KATHMANDU: Nepal is at a crossroads. The majority have praised the establishment of a consumer court with the authority to rule on claims involving medical malpractice as a victory for patient rights. However, as a medical doctor and author who has kept a close eye on this trend, I must issue a warning: despite their good intentions, the court’s recent decisions run the risk of upending an already precarious healthcare system.

Fear, defensive medical practices, and a possible flight of healthcare personnel are being fueled by the increasing legal constraints on physicians and hospitals; these outcomes might jeopardise patient care nationwide.

The Consumer Court’s Emergence and Early Cases

The consumer court began its operation on March 15, 2025, under the Consumer Protection Act of 2018, designed to provide swift justice to aggrieved consumers, including patients. Within just three months, the court has heard and ruled on several high-profile medical negligence cases, awarding compensation that has sent shockwaves through Nepal’s medical community.

The Om Hospital and Research Centre in Kathmandu got involved in one of the first notable instances. Basanta Gautam, the complainant, claimed that his father, Harihar Prasad Gautam, 98, died as a result of the hospital’s carelessness.

According to the court, the physicians discharged the patient with merely painkillers without doing the required imaging or admitting him for monitoring, despite the patient’s obvious clinical symptoms of acute pelvic discomfort and incapacity to bear weight.

The hospital was sentenced by the court to pay Rs 5.68 million in compensation, which is a substantial amount in Nepal, where doctors have to fight for a salary equivalent to that of government officers at the same level.

Another case involved Nepalgunj Medical College, where, according to the family, unsupervised medical students treated a patient with fever, Manital Shrestha, resulting in fatal errors. The court gave its verdict against the institution and fined it Rs 2.6 million for inadequate monitoring.

The Nepal Medical Council(NMC) has long faced criticism for delays in investigations and a lack of accountability in medical malpractice cases. This has led people to prefer approaching the consumer court, and the court’s arbitrary decisions in favour of patients have signified a shift away from the traditional reliance on the NMC.

The Medical Community’s Growing Anxiety

Although consumer advocacy associations have applauded these rulings, healthcare professionals and institutions are deeply alarmed. The medical community worries that a culture of dread and ambiguity is being fostered by the court’s rigid interpretation of the “duty of care” and the significant financial penalties associated with it.

Defensive Medicine on the Rise

In order to shield themselves against lawsuits, doctors in Nepal are reporting a startling rise in defensive medicine, which includes ordering a lot of tests, avoiding risky treatments, and overdocumenting clinical judgments.

For instance, a medical officer at Ayurveda and Alternative Hospital, Nuwakot, Dr. Shraddha Lamsal, shared, “We are no longer treating patients based solely on clinical judgment. Every decision is weighed against potential legal repercussions. This means more unnecessary imaging, longer hospital stays, and higher costs.”

This phenomenon inflates healthcare expenses and can delay care, ironically harming the very patients the consumer court aims to protect.

Impact on Medical Education and Workforce

The Nepalgunj Medical College case has had a chilling effect on medical training. Supervisors have become reluctant to allow students to participate in patient care, fearing legal consequences. This limits hands-on experience critical for developing competent doctors.

Furthermore, new medical doctors are being discouraged from pursuing professional expertise by the fear of lawsuits, particularly in remote areas where the chances are greater and resources are limited.

According to reports, the number of highly-skilled doctors interested in residency in Nepal is decreasing each year, while the number of doctors pursuing their careers in countries such as the USA, Australia, the UK, and others is rising.

Despite the fact that Nepal has more than enough medical professionals needed to meet the World Health Organisation’s recommended doctor-to-patient ratio, there is still a significant imbalance in the distribution of healthcare professionals.

The majority of them are reluctant to work at rural healthcare facilities because of the low pay, uncertainty in career advancement, the terrible conditions of employment, and interference by politics. This rising discrepancy undermines access to high-quality healthcare in the country’s most rural and underdeveloped locations.

Institutional Strain and Patient Access

This puts hospitals in a vulnerable position. Many are planning to increase the consultation fees and treatment expenses to counter the financial burden created by future litigation, making healthcare services more expensive for communities with limited resources.

