On April 19, at around 2pm, Dr. Hilal Azad, a second year postgraduate doctor from the department of surgery in SMHS, was walking along with the Registrar when a man suddenly appeared in front of them. The attendant of a diseased female patient, who had earlier expired in SMHS, then pulled out a knife like object from his shirt and tried to assault the doctor. The young doctor, who survived the assault, is in a state of shock since then. And he’s afraid, too.
“I was saved by the Registrar who was walking with me that time,” says the terrified doctor.  The person who attacked him turned out to be the attendant of an 80-year old female patient of Habakadal. She was admitted with Stage -IV colon cancer in Emergency ward of SMHS Hospital some time back.  Due to poor health, the women expired soon after. “She was in shock when she was admitted in the hospital,” says Dr. Hilal. “We resuscitated the patient and shifted her to the theatre where she expired,” he says.
Even at that time, the doctor recalls, the attendants barged inside the theatre, and started beating up the doctors and operation theatre assistants. “They were around 20-25 attendants and they starting beating us and did not even allow us to speak,” he says. “After half an hour the police came and took us away.”
This is not the first time doctor was attempted to assault. Such incidents have been on the rise in the valley in the recent past.  Recently, in another case, a surgeon at District Hospital Islamabad (Anantnag) was reportedly beaten by the people. Reason: a patient had to be referred to Srinagar for the CT scan of Head as the facility is unavailable in the hospital.
“Doctors are also human beings and there are chances they fault at occasions, but no matter how worse a doctor is, he will never play with the life of a patient,” says Dr. Muzzafar Malik, a surgeon posted in a government health centre in South Kashmir. “The life of a patient is always of prime importance to any doctor.”  He says some unfortunate instances turn so ugly that the doctors are beaten to pulp by the angry attendants for no fault of theirs, and even their life is threatened at times. “The lives of medical professionals are at stake here; time and again there are assaults by the attendants, and there is lack of security,” he says.
Dr. Muzzafar says recently a lady Assistant Surgeons at Banihal Hospital and District Hospital Baramula were beaten up, and then arrested for death of females after they delivered a baby. “But you have to understand that there is a complication called Post Partum Haemorrhage, where a female can profusely bleed after the delivery of a child which in any setup of the world can prove fatal,” he explains.
Giving another recent example, he says a doctor was tried for negligence for poisoning a patient who had reported to the hospital in a comatose state and was convulsing (in itself a bad prognostic factor). “The relatives of the deceased raise a hue and cry only to save themselves from the after effects of that poisoning issue,” he says.
The Supreme Court recently came up with a clear ruling against the harassment of doctors. Noting that frivolous complaints against doctors have increased, the Supreme Court held that the police cannot arrest doctors over complaints of medical negligence without prima facie evidence. The apex court also restrained courts, including consumer fora, from issuing notices to doctors for alleged medical negligence without seeking an opinion from experts. “While this court has no sympathy for doctors who are negligent, it must also be said that frivolous complaints against doctors have increased by leaps and bounds in our country particularly after the medical profession was placed within the purview of the Consumer Protection Act,” the court said.
The bench, consisting of Justices Markandey Katju and R.M. Lodha, said that a medical practitioner is not liable to be held negligent “simply because things went wrong from a mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another. He would be liable only where his conduct fell below the standards of a reasonably competent practitioner in his field.”
The Bench further observed that, “the courts and consumer fora are not experts in medical science and must not substitute their own views for that of specialists. It is true that the medical profession has to an extent become commercialised and there are many doctors who depart from the Hippocratic oath for their selfish ends of making money. However, the entire medical fraternity cannot be blamed or branded as lacking in integrity or competence just because of some bad apples.” Sometimes, despite the best effort, the treatment of a doctor fails. “For instance, sometimes despite the best effort of a surgeon, the patient dies. That does not mean that the doctor or the surgeon must be held guilty of medical negligence, unless there is some strong evidence to suggest that he is,” the bench observed.
The Bench further ruled that courts must first refer complaints of medical negligence to a competent doctor or a panel of experts in the field, before issuing notice to the allegedly negligent doctor. “This is necessary to avoid harassment to doctors who may not be ultimately found to be negligent. We further warn the police officials not to arrest or harass doctors unless the facts clearly come within the parameter laid down in Jacob Mathew’s case, otherwise the policemen will themselves have to face legal action,” the apex court said.
The doctors admit that they can make mistakes, but it is never intentional as they value the life of the patient. “The medical fraternity of Kashmir has worked in one of the most difficult times and served people in most hostile situations when other people used to stay indoors,” says Dr. Muzzafar. The 2010 uprising, he says, is the latest example. “I and my colleagues, putting our lives at risk, braved the CRPF, Police and even the angry people to come out regularly even in stone pelting and even when strict curfews were in place,” he says. “We attended to our duties and never hesitated from treating the injured,” he adds.
Dr. Muzzafar says lack of infrastructure in the district hospitals compounds the problems. “When there’s a huge inflow of patients, what is the doctor supposed to do?” he asks. “And then the doctor feels insecure as the attendants can anytime beat him up at will.”
