On the morning of 2 February (2025), AHM Nurul Alam Hasan, a businessman from Chattogram, was having breakfast with his family when he began to speak strangely. He misnamed familiar people, shared incorrect information and asked irrelevant questions.

Initially, his family did not realise the gravity of the situation, dismissing it as momentary confusion. As his odd behaviour persisted and he complained of a headache, they rushed him to a renowned private hospital in Chattogram.

After preliminary tests, doctors at the hospital wrongly diagnosed him with an early-stage brain tumour. He spent one night under medical supervision and was discharged the following morning.

Unconvinced by the diagnosis, his family convened a meeting on 4 February, deciding to take him to Dhaka for further investigations. The decision-making process took two days, and by the time Mr Hasan reached the capital on 5 February, four days elapsed before the correct diagnosis was made—he had suffered a brain stroke.

The delay in identifying and treating the stroke has left the 74-year-old businessman struggling to regain his memory.

A specialist physician, speaking anonymously to UNB, emphasised the dire consequences of such delays. “A four-day delay in stroke treatment can lead to severe complications and drastically reduce the chances of recovery,” the doctor said.

The Perils of Delayed Stroke Treatment

When a stroke occurs, every second counts, he says, adding that the critical importance of swift intervention to prevent irreversible damage. Here are the primary risks associated with delayed stroke treatment as he said:

1. Increased Brain Damage

o Strokes occur due to blocked blood flow (ischemic stroke) or bleeding in the brain (haemorrhagic stroke).

o Within minutes, brain cells start dying due to a lack of oxygen and nutrients.

o A delay of four days allows irreversible damage to spread, affecting a larger portion of the brain.

2. Higher Risk of Permanent Disability

o Delayed treatment can result in long-term impairments, including:

§ Speech and communication difficulties (Aphasia)

§ Paralysis or muscle weakness

§ Cognitive decline, including memory loss and confusion

§ Vision and balance disorders

3. Reduced Effectiveness of Clot-Busting Treatment

o Ischaemic stroke patients require thrombolytic drugs like tPA within 4.5 hours of symptom onset.

o After four days, these drugs become ineffective, making recovery more difficult.

4. Increased Risk of Secondary Stroke

o Without immediate treatment, patients face a higher likelihood of suffering another stroke, compounding health complications.

5. Swelling and Brain Pressure

o Delayed care can cause brain swelling, increasing intracranial pressure and worsening brain function.

o In severe cases, this can lead to brain herniation, which is often fatal.

6. Other Medical Complications

o Pneumonia: Stroke patients often have difficulty swallowing, increasing the risk of aspiration pneumonia.

o Bedsores & Blood Clots: Prolonged immobility can lead to deep vein thrombosis (DVT) and skin ulcers.

o Urinary Tract Infections (UTIs): Common among stroke patients due to bladder dysfunction.

7. Mental Health Consequences

o Patients and families face increased risk of depression, anxiety, and emotional distress due to delayed recovery.

8. Higher Mortality Rates

o The longer the delay in treatment, the lower the patient’s chance of survival.

Medical Negligence in Bangladesh

Medical negligence is a growing concern in Bangladesh, with frequent reports of misdiagnoses, surgical errors, and inadequate treatment. While many countries have robust legal frameworks to address such issues, Bangladesh lacks comprehensive legislation to combat medical malpractice.

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Consequently, most incidents go unpunished, leading to public frustration and, at times, violent reactions against healthcare professionals.

Medical negligence generally falls into several categories:

1. Misdiagnosis

2. Delayed Diagnosis

3. Surgical Errors

4. Childbirth Trauma and Malpractice

5. Negligent Long-term Treatment

For a case of medical negligence to be established, four elements must be proven:

· Duty: The healthcare provider owed a duty to the patient.

· Negligence: The provider failed to take reasonable care.

· Damage: The patient suffered an injury due to the negligence.

· Causation: The injury was directly caused by the healthcare provider’s actions.

Legal Safeguards and Challenges

Bangladesh’s Constitution protects the right to life (Article 32) and mandates the State to ensure access to healthcare (Articles 15, 18). However, the enforcement of these rights remains weak. Patients can seek redress through Article 102 (Writ Petitions), but the lack of a dedicated medical negligence law leaves many without justice.

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While doctors work under challenging conditions in an overburdened healthcare system, the lack of accountability erodes public trust. Misdiagnoses, delays, and inadequate treatment force thousands of Bangladeshis to seek medical care abroad, draining billions from the national economy each year.

Unlicensed Hospitals

The private sector provides 60% of Bangladesh’s healthcare services, with over 100,000 hospital beds. However, regulation remains inadequate. In February 2024, the Directorate General of Health Services (DGHS) found 1,027 unlicensed hospitals operating across the country. Such institutions often lack qualified professionals, contributing to cases of medical negligence.

Exodus of Patients: Trust Deficit in Local Healthcare

Bangladesh’s healthcare shortcomings have led to an exodus of patients seeking treatment abroad. In 2023, over 4.5 lakh Bangladeshis travelled to India, Thailand, Singapore, and Malaysia for medical care. The reasons include:

· Advanced medical facilities

· Specialised expertise

· Higher perceived quality of care

· Limited access to specialised treatment in Bangladesh

This trend has severe economic implications, with billions of dollars flowing out of the country. Strengthening local healthcare could retain patients and boost the economy.

Reforming Bangladesh’s Healthcare System

Experts said that to prevent cases like that of AHM Nurul Alam Hasan, Bangladesh must do the following things:

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1. Invest in Healthcare Infrastructure – Increase funding for public hospitals and ensure they have modern medical technology.

2. Improve Diagnosis and Treatment Protocols – Implement stricter guidelines for stroke and emergency care.

3. Strengthen Medical Regulation – Enforce licensing requirements for hospitals and clinics.

4. Introduce a Medical Negligence Law – Establish a legal framework to hold medical professionals accountable.

5. Build Public Trust – Improve training for doctors and enhance patient-doctor communication.

6. Create a Health Service Commission – Oversee quality standards and investigate malpractice cases.

The case of Mr Hasan is not an isolated incident—it is a symptom of a healthcare system that struggles with misdiagnoses and delays. Unless systemic reforms are undertaken, countless others will continue to suffer due to preventable medical errors.