Indian medics are facing a pincer attack from those afflicted by the 2020-2021 COVID-19 pandemic.
The first is by enraged relatives of deceased claimed by the coronavirus and two, through a series of litigations claiming 'negligence' on the part of doctors for deaths that have occurred in hospitals.
In the last two years, doctors, medical staff, attendants and virtually anyone resembling a hospital employee at any given point of time, have run certain inbuilt professional risks – most notably the probability of an assault in case of the death of a patient in their charge.
Instead of appreciating the logic of nature taking its course or a medical complexity that knows no cure, the blame is apportioned on the hapless medic.
Consider the following:
Frequently Asked Questions
A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.
There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.
Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.
These are a smattering of cases; an equal or more number have gone unreported – or worse unnoticed.
What the law says
Last September, the Parliament passed the Epidemic Diseases Amendment Bill, 2020, bringing in a law that punishes those who attack health workers or doctors fighting the coronavirus outbreak or during any situation like the current COVID-19 pandemic.
It provides for up to five years imprisonment for those who attack doctors and health care personnel.
These corona times, however, even an act of Parliament is no guarantee that a law can be implemented effectively on the ground.
Says Dr Vinay Agrawal, a former national president of the Indian Medical Association (IMA): "When I have to arrange scarce oxygen, manage hospital infrastructure and handle an overload of patients, do I have the time to go a police station to file an FIR? Thousands of bodies were cremated by us because their loved ones preferred not to turn up. There were potentially dangerous situations that I had to tackle, but many of them ended in apologies by other relatives of the deceased. In this melee and confusion, many doctors like me decided to look the other way than pursue the Epidemic Diseases Amendment Bill to its logical conclusions."
Post-COVID, doctors and the medical community is looking at another trend, which can have far-reaching consequences – an increasing number of litigations against medics, health workers and hospitals by relatives and friends of those who have died during the pandemic.
The litigants are citing 'negligence' in coronavirus cases, without considering the spread of the virus, national toll, the global nature of the pandemic and all related features.
While it will take some time for a list of such litigations to emerge, a hint about the trajectory in cases like these is beginning to emerge.
Last month, eight families of patients who died at Delhi’s Jaipur Golden Hospital in April 2021, allegedly due to a dip in oxygen levels, have approached the Delhi High Court for a court-monitored CBI probe into the case. Twenty-one patients undergoing treatment at the hospital had perished, in a case that had made headlines then.
Rising number of cases
Similar cases in other parts of the country have set alarm bells ringing within the medical fraternity. The Indian Academy of Paediatrics (IAP) – an association of over 36,000 practitioners - has recently written to Prime Minister Narendra Modi, requesting his government "to bring an Ordinance or notification to provide legal immunity from litigations for treatments during the COVID period, alleging medical negligence."
``Many doctors have died during duty, looking after COVID patients, and contracting infection unwarily. Nobody can be blamed for such risks, but at least, their sacrifice needs to be acknowledged and remembered,” the petition pleaded.
The paediatricians have quoted the example of the US where such legal immunity has been provided by The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which included provisions that can potentially limit or immunize specific health care providers from liability during the COVID-19 pandemic.
Earlier on March 24, 2020, a US government order had stated: "For health care professionals to feel comfortable serving in expanded capacities on the frontlines of the COVID-19 emergency, it is imperative that they feel shielded from medical tort liability."
India, by all indications, is still some way away from such thoughtful and sensitive legislation.
Says Dr Piyush Gupta, President, IAP: "Doctors are soft target, available on the spot to be confronted, often because there is lack of communication. COVID has accentuated this problem. Given the high levels of infection, a patient must be alone, unlike other diseases where family members are in proximity. So, it is quite likely that a healthy enough patient in the morning has died in the evening. Emotionally charged relatives are naturally traumatised and blame the doctors or hospitals because they have no idea of what happened."
Others like Dileep Mavalankar, currently head of the Indian Institute of Public Health, Gandhinagar, Gujarat, and India’s best known and decorated preventive and social medicine expert, believe that the Indian hospital system – particularly public hospitals – are like fish markets.
"Doctors in India, particularly at public hospitals, are trained as if they are in a bazaar. There are far too many patients and very little staff. Communications are neglected. There are no social workers or managers in hospitals. The doctors are managers and beyond them they have health workers and nurses, all deeply involved in their work and not trained for public relations. So, who will keep the patients and their families informed?"
As for high-end hospitals, their charges are too exorbitant and emotionally distressed relatives of those who have died in the pandemic, have a right to know. There is no one to tell them, Mavalankar points out.
Clearly then, expectation mismatch is a crucial area that needs attention.
Prof. Rajesh Chandwani, Chairperson, Centre for Management of Health Services at the Indian Institute of Management- Ahmedabad (IIM-A), spots this violence and litigation as a growing trend in this part of the world, especially in the last decade or so.
"India’s healthcare system is not public-friendly. What this pandemic has brought in is a new disease and doctors, too, are making sense of this environment. A new disease has new protocols and new medicines, some of which may work, and some may not. All this leads to uncertainty and an expectations mismatch," he points out.
There has to be "clear and frequent communications in a pandemic system when the preventive mechanism does not work, explains Chandwani.
Add to it rumours and uncertainty that create panic in a system, which is already overwhelmed, and the quality of service has deteriorated.
Surely, these are tough times ahead for India’s already brittle health care system. The point is whether substantive reforms can be introduced.