Presentation On

UNETHICAL MEDICAL PRACTICES IN BANGLADESH

Submitted By
Md. Arif Imran Khan, ID: 1110885

Md. Nazmus Sakib, ID:1231066

Mostafizur Rahman, ID: 1221544 Mohammad Imran Khan, ID:1110835

Md. Abu Hayat Adnan, ID: 1231067

Farjana Yasmin, ID: 1221554

Introduction
Health Service" sector of the country is one of the very crucial needs of the

country and to ascertain the status of the Medical Service. We have selected the most renowned hospital of the Capital - "Dhaka Medical College Hospital" from the Public Medical sector and some renowned Private Medical Hospitals for our presentation.

OBJECTIVES
The goal of this study is to bring about how unethically the government and

private hospitals are operating their service/business To evaluate the Utilitarianism, right, ethics of care and justice in the government and private hospital. To identify illegal and unethical practices of medical sector. To get an idea about the violation of patients rights and justices. To find/check whether the private hospital ethically and legally increasing the service charge or not. Describing how the society is losing benefits by those unethical practices based on Utilitarian theory, Rights and Justice Point of view. We have described all of the above issue throughout the report and we have tried to show how the private hospitals are fixing the service charge without government control as well as how the public is suffering.

METHODOLOGY
This study involved in understanding the current situation of government and private hospital and the reasons behind the rapidly increase in service charge of private hospital and decreasing the service of government hospital. There are significant findings which we have collected by working intensively.
Collected and analyzed primary information through market visit,

interviewing patients , pharmacy, as well as media representatives. Collected the primary information from government authority. Collected and analyzed secondary information/data from published research documents, newspapers, and other media. Collected additional Secondary information from Internet and printed resource.

Regulations of Healthcare Professionals:

The Medical and Dental Council Act, 1980

The Bangladesh Nursing Council Ordinance, 1983

The Bangladesh Homoeopathic Practitioners

Ordinance, 1983 The Bangladesh Unani and Ayurvedic Practitioners Ordinance, 1983 The Medical Practice and Private Clinics and Laboratories (Regulations) Ordinance, 1982

Present Status of Dhaka Medical College Hospital

DMCH was established in 1946. Every day, on an average, 1,432 patients come to the outdoor and 450 to the emergency units of the hospital, while 184 patients are admitted to the indoor for treatment. The patients are supposed to receive medical treatment at a low cost as it is a government-run hospital. However, it is alleged that the patients are regularly deprived of the health facilities due to a number of irregularities and corrupt practices. There are 1,700 beds in the hospital at present, out of which 1,441 are general beds, 143 hired beds, 43 double cabins, and 30 single cabins. The DMCH has one director, one deputy director and two assistant directors. The total administrative manpower is 1,137 (194 female and 943 male). Out of the service providing manpower there are 594 doctors (199 female and 395 male), 653 staff nurses, and 673 student nurses. There are 25 departments, 48 units, and 45 wards in the hospital.

Key Findings of Unethical Medical Practices in DMCH

Patients are attended at the outdoor between 8.30 am and 1.30 pm. However,

most of the patients informed that they had to wait for the doctors for 78 minutes on an average. Senior doctors are expected to visit indoor patients at least once a day, but some of the patients alleged that doctors did not visit them regularly. Patients were not satisfied at the services of the doctors outdoor and indoor patients showed their dissatisfaction. The outdoor patients mentioned absence of doctors on time, careless treatment and presence of other people (such as medical representative) during treatment as the reasons of dissatisfaction. They further informed that the doctors spent only 5 minutes on an average for attending each outdoor patient, and many of them were suggested to visit the doctors private chambers.

Key Findings of Unethical Medical Practices in DMCH (Contd)

There are numerous allegations against the nurses. Many of the patients did

not receive good behavior and many of them did not get regular services from the nurses. Most of the indoor patients reported about maltreatment from the ward boys and other 4th class attendants, while most of them did not get them in time of their necessity. Employees of the outdoor are also alleged for breaking of the serial of the patients waiting for the doctors in exchange of bribes. Many of the patients gave Tk 21 each as bribe for visiting doctors breaking the serial. The domination of dalals(middlemen) in the DMCH is also remarkable. Different classes of employees including ward boys, sweepers, gatekeepers, and even the relatives of many employees are involved in the strong network of dalals. They are actively involved in arranging appointments with doctors, admitting patients, diagnostic tests, arranging operations, managing beds, and all such activities of the hospital.

Key Findings of Unethical Medical Practices in DMCH (Contd)

It is found that many of the outdoor patients took assistance of the dalals and

for this they gave Tk 96 on an average. However, many of them stated that they did not get help from the dalals even though they had paid money.

Key Findings of Unethical Medical Practices in DMCH (Contd)

The patients of the DMCH also face financial irregularities. The fixed rate of the

admission form is Tk 5.50, but the patients were forced to pay Tk 11.50 on an average. Accordingly, an additional Tk 4,02,960 is collected illegally from the patients annually in this way. It was informed that a few dishonest employees acquire additional benefits through bribes by creating artificial crisis of beds. They manage to provide beds to the patients by taking bribes. Among the patients, most of them had to give bribe to the middlemen an average Tk 188 to get bed in the hospital.

