Tips to handle mob violence in hospitals

1. Rush team: A local “rush team” of doctors for helping a doctor in distress should be formed. This team should include senior respectable practitioners (e.g., Surgeon Gynecologist, GP, Anesthetist, etc.). The team should be only one phone call away in case of impending suspected mob violence. The team’s responsibility is to help the affected doctor in medical management (if needed) and for ensuring proper communication with the relatives. Ideally death should be declared only when the rush team arrives. The rush team must conduct itself properly and with dignity. They should not take charge of the situation. The owner should take the main chair and do the talking. Team members should interfere only if the communication is taking a wrong turn.

2. Security: Security personnel on duty will always be outnumbered by the mob and hence inadequate during such vandalism. However, each establishment should have CCTV cameras installed and there should be boards at conspicuous places saying, “You are under electronic surveillance”. This will curb many such untoward incidents. Time has come that local associations hire a team of bouncers who can rush to the scene in the same way as the “rush team” to avert any possible vandalism.

3. Self-protection: Whether doctors should resort to holding gun licenses and possess legally allowed weapons to protect themselves is a matter of debate; however, incidences of deaths and lynching encourage such debates going on behind closed doors at the moment.

4. Insurance: Apart from professional indemnity, healthcare set-ups should also have insurance for damage to property due to riots. The premium for these insurances is very small in amount.

5. Photographs: As soon as the vandalism occurs, take photographs of the damage. These are to be submitted as evidence of damage in “police report” and for insurance to claim damages.

6. Injury certificates: If any of the doctors or staff has been manhandled it is important to send them to another nearby hospital (preferably a government hospital) for first aid and to get an injury certificate which is needed in the police report and later in the court.

7. Politicians: Avoid involving politician at this stage because politicians are like double-edged swords. They may help you in the present situation but will take advantage later. If they are from the side of the miscreants (being their vote bank), they will insist on cleaning the mess and destroying the evidence before photographs are taken. Another view is that we should call a known politician ourselves because when such an incident occurs politicians will come to the site any which ways, whether you call them or not. Secondly, when a doctor's life and that of his/her staff is in danger we should utilize all resources to curb it.

8. Call the police: This in fact the first thing that has to be done when a mob violence is even suspected. Presence of police usually averts any law-and-order problem.

• If there is intra-op death or immediate post-op death, then avoid giving DC (death certificate) and put the onus of explaining (to the relatives) and the need for medicolegal postmortem on to the police. While following this, it is important to remember the following:
• No law in our country prevents doctors from giving a DC if the cause of death is known. However, in case of intra-op death which is generally not expected to occur it is better to get the PM done by a medicolegal PM surgeon because in case of litigation the operating surgeon is usually one of the accused. Hence, even if the relatives or the police force doctors to give a DC, it is prudent to convince the police to take away the body for a medicolegal PM.
• It is not a statutory law that all deaths on table should be informed to the police. Only those cases in which the death during surgery is generally not expected need to be informed so that the police can take a call on whether the body needs to be sent for a medicolegal PM. If a high-risk case (e.g., ASA grade 4 with all consequences explained) dies on the table, police need not be informed.
• Hand over the photographs and CCTV footage to the police.
• Co-operate in the police report process.
• Insist that FIR against the culprits is made as soon as possible.
• Many times, the police are not aware of the act against such vandalism. Hence it is prudent to have a copy of this act always.
• Police may want to delay immediate arrest of culprits because it can worsen the law-and-order situation. However, if the police are delaying arrest even after the cremation, make a complaint to the senior police officers, or go ahead with writ petition.
• Inform the insurance company with a copy of the FIR, CCTV footage, and photographs.

Taken from: Tips to handle mob violence in nursing homes & hospitals