TNM spoke to a few doctors to understand what such attacks do for their morale, especially at a time when healthcare workers have been on the frontlines of the COVID-19 pandemic.

A doctor wears a mask and surgical cap with a stethoscope around his coat Picxy.com/DREAMWORKS
news Health Wednesday, July 07, 2021 - 17:06

This story is a part of the TNM COVID-19 reporting project. To support this project, make a payment here

It’s been more than a month since Dr Priyadarshini was assaulted by a family member of her patient. The incident on May 23 during the peak of the second COVID-19 wave left her rattled but hasn’t shaken her determination to continue doing her job. “Right now it’s been quite a long time. I am back to my normal duties. That memory has faded away a little bit,” she says.

Dr Priyadarshini had been posted at the COVID-19 ward in the Vijayanagar Institute of Medical Sciences (VIMS), Ballari in Karnataka. One of her patients — a 65-year-old man who had a cardiac condition and COVID-19 — suffered a heart attack and died despite her attempts to revive him. When she broke the news of his death to his relatives, she was assaulted by his son. The attack that was captured on CCTV camera showed the young doctor in PPE standing by the bedside of the elderly patient who had passed away. With her back to the camera, Dr Priyadarshini is seen counselling two of the patient’s relatives, when one of the men hits her across the face, the force of which causes the doctor to fall on the bed. While she moves away, her attacker continues to threaten her and attempts to assault her, even as other staff come forward to help Dr Priyadarshini. 

The video of the assault went viral on social media and triggered outrage among other doctors and healthcare workers. While Dr Priyadarshini’s attacker was arrested and later let out on bail, she admits that the assault left her feeling anxious for a few weeks, fearful of another attack. “Initially, for one or two weeks, I was apprehensive. Whenever I used to step out, I used to look out to see if someone was coming (behind me). Every time I stepped out, I would look out for people on bikes with bottles,” she says. 

Increasing number of attacks 

Karnataka alone has seen at least 11 incidents of assaults on doctors and healthcare workers in 10 months, according to the Karnataka Association of Resident Doctors (KARD). The attacks range from mobs vandalising hospital property and setting an ambulance on fire to physical assaults and verbal abuse against doctors, nurses and anyone wearing a PPE by attenders of patients. Violence against doctors, nurses and paramedical staff have been reported from across India. In June, a junior doctor in Andhra Pradesh suffered injuries after being attacked by a group of 12 men for performing a post-mortem on their deceased relative. 

In most cases, the attacks take place after doctors inform the patient’s attender of their death. 

Take the June 2021 case of Dr Rahul Mathew, who was attacked by a policeman for declaring his mother as ‘brought dead’ in Kerala’s Mavelikkara district hospital. In Telangana, two doctors at Gandhi Hospital in Hyderabad had plastic and steel chairs thrown at them in June last year after the death of a COVID-19 patient. Tamil Nadu has also seen violence unleashed on its frontline workers, with at least one case reported in May of an attender attacking a doctor in Dharmapuri following the patient's death, and another case in Coimbatore last month where a doctor and other staff were assaulted with logs and stones by a deceased patient’s relatives over treatment expenses. 

Many doctors say that while physical assaults were reported prior to the pandemic as well, COVID-19 has exacerbated the situation, putting many healthcare professionals in harm's way. 

Dr Namratha C, President of Karnataka Association of Resident Doctors, points to the severe shortage of human resources and hospital resources during the COVID-19 pandemic as one of the reasons for the spurt in such attacks. “With the shortage of human resources, and shortage of hospital resources, we aren't able to do anything besides what we have done already. For example, if a person comes to Casualty with shortness of breath, what we have to immediately do is put him on a ventilator. But if we don't have a ventilator, what else can we do besides referring the patient to another hospital? So while referring the patient, he/she may die on the way, so that causes enragement,” she explains.  

