Honour Under Siege

Even as the Supreme Court has decreed that institutes should address incidents of sexual harassment, hospital managements chooses to remain insensitive in the face of rising cases of violation of dignity. Nayantara Som explores the reasons for the apathy

The recent alleged molestation of a doctor by her senior in a reputed Mumbai corporate hospital has set alarm bells ringing for the medical community. While the case has not been reported by the media so far, reliable sources say that the doctor was molested by another doctor and apparently she had reported the matter to the hospital's enquiry committee, established for the purpose, but shockingly they turned a deaf ear to her complaint. "Instead of providing some sort of solace, the hospital found it apt to fire her saying that her contract had come to an end - a good excuse to wash their hands of the controversy," say sources.

When this hospital closed their doors on her, the aggrieved doctor lodged a complaint with the Maharashtra State Commission for Women. After looking into the matter, the Commission ordered the hospital to institute another fresh enquiry. It is over six months since the Commission sent the enquiry order to the hospital, and yet the hospital has not submitted the enquiry report. Is the hospital authority deliberately prolonging the enquiry so that the victim ultimately gives up on the case?

This is not the sole incident where the hospital did not pay heed to a doctor's complaining about her dignity under siege. Some years back, a female doctor at Cama Hospital, Mumbai was sexually harassed by a senior doctor from another department. When she lodged a complaint with the hospital, it was immediately dismissed.

The overwhelming number of doctors, nurses, attendants and sweepers falling victims to rape, molestation or harassment is sickening to the stomach. A study conducted in Mumbai's JJ Hospital and Grant Medical College, Mumbai in 2004 by the Research Centre for Women's Studies of SNDT University, sponsored by the Maharashtra State Commission for Women and released recently has given some alarming statistics. "The rationale for the study was the lukewarm response from all healthcare educational institutions and workplaces to implement and put into practice the guidelines issued by the Supreme Court," says Sanjeevani Kutty, Member Secretary, Maharashtra State Commission for Women.

According to the survey, while out of 249 nurses in JJ and Grant Medical College, around 12.39 per cent admitted to having faced sexual harassment through physical contacts, the report clearly states that the incidence would be much more as this category faced the maximum amount of harassment. The report concludes that around 80-90 per cent faced sexual harassment in some way or the other either through physical contact, or sexually coloured remarks, molestation or rape or by being shown pornography.

Other female professionals facing sexual harassment were MBBS students and those working as interns. They were followed by resident doctors, ayahs, nursing students and sweepers. The research also reveals that it was not just merely the nursing staff and the students (though they constituted the major portion) who faced sexual harassment and physical assault, but even senior lady doctors and surgeons are included in the club. The research underscores that women were reluctant to share their personal experiences of sexual harassment because of the gnawing fear that they might be harassed again by their harassers. Hospital professionals obviously also felt let down by the hospital management as they did not take any steps to protect them.

An Old Story

Female hospital professionals being made the prey for such grotesque mishaps is nothing new. The malaise has been prevailing in our system for ages. More than three decades ago, on November 27, 1973, Aruna Shanbaug, a nurse from Mumbai's KEM Hospital, was tied with a dog chain and brutally raped by a sweeper of the same hospital. Sohanlal, the sweeper, had a personal grudge against her and rape was his brutal way to vent his anger. Aruna lost her sight, speech and movement and went into coma for 25 years. Subsequently, she was abandoned by her family and fiancé. To make matters worse, her rapist Sohanlal was awarded a mere seven-year sentence for 'robbery and attempt to murder'. No doctor or nurse had the courage to protest against the verdict despite being aware of the truth. Aruna suffered in silence for 25 years and remained a living corpse until her death a few years back.

Unfortunately, it seems Aruna's story has made no impact on our healthcare industry. Nurses, female patients and doctors are still being forced to be victims to men's carnal desires within a hospital premises. Who are the harassers? Over the years, studies have revealed that mostly ward boys and technicians are the main culprits. A few years back, at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, a patient had come to the hospital to donate her kidney to a relative. She was then asked to be given a hot water bath by a hospital employee on the pretext that it was a necessary part of the surgery. The employee while giving her a bath molested her. She, however, reported the matter to the staff nurse only the next day.

