Heinous crime at healthcare facility: Need for a holistic solution

A HEINOUS ACT OF VIOLENCE

Nationwide shockwaves have been caused by the unfortunate tragedy that occurred recently at the RG Kar Medical College and Hospital in Kolkata. In addition to bringing attention to the vulnerabilities that women in our society confront, the vicious rape and murder of a young budding lady doctor has also sparked grave concerns about the safety and security protocols that are in place at educational and healthcare facilities. This raises issues regarding the safety of women in our country and in the workplace. Similarly, many incidents of assaults on resident doctors are reported every now and then from various healthcare facilities spread across the country. Two major issues—(1) crime against women and (2) the safety of doctors and healthcare personnel at the workplace—need urgent attention¹.

A CALL FOR JUSTICE

Protests and widespread indignation have been triggered by the horrific incident, with people from all walks of life calling for the victim to receive justice quickly. It’s understandable that people are furious. The event has brought to light the obvious flaws in our system that permit such crimes to take place. It is especially concerning since the incident happened in the hospital of a reputable medical college, which emphasizes the pressing need for stronger security measures.

AN APPEAL FOR SYSTEMIC ADJUSTMENT

This is not the first time such an incident has happened and it is high time the government take this unfortunate occurrence for definitive action. Need for deterrent measures are a must and awareness of severe punishment needs to be put in place, which might prevent such crimes from occurring in the first place. We must address the underlying causes of these acts and put in place thorough preventative measures. This entails promoting an egalitarian and respectful culture in addition to enhancing the security infrastructure. To protect the safety of its employees and students, educational institutions must act proactively, and the government must be held responsible for its deeds².

STRENGTHENING VOICES

The effectiveness of collective action is demonstrated by the public demonstrations and the participation of numerous groups in the call for justice for deceased young doctors³. Seeing people bonding together to demand structural change and to support the victim’s family is indeed encouraging. Nevertheless, it is imperative that these voices are heard and that tangible steps are taken to address their needs, both by the central investigating and the central judicial authorities. Similarly, every now and then, we get news of resident doctors being thrashed by unruly attendants of a patient. The frequency of strikes at local, state, and nationwide hospitals is increasing at an alarming rate. Such strikes not only disrupt the training of doctors but more importantly, disrupts patient care. The worst sufferers in these frequent strikes are the patients and their families, who have traveled a long distance to reach medical college/tertiary care hospitals for their appointments, and many lives are lost in emergency situations. Every time a promise is made by the administration, strikes are called off with the hope that such incidents will not occur again.

The current and past episodes raise two issues:

• Crime against women: This issue has been long debated and everyone agrees that crime should not happen in the first place. Once it has occurred, the culprit needs to be identified and punished in the shortest possible time. This can only happen if our system universally shows a commitment to address the issue and act. This crime is most heinous against humanity and should not become a political issue. If one case is unsolved, then it should not become ground for a casual approach in other cases. These cases should not only be investigated promptly but also the guilty should be punished at the shortest possible time.

  1. Making a stringent law supported by political system, with no partisan views on this issue.

  2. These cases need to be handled with seriousness and all law agencies (local police, CBI, etc.) must act fast.

  3. The investigation should be conducted according to the principles of investigation, and anyone found wanting in carrying out police investigation needs also to face displeasure in their service record. If a healthcare worker is found wanting while treating a patient for negligence, then the investigating officer also should be held accountable for his/her lack of initiative and action. There have been innumerable cases in the recent past where no conclusion could be drawn after a botched-up investigation, such as rape and murder, delaying and denying justice. Inadequacy of action in the past is no ground for inaction in the present and future.

  4. Such crimes should not occur at first instance. The safety/security and workplace environment need to be surveyed. The resident doctors should be provided with a safe and secure environment to deliver services. This one is the most neglected part in public hospitals. Whenever a healthcare facility is planned, it must have safe and comfortable duty rooms ready for doctors/nurses, which is one of the most neglected areas in government hospitals. If a random survey of all health facilities is conducted on minimum standard criteria, the majority will be found wanting. Since these staff work round the clock and do odd-hour duties, safety should be ensured in their movement to hostels/residences. The hospitals should be well lighted and under cover of CCTV with 24-hour monitoring. This is the responsibility of the facility in-charge (medical superintendents, medical directors, principals of medical colleges), departmental heads, and consultant in-charge in all the hospitals to ensure safety/security of all staff.

• Attacks/assaults on doctors/nurses in healthcare facilities: it is now very frequent at the district/primary health center/tertiary healthcare center where the relatives of patients assault/attack the treating doctors and healthcare personnel. It is surprising that relatives of a patient (who is in pain) while getting redressal of his/her problem, starts taking the law in to their own hands and harm the healer. This problem also needs to be addressed in the right perspective. Why should a person/relative who comes for treatment takes the law into their own hands? Such people should be dealt with stringent actions as the lawbreaker is committing multiple damages:

• Physical assault of doctors/nurses causing injuries and risking their lives.

• Obstructing the treatment of other patients who also are in pain and in need of treatment, thus risking other’s lives also.

• The collateral damage caused by frequent strikes by doctor/nurses/healthcare workers in response to such episodes disrupts the normal working in hospitals and causes inconveniences to the millions of patients,

• A negative impact on health economics.

At first instance, such episodes should be prevented and dealt with tough laws and by deploying adequate guards/security staff and having safe healthcare facilities with adequate CCTV cover. In a nutshell, not only adequate law should exists but also its implementation should be ensured on the ground.

Other important aspect is root cause analysis of such instances as to why they have occurred in the first instance and how we can avoid them. The main dissatisfaction and trigger for such incidents is overcrowding and lack of balance between the number of patients and available infrastructure and manpower (doctors and nurses). The counseling of patients takes a back seat in overcrowded hospitals/clinics. The audit of infrastructure and patient load should be carried out periodically so that the infrastructure is augmented for the increased footfall.⁴ There should be sufficient waiting areas with properly planned outpatient chambers with adequate manpower so that each patient’s medical problems are addressed in a satisfactory manner. The counseling facility for patients in public hospitals also needs to be upscaled. The infrastructure should be organized in such a manner that patients are able to get solutions to their clinical problems on a single visit to the hospital, which will reduce overcrowding in the hospital significantly. The available hospital outputs should be audited to get optimum utilization of facilities.⁴ The waiting time for the procedures to be reduce by upscaling operating facilities to fulfill this unmet need.

IN SUMMARY

The rape case involving RG Kar Hospital serves as a sobering reminder of the amount of work that must be done to protect women’s safety and dignity in our society. It is a call for action to all of us to take a stance against these crimes and endeavor to make the world a safer, more equitable place. We should be motivated to work toward a society in which tragedies like this are a thing of the past in the memory of another Nirbhaya. The respect to treating doctors/nurses needs to be restored so that violence in any healthcare facility is prevented.

Jai Hind.

Anil K Jain

Lt Gen (Dr) Velu Nair