With a majority of assaults taking place after the demise of a patient, doctors say that family members are unable to come to terms with the death and instead lash out. Dr Sanjeev Singh Yadav, Vice President of Indian Medical Association (IMA) Telangana, says, “The most common reason for attacks on doctors is lack of understanding by the patient’s attender. They are trying to vent their feelings if they see somebody die. They won’t understand the situation under which we are working. There could also be another reason, where they don’t understand the gravity of the situation.”

Dr Priyadarshini concurs, “People don’t get us. They don’t understand what doctors go through.” She says that in her case, the patient’s family accused her of negligence. She recalls, "The attenders thought there was something that we could have done to save the patient. But from my point of view, I tried everything, I tried CPR and declared death.” 

Most of the assaults are reported from the ICU, and Casualty or Emergency wards of government hospitals. Dr Namratha observes that half-knowledge on the medical situation of a patient is another reason for the rise in such incidents. “People start googling their symptoms. They assume things and then they get disgruntled with the opinion of medical doctors,” she explains, adding, “We counsel the patient’s attendant before breaking the news to them. People expect us to tell them what they expect. They expect miracles to happen. Some miracles do happen but that happens on a scientific ground.” 

And although physical assaults like the one Dr Priyadarshini experienced are the ones that come to the public’s attention, all doctors TNM spoke to say that they face verbal abuse on a daily basis. Dr Rahul Roy, President of the Andhra Pradesh Junior Doctors Association (APJUDA), says, “Many attacks go unnoticed. If it is a brutal attack, it comes in the media. But verbal attacks happen every day. But they go unnoticed. Even verbal abuse causes us mental disturbance.”

Dr V Naveen, President of the Telangana Junior Doctors Association (TJUDA) also says, “We see people using unparliamentary language against us. This occurs daily. Physical assaults may not occur daily but I consider this (verbal abuse) as assault. If they can raise their voice against doctors, they can raise their hand against us.”

Declaring deaths 

But what do such attacks on doctors do for the morale of healthcare workers? Do they fear being assaulted when informing a patient’s loved one or attender of their death? 

Following the assault, Dr Priyadarshini says that she felt a sense of betrayal. “I was not posted in COVID-19 duty, as a concession. The hospital knew that I won't be able to put forth my 100%. At that point of time, there was a betrayal that I felt. I was standing in that ward, with all those patients I know by their first name. When that attender came to hit me, none of the others attenders came forward to help me. That betrayal was there. So that is something I cannot come out of. I can forget the attender, but that thing will never go away because no matter how much we do, people will never think of us as one of their own,” she says.  

Dr Naveen asks, “Won’t it be demotivating to anyone who does service and who in return gets these bad experiences? As doctors we think we will get good respect.” 

The Telangana doctor explains that breaking the news of a death to a patient's family is always a delicate issue, but especially so in a government hospital that sees hundreds of patients. “We don’t know how they will receive the death. In private colleges, if something happens there are bouncers (to protect the staff). But in government colleges, we are scared to announce any death. Some attenders understand that death is inevitable and can happen at any time. But some attenders, how ever much we counsel them, they can’t accept it.” 

The sentiment is shared by Dr Rahul of APJUDA. “Every day in Casualty or in the ICU, during our duty days, we sit with our fingers crossed until our duty gets over. We don’t know what kind of condition the patient will be in. Most of the road traffic accident patients are drunk and their relatives are also drunk. So there the argument starts,” he observes. 

Dr Namratha points out that declaring death is never easy. “When the patient is a young person, it is very difficult. It’s heavy hearted for us. We can’t see a young patient who is our age dying before our own eyes.” She, however, says that as doctors they know that informing a patient’s attender of death is part of their job. “When I have chosen the profession, we can’t run away from it. We have to face it. And you have to learn to deal with it,” says the Bengaluru-based doctor.  

Legal cell and a central law

Following most physical assaults, doctor associations go on strike, boycotting services for an hour or more, demanding action against the attacker or seeking better security. Relief, however, is temporary, say doctors. 