Professor Anil Kumar Gupta, Medical Superintendent, PGIMER, Chandigarh, recollects, "By the time the matter was brought up to the committee, it was too late. The matter was taken to court and legal action was taken against the accused. The employee was outsourced from a contractor and as in other cases, his service was immediately terminated."

Some Cases Of Sexual Assault /Harassment

Case 1: Three years back on the 7th of September at east Delhi's Shanti Mukund Hospital, a nurse was attending a coma patient when Bhura, a ward boy of the hospital taking advantage of the situation, dragged her to the bathroom and raped her. He injured both her eyes with his fingers. The victim lost her right eye in the process as it was damaged due to severe infection. Bhura was almost given a death sentence but on the day of his sentence, he filed an application whereby he was willing to marry the victim without dowry. However, Bhura was later given a 10-year sentence. Case 2: A youth disguised as a doctor entered the premises of the Karnataka Institute of Medical Sciences (KIMS), Hubli, on the pretext of checking a patient who had a severe leg injury. The youth started a conversation with the patient (who was sleeping) and later asked her to accompany him and molested her. He was later identified as the attendant of the X-Ray centre of the Hospital. He was produced before the KIMS administrative officer. He was let off only with a warning. Case 3: Cases of rape are nothing new to Safdurjung Hospital, New Delhi. In May 2004, a 16-year-old girl had gone to see her doctor, Ravi Kumar, who was an intern at the hospital. The doctor instead took her to a room and there raped her for two days. On September 17, 2005, a 30-year-old woman had come to the outpatient department on the fifth floor with her relative (who was pregnant). There she was looted and raped by a person by the name of Sanjay. According to reports, Sanjay, a chronic alcoholic, would often pose as an employee of the hospital and dupe patients. He was later sentenced to jail. Case 4: At PGIMER, Chandigarh, a lady technician complained to the enquiry committee that a private secretary had deliberately tried to touch her private parts. The lady reported the matter to the enquiry committee of the hospital. Considering that there was a case of false allegation before, the hospital thoroughly investigated the matter. The private secretary was transferred and even lost the chance of a promotion.

Anti Sexual Harassment Committee

In the policy statement of most hospitals, the section on sexual assault and harassment comes under the subhead of 'Misconduct'. Can misconduct in any way be compared to a sexual assault or harassment?

In this respect, the Supreme Court's landmark judgement on the Vishaka and others vs the State of Rajasthan case (AIR 1997 SC 3011) deserves attention. Passed in response to a writ petition against a gang rape of a government development worker in Rajasthan, the Supreme Court (SC) held that all employers are responsible for not only providing a safe environment for women free from sexual harassment, but also for resolution of the conflict.

As per the SC judgement, every institute should have anti sexual harassment committees to address such grievances. It is not that healthcare institutes do not have such committees. They are present in some hospitals-public as well as private. The question is how beneficial or active are they? Unfortunately, these committees have been initiated only as a mere formality, on paper stacked in files, hidden in one corner of the hospital and then becoming history. In Mumbai, the Brihanmumbai Municipal Corporation (BMC) formed a sexual harassment committee with a host of medical officials, medical superintendents, doctors, technicians and nurses. The apex committee is headed by a chairman, who as a rule laid down by the SC, is always a woman assisted by a lady secretary. This apex committee has established 60 complaint committees in all the peripheral hospitals, medical colleges and central offices.

But considering that there have been overwhelming cases of sexual harassments on nurses in particular, why have merely eight-ten cases come to the forefront of the committee? Dr Seema Malik, Medical Superintendent for all peripheral BMC hospitals and a member of the apex committee opines, "Though there are only few cases, we know that the statistics are much more." Most of the cases reported usually pertain to ward boys or sweepers raping and molesting their female counterparts.

According to another key member of the committee, "The under-reporting is due to the power structure of the committee. It has a great influence on reducing the number of cases."

