whose fault

India's hospital assaults: Patients blame doctors while doctors blame the broken health system

Five doctors in Maharashtra have been attacked by relatives of patients in separate incidents over the past two weeks.

When Sion Hospital resident doctor Rohit Tated was assaulted by relatives of a deceased patient, he had already clocked in 36 hours of duty. Since then, Tated, who has come to Mumbai from Raipur in Chhattisgarh, has locked himself up in his tiny hostel room. Outside the room hangs a sign “Nawab of Medicine”. Tated’s father asked him to return to Raipur but the doctor decided to stay back. “Abhi mamla garam hai,” he told his father. It is a burning issue right now.

Tated was referring to the “indefinite mass leave” called by the resident doctors association in Maharashtra after the attack, which could adversely affected patient services. About 500 surgeries at public hospitals in Mumbai were cancelled on Monday.

“She was a bad patient,” said Tated about the 60-year-old patient who died. By “bad”, he means she was brought to the hospital in a critical condition. She had end-stage kidney failure and was unconscious.

“She improved with our treatment but her blood pressure kept on dropping and we could not save her,” Tated recalled. He broke the news of the patient’s death to her son who started crying inconsolably. Minutes later, the doctor found himself being slapped by relatives of the deceased. “I was so shocked that I didn’t move and just sat on my chair covering my face,” he said.

At that moment, Tated was handling close to 45 patients admitted in the ward and seven of them were critically ill. Tated is afflicted with polio and uses a caliper to walk. Once, at a personality development class, he was asked to draw his ambitions. “I drew a newspaper with a headline ‘President felicitates Dr Rohit’,” said Tated who unfortunately made it to the newspaper for a different purpose.

Tated is now hesitant to go back to work. “I don’t want to face the patients who saw me getting assaulted,” he said.

Dr Rohit Tated who was assaulted by relatives of a deceased patient. (Photo: Priyanka Vora)
Dr Rohit Tated who was assaulted by relatives of a deceased patient. (Photo: Priyanka Vora)

More than just security

Tated’s batchmates who gathered in his room on Monday afternoon were agitated with the hospital’s administration. “The incident happened even when security was present in the ward,” said Dr Lokendra Thakur, another resident doctor at Sion Hospital. “We don’t feel safe.”

At the time of the incident at Sion Hospital, two security personnel were present in the ward but were unable to control the mob of relatives. By the time additional security personnel could be called, the mob had disappeared, said Wadal.

Most public hospitals have closed circuit television cameras to monitor the hospitals, but these have helped little except to record evidence of attacks. Doctors have demanded that, like private hospitals, public hospitals allow only a few relatives to accompany a patient to a hospital. On Monday, authorities at Brihanmumbai Municipal Corporation assured resident doctors that they would implement this system soon. However, given the paucity of support staff in public hospitals, relatives of patients push wheelchairs and run around to get medicine for the patient. Hence, several relatives, neighbours and friends usually accompany the patient.

After a similar attack on a doctor at Sion Hospital, the dean Dr Suleman Merchant had hired bouncers from private security agency to provide protection to its doctors. However, the arrangement did not really work and was discontinued.

Several states, including Maharashtra, have enacted legislations to protect doctors and healthcare facilities from such attacks but the laws have failed to act as deterrents because they have been poorly implemented.

Resident doctors at medical colleges claim that verbal assaults by relatives of patients are common. “They think medicine is like magic,” said Dr Sujay Rainchwar, who also works at Sion Hospital.

A doctor was severely assaulted in Maharashtra’s Dhule district on March 12. The doctor had referred a patient to another hospital since the Dhule medical college did not have a neurosurgeon. The doctor Rohan Mhamunkar may now suffer from vision loss.

“It is not the doctor’s mistake that the medical college didn’t have a neurosurgeon but he was the target,” said Dr Sagar Mundada, psychiatrist and former president of the Maharashtra Association of Resident Doctors.

Dr Rohan Mhamunkar who was assaulted by relatives of a patient in Dhule. (Photo: Resident doctors association)
Dr Rohan Mhamunkar who was assaulted by relatives of a patient in Dhule. (Photo: Resident doctors association)

Another challenge with public hospitals is that most patients access them when the disease has advanced, said doctors. The problem, experts said is with the healthcare system. “The poor are exploited by doctors in private hospitals and when they reach public hospitals, their treatment is challenging,” said a senior doctor working in a medical college in Maharashtra. “They are already frustrated which adds to the tension.”
Mundada who was a resident doctor until last year said that the emergency duty can go up to 36 hours as it happened in the case of Tated. “We are not in our senses and it is humanly not possible to work continuously for so long,” said Mundada.

Lack of empathy

Senior doctors believe that doctors need to work on improving doctor-patient relationships and show empathy while communicating news of death. “I sit down with the relatives and explain the situation to them,” said Dr Sanjay Nagral, publisher of the Indian Journal of Medical Ethics. “I even offer to help them in transporting the body.”

Anant Phadke, the co-convener of the Maharashtra chapter of the Jan Swarthy Abhigyan, a non-governmental organisation, blamed the senior doctors. “In public hospitals, senior doctors are sometimes insensitive towards their patients, which juniors pick up,” he said. “Unlike private hospitals, the patients in public hospitals are poor and meek.”

Phadke suggests that hospitals should have a immediate grievance redressal system to address the problems of patients.

Mundada agrees that doctors need to be trained on talking to relatives of critical patients. “Some doctors could be blatantly very rude,” he said. “But, we need to improve services. Patients travel a lot and then if we tell them that medicines are not available, they will be agitated.”

Meanwhile, at Sion Hospital, Mohammed Balwan is hoping that the standoff will be resolved and the doctors on mass leave come back to work soon. Balwan, a resident of Dharavi was abruptly discharged on Monday instead of preparing for his fourth surgery to remove a tumour. “I was to be operated on Tuesday but the nurses told me to come to the hospital after the strike is over,” he said.

Mohammad Balwan's surgery has been postponed while doctors go on mass leave. (Photo: Priyanka Vora)
Mohammad Balwan's surgery has been postponed while doctors go on mass leave. (Photo: Priyanka Vora)

Recent attacks on doctors in Maharashtra

  • March 12: A 35-year-old resident doctor Rohan Mhamunkar was brutally assaulted by a mob of relatives at the Dhule Civil Hospital. 
  • March 16: Three hospital employees – a trainee doctor, a medical officer and a staff nurse – were allegedly assaulted by relatives of a patient who died of H1N1 in Nashik Civil Hospital. 
  • March 18: Dr Rohit Tated, a polio-afflicted resident doctor from Sion Hospital was assaulted by relatives of a 60-year-old patient with chronic kidney disease. 
  • March 18: A group of about ten people attempted to attack Dr Sarang Dave at the Parel’s Wadia hospital due to unavailability of Neonatal Intensive Care Unit (NICU) bed. The hospital, however, denied the incident.
  • March 19: An orthopaedic junior resident at Government Medical College in Aurangabad was beaten up by a patient’s relatives.
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