Ways to tackle medical negligence and malpractice in Bangladesh
Medical negligence or failure by a healthcare provider to meet the accepted standard of care, resulting in harm to the patient, has reached a new level in Bangladesh. It is now eroding public trust in the local health system despite tremendous achievements, especially in the private sector. Recent high-profile cases, such as the death of a five-year-old during a routine circumcision at a hospital, the tragic demise of a young, expectant mother during childbirth at another hospital, and the death of a young male during an outdoor endoscopic procedure, underscore the gravity of the issue. Incidents like these, often attributed to profit-driven motives, unregulated practices, and a lack of accountability, reflect a healthcare system under strain. The widespread apathy and lack of legal due process for victims of medical negligence also result in frequent violence against healthcare professionals. In September 2024 alone, newspapers reported separate attacks by angry "mobs" at four major hospitals—Dhaka Medical College Hospital, Mugda Medical College Hospital, Cox's Bazar Sadar Hospital, and Shariatpur Sadar Hospital. These do not include the incidents that happen in smaller clinics and health centres in the nooks and crannies of the country.
One of the key challenges is, Bangladesh lacks a unified law addressing medical malpractice. While provisions in the Penal Code, 1860 (Sections 304A, 336–338) and the Consumer Rights Protection Act (CRPA), 2009 (Section 53) offer remedies, enforcement is weak. The burden of proof rests heavily on plaintiffs, requiring expert testimony and facing procedural delays. Besides, the Bangladesh Medical and Dental Council (BMDC) Act, 2010 allows disciplinary action against professionals, but its scope is limited to registration issues of the concerned healthcare facility and practitioners.
For all latest news, follow The Daily Star's Google News channel. Victims often resort to violence or settle out of court due to distrust in the legal system. A 2008 report by Ain O Salish Kendra documented 504 cases of medical negligence between 1995 and 2008, yet few resulted in convictions. There is also a general lack of understanding that in medical practices, adverse outcomes, despite following standard protocols, are not uncommon, even in developed countries. Hence, the difference between negligent misconduct and honest error is often overlooked, creating antipathy towards healthcare providers.
Comparison with India's approach to medical negligence offers instructive insights. While both nations face similar challenges, India's legal framework and judicial precedents provide a more structured pathway for redress. India explicitly includes healthcare under the term "services," enabling patients to seek compensation through consumer courts. The country also applies the Bolam Test to assess whether a doctor acted in line with peer-approved practices, reducing subjectivity in negligence claims. Besides, bodies like the Maharashtra Medical Council adjudicate complaints, streamlining resolution without prolonged court battles.
In Bangladesh, addressing medical negligence requires a multi-pronged approach combining legal overhaul, institutional strengthening, and cultural shifts as follows: i) codify negligence definitions, compensation standards, and penalties. Include guidelines akin to the UK's Ogden Tables for calculating damages based on injury severity; ii) amend the Consumer Rights Protection Act, 2009. Explicitly classify medical services under "service" provisions to empower consumer courts; iii) establish Quasi-Judicial bodies. Create medical tribunals under the BMDC, which should outline the standard procedures to expedite cases; and iv) separate the responsibility of the doctor and the hospital. A doctor should be held responsible when any professional misconduct is proven by comparing it to the standard procedure. A hospital is accountable, but to what extent (for example, if the incident happened during outdoor practice, etc), that also needs to be outlined.
Systematic improvements are also required, which includes: mandating a national accreditation system for clinics and hospitals; empowering the Directorate General of Health Services (DGHS) to penalise unethical practices, including unnecessary tests and kickbacks from pharmaceutical companies; increasing health spending in the GDP; aligning with World Health Organization recommendations; and allocating funds for infrastructure, training, and rural healthcare access.
We should also focus on building trust with transparency by enhancing doctor-patient communication and running public awareness campaigns.
Bangladesh's healthcare situation demands urgent action. By integrating legal rigour, adopting global best practices, fostering institutional accountability, and awareness building, the nation can transform its healthcare landscape. Reforms must prioritise patient safety, equitable access, and trust-building to curb medical tourism and restore faith in local facilities.
A M Shamim is founder and managing director of Labaid Group.
Views expressed in this article are the author's own.
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