A Case In Point

Reports have been pouring in about nurses being harassed by doctors, ward boys or sweepers at Lokmanya Tilak Municipal General (LTMG) Hospital, Mumbai. Again, there is a committee established in the hospital with members representing all the sections of the hospital staff, from the department heads to the technicians, professors, ward boys, nurses and sweepers. But that does not stop harassment on female professionals in the hospital. As far as curbing the number of such cases, the committee has reached a dead end with no results. Some senior doctors claimed ignorance about the existence of a standard protocol in case of a sexual harassment, let alone an enquiry committee. A doctor even innocuously enquired, "How can one doctor harass another doctor? Such a situation can never happen."

Hospital authorities even clearly stated that in case of such a situation, the hospital would not interfere in the matter. A professor, who is also a part of the committee, states, "It is only the security staff who is involved in the matter and if the matter goes beyond hand, then it is taken to the police." For an institute where such charges are rampant, the statement of the dean Dr ME Yeolakar came as a shock. "We only give prompt medical and psychological help required to the victim. We do not grant leave to the victim, the management does not think it is necessary," he said.

Reality Bites

Blame it on the fragile nature of the administrative system, the ignorance or rather self denial from the administration, the lackadaisical security system in Indian hospitals or the lack of integrity in medical professionals; the chilling fact remains that the management prefer to remain silent spectators, despite cases of molestation and rape of their very own staff members within their own premises. A top official from one of the most reputed corporate hospitals in the country even states, "Cases of sexual assault and harassment are very rare among doctors and nurses. I think it only happens with patients." Why has the medical community gone into a prolonged denial? Is it not high time that they face reality that is pervading this industry?

The problem also stems from the ignorance of the hospital staff members. BMC's Dr Malik states, "There have been cases where people are not aware of the exact definition of sexual harassment and assault. A senior might be troubling his junior(s) and people have actually come forward and complained that they have been sexually assaulted."

Experts feel that merely having workshops on "How to be A Good Health Professional" and "How to inculcate Good Human values" once in a while is definitely not the solution. It's time that medical professionals realise that it is long-term and not short-term measures which can provide a permanent solution to this menace.

"Hospitals are introducing methods of economy and cost cutting which has led to authorities paying no heed to the aspect of sexual harassment" - Dr Amar Jesani Co-ordinator Centre for Studies in Ethics and Rights

Why do women dread coming to the forefront and boldly admitting that they have been sexually harasseded? The fear of being shunned is perhaps the hindering factor. Dr Amar Jesani, Co-ordinator, Centre for Studies in Ethics and Rights and founder member of CEHAT, informs, "It all goes back to our social system. Women are scared and apprehensive that society will refuse to accept them, if they come to know that they have been raped or molested." Ironically, fingers usually point towards the so-called 'loose character' of the woman rather than the accused. Rather than hashing out a concrete solution to the situation, her past sexual experiences are all brought to the forefront while the accused is pushed to the background. "Moreover, hospitals are introducing methods of economy and cost cutting which has led to authorities paying no heed to the aspect of sexual assault," says Dr Jesani.

Authorities fail to understand that at the end of the day even hospital professionals need assurance of the basic security which is the right of every working professional. Medico-legal expert and former Judge Consumer Court, Mumbai, Dr Gopinath Shenoy, opines, "Despite doctors and nurses being sexually harassed and assaulted in swelling numbers, these cases are unfortunately never brought to the limelight for various reasons. At the end of the day, even health professionals are human beings whose life is as dear to them as ours to us."

Why Are Nurses Prime Targets?

Lacking professional training, absence of a registered license, deprived of a fully paid salary, nurses become easy targets for men who want to satisfy their carnal desires. "In small nursing homes, due to cost cutting, unregistered or unqualified nurses are employed. They do not have the capability to organise a union and are totally dependent on the meagre salary that is given to them," explains Dr Jesani. This puts these nurses in a vulnerable position.

In private hospitals, the situation is as bad as it can get. Delhi, for instance, had always witnessed an influx of outstation nurses and just to eke out a living they are ready to bear working in appalling conditions and staying silent in the direst situations. Manjula Sharma, Assistant Secretary, Delhi Nurses Union (DNU) says, "In private hospitals, most of the nurses are not even trained and most of them do not have a proper license. These half-trained nurses are so desperate to earn a living that they are even willing to work on a half salary. So, it is but obvious that the men will take advantage of such nurses."

