A senior resident and neurosurgeon in Thiruvananthapuram Medical College Hospital was assaulted and kicked in her stomach on November 23. The only fault of Dr Merry Francis Kallory, who was attacked, was that she informed a person named Senthil Kumar from Kollam about his wife’s death. However, this is not the first instance of doctors and Healthcare Workers (HCW) facing abuse and assault at the hands of the public.
Earlier last year, a woman doctor and other staff in Thiruvananthapuram Fort Taluk hospital were abused and assaulted by two men. The inebriated men even tried to pin the doctor on the wall. The reason: they – who came with minor injuries – were asked to wait. The same month, another doctor in Parassala was attacked by a group of four men, who were asked to wear masks before entering the hospital. In yet another case in Mavelikkara, a doctor was slapped by a police official, after the latter’s mother, a COVID-19 patient, was declared dead upon arriving at the hospital. The situation looks grim in the neighbouring state of Tamil Nadu. Earlier in 2022, a doctor in Madurai was assaulted by two men, interfering in the treatment process.
Speaking to TNM, Dr GR Ravindranath, general secretary, Doctors’ Association for Social Equality, said that while there are laws in place to take action against the perpetrators, there is no sustained effort to follow up the cases. “If a HCW is attacked, the concerned hospital tries to smoothen the issue. Even when a case is filed, the hospital or the clinic does not come into picture to go forward with the case, fearing disrepute. Only if there is a continuous follow-up, people will refrain from indulging in such activities,” he says.
Ravindranath feels that such incidents are recurring because people have lost trust in the healthcare system. “Their frustration and disbelief towards the system is manifesting in the behaviour towards the HCW, who are in direct contact with the public.” He believes the attacks have increased in the past two decades due to privatisation, commercialisation, and corporatisation of healthcare.
Touching upon a similar law in Kerala – the Hospital Protection Act – Kerala Government Medical Officer's Association (KGMOA) state president Dr GS Vijayakrishnan says that while the Act, which makes assaults against HCW a non-bailable offence, is in place since 2012, it is not being implemented properly. Arrests are recorded only in half the cases, he points out.
Dr CN Raja, national vice-president of the Indian Medical Association (IMA), says the increasing healthcare costs is another major issue. “People are under stress due to mounting medical expenses, which they take out on HCW. After the Consumer Protection Act became applicable for the sector, the doctor-patient relationship ceased and customer-service provider relationship became the norm. This has made people forget that doctors are also human beings.”
“Lack of communication and trust between doctors, patients and their relatives is another major reason behind these assaults. We all know that cent per cent success (in treatment outcome) is not possible, and the limitations are not accepted by people. Further, there are infrastructural issues despite the government trying to improve facilities. These issues frustrate the public, which they take out on doctors, who are easy targets,” says Dr R Premalatha, president, Obstetric and Gynaecological Society of Southern India.
“The entire health system is under stress due to less manpower. The doctor-patient ratio is skewed. So the public doesn’t get the service care that they expect and get frustrated. Now, as doctors are soft targets and won't attack back, they are assaulted by the public,” says Dr CN Raja.
Dr Premalatha is also critical of the media reporting on incidents of alleged medical negligence. “No doctor gives wrong drugs or keeps patients inside ICU after they are dead,'' she says. The inaccuracies in portrayal in cinema and exaggeration of medical accidents are another issue, according to her.
Dr CN Raja says most doctors are stressed and overworked. “Doctors, especially women doctors, are scared to work, particularly at night. They fear for their safety. Even if other supporting staff makes a mistake, the doctors will have to bear the brunt.”
Dr Vijayakrishnan says when doctors are attacked, service offered to other patients is affected and that there is an overall morale dip. Dr Ravindranath feels the government should rectify the issues within the public healthcare system, including lack of manpower, and bring in a progressive work culture. Steps should be taken to increase social responsibility of the doctors and improve their wages. “More importantly, a sense of social responsibility and commitment should be inculcated within the doctors and the patients,” he said.
He also adds that if any mistakes happen, they must be probed properly. “All doctors follow treatment protocol to the best of their ability. However, mistakes should not be taken lightly. At the same time, the media should also not exaggerate an issue. It is important to note that doctors are targeted from every side”.
The Kerala Medical Post Graduate Association (KMPGA), in a letter to the Kerala Health Minister Veena George, have put forth eleven measures that can increase the safety of health care personnel in hospitals. They include setting up police outposts with adequate police personnel in medical colleges and general hospitals and linking them with hospital intercom. According to them, in Tamilnadu, major hospitals have police outposts dedicated to the hospital.
The other measures proposed are having a ‘Bad News Breaking Protocol’ and a console rooms in ICU where the prognosis and death of the patient can be explained in a safe environment with CCTV coverage; an emergency code to indicate threat perception to hospital personnel, a dedicated team which can respond immediately, display boards creating awareness on Hospital Protection Act and relevant sections of the Code of Criminal Procedure, addressing staff shortage, measures to reduce public grievances and setting up a grievance cell for health workers.