This article is not about ISI terrorists releasing drug resistant microbes into the water supply. It is prompted by a Trust formed in Guwahati the “Anamika Ray Memorial Trust” to launch a nationwide movement “Stop Medical Terrorism”. Anamika Roy died following complications of gall bladder surgery in New Delhi. Negligence was alleged, and the husband created the Trust with June 25 designated ‘Patients’ Rights Day’ and July 19 the ‘Anti-Medical Terrorism Day’, equating medical mishaps with medical terrorism. Terrorism is defined as “a policy intended to strike with terror those against whom it is adopted”. Creating such a Trust constitutes extremely irresponsible behaviour whipping up mass hysteria and scare mongering. 5.2 million cases were reportedly recorded in India. I traced this starting with the quoted reference, Yadav’s paper in IJFM through India Today’s TV magazine to Ashish Jha from Harvard School of Public Health. Jha only substantiated the global figure and not the Indian one. Unsubstantiated statistics quoted without confirmation or analysis is the crassest form of debate.
Two thirds of court cases in India have been dismissed. More relevant, how many doctors have been found guilty of and jailed for criminal medical negligence (as opposed to civil suits in consumer forums or criminal non-medical acts)? I was able to track down three or four. There might have been some justification for such a trust if this number was significant.
Terrorism occurs with a mob attacking the Chicalim HC with the terrified doctor locking herself up in a room to escape the mob; and this without a shred of evidence for medical negligence. The absence of any law enforcement compounded the terrorism. It is terrorism when a person walks into an OPD and shoots the doctor who is in the middle of examining a child. In Kalyani, junior doctors on duty at the Jawaharlal Nehru Memorial Hospital, were sipping tea at a kiosk near the hospital gate. A mob of local pharmacists surrounded and abused them for prescribing generic drugs as it had precipitated a drop in their incomes. They assaulted the doctors for following government orders and MCI guidelines. When colleagues rushed out of the hospital to assist them, one of the attackers held a gun to a doctor’s head. This is naked terrorism and is becoming almost a daily occurrence across the country.
Like the Spaniards, we need a “National Day Against Aggression in Healthcare” instead of this Trust, which is like the dictates of Hammurabi the Babylonian king who ordered physicians hands be cut off for mistakes. Having laws against such attacks, as 18 states do, has not worked due to lack of police awareness and failure of the authorities to respond appropriately. So much so that Sion hospital recently took the unprecedented step of appointing 40 bouncers; a debatable remedy, because when doctors at the Lady Harding hospital were assaulted and one doctor actually had his forearm bitten, the security staff all ran away!
The government appears to have finally woken up. In a written reply in the Lok Sabha, the Union Minister of State for Health Anupriya Patel stated “An inter-ministerial committee has been constituted under the chairmanship of additional secretary (health) comprising representatives from Law and Justice Ministry, department of Consumer Affairs, Home Ministry, Medical Council of India and three representatives from IMA”. The Terms of Reference of this committee include frequent instances of assault on doctors and clinical establishments across the country and the need for a central legislation for providing protection to the same. We hope the committee will look at the following parameters identified following discussions in Delhi.
The community: Expectations have risen dramatically; but the public must realize that every error of judgment is not negligence and every surgical procedure has its own recognized inherent complication rate. The public should be equally concerned about the WHO findings that 31% of all those who claim to be allopaths in India have no qualifications at all. In rural areas only 18% were qualified.
The profession: There is no doubt that we have failed society badly. Patients must be counseled on every aspect of therapy. What will happen in the event of surgery with the inherent risks; and what will happen without surgery, must be explained to the patient. Communication skills have to improve; and must be included in undergraduate curriculum.
The health services: In far too many cases doctors are blamed for inadequate infrastructure. In a recent incident, the power supply was so bad that all four generators of the hospital failed and resulted in a series of deaths. This is unacceptable. Health care budgeting must improve from the miserable levels it is stuck at for years.
The media: which is preoccupied with readership and viewership. When Dr. Praful Desai a renowned cancer surgeon and Padma Bhushan awardee was dragged through the courts, every newspaper and television channel screamed the news. Yet when he was cleared by the SC a painful 29 years after the incident, what coverage did this get? Whilst freedom of the press is enshrined in our constitution, I have little or no respect for the media in matters of reporting of medico-legal issues.
The police: There is pitiful ignorance of the existing laws against violence in health care and as a result police responses are woefully inadequate. Such acts are non-bailable and carry stiff penalties. How many cases of assault have been successfully investigated and brought to trial in Goa? As far as I am aware, only one.
State medical councils: SMCs must take more aggressive action against erring doctors. There is a deep seated perception that they function only to protect wrong doers.
Politicians: In far too many cases, the perpetrators enjoy political patronage. This cannot go on.
But then, when hangings, beatings, rapes and murders are endorsed in the name of caste and gau raksha, can we expect any better?
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council.)
