Assaults on healthcare personnel and hospitals have increased exponentially in recent times both in frequency as well as severity. Goa witnessed a series of such attacks recently. At Hospicio, Margao, the doctor though not physically assaulted, was abused and equipment destroyed. There was no affirmative action either by the DHS or the government. Shortly thereafter at the Chicalim hospital the doctor on duty had to barricade herself in the duty room to save herself from relatives who had gone berserk, abused and threatened to kill her. Again the follow-up was pathetic tokenism that led nowhere. More recently, at the GMC a woman slapped and kicked the doctor because she was dissatisfied with the treatment of her daughter. In this case the police registered an offence under assault or criminal force to deter public servant from discharge of his duty, intentional insult with intent to provoke breach of the peace and for voluntarily causing hurt.
Such incidents are by no means confined to Goa. A nationwide survey estimated 75% of doctors have experienced some form of violence in their careers. In Utarakhand, a highly regarded pediatrician was shot dead whilst treating his patients. Two assailants approached the OPD of the Jashpur Government Hospital, on a motorcycle at about 10.30 am. One of them went inside and shot the doctor in the chest at point blank range, “to avenge the death of his three-month-old daughter”. The Amreli Sessions court in Gujarat sentenced the BJP MP Naranbhai Kachhadia to three years’ imprisonment for assaulting a doctor at a government hospital and imposed a fine of Rs 35,000 on him. Disqualified from the Lok Sabha, the matter has now reached the SC. A first year junior resident working at the Medicine department at Sion hospital was assaulted following the death of a 70 year old patient. And just a few days ago, at Nanded in Maharashtra, an assault on a doctor by four drunken men was recorded on CCTV cameras. In all these cases there followed a shutdown of the medical services for varying periods. After the Nanded incident angry members of MARD have demanded that doctors be permitted licenses to carry firearms.
Where on earth are we headed? These incidents have occurred in spite of the fact that about 18 states in India have enacted laws like the Goa Medicare Service Personnel and Medicare Service Institution “Prevention of Violence And Damage Or Loss To Property” Bill 2013. Yet the violence continues; largely because till date there has not been a single conviction under this law in the entire country. Even the Gujarat conviction was under a different law. A classic example of “the law is an ass”. In none of these cases was there any evidence to suggest medical negligence. In one case in Goa, the doctor was actually suturing a wound when the patients’ drunken friends assaulted him. That the case went to court and the perpetrators sentenced is reassuring. For the sake of argument, even if there was negligence, nothing can justify these assaults.
In Goa, after the GMC incident, there was much made of the fact that the rules for the prevention of violence act has not been framed, hence the Act is impotent. This is not true. Legal experts have pointed out that there is nothing in the Act as passed, to stop the authorities to take punitive action. Such assaults under this Act are cognizable and carry hefty penalties. All that is needed is the political will and moral fibre on part of the government to take action. If they don’t, the consequences can be disastrous for the healthcare sector.
There are a nearly 300 posts vacant in the Goa health services. Who in his right mind will be tempted to join the services against this background? Uttarakhand is short of 60% allopathic doctors. India needs about 4 lakh more doctors by 2022. Already there is a noticeable slowdown in medical education as well as the demand for medical admissions. Private medical colleges are feeling the pinch and are in trouble because the best and the brightest are opting for “safer” professions; specialists and teaching faculty remain in short supply. Instead of providing reassuring security to serving doctors, and taking swift exemplary punitive action in such cases, the government attempts to block migrating doctors by refusing to issue NORI certificates.
It is not just the threat of physical assaults that is a deterrent. The shadow of “legal assault” to coin a phrase looms large in the form of litigation. Claims as well as awards in crores are now par for the course. On the one hand it is a statistical fact that the vast majority of claims are rejected; those that do result in awards make for inaccurate and disparaging publicity. A renowned cancer specialist had the case against him thrown out by the SC and the complainant severely castigated for wasting the courts time. All very laudable; except for the fact that the final verdict took nearly 30 years. Only a man of his stature could withstand such pressure which would have surely destroyed a lesser practitioner. How does one get one’s life back in such cases?
There is no doubt in my mind that there are instances where doctors have indeed indulged in grossly unprofessional, even illegal, activity and deserve to be brought to book. But in every case this must happen through the laws of natural justice. There is no room for violence. Unnecessary litigation must be curbed by introducing a system of vetting claims by specialist committees before they enter the endless maize of court proceedings. Maybe, just maybe, we will then get the health care we badly need and deserve. Sadly I do not see that happening anytime soon with Sripad Naik labeling doctors’ anti-national if they do not prescribe Ayurvedic medicines! Would that make Ayurveds who prescribe allopathic medicines terrorists?
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council.)
