Even if it proves to be a fault of a particular individual, hospital is generally made a co-respondent. Even if it is not implicated, the adverse media publicity is sure to do enough damage to the hospital. Safety of the patients, staff or public can be violated in many ways such as unsafe buildings, services, faulty equipment, incompetent/negligent staff, spurious drugs, transmission of infections or failure of security apparatus. Management has to take proactive steps in the form of regular periodic Hazard Identification and Risk Analysis (HIRA) and instituting suitable measures for reduction of the risks identified. An active and effective Safety Committee and a seriously implemented Patient Safety Management Program (PSMP) can go a long way in making the hospital, a safer place through continuous monitoring and surveillance.
Careful selection, credentialing and privileging of the staff can go a long way in averting the damage. Firstly by efficient and effective discharge of duty, the staff can prevent a lot of hazards. Secondly, if an incident does take place due to an individual’s fault and the individual takes the plea of ‘Response Superior’, the management does have a valid plea that they had exercised due care and caution in recruiting duly qualified and experienced staff. The plea may not get them completely off the hook but the degree of accountability may be reduced. An issue becoming increasingly important is the occupational hazards to hospital staff.
Up to now, the incidence has been very low probably because the hospital staff (at high risk) has been ignorant and often don’t even report the incidents. However, accidental transmission of HIV or Hepatitis, inter alia, to staff or a patient, due to someone’s negligence, can become a big issue, particularly if it is proved that the hospital had not taken adequate precautions in terms of an Infection Control Program, Infection Control Committee, Training of staff, provision of Personal Protective Equipment or Proper system of Bio Medical Waste management. In Suraj Mai Chhajer vs. State, the petitioner, Dr. Veena Chhajer, aged 25 years, was a resident doctor in a Govt, hospital at Jodhpur. While performing her duties she contracted Hepatitis ‘B’, which resulted in her death.
The inquiry committee found that ” She might not have contracted the disease, had she been vaccinated earlier against Hepatitis ‘B’ and adopted other preventive measures such as using disposable syringes, needles, gloves, aprons, etc. There may be lapse in the availability of these above mentioned preventive measures.” The Rajasthan High Court directed the State Govt, to pay an interim compensation of Rs 5 lakhs to the petitioner. The High Court also directed the State Govt, to appoint a high powered committee consisting of at least 5 independent eminent persons, one of whom should be from medical profession (not connected with Dr. S N Medical College, Jodhpur) to inquire into the circumstances leading to the death of Dr.
Veena Chhajer. Most of the hospitals are not doing proper pre-employment medical check and very few are doing post, employment periodic health check of the employees. That may add to the liability of the hospital in case the employee develops certain occupational hazard such as HIV/Hepatitis B infection. The accountability of management extends to even the acts of its outsourced staff such as security, housekeeping or dietary services. Even if the errant staff is outsourced and not a direct employee of the hospital, as far as patients is concerned, management is answerable because to them the services are provided under the arrangement of the management.
Third parties, the immediate employer of the outsourced staff have no locus-standing in the eyes of the patients/public. It is, therefore, important that the hospital management always remains alive and alert in this respect and exercises proper supervision and control through their own supervisory staff. In most of the hospitals the management does not show adequate concern for the safety aspects. They get a rude jolt and wake up when something serious happens. However, by then it’s too late. Situation is worse in government hospitals as compared to private hospitals because of the false impression that they are immune to any action as Consumer Protection Act is not applicable to them. Nothing could be farther from truth.
They are as much vulnerable to civil/criminal law suits as any private hospital. It’s an altogether different matter that even if convicted, the management/staff of govt, hospitals generally escape the personal liability and do not have to pay the fines from their own pockets. The accountability and, therefore, the need for preventive measures, is increasing now because of increasing level of awareness of the public, availability of CPA as a cheap and speedy remedy and more scope of litigation s a result.