Death of a doctor

On Oct. 26, I was awakened at dawn by piercing stomach pain. Rushing to Asian Hospital and Medical Center, I was diagnosed with appendicitis. Fortunately, the appendix had not yet burst.

That evening I was prepped for an appendectomy. By 7 p.m. I was wheeled into surgery. By 10 p.m. I was awake. Before 11 p.m. I was in a private room, with all medications administered intravenously.

Two days later I could take a shower by myself, after all the IV medications were used up. At 1 p.m. I checked out.

The next day I played the piano for two hours straight. On Monday I voted in the barangay elections and briefly visited a mall. By Tuesday I was back in the office, although moving slower.

This quick recovery was possible because I had a laparoscopic appendectomy. Three small incisions were made, to insert a probe and then pull out the appendix.

My mother had an appendectomy when I was in grade school. She has a long scar to show for it, and I remember it took her so much longer than four days to recover enough to return to work.

So I am grateful that laparoscopy, still rather rare pre-pandemic even in our top hospitals, has become widely available for numerous surgical procedures.

And I am eternally grateful to the highly competent doctors and nurses who cared for me, from emergency to post-ops, led by surgeon Laren Saguros.

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We need more doctors, nurses and health professionals. Even at Asian Hospital, there was an ad at the lobby for various types of nurses, medical technologists, pharmacists and midwives.

The long lines in most hospitals indicate the dire need for doctors (general practitioners and specialists alike), plus nurses and other health professionals.

And it’s distressing to learn that one of our top orthopedic surgeons, Dr. Benigno “Iggy” Agbayani Jr., died of a heart attack last month.

Surely the stress of finding himself in jail following a conviction for reckless imprudence resulting in physical injuries contributed to the heart attack.

In an open letter to his fellow doctors dated Sept. 16, two weeks before he died at the Manila City Jail on Oct. 5, Agbayani cited the need “to protect our beloved profession better against predators and opportunists who are already using my case as a legal precedent to file criminal cases for any complication arising from any of our treatment or surgery. It is time we doctors heal and protect ourselves, too, but eventually for the good of our patients.”

Reaction to this story from the medical community has been a slow burn. The case, in litigation since 2006, was largely ignored, until Agbayani’s death became known, and his colleagues wondered what he was doing behind bars.

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Agbayani was convicted in 2013 by Judge Manuel Recto of the Manila Metropolitan Trial Court and sentenced to two years. The doctor reportedly lost his appeal because his lawyer failed to file within the court-specified period the required pleading. The Supreme Court upheld the MTC ruling in 2021, but reduced the sentence to one to 12 months, with motions for reconsideration dismissed last year.

His patient, a lawyer who is reportedly a professor of criminal law, sued Agbayani for using an arthroscope – an instrument for non-invasive examination of a diseased joint – that allegedly was not sufficiently sterilized, during surgery on the patient’s left knee in January 2006, causing an infection in the knee that incapacitated him for 30 days.

Having been a patient myself many times, I agree that patients also need protection from medical malpractice. But the offense needs careful legal definition, balancing the rights of both patient and doctor.

Agbayani’s defenders point out that guilt beyond reasonable doubt was not established. Despite his demise, they are calling for a review and clarification of the ruling, because of the precedent it is setting.

Colleagues have described Agbayani, a product of the Philippine Science High School and University of the Philippines system, as one of the country’s top orthopedic surgeons.

Doctors’ groups, apart from mourning the loss of a colleague, have released statements of concern about the ruling, and are seeking a review of the case, which they fear could open the floodgates to legal harassment and frivolous lawsuits.

Rontgene Solante, an infectious disease specialist at San Lazaro Hospital who is the current president of the Philippine College of Physicians, and his immediate predecessor in the PCP, pulmonologist Maricar Limpin, stressed that doctors are guided by ethics in their work and are bound by their oath to save lives and do no harm.

Both Solante and Limpin were familiar, helpful faces throughout the COVID-19 pandemic. It’s too bad that after the public health crisis that claimed so many medical frontliners, they must now contend with this tragedy in their community.

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On “The Chiefs” last week, which I could co-host in person at the Cignal TV studio just a week after my surgery, both Solante and Limpin said Agbayani’s story highlighted the importance of clearly communicating to patients the risks in any medical procedure, from the treatment itself to the recovery stage.

But how detailed can the explanation be, and what if time is critical in the medical response?

No medical procedure is 100 percent risk-free. Apart from the requisite signing of an informed consent (I signed one) prior to the procedure, the fine print with its salient points especially about the risks can be explained to the patient. In light of Agbayani’s tragedy, the wording of the informed consent that all patients must sign prior to surgery may be revised.

Malpractice is not in the country’s statute books, which is why Agbayani was charged instead with reckless imprudence resulting in physical injuries. If it’s any consolation to the medical community, there is spirited discussion among legal professionals about the merits of the case.

Limpin said Congress is deliberating on a proposed Physicians’ Act, which will define the rights and responsibilities of doctor and patient alike.

She and Solante noted that if malpractice becomes a crime, doctors will get malpractice insurance, which can significantly raise the cost of medical consultations and treatment.

Left unsaid was the possibility that in this country awash with lawyers, doctors might avoid treating legal professionals. Or worse, we might lose even more doctors to hospitals overseas.

Solante sums up the mood in the medical community: “We are all vulnerable to litigation. That in itself is something that we need to ponder now… We should be more watchful now.”