Recently, a very senior surgeon from a north Kashmir town was manhandled by an irate mob whose relative he had operated upon. The patient had developed a common postoperative complication, for which he needed specialised, institution-based care, and another surgery. The patient undoubtedly was in a serious condition at the time of the episode.
The relatives had apparently trooped to the doctor’s clinic, and broken furniture and attacked the staff before beating him up – a scene replayed when the doctor fled to another hospital. Later, the doctor was taken into custody by the local police, and released after a couple of days.
The surgery performed on this patient was a very common laparoscopic procedure (key-hole surgery) for removing diseased gall bladders. The complication most encountered (0.6-0.9 per cent) in this procedure is injury to the bile ducts – the tubes that connect the liver to the lower intestine. As a result, the patient may develop a number of post-operative problems, such as jaundice, infection, and long-term liver damage. Surgeons are trained to prevent such injuries, yet they can occur, even in the best of hands, particularly if the sterile conditions needed for the procedure are not strictly maintained. It is a testament to the training and adaptive skills of surgeons that the incidence of such injuries has fallen since the 1990s, when laparoscopy was first used, to the present low of 0.6-0.9 per cent, depending on institutional experience. Yet, despite the best of skills, the best of preparations, and, certainly, the best of intentions, such complications occur.
It is the reaction to these complications that needs to be addressed by the Government of Jammu and Kashmir. It is not appropriate for relatives to go on a rampage and damage the property and livelihoods of doctors, and put the lives of other patients at risk, without taking proper recourse to law. All doctors, unfortunately, fall under the Consumer Protection Act, and, hence, their work is subject to judicial scrutiny. That should be enough for most patients and their relatives, as the law has recently been taking a very severe view of the medical profession. Many doctors have found themselves behind bars, with serious jail terms, hefty fines, and revoked licenses. Can such penalties be imagined for shopkeepers who sell counterfeit, unhealthy foods openly? Or truckers who put hundreds of lives at risk on the highways with their rash driving? No shopkeeper has been asked to wind up his business and start afresh, and no driver has had his truck confiscated or license snatched for rash driving. But doctors, whose sole intention is to treat patients, find themselves in jail when something goes wrong. Such is the state of law enforcement in Kashmir that even in civil cases the police finds itself pressured to act first and ask questions afterwards.
Doctors will naturally retreat to their zones of security. They will not operate on patients in rural areas, they will not take up risky cases, and will keep on referring patients to Srinagar, putting further stress on its already overburdened hospitals. The ultimate sufferers are patients themselves.
No treatment is perfect, no human is perfect either, and no two humans are similar. Each person’s body reacts to a disease process in his/her unique way, most of the times unpredictably so. That’s why there are people who have smoked thousands of cigarettes showing no signs of cancer and living into their 80s, and there are heavy smokers dying of cancer in their late 30s. Our genes are unique to us alone, and by extending the argument, everyone’s internal anatomy is unique too. Hence, some surgeries can be performed easily and without much complication, like removing an appendix or repairing a hernia, but, others require higher levels of skill and patience.
The law must act both ways. One, patients should be clearly briefed on the consequences of their treatment. The Supreme Court has held that the rarest complications need not be routinely explained. An explicit, legal consent form should be available at all hospitals, testifying that patients and their relatives have clearly understood the surgery, the procedure, and its consequences. Two, patients and their relatives need to be restrained, in the strictest possible manner, from attacking members of the medical profession and their property. Recently, Queensland, in Australia, came out with a strict law against attacks on medical professionals in ambulances – jail sentences of up to 12 years can now be handed out to anyone who even just slaps a medic. Gujarat and Orissa already have their medical services protection bills, which entail jail-terms of three years and fines of up to Rs 50,000 for damage or loss to property. Jammu and Kashmir has nothing. No wonder doctors are lured into practising in urban areas, where the protection is better in terms of larger hospitals, and more staff.
Unless their lives and livelihoods are protected by law, doctors will always tread the path of the least risk, and save themselves, as opposed to saving patients.