Give extra care to mentally ill patients

Pushpa Girimaji
Pushpa Girimaji

EVEN though our traditional systems of medicine and even yoga laid stress on not just physical but also mental health and well-being of a person, over the years, we in India ignored to a large extent the importance of mental health. Even when it came to mental illnesses, instead of treating such disorders, we preferred to brush them under the carpet. This is slowly changing. The recognition of the need to treat various mental illnesses as well as addiction to alcohol and drugs with the same degree of skill and expertise and perhaps a higher degree of sensitivity, has spurred the growth of a large number of nursing homes and hospitals catering to such patients.

This week I would like to write about an order of the apex court that reinforces the need for such hospitals to pay utmost attention to the safety of such patients, without curtailing their movements or freedom. This in a way is a sequel to the column on patients' rights that I wrote a couple of weeks ago. I did not add this particular case to the list of orders of the apex court on the rights of consumers vis-`E0-vis health services because this was a rare case pertaining to mental health.

This particular case, even though decided last year, is of utmost importance because it lays stress on a different kind of duty of care expected in the treatment of those who may be mentally ill or psychologically unstable. By awarding compensation to the wife and child of a 24-year-old man who committed suicide in a hospital, the apex court in this case has highlighted the responsibility of such hospitals. Failure to keep a constant watch over them and monitor them also constitutes negligence, the court has said. The order of the national consumer disputes redressal commission in this case has its origin in the admission of Varghese Mathai to a hospital for the treatment of alcoholic psychosis and de-addiction of drugs on May 3, 2000.

Five days later, he had hung himself in an empty hospital ward, using his lungi. In response to the complaint of negligence filed against the hospital by the wife and the minor child of Mathai, the district consumer disputes redressal forum directed the hospital to pay them a compensation of Rs 2,75,000 along with interest calculated at the rate of 9 per cent.

While opposing this in its revision petition before the national commission, the hospital argued that the wife of the patient had been asked to be with him all the time and she in turn had ignored this instruction. So, it was she who was negligent and not the hospital. The wife, on the other hand, said no such instructions were ever given to her. The national commission, after hearing both the parties, pointed out that the cross examination of the Medical Superintendent of the hospital had made three things clear: (a) that the nature of the patient's illness was such that he required close watching and monitoring. This, however, was not done; (b) the patient's wife was allowed to be with him only during visiting hours; and (c) the instruction asking the wife to be with the husband all the time and shown by the hospital as part of the records was clearly manipulated and inserted after the filing of the complaint before the consumer court.

In fact the colour of the ink here was different from the rest of the instructions. The nurse's daily record, the commission said, also indicated the patient's mood swings and the need for careful watching. He had not eaten the previous day. "News of this incident (suicide) was brought to the notice of the nurse by the co-patients and not the hospital staff, which shows their lackadaisical attitude. Mere mention by the petitioner that the hospital is not an asylum to monitor the patient continuously and cannot be accountable is a baseless averment because a patient, who is suffering from alcoholic psychosis and is a drug addict, needs extra care and constant watch as he may have suicidal tendency", the commission observed.

Concluding that there is clear-cut deficiency and negligence on the part of the hospital, the national commission said it saw no reason to interfere with the orders of the lower courts, awarding compensation ( The Medical Supdt, St.Gregorious Mission Hospital, Mannar, Kerala, vs Jessy and another, RP No 4080 of 2008).