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The Perils of Medical Malpractice in Malaysia
Deceased patient becomes a poster boy for system’s shortcomings
By: Murray Hunter
The sudden death of Nur Muhammad Tajrid Zahalan last week from complications brought about by alleged medical negligence in a Kuala Lumpur private hospital in 2015 continues to reverberate through Malaysia’s medical system, with complainants still seeking justice seven years after the procedure that paralyzed him.
According to his death certificate, Nur Muhammad died from severe septicemia due to complications caused by paralysis from the allegedly botched surgery after years of suffering. He developed stomach ulcers he apparently couldn’t feel and the stomach perforated, with the contents leaching into his abdomen, causing septicemia.
The 38-year-old businessman’s case was belatedly heard in June by the Malaysian Medical Council after years of delays. It ended with the surgeon, Tikfu Gee, released from three charges of gross professional misconduct after the MMC refused to accept what complainants described as evidence that Gee’s defense statement may have contained falsities.
Gee was the last of four physicians at Prince Court Hospital – Ramesh Kumar, Deepak Singh, and Consultant Neurosurgeon Jagdeep Nanra – to face discipline in the case and who were referred to the medical authorities. All have been cleared despite what Nur Mohammad before his death said was medical malpractice or negligence.
The case is far from isolated. At one point, medical negligence was named as one of the most prevalent causes of death in Malaysia in the publication Issues in medical law and ethics. However, the issue has been ignored by the authorities, allowing doctors to use the MMC as protection against misconduct. According to the Ministry of Health’s official figures, medical malpractice incidents have risen dramatically over the last few years. Cases involving wrongful surgery, unintended retention of foreign objects and falls while in hospital reached nearly 10,000 cases in 2020.
Taking medical negligence cases to the court system is extremely costly and the technicalities extremely difficult. In addition, the Federal Court has ruled that private hospitals have no general liability for any negligence performed by doctors working within their facilities. This leaves patients with the option of making a police report, going to the Malaysian Anti-Corruption Commission (MACC), or making a report to the Ministry of Health. Most cases are referred to the MMC for investigation.
The litigation success rate is so poor, however, that very few lawyers advise their clients to pursue cases. Compensation usually fails to cover legal costs. In addition, plaintiffs are severely hampered in obtaining access to their medical records until a case is ready to take to court. This is partly why the MMC medical tribunal was established to hear and access these cases.
Doctors protect their own
The medical tribunals, however, are full of members with conflicts of interest with the cases they adjudicate, as previous Asia Sentinel stories have detailed. In effect, doctors are investigated and judged by their peers with intricate, intertwined relationships that potentially interfere with impartiality and objectivity. No legal practitioners, members of advocacy groups, or public representatives are allowed on the council.
According to the MMC’s 2016 annual report, 112 cases were put before Preliminary Investigation Tribunals by the MMC president, who was also the Director General of the MOH in both 2015 and 2016. Of those, in 2015 81.7 percent were dismissed, while 59.3 percent were dismissed at the council level. In 2016, 79 percent were dismissed by PICs, while 41.9 percent were dismissed at the council level. The MMC stopped publishing case data in their annual reports from 2018 on.
This is an alarmingly low number of cases investigated and reviewed considering the number of cases reported by the MOH back in 2020. The former president of the Malaysian Medical Council Dr. Mohd Ismail Merican in 2018 publicly warned of bias and prejudice by council members over discipline and professional misconduct, intimidation by senior council members, and lack of transparency within council processes, just after MMC stopped reporting the number of cases and outcomes.
Justice denied in Nur Muhammad’s case
Nu Mohammad charged prior to his death that he was left permanently disabled in 2015 in what could only be described as a medical malpractice nightmare of negligence, unnecessary surgery, false expense charges and insurance claims, and other misuses after entering the hospital complaining of back pain and other minor symptoms as detailed in a series of Asia Sentinel stories in 2019.
A three-year investigation by the Malaysian Medical Council into the affair, which took place at Prince Court Medical Center in Kuala Lumpur, cross-examined 12 doctors and referred charges against four physicians.
Geoffrey Williams, who brought the 2015 complaint on behalf of his dead friend, explained, “Tikfu Gee was charged with trying to force unnecessary expensive endoscopy procedures onto Nur Muhammad when he was still in severe pain and recovering from major surgery. The case found that Gee had to be physically stopped from trying to see Tajrid and was eventually blocked by a nurse and the primary surgeon dealing with the case.”
Gee was requested to see Nur Muhammad urgently just after midnight on July 18, 2015 to help diagnose the cause of his excruciating pain. However, Gee show up, and at 7.45 am, nearly seven hours later, a nurse finally called him to get him to respond.
The nurses had recorded multiple complaints of severe pain during the period from just after midnight to the early morning. Williams had informed the MMC of all of this, but Tikfu said in his defense statement that no one had called him.
Williams was asked to present evidence that the nurse had called Gee. Williams did so on June 13, a week ahead of the hearing, which included the official hospital records which were also available to Gee.
According to Williams, these records prove Gee had been telephoned and that he had also been called urgently seven hours earlier by the primary surgeon Ramesh Kumar, but never showed.
The records also show that Gee’s written statement, which was also read out by Gee and recorded by the MMC, was false. However, Williams alleged that the chairman, Lim Joo Kiong ruled that the MMC would not accept the evidence. Williams requested the MMC reconsider, at which time Williams claims the chairman requested him to leave the room and leave his belongings.
On his return, Lim said the council would not accept the evidence. Although Williams referred the chairman and the council members to the MMC Standing Orders, which state that all evidence must be heard, the council members simply refused.
At the end of the hearing, Gee was cleared by majority decision, saying the three charges had not been proven.
“I have made a police report and given my statement to PDRM to ask them to investigate whether the evidence submitted by Tikfu Gee is false or not and whether there are any criminal issues in the use of false evidence by Chairman Dr. Lim Joo Kiong and all of the members of the MMC statutory disciplinary hearing,” Williams said.
The current health minister Khairy Jamaluddin and Director-General of the MOH Dr. Noor Hisham Abdullah have been aware of this problem for a number of years. Neither has answered emailed questions over the issue.