Open to injury

Doctors recount how close they came to being attacked by patients' relatives

28-Ankit-Fusakele Job risks: Dr Ankit Fusakele was threatened by a patient's attendant at the Jabalpur Medical College.

Soon after her delivery, Anjuly Jerrin, 25, developed postpartum psychosis, and was admitted to a psychiatric nursing home in Nanded, Maharashtra. Dr Mohit Sholapurkar, who runs the nursing home, explained the treatment to the patient and her family. The caregiver signed the consent form and read the rules and regulations of the nursing home. “We gave five sessions of electroconvulsive therapy to her, and she got back to normal,” said Sholapurkar. “She started taking care of her child and lactating it.”

When the caregiver was given the bill on discharge, he pleaded with the doctor to reduce the charges. Considering his socioeconomic status, Sholapurkar waived off the consultation fee. “Then the caregiver got angry without any reason and gathered a mob of 40 people,” said Sholapurkar. The mob refused to pay the bills and threatened to destroy the furniture in his consultation room. “We told them it would be difficult to waive off the entire cost even in a government setup, where they charge Rs35 per day,” said Sholapurkar.

The patient's family assembled more people, some of whom were drunk. The mob brought a bottle of kerosene and poured it around Sholapurkar's cabin. “I was all alone,” he said. “I sensed danger and alerted the medical association.” The mob, however, told him that he could call the police superintendent and that they were ready to go to jail. Sholapurkar somehow managed to escape. But the incident still sends shudders down his spine.

The Indian Medical Association reports that 75 per cent of doctors in India have faced violence at some point in their lives. The situation has escalated to such an extent that surgeons sometimes refuse to do emergency surgeries fearing for their lives.

Patients themselves are not violent, but their relatives are, said Dr Vivek Kadambi, chairman, IMA's National Committee for Functional Medicine. “In government hospitals, poor infrastructure and perceived lack of sympathy by doctors are responsible for patient anxiety,” he said. “Long waiting hours and doctor's behaviour towards patients and relatives contribute to aggression. In corporate hospitals, the financial anxiety and billing opacity create frustration and emotional volatility.”

Dr Ankit Fusakele, secretary of Jabalpur Surgeons Association, has had nightmarish experiences in hospitals. While doing his masters in general surgery at the Jabalpur government medical college, Fusakele attended to a patient with gastrointestinal perforation. He needed a blood transfusion. “It was the resident doctor's responsibility to arrange for blood and make all the arrangements for the operation,” he said. While Fusakele was getting things done, the patient's attendant walked in, grabbed him by his throat and said, “Arranging blood for the patient is your responsibility, not ours.” Fusakele told him that he had been trying to find a blood donor. “He said I was purposely delaying it as I didn't want to do the surgery,” said Fusakele.

By then, Fusakele's colleagues came to his rescue. Together, they found a donor, got blood from a bank, and the patient was operated upon. The surgery went well. “Even after the surgery, I lived in fear. I was told that the patient's relatives were likely to come back to attack me. I was sent on leave. I rejoined only after the patient had stabilised,” said Fusakele.

As legal procedures in India take a long time, patients and their relatives prefer to take the law in their hands to punish the doctor. “They have cleverly learnt to use goons to attack doctors as a mob, knowing well that the hand of the law is weak and mob confusion helps them get away with the assault,” said Kadambi.

The apathy of hospital authorities makes matters worse. Having a grievance redressal system in place could help hospitals prevent attacks on doctors to a great extent. Fusakele said Jabalpur Medical College did not try to beef up security even after the incident. “In government hospitals, you have to take care of yourself,” he said. “If you file an FIR, you will get entangled in a legal muddle. Nobody would want to go through that.”

Added Dr Rohit Shetty, chairman, Narayana Nethralaya, Bengaluru, “Violence against doctors is escalating because there is an increasing belief that the delay in giving treatment or negligence is solely because of the doctors, completely disregarding the system and background infrastructure, which the doctors do not have any control over.”

Even female doctors are not spared. Shraddha Khandelwal, 37, a general and laparoscopic surgeon based in Madhya Pradesh, no longer does emergency surgeries after having done a surgery “at gunpoint”. She once got a call from the casualty around 8pm while she was putting her children—aged 6 years and 10 months—to sleep. She rushed to the hospital. “There were two patients with stab injuries. One of them had died while being brought to the hospital. The other one was 65 years old. His blood pressure was falling, and he was unable to breathe. He was stabbed in the abdomen,” she recalled.

The patient needed emergency surgery. Khandelwal got all the investigations done. By then a mob of 400 people had gathered in the hospital. “Can you give us a 100 per cent guarantee that the patient will be saved?” they asked. Khandelwal said that she would try her best to save him. While she was taking the patient to the operation theatre around midnight, 200 people surrounded the OT and told her, Bach jana chahiye, madam. Nahi toh, dekh lenge (He should be saved, or else).” Khandelwal was the only woman in the OT, which had five people inside, including the anaesthetist and two technicians. The surgery got over by 5am.

“The moment I came out, the mob started questioning me,” said Khandelwal. She told them that the patient would survive, and would be shifted to the ICU in a while. They told her, “We won't let you go home until we see our patient is doing fine.”

The surgery made headlines the next day. “There were interviews with the patient and the hospital management,” recalled Khandelwal. “But nobody bothered to understand what I went through that night. I could have been attacked by the mob anytime.” That was the last time she did an emergency surgery.