Sunday, January 29, 2012

Doctor, nay Director, heal thyself

Last week a Pune State Transport Bus driver ran amuck and killed 8 persons on the road and injured at least 28 others. Who should be held responsible for the incident – the Driver, the Managing Director of State Transport or the Transport Minister? The answer is clear – it’s the bus driver certainly. But, if we were to alter the situation slightly and it’s established that the accident occurred due to poor maintenance of the buses, which was within the knowledge of the administration – the proposition will change dramatically.

The primary responsibility of a public transport service is to ensure the safe travel of its passengers. If safety standards were compromised knowingly or willfully – the blame cannot be limited only to the driver and it should rightly go all the way to the helm of the organization. If it’s proven that, the bus driver was mentally unsound (just as it could have been a case of bad eyesight) the question would arise if the organization had a system of regular health check-ups of its employees – especially the drivers in whose hands you trust the lives of hundreds of passengers.

Since the AMRI incident, an analogy is being drawn with a train accident or deaths in government hospitals and the question being asked is – if the Railway Minister or State Health Minister are not arrested after a rail or hospital tragedy, why should directors of a private hospital be charged for an accident in their establishment. The question has been raked up again with the arrest of the 2 famous Doctors on the AMRI board - Dr Mani Chhetri and Dr Pronab Dasgupta - last Friday. In my opinion, the logic is both warped and specious.

The larger issue is one of Corporate Governance. Historically, Corporate Directorships were treated as a freebie – a lot of perks without responsibility or accountability. The Satyam, Enron and other cases of corporate misfeasance brought home the point that, Directorship is serious business. But, the focus was primarily on financial aspects and softer issues like safety at work place didn’t get too much attention. The only case in which the culpability of directors for an accident was tangentially touched upon was – perhaps – Union Carbide’s Bhopal Gas Tragedy matter.

Managing a hospital as a corporate business enterprise – where you are dealing with the lives of people is a different ball game. There is a huge element of trust and an unwritten contract of indemnity involved. When you are soliciting patients for treatment and care, in a way you are taking charge of their lives. Here, people getting onto the Board of the Hospital can’t treat it casually - like the Membership of a Club Committee – and must be conscious of the responsibilities that come along with it. You can’t accept the position of “Managing Director” being na├»ve about the legal obligations of the role.

The AMRI case is, of course, muddied by murky politics. Initially, there was a parochial twist given to it by insinuating that, only the Marwari (and “non-Bengali”) directors had been singled out. The subsequent arrest of the 2 doctors on the Board – could well have been as a reaction to that criticism. Now there is an outrage amongst the doctors’ fraternity in the city that, this will deal a severe blow to the medical profession itself. But, both don’t change the basic nature of the contentions.

The public has a right to know what kind of pecuniary benefits these ‘external’ directors drew from the company both directly and indirectly (e.g. did they treat patients privately in the hospital – which would be a direct conflict of interests unless they were also engaged in a ‘professional’ or 'executive' capacity and could itself could upturn the case on its head – taking the wind out of the claims of these doctors that they had no knowledge of the day-to-day running of the place). To what extent – they involved themselves in the affairs of the hospital beyond signing Board Minutes and collecting ‘sitting fees’. If they didn’t take interest in the basic functioning of the hospital it could tantamount to dereliction of duty.

A “company” is a creature of law. It has a ‘legal persona’ – which is represented to the world at large through its Board of Directors. In case of lapses, the final recourse of the law is to the Directors. But, if they can’t be hauled up – due to any lacunae of law – then it would tantamount to letting the companies go scot-free.
The defining question, to my mind, is – whether this was a sheer accident or was it preventable in anyway. If the weight of evidence points towards the latter and there is proof of legal violations found – there is no way the Directors should escape indictment.

To use a cliche - the law has to take its own course. But, the government machinery is notoriously inefficient. So, one can take it almost as a certainty that by engaging the best of legal fire-power – all of the Directors would walk out unscathed sooner than later. But, if this leads to people thinking twice before accepting directorships – doing their own due-diligence on the organization and credentials of the promoters and insisting on their rights as directors to be involved and kept informed about the operations of the hospital – it would still serve a limited purpose. The best, of course, would be if this restrains – at least to some extent – the crass commercialization of Healthcare in our country. But, perhaps, that’s a little too much to expect even after so many people paid through their lives for this sad lesson to the society.