Bhutan Medical and Health Council (BMHC) has reprimanded three doctors and three nurses and withheld their “certificate of good standing” for a period of two years for negligence of duty.

This means that the six health professionals will not be eligible for certificate of recommendations or appreciation for training or employment for two years from the date of the pronouncement of the BMHC’s decision. The BMHC issued its decision on November 8.

A patient, Bali Man Rana, who was in his thirties, from Dagana died at the Jigme Dorji Wangchuck National Referral Hospital in April this year after a surgery. The patient’s family lodged a complaint of negligence with the BMHC after the apex hospital denied any negligence of duty.

It was found that the health professionals had breached the “duty of care” to the patient by an act of omission and breached Section 6.2.3 of the Medical and Health Council Regulations 2005.

The decision from the BMHC has come after it carried out a thorough investigation and studied the facts and various evidences to see if it substantiates the allegations made by the victim’s family. The council stated that it verified all the evidences and statements of the witnesses, patient history sheet,    expert opinions and professionals involved in providing care to the patient.

The operation was carried out by a consultant surgeon Dr Robert, who was on-call. However, the doctor had not instructed the resident doctor on call to closely monitor the patient after the surgery.

The BMHC noted: “Dr Robert being consultant surgeon who operated the patient should have given clear instructions to monitor the patient post-surgery to the resident doctor on call. As the conduct of the doctor had not met the standard practice expected of a registered medical practitioner in Bhutan, Dr Robert has violated Section 6.2.3 of the Medical and Health Council regulations 2005.”

BMHC, therefore, reprimanded and reminded the surgeon to be responsible for management of patient and provide clear instructions to the health professionals involved in providing care to the patient.

BMHC noted that Dr Sagar Gurung, who was on-call for the surgical ward, owed care to the patients in the ward. “Resident on call was found involved in the surgery till 10pm assisting the surgeon on call instead of monitoring the patients who required critical attention of the doctor,” it stated.

Further, it was found that the resident doctor had not informed or involved the surgeon who was on-call duty during the incident. Dr Sagar Gurung, therefore, violated Section 6.2.3 of the Medical Health and Council Regulations, 2005, the BMHC noted.

BMHC reprimanded and reminded Dr Sagar Gurung to be cautious and manage the patients appropriately once on call.

On the day of the incident, Dr Dago Dem was the intern doctor on-call for the surgical ward and that she owed care to the patients in the ward. BMHC noted that even though it was found that the intern doctor had provided immediate management for the pain when the patient complaint, it was found that the intern doctor had not informed the resident doctor on-call, violating Clause e of Guideline for Undergraduate Medical Internship Programme in Bhutan 2016.

Dr Dago Dem had also violated Section 6.2.3 of Medical and Health Council Regulations 2005. BMHC, therefore, reprimanded Dr Dago Dem.

Rinchen Wangdi, Rinzin Lhamo and Doley Dem were the nurses on duty for the surgical ward. BMHC noted that the nurses owed care for the patients in the ward.

“Even though they had monitored the patient in the ward till 2am, it was found that they had not monitored the patient after 2am,” BMHC stated. It also concluded that the nurses on duty were not found at the nurses’ duty station when the patient attendant was looking for nurses on duty as the patient’s condition started deteriorating.

“It was conclusive from the witnesses’ statements and statements of the nurses that they were not present in the nurses’ duty station but were resting elsewhere which were not familiar to the patient attendant,” it stated.

BMHC ruled out negligence by the Paro hospital, which had referred the patient. BMHC stated that the Paro hospital had provided all the necessary care to the patient within the standards and had managed the patient diligently.

The council, therefore, cleared the Paro hospital of any negligence.

MB Subba