnity Insurance from commercial insurers.

though the cost may be much much lower [ AS a comparison the premiums for an O&G under the MPS scheme is RM 34K but under the commerical insurance scheme it is RM 5K], the cover afforded by the commercial insurer is restricted. For one - examplary damages are excluded.

In the case above - the RM 1 Million would not be covered by the Insurers.