Steps To Improvement

Firstly, words 'Sexual Harassment' or 'Sexual Assault' should be clearly defined to the hospital staff. Dr Sanjeev Malik, CEO, Max Group of Hospitals, states, "In the west, if a male colleague invites a lady for lunch and the lady refuses and if he persists, it is called sexual harassment in their dictionary." According to Dr DP Saraswat, Chief Operating Officer, Kasturba Hospital, Manipal, when doctors from the opposite sex work closely with each other in an emergency situation, the physical contact between them may often be misconstrued as a harassment by one of them.

Max Healthcare has come up with an 'Anti-Sexual Harassment Policy', clearly defining sexual harassment, which includes myriad aspects like harassment by managers and supervisors, and hostile work environment. Under this, the responsibility of the employee, the complaint procedure, investigating procedure, the role of the investigator, interviewing the involving parties, training of supervisor and employees are clearly stated. "Ideally, every healthcare institution, whether public or private, has to establish an enquiry committee or a redressal as a mechanism for protection of its working staff," says Kutty. The forum/committee is a platform which gives the victim an opportunity to put forward her case or complaint. The forum usually consists of doctors, medical officers, nurses, paramedics, sweepers and representatives from all the sections and departments of the hospital. It is this committee which decides the course of the case and the steps that ought to be taken.

"Around 50 per cent of the committee members, and the chairperson should be a woman. An NGO must also be represented," says Kutty. In fact, the landmark SC judgement also states that failure to follow the redressal guidelines by hospitals would amount to Contempt of Court.

Further, if the woman is not satisfied by the decision of the hospital committee, she can approach the State Commission for Women. Anagha Sarpotdar, Unit Co-ordinator, Campaign Against Sexual Harassment Unit, mentions, "The Vishaka case is only the beginning and a platform. Unfortunately, hospitals decide to have a grievance committee only when a victim has been sexually harassed. But that should not be the case."

Steps To Lodging A Complaint

In a case of sexual harassment and not rape or sexual assault, the aggrieved has to lodge a complaint with the redressal committee of the hospital, specially constituted for the purpose.

Unions also help. "The DNU is powerful. The minute there is a case of harassment, nurses immediately report both to the hospital and the union. We then take a decision along with the administration and then chalk out the final decision," says Sharma of DNU. "If not a union, at least an NGO of social workers should be formed in all hospitals. They have a powerful stand and a voice to ward off any kind of injustice," says Dr Jesani. According to Dr Shenoy, it is high time that all health professionals come together to form a council.

After weighing both sides of the story, if the situation so demands, the case should be then handled by the police. "Hospital authorities should also see to it that they provide the necessary safety for the victim," adds Sharma.

"The victim must file the complaint as soon as possible before all the evidence is effaced" - Dr Suganthi Iyer Assistant Director Medical Services and Legal PD Hinduja Hospital

If the matter reaches the police, the hospital should have one spokesperson to act as the mediator between the hospital and the police.Dr Suganthi Iyer, Assistant Director, Medical Services and Legal, P D Hinduja Hospital, Mumbai, points out, "A spokesperson plays a very crucial role as it is that person who knows everything about the case. Moreover, while interrogating the employees, the police will not get a chance to harass them because that spokesperson is always there."

Before the hospital management can take any action, the victim must lodge a complaint stating that she has been sexually harassed and simultaneously stating in clear terms the name of the accused. As long as the complaint is not filed, nothing can be set in motion either by the police or the hospital authorities.

Time also plays an important role. "The issue is not just filing a complaint the victim must file the complaint as soon as possible before all the evidence is effaced. Both the accused and the victim can then be questioned ," says Dr Iyer. Padma Deosthali, Co-ordinator, CEHAT, states, "I understand that at that time it is very difficult for the women to go immediately and say that she has been raped or molested. But the fact remains that a slight delay is the root cause of problems."

Sometimes, it may so happen that due to personal grudges and grievances, the victim may levy false allegations. Additionally, a situation may arise that due to external or internal pressures and threats, the victim may withdraw her statement that she has been raped. In such cases, a Smegma test of the penis of the accused has to be taken. If the Smegma of the person accused is found to be intact, then it can be concluded that their was no physical contact between the victim and the accussed and that she has put a false allegation.

