When docs get it wrong

NST: A baby loses her forearm due to the alleged negligence of a trainee doctor, HIV-tainted blood is given to a woman, and a surgical gauze is left in a woman's abdomen after surgery. These and other incidents highlight medical negligence that is on the rise. TAN CHOE CHOE talks to the experts and the ministry for facts and figures
THE highest number of medical negligence cases in Malaysia occurs in the delivery room.
Health Ministry statistics show that about 4 out of every 10 negligence cases are from the field of obstetrics and gynaecology (O&G).
From 2000 to last year, 61 negligence cases involving government healthcare providers, mainly doctors, have been settled in and out of court.
O&G accounted for 27 of them, or 44 per cent.
Over RM3.47 million has been paid out as compensation. O&G alone accounted for RM1.54 million.
In view of the seriousness of medical negligence, the Attorney-General's Chambers set up a medical negligence unit in 2001 to tackle such cases.
From 2002 until October this year, figures from the unit show there are 186 negligence suits pending in court
Of these, O&G tops the list, accounting for about 41 per cent of the suits.
Media reports of alleged medical negligence in recent years also mostly involve O&G cases.
The most gripping is arguably the death of Felda settler Norizan Ismail last year, four years after she allegedly contracted HIV during blood transfusion after giving birth at a district hospital in Johor.
Then there's Lim Que Moi's story, where a piece of surgical gauze was left in the abdomen during an ovarian surgery in Malacca.
And who can forget the ordeal of baby Lai Yok Shan, who lost her left forearm to gangrene after a houseman inserted an intravenous needle filled with antibiotics into the arm muscles instead of a blood vessel.
Second in the medical field with the most negligence suits is orthopaedics (18 per cent), followed by medical (13), surgery (11), paediatrics (7) and others (10).
This trend is also reflected in the private sector but there's no data to verify this.

But if it's any indication, Medical Protection Society (MPS), the largest indemnifier of private doctors in Malaysia, is recording the highest number of negligence cases in O&G.
However, its head of international medical services, Dr Tim Hegan, declined to reveal figures.
"Many factors could influence (the statistics)... the denominator is up to how many doctors we've got in each group," he said.
"If you're a mum, what you want is a perfect baby. If you don't get it, you'll try to look for an explanation. That's worldwide."
British-based MPS, which has been in Malaysia for more than 40 years, is a world-leading indemnifier of health professionals with about 245,000 members worldwide.
In Malaysia, the medical defence organisation provides coverage for more than 3,000 private doctors, the majority in the private sector.

Dr R. Gunasegaran, an O&G specialist with a private hospital here, said national health indices showed the maternal mortality rate, the infant mortality rate and the neonatal mortality rate had been declining sharply.
"These are the indices to measure how healthcare is doing and these have always been declining, meaning that healthcare has improved. So obviously, there is no worsening of healthcare."
Comparing the indices with the negligence statistics, he found them "a bit of a mismatch" -- the quality of care is improving but litigation is rising.
"It could be because of patient's perception and demand of maternity care."
It may also be that the medical profession has become "a victim of its own success".
"Twenty or 30 years ago, when someone went into labour, there was a fear that the outcome would be quite poor, that you may not have a live mother or a live baby.
"But because we've improved that much, people now expect zero defects," said Dr Gunasegaran.
"There's no perfect outcome. There are risks, both maternal and neonatal, but they are largely minimised."
The total of negligence cases in public hospitals that has been settled by the government averages about nine cases a year in the past seven years, except for a spike last year of 16 cases.
But settled or not, Dr Gunasegaran thinks these cases do not necessarily reflect actual negligence.
"They (the ministry) settle (the cases) on the legal advice that it's better to shorten the whole process by coming to some kind of agreement.
"Like any other legal thing, (when) it's settled, it doesn't mean somebody is wrong, it's settled because (the involved parties) want to move on."
Last year, the ministry's Medical Practice Division received 251 complaints, primarily on unsatisfactory quality of service (54.58 per cent). Most were directed at doctors (49.06 per cent).

MPS is also seeing a gradual increase in overall claims and in the last two years, they average over 200 per year.
Does this mean medical negligence is more rampant?
Not really, said Dr Hegan.
"It's likely to do with increased patients' expectation, as well as their knowledge of their rights and ability to sue and make complaints. (Negligence claims) are increasing in other countries, too. It's a global trend.
"It's not that healthcare is getting worse or doctors are doing funny things. It doesn't relate to that."
This increase could also be due to a better complaints mechanism, said Dr Gunasegaran.
"We've made it very easy for the public to complain. Stop any guy on the street and ask him where he can complain if he's got a medical problem, he'll tell you the MMC (Malaysian Medical Council) or the Health Ministry.
"For other types of complaints, like transport, the person probably won't know where to go."
Interestingly, MPS is recently seeing a rise in claims related to cosmetics surgery. It is recording the second highest number of claims received.
"If I go in (to surgery) to look beautiful and I don't look beautiful when I come out... also, the money thing is important," said Dr Hegan.
"People often sue not because something went wrong and often it isn't. It's because of the amount of money they've paid and the outcome isn't what they wanted."