That’s what one banner said in bold letters, defiantly carried aloft by one of the young striking doctors at the NRS Medical College and Hospital, my Alma Mater. A 75-yr-old man under treatment, expired as a result of cardiac problems. As often happens, the relatives expressed unhappiness over the treatment; there was some pushing and shoving of the residents including some female doctors. In a recorded interview to the media by a senior resident in medicine, the doctors demanded an apology from the people involved in the melee, otherwise the body would not be released. To my mind, the whole incident could have been defused at this stage had there been a social worker, counsellor or administrator around. The relatives left with the threat of “we’ll show you”. The police were alerted, but failed to respond.
About six hours later two truckloads of goons arrived, and triggered off a sequence of events that shook the very foundations of healthcare in India. A young doctor ended up with a depressed fracture of the skull, requiring emergency surgery, and consequences that shattered his dreams of becoming an orthopaedic surgeon, shackled him to a lifetime of anti-epileptic drugs, gait and visual problems, and restrictions on activities like driving and swimming. Fortunately, the team that treated him waived off all charges, thanks to the Alumni Associations intervention.
This is hardly the first such incident. From May 2018 till date there have been 16 major incidents across India. Four doctors have been killed in TN, Mumbai, Delhi and Jashpur Hospital, Uttarakhand. Here two assailants rode up in a motorcycle entered the paediatricians’ clinic and shot him in the chest at point blank range. Skulls have been fractured before; limbs broken before; doctors have been blinded before. So, what was different this time? This time the pressure cooker couldn’t cope, because the matter did not end there. The CM raised the bar with threats and irrational accusations, even though the local student’s union was controlled by the TMC. Not once did she display any humanity by visiting the injured doctor. It would have certainly lowered temperatures. Her childish intransigence led to a nationwide strike call by the medical association, and resignations by nearly 700 doctors across Bengal including the Principal and Dean of NRS medical College. She did eventually meet the doctors and spoke in extremely affectionate and conciliatory tones. A settlement was reached; but at what cost?
One of the earliest incidents of excessive violence was in 2001, when Anand Dighe died in Singhania hospital, Thane. Shiv Sainiks wrecked the hospital, terrorised the staff and burnt ambulances. The hospital never recovered as the owners were not prepared to invest the Rs 30 crore required the resurrect it. In the end who suffered? The general public; whilst goons made a mockery of law and order with the blessings of politicians. The phenomenon has been studied in great depth and research papers published. Alleged rude behaviour by doctors ignores relentless working schedules of doctors, often for more than 48 hrs continuously, understaffed, without equipment or medicines. When he does get a break, he goes back to squalid conditions which pass off as the residents’ hostel in the company of cockroaches and chocked toilets. He does so in the hope of one day achieving success. Does anyone give a damn for this scenario, or for the consequences of violence that the young doctors face? The shortage of staff, equipment and drugs is a result of the government’s miserable allocation of funds to healthcare over many years, because such expenditure does not get votes.
Research papers have identified many areas that need attention. Healthcare expenditure and investment must increase if things are to improve, from the current 1.2% of GDP to 5% as suggested. Working hours for doctors have to come down from the ridiculous current figures to 48 hours a week like many developed and developing economies. Ground realities have to be rectified. Uncontrolled access by relatives to all areas of the hospital has to stop, and visitors restricted to two per patient, or less in ICU. Social workers or counsellors have to be made available to deal with unfortunate events and breaking bad news. A well-publicised grievance redressal system must be available to patients and their relatives.
Training in communication skills must be part of the medical curriculum from day one. Provision of adequate security must be factored in, in hospital management. In Bihar, bigger hospitals have set up their own security guards. Smaller hospitals have pooled funds at Rs 10,000 per month for Quick Reaction Teams, since 2017, consisting of armed ex-servicemen, trained in crowd control, who can reach a trouble spot within 5-10 minutes. Any wonder that nearly 200 infant deaths in Bihar did not provoke any violence? In MP the DC is now responsible for the security of doctors.
Under the constitution, no accused can be punished for the same crime twice. Yet a healthcare complainant can approach the civil court, criminal court, consumer forum, medical council, human rights forum, and the appropriate authority under the CEA, for starters. In contrast, when filing an FIR for violence against healthcare personnel, the CrPC software does not even recognise the Prevention of Violence Act in 19 States. The IPC/CrPC must be amended so that an assault against a doctor has the same gravity as obstructing a govt officer in the line of duty. Is it any wonder that top level students either do not enter the profession or leave the country at the first opportunity after graduation?
There is a very simple, sweeping remedy. All problems would be solved if there was a rule that all MPs, MLAs, politicians and government officers were compelled to use only government hospital facilities for healthcare.
(The writer is a Past IMA Goa State President)