At PGIMER, around few years back, a female sweeper had claimed that she had been molested by an officer from the hospital. "Statements of all the witnesses were recorded. Our investigating officers after weighing the pros and cons found out that it was a false allegation," claims Prof Gupta of PGIMER. The lady then herself withdrew her statement and issued an apology. She was let off with a warning.

Apart from the medical help given to the victim, psychological counselling is a sine qua non. Iyer stresses, "At that time, the victim is in a vulnerable position. She goes into depression and can even commit suicide out of frustration. At that juncture, it is very important to ensure that she recoups mentally. Hospitals must see to it that even the family members are brought in and given a thorough counselling."

The situation cannot be handled alone by the victim. Iyer adds, "Family members are advised to be constantly attending the victim 24x7 and see to it that she is not alone even for a minute. Her mental instability can lead her to do anything." This psychological treatment should be given while the victim is medically treated from the injuries inflicted.

Practical Solutions

"In the night shift, female professionals at any hospital should not work alone" - Dr R Karanjekar General Manager Wockhardt Hospital Mumbai

The maxim 'prevention is better than cure' should be the guiding light for deflecting any crisis. Dr R Karanjekar, General Manger, Wockhardt Hospitals, Mumbai, advises, "Female professionals at any hospital should not work alone. Night shifts cannot be avoided, but in such a situation there should be at least two-three women working at the same time." Moreover, women should avoid venturing into isolated corners of the hospital. Dr Karanjekar adds, "Wockhardt sees to it that at night, male and female staff never work together. It is either only two male members or female members."

For the safety of the patient, female technicians should always be present to assist in the tests, surgeries or treatment. In some cases, it has been observed that sexual harassment takes place in the X-Ray centres, where male technicians take advatnge of female patients while doing their procedure. Supervisors stationed on all the floors of the hospital, should take regular rounds to avoid any mishaps.

To be on the safe side and to avoid being confronted with circumstances where the evidence is completely effaced, hospitals should equip themselves with a Sexual Assault Forensic Evidence (SAFE) kit with a manual giving instructions on the use of the contents of the kit, a protocol, paper envelopes for collection of evidence, sterile swabs, comb (medium/small), nail cutter, EDTA bulb, double oxulate tube, syringe, distilled water, gloves, glass slide, scissors and a speculum. Deosthali informs, "CEHAT has come up with a SAFE kit. It is a comprehensive kit and a must-have at least in all hospitals. At present, almost all the BMC hospitals have introduced it and we are planning to tie up with a private hospital."

"Just having a policy is not sufficient. The anti sexual harassment policy should be drilled into the minds of the staff members" - Dr Sanjeev Malik CEO Max Group of Hospitals New Delhi

Hospitals should also be cautious while recruiting, whether it is a doctor or the ward boy. Careful selection of staff members and a proper filtration process is a pre-requisite. Max Healthcare's Dr Malik points out, "Just having a policy is not sufficient. People do cross the line. The anti sexual harassment policy should be drilled into the minds of the staff members." The working conditions should be safe enough to make hospital professionals feel comfortable and secure.

Some hospitals have already taken steps. For instance, even as Max Healthcare outsources all its ward boys, it conducts personal interviews and does police verification for them. Each ward boy works under a supervisor who monitors the movement and whereabouts of every member. Dr Malik adds, "This filters out all the unwanted elements from the hospital environment."

Moreover, hospitals must include proper educational and training programmes for their staff. "Professionals should be trained how to react or how to attack a person when such a situation arises," adds Iyer. This should be introduced not just at the usual induction programmes, but at regular intervals.

Conclusion

It is not that authorities at the helm have washed their hands of the issue. The envelope has been pushed but now with the gravity of the situation showing a sharp upward trend, the question now is how far has the envelope been pushed. It is high time that all the strata of the medical community come together and put on their thinking caps. Jesani on a final note adds, "The solution lies in hospitals not hushing up the matter. They should realise that it is only by dealing with such cases in a humanitarian manner that their social credibility will rise." Only emphasis on medical ethics and humanitarian values can contribute to a safer working environment for the medical community.

nayantara@expresshealthcaremgmt.com