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Huzaima Bukhari
“Whenever a doctor cannot do good, he must be kept from doing harm”―Hippocrates
If the readers recall what used to happen some years ago when an accident or criminal case victim was brought to a hospital, they would remember that the medical staff would refuse to touch the patient unless there could be presented a first information report (FIR) submitted to the police. This was rather a cruel act because the possibility of a patient dying from excessive bleeding could not be ruled out. This kind of treatment was widely displayed in movies and television plays. Family of the victim would be seen pleading before the doctor and paramedical staff to attend to their patient but they would just turn their heads away demanding medico-legal formalities instead. Of course, these were pathetic scenes and we would wonder whatever happened to the oath taken by new graduating doctors to maintain the utmost respect for human life, from the time of conception; even under threat, and practice profession with conscience, dignity and fear of Allah. How could a patient requiring urgent attention be ignored and left to die or even suffer pain?
Another situation which still persists today in some areas is where patients requiring emergency attention are brought to a private hospital but if they are unable to pay the requisite fee, they are turned away. A government hospital would obviously not do such a thing but most privately-run hospitals would have no qualms in refusing admission to such persons which is again, a violation of the Hippocratic Oath. According to a USA based friend, who was taken aback by the callous attitude of our medical fraternity as depicted in different plays that are widely aired, this is totally inhuman. He failed to understand how money could be given preference over the life of a person.
A first hand experience of this scribe way back in 1995 also led to some bitterness when a senior officer was attacked in office and was taken to a government hospital in the official car. Once there, the staff on duty demanded an FIR even though the officer was bleeding profusely. Since the case was that of a bureaucrat, they were forced to attend him immediately thus saving his life. This kind of a treatment was extended just because he was an influential person accompanied by a team of officers but what about those who belong to the common stock and have no one to stand up for them?
Considering that medical practice is one of the most noble professions, these types of events gets one thinking that when money comes in between a doctor and patient, it loses its sanctity. No doubt, doctors too have families and need income for sustenance but how much is actually required for a decent life? Money closely follows people who are knowledgeable and have complete grasp over their competence. It is not necessary to run after it. Besides, two important occupations, teaching and medicine are not ones that should become businesses because they demand dedication, compassion, humility and above all clear intentions to rise above material gains. However, over time we have seen the rise of both these professions as the most sought after businesses. Consequently, there may have been a phenomenal increase in number of literate persons and hospitals but both knowledge and health have fast deteriorated in quality terms because of lack of proper regulations.
Returning to treatment in case of emergencies, the federal law was passed in 2004 called the Injured Persons (Medical Aid) Act, 2004 that overturned the concept of producing an FIR before seeking medical aid with section 3 of the Act explicitly commanding that an injured person is to be provided medical aid and given priority over all other medico-legal formalities. In the wake of the Constitutional (Eighteenth Amendment) Act, 2010 the Punjab Assembly in 2012 was the first province that adopted the same law within its domain through Injured Persons (Medical aid) Amendment Act, 2012 (III of 2012) This was a great break-through for victims in Punjab province requiring immediate medical attention. The Act also provides instructions about non-interference by the police until the patient is stabilized, prevention of taking an unstable patient to the police station or transfer to another hospital and in certain cases does not require permission of the patient’s relatives to begin the aid process. Under this law, even the person bringing in a patient is not to be harassed either by the hospital staff or the police. This is indeed a commendable piece of legislation that did take time to materialize but better late than never.
In 2014 Khyber Pakhtunkhwa introduced the Khyber Pakhtunkhwa, Injured Persons and Emergency (Medical Aid) Act, 2014. The Sindh Assembly also legislated the Sindh Injured Persons (Medical Aid) Act, 2014 but later on repealed it and went a step further by enacting Sindh Injured Persons Compulsory Medical Aid Treatment (Amal Umer) Act, 2019. This happened after a 10 years old girl Amal Umer was injured by a stray bullet during a police shoot-out with robbers in August 2018. She later died due to the alleged negligence of the hospital where she was taken. The Act says:
“No hospital or doctor shall demand any payment for providing compulsory medical treatment or other such medical assistance from victim, if he or she is unable to make payment. The cost of compulsory medical treatment shall be borne by the government,” adding that the injured persons are to be shifted to a government hospital immediately after their condition stabilizes. And one of the clauses further says: “If he or she chooses, they may remain in the private hospital subject to paying the charges of the hospital.”
The penal provision provides that persons or hospitals violating this law would be subjected to imprisonment for three years or more or a fine not less than Rs. 500,000 or both.
Balochistan is still following Injured Persons (Medical Aid) Act, 2004 and it will remain effective till the time it enacts ins own law as provided in Article 270AA of the Constitution of Islamic Republic of Pakistan. In 2021 the Federal Government has presented a Bill in the National Assembly to this effect for Islamabad Capital Territory, and till that time the Injured Persons (Medical Aid) Act, 2004 will remain effective. With this information, it is hoped that Pakistani dramas and movies would reflect the true position with respect to providing medical aid under these laws.
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The writer, lawyer and author, is an Adjunct Faculty at Lahore University of Management Sciences (LUMS), member Advisory Board and Senior Visiting Fellow of Pakistan Institute of Development Economics (PIDE).