Citing unsustainable liability, several hospitals are forced to think about scaling back or shutting down high-risk divisions, including emergencies and oncology units.

Another worrying tendency is “risk-averse triage,” in which individuals with complex or life-threatening illnesses are referred to public hospitals that mightn’t be ready to handle them, overburdening the entire health system and holding off treatment.

Legal and Systemic Challenges

The Consumer Protection Act fails to adequately address the fundamental issues with the national healthcare system, even though it has been provided with greater authority.

• Inequalities in Resources: Many rural healthcare facilities lack experts and necessary diagnostic equipment, such as CT scans and MRIs. It is unjust and impractical to assure patients the international standard of service with that setup.
• Triple Jeopardy for Doctors:Physicians can simultaneously face disciplinary hearings by the NMC, civil suits in consumer courts, and criminal investigations. This convergence creates immense psychological and professional stress.
• Documentation of the Evidence:Medical records are frequently lacking or inadequately maintained, particularly in rural areas, which makes the legal procedure more difficult and occasionally results in unfair decisions.

Despite the Supreme Court’s ruling requiring offices in all seven provinces, the consumer court at present functions only in Kathmandu, Bhaktapur, and Lalitpur. Large segments of citizens are thus deprived of this fundamental and legal choice.

The Human Cost: Violence and Distrust

The rising legal pressures have fueled public frustration and, alarmingly, violence against healthcare workers. In just a few weeks, there were at least five reported assaults on doctors by aggrieved families seeking immediate “justice.” Dr. Sagar Panthi says, “Mob attacking our colleagues inside the hospital, shouting that the court’s compensation is not enough, and they want vengeance, is not a civil practice.”

The decline of trust between doctors and patients risks damaging the fundamental core of the health care system.

Balance Between Accountability and Sustainability

Nepal’s consumer court plays a vital role in the empowerment of patients and medical liability. Therefore, it faces the danger of weakening the medical system that it is meant to strengthen and develop.

Legal Reforms

• Upholding Good-Faith Clinical Practice: The Consumer Protection Act should be formulated to protect medical professionals who practice based on the widely accepted recommendations from being held responsible for unfavourable outcomes. While doctors are committed to serving patients with integrity, framing them strictly as ‘service providers’ under consumer law may oversimplify the moral and clinical complexity of medical care.
• Simplifying the Regulations of Nepal Medical Council: Set clear due dates for investigations of the NMC and integrate them with consumer court procedures to avoid duplication and relieve the strain on healthcare workers.
• Expanding Court Access:Establish consumer court branches in all provinces to ensure equitable access.

Institutional Improvements

• Compulsory Monitoring Protocols: To avoid tragedies like the one in Nepalgunj, create nationwide regulations for trainee supervision.
• Standardising Medical Records: Allocate capital for electronic medical record systems to promote standardisation and transparency throughout the country.
• Malpractice Insurance: To protect the financial interests of medical professionals and healthcare institutions, government-funded insurance plans should be established.

Public Understanding and Discussion

• Patient Education: Start initiatives to educate patients about realistic outcomes and the complexity of health care procedures.
• Building Trust: To prevent miscommunications and lawsuits, promote candid dialogue between health care professionals and patients.

The Stakes Are High

As a doctor who has spent years caring for patients in Nepal and a freelance writer and social activist who is committed to exposing the truth, I see the emergence of the consumer court as a double-edged sword.

In addition to offering patients protection against medical malpractice, it instils fear and pressure among already anxious healthcare workers who work tirelessly to save lives under difficult conditions.

We face the risks of creating a healthcare sector that is weakened by fear, shedding talent, and becoming harder to access for those who need it most if the country’s law changes are unable to achieve an equilibrium between the responsibility and encouragement for medical personnel.

The challenge is clear: to deliver justice for patients without undermining the doctors, nurses, healthcare workers, and hospitals that form Nepal’s healthcare foundation. Only then can the consumer court’s promise lead to a healthier, more equitable Nepal.