Dealing with Mob Violence?

Dr Nikhil DatarMD DNB FCPS FICOG DGODHA LLB

Dr Nikhil D DatarMD DNB FCPS FICOG DGO DHA LLB

•Medical Director Cloudnine Hospital Mumbai•Founder President Patient Safety Alliance•Health Rights Activist known for his work on MTP Act amendment •Adviser Government of India on E-health•Consultant USAID

When do the relatives lose patience?

Unexpected, unanticipated and sudden death Suspected or perceived negligence Trigger points

Bill Staff behaviour

Naked truth about healthcare

Doctor patient relationship of faith is fractured and GPs have almost vanished

Healthcare has become a commodity Costs of healthcare …High Poor communication and complete lack of informed consent

Sufficient Information Vs Consent Mere signing of a form is not enough to say

that sufficient information is given

Challenges in counselling How much information is sufficient? How to do it without frightening the patient? How to get over the language barrier? How to give sufficient time? How to improve patient recall? How to improve patient experience?

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Perceived lack of care/ Fragmented care

Perceived lack of availability Discounting patient’s concerns Poor delivery of information Mal occurrence suggested by another doctor

---Archieves of internal medicine 1994

Intolerant society Death is a natural consequence of disease

and not medical treatment…. Every unexpected or unanticipated medical

outcome is BECAUSE of the doctors

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Tips :Managing the violent relatives

Tip no 1 – You are under electronic surveillance

Security and bouncers No use during riots

CCTV Easy and cheap Evidence for police/court

Tip no 2 -- Insurance

No body forgets professional indemnity

Insurance for damage to furniture, riot, fire, calamities etc Premium is meagre

Tip no 3 – Rush team

Develop a local “Rush team” of colleagues who can rush to stand by you. Helps communication Prevents manhandling and vandalism

Rules for rush team

Main chair belongs to the “captain” doctor

Communication is the job of captaion’s job. Your role is of a facilitator

Do not take it as an opportunity to settle scores by giving subtle hints to relatives that there was negligence

Intra-op or immediate post op death

Post mortem or death certificate?

Relatives are ready to give an undertaking! Is it OK?

Dr Nikhil Datar

Death CertificateTo Be (given) Or Not To Be

(given)!!

Dr Nikhil D. Datar

NOC for disposal Information to the police Panchanama and statements NOC for disposal of body

Dr Nikhil D. Datar

Sure shot recipe for violence

Dead on arrival… CMO states “Patient serious hai. Yaha kuch nahi ho sakta. Jaldi se bade hospital leke jao”

Patient was taken to another Hospital CMO at that hospital said “patient is dead”

Tip no 5 -- Photographs

Take photographs of the damage done to the property- for court and insurance

Do this before the police (whom you will call) arrives and before the local politician (who will come any way) arrives

Tip 6 -- Medical check up of injured

Send all the injured staff and doctors for medical check-up and first aid preferably to nearby Government hospital

Make MLC in that hospital and preserve all the injury reports

Tip no 7 – Don’t involve politicians

Calling a known politician is a double edged sword May spare you from the particular situation but will take

advantage later

They may be from the side of the miscreants, then they will insist on cleaning the mess and destroying the evidence before photographs are taken

Tip no 8 - Inform the police

Mentions the names of the miscreants if known in the FIR

Otherwise make FIR in the name of “unknown”

Hand over a copy of the CCTV footage so that police can identify the miscreants

Tip no 9 - Insurance company

Immediately inform the insurance agent with photograph and copy of the FIR

Tip no 10 – Keep a copy of the Act!!!

Prevention of violence and damage to property act has been passed by AP. Maharashtra, Orissa, Chattisgarh, Tamilnadu ,Karnataka . Manipur.

Kerala and Bihar were in pipeline

IMA is demanding a central act to this effect

Salient pointsMaharashtra medicare service persons and medicare service

institutions (prevention violence and damage or loss to the property 2009

Commitment, attempt to commit and abetment are all punishable

Imprisonment which can extend to three years with fine which can extend to 50,000/-

Compensation double the amount of loss or as judged by the court

Cognizable, non-bailable and triable by court of judicial magistrate first class

Tip no 11 - Never compromise –

It is non-compoundable

Crime is against the State Parties have no right to “settle” the dispute Requires a writ in the high court

Do not succumb to requests and pressures by politicians or goon to compromise

One miscreant learnt a lesson in Aundh. Hope the word spreads

Policy:Blame free redressal

Effective mechanism of redressal of grivances of consumers must be strengthened…

“Criminalization” of at best “deficiency of services” can’t be accepted at any cost

Zero tolerance against vandalism in healthcare organizations has to be policy decision and strictly implemented

To conclude

Aim at getting the culprits arrested under the act Rush team CCTV camera Photographs Inform Police and keep politician in loop Insurance for infrastructure damage Keep copy of act Never compromise