Patient Abuse

Synopsis

The present article comprehensively discusses the concept of patient abuse and neglect and throws light upon the current state of healthcare facilities in India. Going further, the Article then examines the right to health and right against inhuman treatment on an international level and in India as well. The article then deliberates upon some out of many instances of patient abuse in India displaying the current system of health care and the urgent need for reforms.

Introduction

"Patient experience is at the heart of healthcare," – Jason wolf

The quote above rightly reiterates the need to ensure the best possible experience for a patient engaging in services of any sort of health care facility. Time and again, the governments and the society in general, has emphasised upon the need to show compassion and gratitude towards those who stand in the front-line to save people lives and treat their ailments to provide them with the best experience.

Even though there is a duty conferred upon these service providers in the health care industry to treat patients with paramount care and support, countless incidents of ill-treatments and abuse occur in these health care facilities but only some make the headline news.

Extensive amount of cases relating to abuses and neglect against patients and individuals under medical supervision are reported in health care facilities, juvenile detention centres, orphanages, drug treatment centres, and social rehabilitation centres. However, often in these health care settings, the service providers may be compelled to take on treatments that negligently or intentionally cause severe pain or suffering for no legitimate medical purpose.

Patient abuse is any act or omission on part of a hospital, clinic or other health care facility which causes unreasonable misery, suffering or harm to a patient. The abuse may be physical, sexual, verbal or mental and may include intentional withholding of necessary food, physical care and medical attention to the patient. The broader term also includes patient neglect, that is, failure to attend to the needs and care of a patient in an optimum manner or causing of injury to a patient unintentionally, whether by act or omission.

Physical Abuse

It refers to the non-accidental or intentional use of force towards a patient in order to inflict injury,pain or impairment. These types of abusesinclude assaults, hitting, shoving and also, confinement and unreasonable administration of drugs.

Unknown marks of injury and bruises, broken bones, marks of restraint, fear of being alone are some signs of physical abuse. Elderly people, juveniles and other at-risk adults are often more vulnerable to physical abuses.

Mental or emotional abuse

When verbal or non-verbal methods employed by a health care provider causes emotional pain or mental trauma, it can be referred to as mental abuse. Ignorance, harsh words, isolation from the community and threats are some methods of causing mental or emotional abuse.

Sexual abuse

Any non-consensual sexual contact with a patient amounts to sexual abuse. At-risk and vulnerable patients often find it difficult to even report or remember the abuse suffered by them. The signs of sexual abuse may be physical or emotional such as bruises on private parts of the body, unidentified vaginal bleeding, STDs, depression and withdrawal symptoms among many others.

Neglect

Neglect is a pattern ofunintentional conduct of a health care provider resulting in the deprivation or excessive delay of food, water, medication, medical services, adequate shelter, or other services necessary to maintain the patient’s physical or mental healthand can often occur in addition to other types of patient abuses.

Unusual weight loss, physical problems, unsanitary or unsafe or unsafe living conditions ignorance or lack of attention are some signs of patient neglect.

International Conventions On Right To Health And Medical Care And Patient Abuse

The Constitution of World Health Organization(WHO) envisages the highest attainable standard of health as a fundamental right of every human being.

Right to health is one of a set of internationally agreed human rights recognized under the Universal Declaration on Human Rights, 1948 and includes and transcends the right to medical care therein.

Right to procure attainable standards of health has been enshrined under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) along with emphasis on creation of conditions to assure all possible medical services and attention in event of sickness.

Medical care which makes the patient subjected to severe pain and suffering for no justifiable reason can be referred to as cruel and inhuman treatment and when there is a specific intent to perform such actions, it can be termed as torture.

The International Covenant on Civil and Political Rights(ICCPR) has embraced the right against torture and other cruel, inhuman or degrading treatment (CIDT) under Article 7 of the Covenant. In particular, no one shall be subjected without his free consent to medical or scientific experimentation."

The UN Human Rights Committee stresses on the fact that Article 7 of ICCPR protectspatients in teaching and medical institutions, in particular. Also, The UN Manual on Reporting underlines that  "Article 7 protects not only detainees from ill-treatment by public authorities or by persons acting outside or without any official authority but also in general any person. This point is of particular relevance in situations concerningpatients in medical institutions, whether public or private."