“Supreme Court has given a ruling that you cannot arrest a doctor for negligence till the time he is not held responsible by a medical team investigating that particular case,” he says, adding that in case of proven medical negligence, the doctors should be punished. “But for that you have to follow a proper protocol, and take the matter to the medical team. But here in our valley all rules and legislations are put aside,” he rues. 
If doctors are not allowed to work in a secure environment, he says, they will be afraid of prescribing medicine even for a simple headache. “People need to understand that a doctor can make mistakes, but no doctor would want to deliberately harm the patient,” he says.
Dr. Gowhar Yaqub, a dental surgeon posted in Anantnag, says recently a patient, who was dated for surgery in a government hospital, died before he could be properly examined. “The doctor had not even touched the patient, but the attendants levelled allegations against the doctors and the doctor was harassed,” he says. When a doctor is picked up from the hospital by the police, he says, it affects his work and his image as a doctor, and instils fear in him.
“If some treatment is counter-productive, it can happen, but you can’t punish a doctor for that as he is trying his best to treat the patient,” he says. “If there is medical negligence, punish the doctor, but only after referring the case to a expert medical committee who will judge if it’s a case of medical negligence that deserves punishment,” he adds.
“Some things are beyond the control of doctors as well,” says Dr. Intikhab Alam, a surgeon working in a government hospital in Srinagar. “After all doctors are not gods,” he says. Some patients can develop complications even after receiving the best treatment.  “Sometimes people here expect immediate relief from pain which is not possible,” he adds. “They don’t have patience. They are not ready to see that their patient can develop complication even after treatment and best efforts of doctors.”
About the recent case of an old patient who was brought to the SMHS hospital in a terminal stage, he says, “Outside our state, hospitals don’t even take such patients. They are taken care of in care centres.” Dr. Intikhab, who also worked as a Registrar in SMHS two years back, says there have been incidents when some attendants accompanying the injured started beating up the doctors just for not getting treated first for their minor injuries. “Doctors can’t work under such circumstances as they will always be apprehensive that the attendants will beat them, or the police will arrest them if anything happens to the patients they are treating,” he says.
The doctors say there a protocol in place which should be followed in case of a medical negligence. “If a team of senior doctors find a doctor guilty of negligence, then he should be punished but you have to follow the protocol,” says Dr. Intikhab. “People can’t take law in their own hands and police can’t judge the doctors. They should ascertain from the senior doctors and seek their views before charging the doctors of medical negligence,” he adds. “Police too should be made aware of these guidelines to be followed in such cases.” Another doctor from SHMS says when the attendants put pressure on the doctor there is a tendency of over-investigation of the patient which is not good.
Director Health Dr Saleem-ur-Rehman says cases of harassment and assault on doctors by the attendants is a worrying trend. He says they have reports of 3-4 such cases that take place every month when attendants rough up the doctors. “People should know that a doctor tries his best to treat the patient,” he says. “But when there is threat of attendants beating up the doctors, they will not be able to work in such conditions where they have to work in fear,” he says. However, he adds, there is no excuse in case of a proven medical negligence. “We take cognizance when a doctor is found to be negligent, and we have punished such doctors in the past,” he informs.
Dr. Saleem says the role of police is to take cognizance of the offence when attendants assault the doctors, but police can not be sympathetic to attendants only and harass the doctors without following the proper protocol. “Our doctors are hard working and they need respect from people and a sense of security,” he says. “If people give them confidence and respect and trust them, they will do everything for the patients,” he assures. “But if doctors are harassed and treated badly, they will be afraid of even treating patients for the fear of repercussions if anything goes wrong,” he says.
The Principal GMC, Dr. Qazi Masood says that there is a lot of rush of patients in the busy causality ward and OPD of hospitals like SMHS. “Because of lack of infrastructure in district hospitals, a lot of patients are referred to SMHS from the districts as well,” he says. “People should have patience as our doctors have to see many patients in a day and treat all of them well,” he says. “When there is emergency cases, people expect their patients to be treated quickly with complete healing. But it takes time and people should have patience to wait,” he says, adding that assault on doctors and harassment cases have also increased in the districts, where doctors are handicapped due to lack of medical facilities.
When it comes to terminal stage patients, Dr. Masood says the attendants should know that there is a possibility that the patient may die despite all the attempts made by the doctors. 
The police officials say the incidents of attendants giving vent to their anger and assaulting doctors is a routine matter. The increased inflow of patients in the Srinagar hospitals like SMHS and SKIMS adds to the already existing woes. “When doctors are forced to see 200 patients a day, such cases are bound to happen,” says a police official. “But when doctors are beaten up by the attendants, we register cases against the attendants,” says a police official from Karan Nagar. “We have registered more cases against attendants than doctors.” he says. “This month we registered two such cases where the attendants of patients had assaulted the doctors.”
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Lastupdate on : Sat, 5 May 2012 21:30:00 Makkah time
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