Doctors being attacked by enraged relatives of patients have become a routine affair in India. Most government hospitals in the country would confirm at least one case of assault on doctor on duty or vandalism in their premises. So, when recent articles in the media announced how a government-run hospital in Delhi has employed bouncers to ward off angry kin of patients, it seemed like a much needed ‘stop-gap’ (in my view) arrangement to safeguard doctors and hospital infrastructure.
The 640-bed Deen Dayal Upadhayay (DDU) hospital, located in west Delhi, employed bouncers in April, a week after a doctor was assaulted by friends of a patient, who also broke windows, lights, furniture and thrashed few other staff members, reported FirstPost article. The same article further stated that the DDU had borne one attack every month, with medical staff going on strike over the safety issue 20 times in the last six years.
In fact, the news of bouncers as security personnel in hospitals came in the media, yet another incident of similar nature was reported in Bihar, where a hospital in a district was torched because of woman’s death post delivery. Her kin alleged medical negligence and displayed their ire by putting the hospital on fire.
Similar protests and strikes have reported in others states too. Perhaps the assaults are more in state run hospitals and medical centres due to poor security and, often, lack of adequate infrastructure and manpower. In June, this year, a leading newspaper reported how house surgeons and medical staff from government hospitals in Madurai and Trichy in the southern state of Tamil Nadu had discontinued work due to assault on a duty doctor at a government hospital in Chennai. Their demand – protection from angry relatives of patients.
“Few relatives of the patients come in an inebriated state to the hospital. They pick up quarrel with the health staff and sometimes even assault us. The government should provide adequate security personnel to hospitals to prevent such incidents,” said an agitating house surgeon. (Times of India Madurai edition) Interestingly, the protesting doctors demanded police security specifically in maternity and intensive care units (ICU), the report mentioned.
Again in November, last year, doctors as well as the nursing staff from a district hospital in Rajasthan went on strike after two doctors were attacked at night. In this incident, the doctors were bashed for not having time to attest certain documents, which their attackers had brought. “We will not go to work until we get it in writing that a police chowki will be set up in the hospital,” Dr Rajiv Sharma said. (as reported in TOI Jaipur, Nov 27,2011)
Law, a paper tiger
Since health is a state subject in India, the onus of creating stringent laws to punish assaulters, who not only beat up doctors but also destroy public property in hospitals, falls on state governments.
Although, some states like Andhra Pradesh, Tamil Nadu and Maharashtra have passed laws that make assault on medical practitioners a punishable offence, few are actually prosecuted. In Andhra Pradesh, ordinance was passed in 2007, which makes assault on doctors, nursing staff and paramedics a non-bailable offence with three years imprisonment. And, this after 5,000 junior doctors across 10 teaching hospitals went on strike. (reported in Indian Journal of Medical Ethics, which took it from Indian Express, Mumbai, December 18, 2007)
Similarly, The Tamil Nadu Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act came into force in July, 2008. Under the act, which is non-cognisable in nature, a person can be booked upto 10 years in prison. The person is also liable to pay for the damages. Yet, a doctor in Tuticorin, Tamil Nadu, was killed by a patient’s husband in January, this year. Indian Medical Association (IMA) president Dr K Prakasam was quoted in a report (TOI, Jan 8, 2012) saying about 50 cases of reported assaults were registered in different police jurisdictions in last two years. However, few of the accused were charged and tried under the Act.
According to an interview carried out by Centre for Studies in Ethics and Rights (the article was published in Indian Journal of Medical Ethic) on doctors and hospital staff about causes for such violence, sudden death seemed to be the most common cause. Delay or denial of taking in patients, lack of drugs or equipment in emergencies or negligent staff were also resulted in patients’ kin going berserk. Unfortunately, the situation does not get better, when an inexperienced junior doctor is given the task of announced the patient’s death. Ill-equipped to handle with tact, the situation often gets out of control.
The article further highlighted shortage of staff as a persistent issue that most respondents complained about. ‘Several doctors mentioned that orderlies and ayahs are often on leave. Nurses and doctors are compelled to do jobs like crowd management, pushing trolleys, getting drugs and equipment and escorting patients between departments. This affects their interaction with patients. They also feel that such work reduces their status in the eyes of the relatives. It does not help that residents (resident doctors) are bullied by ward staff who view them as novices. The stress is compounded by the environment of the outpatient department, where crowds of patients, each pushing case papers to get the doctor’s attention, surround doctors and nurses. If Class IV staff is absent there is no system to manage the stream of patients.
Residents reported that absenteeism is common among senior doctors (lecturers, assistant professors and professors) who may make cursory rounds of the wards and are often missing during duty hours when they are required. This affects the quality of care and dampens the residents’ morale.’
Core issues to be addressed
- Usually, during late nights and on weekends, especially Sundays, the hospital usually has skeletal staff of doctors. Junior doctors man the emergencies who have little knowledge of the hospital functioning and are inexperienced in handling conflict situation with tact. The specialists and doctors in the management position are on emergency calls. But shouldn’t each department at least have two senior doctors present at all hours.
- Often patients feel doctors do not explain the patients’ condition to them. One understands that the doctors would lose a lot of time, if they started explaining the illness and the line of treatment for each patient. However, if directed, a nurse can communicate the same to the patients. Doctors need to be more open with relatives of patients about the ailment and the course of treatment. They need to explain to them in laymen terms what is happening, what they expect, how much will a particular course of treatment cost and the risks involved.
- Due to constant crowd and pressure, many doctors, nurses and paramedical staff treat patients rudely and with disrespect.
- The general notion that a doctor is next to god and when the doctor cannot keep up with the expectation for various reasons. In many cases, patients are brought to government hospitals after been refused admission in private hospitals or having been asked to leave because they can’t cope with the treatment cost.
- Since the out of pocket expenses are so high, the relatives feel cheated when the results are not as per expectations or worse, if the patients die.
- Lastly, laws against assault on healthcare providers need to be enforced harshly and damages claimed. Someone’s ire can only cause futher inconvenience to other patients.