Indian Perspective On The Right To Health

The Indian Constitution has integrated provisions that guarantee the right to the highest attainable standard of physical and mental health within the right to life and personal liberty under Article 21. The Supreme Court of India has ruled that Article 21 includes within its ambit the right to live with human dignity and protection of health and the state shall endeavour to protect and provides health care facilities in accordance with the Directive Principles Of State Policy under Part IV of the Constitution.

Also, in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (AIR 1996 SC 2426), it was observed by the Apex Court that failure of a government hospital to provide a patient timely medical treatment results in violation of the patient’s right to life. 

Several PILs are continuously being filedin regard to violations of the right to health on account of failure to provide special treatment to children in juvenile centres, inhuman conditions in hospital and after care homes, non-consensual medical experimentations, refusal to take in patients, sexual and mental abuse and many more.

Especially in India, people in dire need of medical aid, mainly those who are poor or uneducated, are refused treatment or provided with worst quality of treatment in hospitals. The families of the patients which can afford high-qualitymedical care are exploited just to mint money out of their pockets.

In the prevailing state of health conditions and facilities owing to the ongoing global pandemic, which by the way,aredeteriorating at the speed of light, people across the globe are being subjected to patient abuse and neglect in health care facilities because of factors such lack of specialization in treatments, surge in coronavirus cases, scarcity of beds in hospitals, inexperience of medical professionals, incapacity to pay bills due to loss of livelihood, etc. which has in turn, lead to major violations of their right to health.

Some Instances Of Patient Abuse And Neglect

Food served on floor to woman with fractured arm

In 2016, a woman named Palmati Devi, admitted to the orthopaedic ward of Jharkhand’s biggest government hospital, Ranchi Institute of Medical Sciences having an annual budget of over 300 crores, was denied a plate to eat her meal compelling her to eat off the food served on the floor. The Director of the hospital assured inquiry into the matter and informed that it is not a common practice there.

The Chief Minister of Jharkhand at the time, also ordered inquiry and guaranteed that stringent action will be taken against the persons responsible for such abuse.

Refusal to arrange mortuary van by hospital authorities

A tribal man in Odisha was compelled to carry his dead wife’s body on his shoulder from the hospital where she had undergone treatment, to their village(approximately 60 kilometres), as the hospital did not offer any help to arrange for mortuary van even after repeated requests of the tribal man. However, locals informed the District Collector and an ambulance was arranged soon thereafter.

Abuse during childbirth

In India, SCs, STs and people from low-income groups prefer home deliveries as opposed to delivering a child in hospitals just to prevent patient abuse in government hospitals. Otherwise, Public/ government hospitals are preferred as they cannot afford private health care. Many instances of dreadful violence in labour rooms during institutional deliveries occur every now and then, which mostly go unreported in remote areas. The worst form of such violence is refusal to admit a pregnant patient irrespective of the gravity of the situation. Nineteen such matters have been reported in 2018-19 across various states in and around Delhi.

In UP’s Bijnor district, a pregnant woman was referred to Meerut Medical College as her husband didn’t have Rs 4,000 to pay as bribe to the hospital staff. She had to deliver the child outside the hospital while she was waiting for a bus to the medical college, leading to unfortunate death of the child due to head injury.     

Elderly Man Tied up for non-payment of medical bills

In a very fresh incident of patient abuse in Shajapur District of Madhya Pradesh, limbs of Mr. Laxmi Narayan, a man of about 80 years of age were tied to a hospital bed as he could not settle his medical bills. He was also denied of proper food and medical care for three to four days. The daughter of the patient claimed to have paid some amount at time of admission but accepts that she couldn’t pay the entire bill as they had suffered losses due to the ongoing coronavirus pandemic.

The hospital authorities tried to defend themselves by stating that the act was a precautionary measure to stop the patient from hurting himself as he was suffering from convulsions due to an electrolyte imbalance. The Chief Minister of Madhya Pradesh and District Collector of Shajapur District assured that stringent measures will be undertaken against the hospital for such inhuman treatment.

The above incidents and many others raise a question over the right to dignified medical care which is a basic human right and ethical and humanitarian values of the medical fraternity.

Conclusion

Especially when the health care industry is expected to operate at its best, more and more cases of patient abuse and denial of medical care are being reported throughout the world. Through this article, I have attempted to deliberate upon the right to health and the need to reprimand those who exhibit inhumane and unethical behaviour against patients in health care facilities, while reiterating on the necessityof proper medical care facilities and humanity in the heart of the health care professionals.