It was not quite long ago when the news of death of 3-year-old Imane Malik flashed across television screens, appeared in newspapers, social media and was shared widely through mobile networks. The young girl had died due to wrong administration of drug through injection by an employee of a private hospital. This person was neither skilled nor authorised to inject drugs.
There was a concerted campaign against this negligence spearheaded by the parents of the deceased child. Imane’s father raised his voice at various fora against medical practices. His point was that though he had lost his loved daughter forever he was struggling to ensure such “criminal acts” are not repeated in future. He wanted to bring those responsible to the book and get them punished under law so that others become careful in their dealings.
This tragic incident took place in November 2009 and good four years down the road the situation has not improved much. There are endless complaints related to health service delivery and every other person has a story to tell.
So, the question is what happened to all those campaigns and the hue and cry raised by masses after Imane’s death? Did all that went in vain or is there any hope left?
Though most common people would be confused on what to say, there are some who believe the efforts had paid to an extent. They refer to the formation of a health sector regulatory body in Punjab to take cognizance of certain cases of medical negligence and substandard service delivery. Called The Punjab Healthcare Commission (PHC), this body is an autonomous health regulatory authority established in consequences of the PHC Act 2010 passed by the Punjab Assembly.
The commission team is headed by a Chief Operating Officer (COO) and has four directorates namely complaints, clinical governance and organisational standards licensing and accreditation and business support. Its staff mainly comprises healthcare professionals with a few employees belonging to the fields of management and law. The idea behind setting up this body is to improve the standards of health service delivery through licensing, inspections and suspensions.
Besides, it is responsible for development of Minimum Service Delivery Standards (MSDS) and their enforcement in all the healthcare establishments, from tertiary care hospitals to homeopathy or tibb clinics as well as diagnostic centres and laboratories, and allied services like physiotherapy clinics, cosmetic treatment centers and nursing homes.
Against this backdrop, one wonders whether this initiative would be a success or not and if yes, why? There were several similar initiatives taken in the past but the strong lobbies and influential players in health sector did not pay heed to them. So, what’s different this time?
The answer comes from Dr Muhammad Ajmal Khan, Chief Operating Officer (COO), PHC, who says things would be different as this body has come into being as a result of a law passed for the purpose. The commission, he says, is autonomous and also has judicial powers to handle complaints. The executive management processes complaints and the decision is taken by the board which comprises members from the private sectors. These include a retired judge, a chartered accountant and a leading businessman as well.
He tells TNS the impetus for this initiative came from the Supreme Court’s decision in the Imane Malik case as well as other cases of medical negligence in both public and private sectors. Besides, there were several strikes by doctors during the previous PML-N government in Punjab which caused great inconvenience to patients and the general public. The apex court took notice of this and asked the Punjab government to take initiatives to handle such issues professionally.
He dispels the impression that being dependent on government funds, the commission cannot work independently. “We are provided funds by the Punjab government just as the federal government provides funds to regulatory bodies such as PEMRA, OGRA and others. Even the courts get government funding but they take independent decisions.”
He says the commission is hopeful that by 2018, it would become financially independent. The sources of funding would be licensing fees, money coming from donors, fines imposed on violators etc.
Explaining the domain of PHC, he says it would take care of healthcare establishments whereas disciplinary action against medical professionals would be the responsibility of Pakistan Medical and Dental Council (PMDC). However, while investigating a case of healthcare establishment, if the commission finds a professional responsible for negligence his case would be referred to PMDC.
The MSDS will be enforced at around 70,000 healthcare establishments in the province. These will be applicable on allopathic, dentistry, homeopathic, acupuncture and other clinics, shops of hakeems, nursing homes, government and private hospitals, pathological labs, slimming and cosmetic clinics and so on.
These establishments will be required to clearly mention their policies on notice-boards, not to refuse emergencies, clearly mention room rent rates, keep verified educational degrees of their staff with them, establish in-house complaint centres, make the physician report every treatment given to the patient in writing, allow only the qualified professional to treat patients etc.
These establishments will be awarded licenses after due diligence and fined if found non-compliant during inspections. The maximum fine suggested is Rs 5 lakh. However, the bigger threat is close of business and requirement of re-application to get a new license.
The PHC also has Technical Advisory Committee (TAC) whose members comprise key stakeholders from the public and private sectors who are engaged to advise, facilitate and offer assistance on any matter referred to it by PHC. For example, there are representatives from Pakistan Medical and Dental Council, College of Physicians and Surgeons Pakistan, Pakistan Nursing Council, Pharmacy Council of Pakistan, Federal Mental Health Authority, Council for Homeopathy, Council for Tibb, Auditor General of Pakistan, University of Health Sciences, Lahore, a member of the provincial assembly to be nominated by the Speaker, two international health experts to be nominated by the government and others.
Anybody who wants to file a complaint against a healthcare establishment can call at toll free helpline 0800 00 742 or register a complaint online, says Dr Shabana Haider, Head of Communications Department, at PHC. Besides, she says, complainants can visit the office or send a written complaint by post.
Explaining the complaint handling process, she says after the receipt of a complaint the commission determines the maintainability of the cause of action that forms the subject matter of the complaint. If the complaint is found to be based on sufficient grounds, it undergoes a rigorous investigation process at PHC.
This involves affording both parties an opportunity to present their cases, after which every party is allowed to cross-examine the other. Teams from the commission also make field visits to gather first hand information regarding a complaint. Expert opinion is also sought in cases involving medical or surgical procedures. Finally, the evidence and recommendations for disposal of the case are submitted to the board’s complaints sub-committee for review. The final decision is taken by the full board.
On the private sector service providers’ concerns regarding arbitrary exercise of authority, she says they have been addressed repeatedly by the commission which views itself as a facilitator for the service providers and a bridge between the patients and medical professionals. They have been ensured that the commission would apply the same criteria to public sector establishments as it would to private health care establishments, she says.