Key Findings of Unethical Medical Practices in DMCH (Contd)

Considering the disease and nutritional need of the patients, the DMCH

provides 11 types of food. For this purpose Tk 45 per person per day is allocated. In reality, the quality and quantity of these foods is not maintained. Our investigation found that quality were bad odor in food, bugs and other elements in food, and poor menu. The reasons behind providing less quality food were manifold. From the suppliers point of view, it was found that firstly the supplier had to pay bribe and they try to get the money back from the food. Secondly, the quality and quantity gets down when they try to increase the profit, and thirdly, they have to bribe the staffs in the kitchen to accept the low quality food. After getting admitted in the hospital the patients have to pay money to different people in the name of tips.

Key Findings of Unethical Medical Practices in DMCH (Contd)

It was found that most of the patients who used trolley paid Tk 42 as tips, the

patients who were bandaged and got dressing paid Tk 53, some of them paid the sweeper Tk 13 to clean the floor around their bed, and many patient staying in the hospital for 15 days on average paid Tk 27 on average every day to the ward boy. The visiting hour in the hospital is between 4 p.m. to 7 p.m. but most of the patients had visitors other than this hour by paying on average Tk 9 to the gate keeper. There are various kinds of mismanagements and corruption in diagnostic tests. In such cases the patients are harassed by the doctors, staffs and the middlemen. Most of the indoor and some of the outdoor patients was instructed to undergo diagnostic tests from particular diagnostic centers. It should be mentioned here that doctors get commission of 30% to 50%from these centers. Blood collected from drug addicts and physically unfit donors are sold here at two or three times higher price.

Key Findings of Unethical Medical Practices in DMCH (Contd)

Since the DMCH is a government hospital, patients are supposed to get free

medicine and other medical apparatus. However, the study shows that most of the indoor and the outdoor patients did not get free medication. the supplied medicines do not reach the patients for some corrupt staffs. These medicines are sold illegally to the nearby drug stores. A list of these places and medicines are given bellow:
Medical equipment Different medicines specially the costly ones Distributed illegally to Drug stores nearby the hospital and some other drug stores Various unpopular diagnostic centers of the city Drug stores nearby the hospital

Laboratory chemical, X-ray films Bandage, fenyl, savlon

Recommendations:

It is suggested that there should be a complaint center for the patients under

the direct supervision of the director. Internal audit should be done and monitoring team should be immediately set up. Harassment of the patients will be reduced if the staffs are ordered to wear uniforms and ID cards. Remuneration of the intern doctors should be increased. The quality of service of the hospital will increase if honest and efficient people get employed by avoiding political pressure, corruption and bribe during the staff appointment procedure. Harassment of the staffs will reduce greatly if the activities of the middlemen can be stopped. Bed and medical supplies for the patients are not adequate and should be increased. Above all the administration should be stricter and free flow of information should be ensured.

Private Hospitals Unethical Practices:

Private Hospitals Unethical Practices (Contd)

In private hospitals especially in the renowned and big private hospitals they

charge three times higher than the normal rate of the consultancy fee. They collect these moneys by the forced purchase of different toiletries items for the patient, gloves and also as service charge. In most of the cases they admit patients unnecessarily just to earn money in the name of checkups which might not be necessary They do provide any emergency lifesaving treatment to the patients if not paid first. They charge three to four times higher than the Govt. rate in all diagnosis. They transfer normal patients to CCU or ICU to charge higher. In many cases they kept dead people on artificial ventilator saying that they are still alive and thus charge an extra bill. They unnecessarily make surgery to the pregnant women who could easily give birth normally for extra profit.

 The most serious allegation against them taking hostage of the dead bodies for

not clearing the hospitalization costs. They lack specialists in off-pick hours like Midnight but still they admit critical patients and sometimes they become unable to give them proper treatment and as a result in some cases the patient died. Tragic Case in Square Hospital: A student of Masters of Business Administration (MBA) of Independent University, Bangladesh was allegedly killed for the miss-treatment in Square Hospital in the month of June 2012. The deceased was identified as Ashique Ahmed, 28, son of Haji M. Shoyeb used to live in Bongshal area of the Capital. He was taken to the Operation Theater unnecessarily without the consent of his parents. (Ref: The Daily Sun, 12th June 2012)

Recommendations
Proper laws should be planned to regulate the private hospitals. A representative of the government should be always available in the hospital as an

administrative officer to ensure that no patient is being mistreated or cheated. There should be a box where the sufferers can post complaints and this should be under the supervision and be investigated by the government representative fortnightly. If anything fishy is found out investigation should be conducted right away. Government audit about the earnings and the sources of those earnings should be ensured annually to see if there is anything unethical going on to increase the rate of profit. There should be exemplary punishments given to the doctors and nurses who are found involved in unethical medical practices. The patients and their relatives should be made aware of their rights and be encouraged to take necessary steps against the authority if anything unlawful is going on while treating them. Many physicians have special connections with various pharmaceuticals and diagnostic companies and are adamant about using their products and services. In many cases they discard the reports of diagnosis if that is not done in their recommended hospitals. The patients should be provided with opportunity to complain about it and the government representative need to handle it immediately.

Recommendations (Contd)

In many cases multiple number of unnecessary diagnosis are prescribed just to

earn commission, such habit should be strongly discouraged and be punished if found to be practiced by anyone. It is the first and foremost duty of a doctor to ensure the best treatment of a patient. This cannot be ensured until they feel it morally and heartily. While they are perusing their graduation and post graduations as doctor there should be moral and ethical lessons regarding the duties of a doctor. Because nothing can be more fatal than a selfish and greedy heartless doctor who thinks of own profit than the wellbeing of his or her patient.

Thank You