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Subir Roy: How sick is our private healthcare?

The horrific AMRI tragedy highlights what is wrong in the way Indians order their lives and do their public duties

Subir Roy 

The 2008 film, The Reader, is about an affair between a teenager and an older woman who, it turns out later, had been a Nazi SS guard. She was one of several who allowed 300 concentration camp prisoners in transit, locked in a church, to be burnt to death rather than open the gates. The woman, played by Kate Winslet, argued in her subsequent trial that they were guards who did not have the authority to let the prisoners out. The trial scene from the film came back to me along with the logic of the woman – helpless under the German cultural tradition of respecting authority at all cost and beyond human concerns – when the fire in killed nearly 90 people.

At the heart of the film was an example of the German mindset, a critical national flaw, which made possible a lot of Nazi atrocities because too many would not question authority. The horrific AMRI tragedy, so utterly unnecessary (the patients died not in the fire itself but of asphyxiation by fumes from a basement fire as they were not rescued in time), happened because of a series of lapses which highlight what is wrong in the way Indians order their lives and do their public duties. Possibly, what happened in cannot happen elsewhere in the country because public standards in and West Bengal are particularly poor. But a lot of the aberrations highlighted by the tragedy are prevalent elsewhere in the country too, if not in the same degree. So the whole country needs to see the clear and present dangers, and think and act so that public institutions and those who run them recover from this nadir.

News reports indicate that a fire broke out around 2.15 a m in the basement of the posh private hospital but the fire brigade got the first call, not from a hospital person, after 4 a m. The staff on duty informed company higher-ups and not the fire brigade since they were under specific orders not to make anything public straightaway in any situation. The senior people kept talking to each other through the crucial hours over phone while attempts were made in the hospital to bring the fire under control and not let it become public. Nearby slum dwellers who, on seeing the smoke, wanted to come in and help in the rescue work were initially prevented by the guards from doing so. The gates were apparently locked because security were under standing orders not to allow patients to leave before they had paid their bills. The media have carried horrific eyewitness accounts of people who, on receiving frantic calls from their relatives in the hospital, managed to come and rescue the patients by risking their own lives.

Of the three hospital employees who died rescuing patients, two were nurses. Till now it is not known what happened to the junior doctors (only one did a heroic rescue job) who must have been on night duty. What did they do? Did they run away? After several days, some specialists have come out with a statement that on rushing to the hospital at 4 a m they found untrained local rescuers had tried to help patients on ventilators and caused their end (taking a person off a ventilator is a specialised task).

Initial police investigations indicate gross violation of fire safety rules including storing inflammable supplies in the basement. Any number of public buildings in the country do the same — misuse basements, block stairways, deactivate smoke detectors for whatever reason. After the tragedy, when distraught relatives gathered before the hospital, West Bengal Chief Minister personally went to the spot and calmed the crowd. Great, but is this her job? Can no lesser leader handle such a situation?

Significantly, AMRI is run by a minority shareholder who was very close to the former Left Front chief minister After the accident, six company directors have been arrested. News reports have appeared on how AMRI was given land rights dirt cheap by the Left Front government and had a meteoric rise. The government not protecting the owners, the press fearlessly exposing the deals of the past are exemplary but how much of this can be traced to regime change?

At the heart of the tragedy is the way private hospitals are run and how doctors play ball across the country. A few top corporate chains may be different when it comes to safety but a huge section of privately provided healthcare is guilty on many counts. Anecdotal evidence abounds of how private hospitals use agents to maximise patient inflow. They are routinely presented with bills inflated by unnecessary stay in intensive care and equally unnecessary diagnostic tests. Specialists attached have to meet business targets.

At most private hospitals, making money comes way before concern for patients. The impunity with which the worst of them operate indicates their confidence that they will not fall foul of the authorities. Two questions don’t go away. Whatever happened to the resident doctors on duty? Why did the specialists “rush” to the hospital at 4 a m and not far earlier? Isn’t it the job of a junior doctor faced with an emergency to try and stabilise the patient and also call the specialist?

Heroic acts by individual hospital staff and doctors have been reported. The boys from the slum next door who risked their lives in rescue work are today’s heroes. What kind of society are we where hospital staff and doctors have long forgotten that patient safety and concern come first?

First Published: Wed, December 21 2011. 00:18 IST