The wounded healers-II
Mob injustice & harassment of doctors and hospitals

Dr S Pahel Meitei *

The Indian Medical Association has confirmed in May 2015 that over 75% of the doctors in India have faced some form of violence at the patient's and patient party's hands in India. There are even instances of doctors being actually killed for following the law. Doctors are the softest targets in the prevailing socio-political atmosphere in Manipur marked by rampant corruption, high-handedness and to-hell-with-the-rule-of-law attitude that is omnipresent. Anyone with professed, or unprofessed but presumed, connections can break the law and do anything under the sun.

How will you justify mob violence against doctors and hospitals, or for that matter, against anybody? How many times do we have to see mad mobs criminalizing and victimizing people for presumed crimes? How many times do we have to see the vested interest arm-twisting and extorting money from the doctors and hospitals? Have we forgot that we have courts of law to decide if crimes have been actually committed? Don't the victims of mob injustice have a right a right to be heard? How can one party of a feud take laws in its own hands and decide that the other party is at fault and deserves disgrace, financial loss, physical harm and even death by mob injustice?

Here is an account a real instance of mob injustice. This female patient, aged about 65 years, presents to a hospital with stone in the Common Bile Duct and Urinary Tract Infection. The surgeon performs ECRP, after which the patient developed severe pancreatitis. A physician who is called into the picture finds that the patient is also having severe anaemia, hypoproteinaemia, hypokalaemia, hypomagnesaemia and hypocalcaemia as well. The patient has four sons, only one of whom is visible near the patient.

There is no one from the family to stay with her on most nights in the hospital. She is all alone most of the time except for occasional visits from one or two female relatives. After a lot of effort from the treating team, the patient recovers from pancreatitis, but develops Empyema Thoracis (pus in the chest). Patient is counselled for the correct approach to problem: Chest tube drainage of the empyema fluid. Patient refuses the procedure.

Two sons suddenly turn up the one and only one fine day and inquires about the patient: does she need to be taken to Delhi? They are told that they are not being given 100% guarantee for improvement or cure, but the opinion of the treating team of doctors is that things are manageable in Imphal at much less financial burden to the family since the line of treatment if not going to be different in Delhi. They are also explained in clear words that it was ultimately their own call whether they should take their mother for treatment anywhere else or not.

After repeated requests and a long delay, the patient finally agrees, and the chest tube is inserted. Just after two days, the patient requests for removal of the chest tube saying that she will get treatment from somewhere else. The chest tube is removed prematurely. Patient does not however leave the hospital. She is advised a new line of treatment to which she responds and is discharged on request after 2 days of fever-free period (she will not listen to any sane advice from the treating doctors and says she has had enough staying in the hospital!) with the advice that she should continue taking the medicines advised on the discharge paper.

Considering the financial burden on the family, the treating doctors give huge discounts on their fees at the time of discharge. She goes home and stops taking medicines. She keeps visiting multiple doctors in between. She returns to the same old hospital again after a gap of 25 days with high grade fever and breathlessness.

The previous physician, who has by now had enough of such a difficult patient with unruly family members, advises treatment somewhere else by some other doctor. However, the patient and the youngest son request for admission under the same particular physician "who had, on the previous occasion, saved the patient". Mollified, the physician reluctantly agrees.

He finds that the empyema fluid has become increased and that now the patient has pneumonia as well. She was having hypoxemia as well. Patient still refuses to go for the chest tube and "begs" to the physician that she be treated without the chest tube being inserted. The physician then explains to the patient and to the youngest son (the only son who used to show his face more than once) that he is not sure whether the patient would improve without the chest tube or not. They say they are ready for the consequences. Patient improves significantly and becomes afebrile after a few days. However, she still has to depend on supplemental oxygen.

Patitient and the youngest son request shifting to the general ward out of the ICU citing financial reasons. Patient gets stuck at a just-stable level of health status. The patient keeps removing the oxygen inhalation device on her own and at her wish. The treating physician re-emphasizes the need for removal of the empyema fluid explaining in the layman's language that the antibiotics being used cannot penetrate the pus and or kill the organisms effectively inside and hence the patient is not improving after a certain level. The patient keeps postponing any decision making saying she has to wait for her once-in-a-blue-moon son for any decision. She says her son's marriage is being solemnized and everyone is busy at home, and hence the loneliness with which she has to stay with most of the time.

Delays, delays and still more delays! Suddenly on one fateful early morning, the patient is found dead by the nurse who has gone to check her BP. The female attendant who was sleeping beside the patient had no idea about the patient's death. Now, there are a few explanations for the same. One, the patient had a heart attack in her sleep, which is quite a possibility in her case since she has many background medical issues.

Two, the patient had been poisoned to death, which is also a possibility since the patient had herself complained to the attending nurses about the neglect and harassment she had to face at the hands of her family members and also since the female attendant who slept near the patient curiously had no idea about the patient's death. Three, the treating doctors are guilty of negligence. And fourth, the treating doctors are inept.

Now, how do you think you will come to know the real reason behind the patient's death without a proper probe into the circumstances and patient's case sheet and without post-mortem examination? Surprisingly, the patient's family members were dead against any post-mortem examination. Why? They were asked by the hospital authority to file an FIR and let the law take its own course and come to the conclusion after post-mortem and other circumstantial analysis.

The family members have gone to the media and hurled baseless allegations against the hospital and the treating doctors. They have built a mob and vandalized the hospital causing loss to the tune of rupees 20 lakhs. Now, they threaten the hospital authority right inside the police station that if their wishes for financial compensation are not fulfilled, they will cause more damage to the hospital and will not allow the hospital to function normally! Whoa! Is this justice? With the police playing a passive role, the hospital authority meekly has to give in to their demands. Who wants to keep trying to make the determined uneducated thugs to see reasons?

A cook never ever wants to cook badly. Likewise, a doctor never ever wants his patients to die. It is a personal tragedy for the doctor when any of his patients dies. However, Medical Science does not have solutions for every illness and clinical situation. Doctors are not Gods either. Both miracles and disasters occur unannounced. People however expect the doctors to save "their" patient at any cost. If the doctors cannot save "their" patient, the doctors are quite often labelled the murderers.

The tragedy with the doctors is that they have to deal with all types of people-educated or uneducated, rich or poor, sane or insane, cultured or uncouth, thuggish or gentlemanly, jealous or admiring.... Failure of proper communication from the doctors' side is frequently blamed for conflicts between patient party and doctors or hospitals. What about the "unwillingness or inability to understand" on the part of the patient party?

What about deliberate misrepresentation of facts by the patient party to get the brownie points in their allegations against the doctors or hospitals, as we frequently come across? Regarding "proper communication", it is not always possible to explain the intricacies of clinical decision making to a layman and it is impossible if the person is not willing to understand. The question is whether the medical professionals should be made to suffer at the hands of the uneducated laymen, uncouth street thugs and determined conmen? However, every such incidence puts a nail into the coffin of the medical fraternity's psyche. When will the last nail be struck and the medical profession become a dead profession?

Dr. Roshan Radhakrishnan says, "I wish it were JUST about losing your family life, working twice the allotted hours and taking home the pitiably disproportionate salary though. But sadly, it isn't even that anymore. Now, it is about getting home in one piece. From stopping patients from dying, the medical field is now being forced to worry about not being killed by the patient's bystanders."

Even though many states have enacted laws to safeguard medical professionals and hospitals, nothing of that sort is in sight in our ever-sleeping state.