Vital steps in preventing , reducing and mitigating mob violence in healthcare organizations, hospitals or clinics.

1. Dealing with Mob Violence?
Dr Nikhil Datar
MD DNB FCPS FICOG DGODHA LLB

2. Dr Nikhil D Datar
MD DNB FCPS FICOG DGO DHA LLB
•Medical Director Cloudnine Hospital
Mumbai
•Founder President Patient Safety
Alliance
•Health Rights Activist known for his
work on MTP Act amendment
•Adviser Government of India on E-
health
•Consultant USAID

3. When do the relatives lose patience?
 Unexpected, unanticipated and sudden death
 Suspected or perceived negligence
 Trigger points
 Bill
 Staff behaviour

4. Naked truth about healthcare
 Doctor patient relationship of faith is fractured and GPs have
almost vanished
 Healthcare has become a commodity
 Costs of healthcare …High
 Poor communication and complete lack of informed consent

5. Sufficient Information Vs Consent
 Mere signing of a form is not enough to say
that sufficient information is given

6. Challenges in counselling
 How much information is sufficient?
 How to do it without frightening the patient?
 How to get over the language barrier?
 How to give sufficient time?
 How to improve patient recall?
 How to improve patient experience?
6

7. Perceived lack of care/ Fragmented
care
 Perceived lack of availability
 Discounting patient’s concerns
 Poor delivery of information
 Mal occurrence suggested by another doctor
---Archieves of internal medicine 1994

8. Intolerant society
 Death is a natural consequence of disease
and not medical treatment….
 Every unexpected or unanticipated medical
outcome is BECAUSE of the doctors

9. 9

10. Tips :Managing the violent
relatives

11. Tip no 1 – You are under electronic surveillance
 Security and bouncers
 No use during riots
 CCTV
 Easy and cheap
 Evidence for police/court

12. Tip no 2 -- Insurance
 No body forgets professional indemnity
 Insurance for damage to furniture, riot, fire, calamities etc
 Premium is meagre

13. Tip no 3 – Rush team
 Develop a local “Rush team” of colleagues who can rush to
stand by you.
 Helps communication
 Prevents manhandling and vandalism

14. Rules for rush team
 Main chair belongs to the “captain” doctor
 Communication is the job of captaion’s job. Your role is of a
facilitator
 Do not take it as an opportunity to settle scores by giving
subtle hints to relatives that there was negligence

15. Intra-op or immediate post op death
Post mortem or death certificate?
Relatives are ready to give an undertaking! Is it OK?

16. Dr Nikhil Datar
Death Certificate
To Be (given) Or Not To Be
(given)!!

17. Dr Nikhil D. Datar

18. NOC for disposal
 Information to the police
 Panchanama and statements
 NOC for disposal of body
Dr Nikhil D. Datar

19. Sure shot recipe for violence
 Dead on arrival… CMO states “Patient serious hai. Yaha
kuch nahi ho sakta. Jaldi se bade hospital leke jao”
 Patient was taken to another Hospital
 CMO at that hospital said “patient is dead”

20. Tip no 5 -- Photographs
 Take photographs of the damage done to the property- for
court and insurance
 Do this before the police (whom you will call) arrives and
before the local politician (who will come any way) arrives

21. Tip 6 -- Medical check up of injured
 Send all the injured staff and doctors for medical check-up
and first aid preferably to nearby Government hospital
 Make MLC in that hospital and preserve all the injury reports

22. Tip no 7 – Don’t involve politicians
Calling a known politician is a double edged sword
 May spare you from the particular situation but will take
advantage later
 They may be from the side of the miscreants, then they will
insist on cleaning the mess and destroying the evidence
before photographs are taken

23. Tip no 8 - Inform the police
 Mentions the names of the miscreants if known in the FIR
 Otherwise make FIR in the name of “unknown”
 Hand over a copy of the CCTV footage so that police can
identify the miscreants

24. Tip no 9 - Insurance company
Immediately inform the insurance agent with photograph and
copy of the FIR

25. Tip no 10 – Keep a copy of the Act!!!
 Prevention of violence and damage to property act has been
passed by AP. Maharashtra, Orissa, Chattisgarh,
Tamilnadu ,Karnataka . Manipur.
 Kerala and Bihar were in pipeline
 IMA is demanding a central act to this effect

26. Salient points
Maharashtra medicare service persons and medicare service
institutions (prevention violence and damage or loss to
the property 2009
 Commitment, attempt to commit and abetment are all
punishable
 Imprisonment which can extend to three years with fine
which can extend to 50,000/-
 Compensation double the amount of loss or as judged by the
court
 Cognizable, non-bailable and triable by court of judicial
magistrate first class

27. Tip no 11 - Never compromise –
It is non-compoundable
 Crime is against the State
 Parties have no right to “settle” the dispute
 Requires a writ in the high court
Do not succumb to requests and pressures by politicians or goon
to compromise
One miscreant learnt a lesson in Aundh. Hope the word spreads

28. Policy:Blame free redressal
 Effective mechanism of redressal of grivances of consumers
must be strengthened…
 “Criminalization” of at best “deficiency of services” can’t be
accepted at any cost
Zero tolerance against vandalism in healthcare organizations
has to be policy decision and strictly implemented

29. To conclude
 Aim at getting the culprits arrested under the act
 Rush team
 CCTV camera
 Photographs
 Inform Police and keep politician in loop
 Insurance for infrastructure damage
 Keep copy of act
 Never compromise