EDITORIAL: The apparatus of apathy
In 2020, the Madras High Court had upheld the notion of mandatory two-year service in government hospitals for all postgraduate medical students in Tamil Nadu admitted under the All-India Quota.
The death of a teenage footballer named Priya due to medical negligence has called into question the accountability of doctors in government hospitals and that of the safety of patients. The reputation of government hospitals, not just in Tamil Nadu, but across India, has been clouded by reports of unsanitary environments, slipshod work ethic, and in worst cases scenarios, botched surgeries that have ended in patients losing their lives.
In September, the CMO of Aranthangi Government Hospital in Pudukkottai had issued memos to a few staffers after a 53-year-old male patient complained of medical negligence. The accident victim’s leg injury had been cleaned and stitched up by the doctors here. But when the patient subsequently developed intense pain, an X-ray taken at a private hospital revealed the presence of stones in the wound, which hadn’t been properly swabbed out during the first procedure.
Similarly, in August, staffers at a government hospital in Tiruttani were found guilty of gross medical negligence by the TN Human Rights Commission, for leaving a pair of scissors inside a patient’s abdomen. The doctors were pulled up for violating the medical code of ethics and the State was ordered to pay a compensation of Rs 10 lakh to the patient. Other horror stories have also emerged from such State-run facilities. These include reports of a 34-year-old woman in Dindigul losing her leg due to a botched surgery and nurses delivering a still-born baby in Chengalpattu, after being guided via video call by a doctor, who was unavailable.
These recurrent episodes demand a multi-pronged approach that can address the problem from its roots. The general impression regarding government hospitals in most parts of India is dismal. The tag of being a State-run health institution carries the assumption that the facilities and services offered cater to the most economically vulnerable sections, which reflects in the quality of infrastructure and treatment such as post- and pre-operative care, as well as the resources allocated, both material-wise and professionally. Unfortunately, underserved communities have no political or business clout to pull up staffers in the event of a mishap. Even in serious cases, erring doctors or nurses are let off with a slap on the wrist, in the form of a transfer or a temporary suspension of services.
In 2020, the Madras High Court had upheld the notion of mandatory two-year service in government hospitals for all postgraduate medical students in Tamil Nadu admitted under the All-India Quota. Unfortunately, many students serving in these hospitals view this service as a mere formality before moving on to more lucrative careers in private healthcare. A series of strikes in the State by 16,000 government doctors in 2019 had highlighted issues involving periodic salary revision and promotion from the State health department, hiring people as per patient strength, 50% State-wise reservation for PG specialty and super specialty courses (as only 20% of doctors working in government hospitals here are from TN), and transparent counselling during appointment of PG students. Working round the clock in perpetually understaffed hospitals has led to around 16 stress related deaths and two suicides by government doctors in the recent past, which gives us an idea of the nature of this line of work.
There is a requirement to significantly improve our healthcare education and delivery mechanisms. Governments at both the State and Central levels must recognise that access to basic healthcare and treatment should not be considered a luxury for a nation that aims at becoming a $5 trillion economy in the near future.