OPINIONS

Opinion: Designate me a ‘Public Servant’

Monday, March 20, 2017

by Dr Neeraj Nagpal

Respected Prime Minister Shri Narendra Modi ji,

Violence against doctors has assumed epidemic proportions and unfortunately it is condoned and sometimes even instigated by public officials. Leave aside the demoralizing effect, physical hurt and economic loss to the doctors, there is extreme danger to other patients admitted or being treated in the facility where such violence occurs. There have been cases of death having occurred while medical staff was involved in altercation with another patient’s relatives as happened at PGIMER recently.

Dr Neeraj Nagpal

There are 19 states in the country, which have the Prevention of Violence Against Medicare Persons and Medicare Institutions Act notified. Unfortunately, these Acts have remained on paper as despite daily incidents occurring in nearly every state, nowhere has the law been used to prosecute miscreants in more than 1% cases if at all. Police officials are not aware of these laws despite they being notified for upto nine years in some states. IPC and CrPC are what the police are trained in and what are followed by the rank and file.

The condonation of such violence stems from the justification apportioned to the death or deterioration in health of relative of the perpetrators of violence. However, if any violence or assault, which is committed due to a grievance, were pardonable then our criminal courts would be empty. Any murder which is committed is committed due to a motive, a grievance or as a revenge for some perceived wrong. Then all these criminal acts which are provoked should be condoned at the outset. Police refuse to file cases against perpetrators of violence in clinics and nursing homes or threaten them with cross FIRs for criminal negligence in treatment.

How is it that a litigant who loses his case in a court of law even if he perceives the judicial system to be biased, unfair and even corrupt, he never indulges in violence or assaults the judge or his advocate in court. It is the fear that prosecution for such action would be swift and harsh. Unfortunately, the same does not apply to such violence in hospitals and clinics.

Doctors, even private doctors, are called upon to perform public service by becoming involved in various government programs. They fulfil duties of Government by providing healthcare to the masses at affordable costs and sometimes even free of cost in emergencies. Healthcare establishments are public places where anyone can walk in or can be brought by bystanders as per the Clinical Establishments Act and expect medical emergencies to be stabilized irrespective of whether any payment is made or promised or not. By virtue of being a noble profession, it has been differentiated from being a trade by various authoritative court judgments. We request you to accord them the privilege of being designated “public servants” so that if assaulted on duty Section 332 and 333 of IPC can be invoked.

When I am dragged outside from my operation theatre my patient on the OT table will also suffer. When I am assaulted, restrained, hurt while on duty other patients, my staff members and the public in general who depend on me are also put at risk. They are the “public” and my service to them, whether paid or free, still remains service and I their “service provider” or in other words a “Public Servant”.

I request you to designate all doctors, even if they work in private sector hospitals or their own clinics, as “public servants” for purpose of Sections 332, 333 & 353 of the Indian Penal Code. This will put a fear in the minds of miscreants and hopefully make the police officials recognize this growing malady, which may have disastrous consequences for the medical profession and the society.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Managing Director, MLAG Indemnity
Ex-President, IMA Chandigarh
Director, Hope Gastrointestinal Diagnostic Clinic, Chandigarh

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2 Comments »

Comment by Dr.Bina R Sawhney
2017-03-20 11:23:17

very good idea, Sir
Instead of asking for security of doctors, this is what we should be asking.

 
Comment by R N Sen
2017-03-23 03:52:49

Activities of miscreants are no way encouraged , but why is happening and on a rise??? Have you ever thought of, why litigation cases of medical negligence are increasing day by day?? do you agree that, clinical eye, experience, attention to details during physical examination of a patient ( keeping in view his /her medical history) , which used to be possessed by fraternity earlier days, is it available with present day young generation?? In addition to this, trained from Russia/China, some of them might have acquired degree in an improper way, never resisted by good minded medical fraternity, who are in fact the whistle blowers. Pl refer the article : “The other side of the moon, where Atlas has …………” by Dr Sundeep Mishra, Editor of Indian Heart Journal, in Jan-Fen 2015. I ref one real case, and then tell me, is it pardonable? But , the relatives of this case, never attacked the team who were responsible..
1) In 2014, a 57 yrs old pt, known case of HOCM( of course diastolic dysfunction) and PH, Pulmonary congestion, was managing compromised quality of life with these conditions. In May 2014, developed atypical Pneumonia ( TLC normal, afebrile) was managed by cardiologist/ chest physician and other specialties and had much improvement. As it is known, in HOCM pt. is dependent on elevated preload and afterload ( reduction of these increases obstruction, that is why earlier days it used to be called Idiopathic Hypertrophic Subarotic Stenosis, IHSS ) and reduced contractility, so to be managed cautiously, unlike normal approach of management , of CHF, DCM and so on. Diuretics to be avoided, if at all required, with a very low dose titration( in case of oedema documented), positive Ionotropes like dopamine are contraindicated, nitrates which reduces venous return not to be used, and so on; that is why its rare disease , in USA its prerelevance is 1 in 500. This pt. had complaint of SOB in Nov 14 , and all those negative issues as indicated above, were done , and in addition , hypokalemia of 2.7 was attempted correction by both oral and IV Kcl, and with K+ sparing Diuretic Spriolactone 50 mg with Torsemide 20 mg , in absence of any life threatening issue like VT/VF/ TdP in ECG . Even when the pt had K+ of 3.9 mmol , IV Kcl was continued for another 7 hrs and again in between oral Kcl 2tsf, one more time. if you calculate, deficit was 4.5 gms and documented order is for 9 gms!!!!!! Can you support this protocol in any way? Starting point was doc trained from Russia and from Bihar ( in 1990), The pt. had asystole within 24hrs of admission with hemoptysis.
Just think about, you had been to any CME , and after returning/ during stay, your wife/daughter/son passes away in the way I have depicted above, what will be your first reaction? Again I say miscreant’s activity is not supported, but if you are in that place, may be you also might have a sudden uncontrolled outburst, and I think , that happens in case of relatives of deceased , which is increasing due to reasons , as i mentioned above.
One more issue, as you said, declaring as public servant, those IPC clauses can be invoked, in that case clause 304A in case of negligence has to be changed to 302, as dual facility without accountability can not run together…

with Regards….

 
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