Several states have passed the Protection Of Medicare Service Persons And Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, which prohibits violence against doctors and other healthcare workers. However, with awareness of the law among police personnel often poor, medical professionals have been demanding that the Union government pass legislation which will punish persons who assault doctors and other healthcare workers. One such draft legislation, the Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage of Property) Bill, proposed an imprisonment of up to 10 years and a Rs 10 lakh fine. However, the Bill, which was to be introduced in the winter session of Parliament in 2019, was rejected by the Ministry of Home Affairs.

Dr Sanjeev, VP of IMA Telangana says, “We are easy targets without protection, that is why these attacks happen. That’s why we are asking the Government of India to pass the legislation in Parliament.” Under the existing state law in Telangana, persons attacking medical professionals can get a punishment of up to three years and a fine of up to Rs 50,000. This means that on many occasions, offenders are not arrested as it is below the prescribed punishment of seven years. Dr Sanjeev says they are also demanding a hefty fine be imposed on offenders, so as to recover costs of any loss of medical equipment.    

One of the key demands of the Karnataka Association of Resident Doctors is the formation of a legal cell. “All the assaults that have happened, FIRs are not registered,” says Dr Namratha, President of KARD. She explains that many doctors don’t come forward to file police complaints. “Fighting legally is cumbersome and a long process. So people don’t come forward to do that. When we are working for the government, they should take the responsibility. We are demanding the formation of a legal cell, which has the Health Minister, and at the district level, and at the state level, advocates who will take forward our case. If a punishment is implemented, society will get awareness regarding this. All these things need strict legal action,” says Dr Namratha.  

Dr Sumit Periwal, a Sikkim-based doctor, who came under attack in 2017 has been at the forefront of a six-year-long campaign seeking a Central law to protect doctors and all medical professionals. “I too have faced the wrath of the mob. Doctors today, including me, are discouraging people to join the medical profession. Doctors get frustrated and want to leave the profession due to daily assaults, verbal assault is a daily affair. Trust me, many doctors feel this way. It is extremely demoralising to see these attacks and no strong action by the government. The man who assaulted a doctor in Hooghly recently told TV news cameras that he was proud of assaulting the doctor and will do it again. He had no remorse because he knows nothing can happen to him in India. That’s why we need a strong law,” he says. 

But more stringent punishment will not serve as a deterrent for such crimes, says Nikita Sonavane, lawyer and co-founder of the Criminal Justice and Accountability Project based out of Bhopal. Pointing to similar arguments being made for the death penalty in rape cases, she says, “Even if there were to be a more stringent law, which for argument’s sake the punishment is increased to more than seven years, if there are family members who are disgruntled with the quality of care and their relatives have lost their lives and they have no other place to address their grievance, they will resort to these ways. You can keep increasing the punishment, but it’s not going to do anything to address the question of violence against doctors.” 

Nikita points to flaws in the criminal justice system and the public healthcare system, observing that this is an ‘apples and oranges problem’. “These are ultimately grieving family members in most cases who have lost their lives who are lashing out. While this violence against doctors or any kind of assault on them cannot be justified, I think the lashing out is a result of the fact that there is no mechanism of accountability beyond criminal law that exists,” she argues, noting that even for families wishing to pursue medical negligence cases, it is a laborious process.  

“We have made criminal law central to a system that has multiple prongs which rests on questions of care, a failing public healthcare system, lack of means and accountability. This means that everybody is saddled with a system which we have established for far graver offences, also doesn’t work,” she says. And while the lawyer says that she understands the frustration of offenders getting away with bail, Nikita explains that in cases where the punishment is a maximum of three years, arrests are not mandatory and a bail is a right. “I dont think it's crime versus punishment. It’s a question of overcriminalization.”   

Doctors like Priyadarshini who have come under attack while in the line of duty, say that their only demand is for people to see things from their point of view and to realise that they, too, are human. She says, “We are expected to empathise with them each step of the way. Death is not an easy thing to declare. I know a life has been lost, I know a father or brother has been lost. But those people don't empathise with us — that we are also someone’s sister, or someone’s mother.” 

This story is a part of the TNM COVID-19 reporting project. To support this project, make a payment here

 

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