Gross Oversight

AT first sight the Amritsar Mental Hospital seems like an idyllic place: 70-odd acres of sylvan green tucked away in a quiet corner off Circular Road. Inside the imposing gates though is a veritable House of Horrors. A report submitted to the Punjab Human Rights Commission this March by Professor Brijlal Goyal, head, department of psychiatry, and principal of Amritsar Medical College, has revealed astounding instances of medical callousness and neglect that has led to 16 patients being blinded due to denial of treatment. This, ironically, in an institution headed by an ophthalmologist, Dr Kiran Kumar.

Even as the government set up a five-member commission last week—headed by retired head of the AIIMS psychiatry department N.N. Wig—to inquire into allegations of institutional staff callousness, the Amritsar mental hospital authorities scurried to organise alibis, cover-ups, glib gloss-over defence and conspiracy theories. That notwithstanding, the tragic tale of traumatised hospital inmates came tumbling out of the closet anyway. Like Mohar Singh, 65, criminal and inmate for 35 years who was being led to a cataract operation even as the Out -look team walked in. The half-blind, half-crazed man could have remained condemned to permanent darkness but for Goyal's report. Or, for that matter, like that of sexagenarian Goongi, mute and blind, who was being belatedly taken for a cataract operation after the publication of the report. Or that of the enfeebled Balwant Kaur who died before the cataract operation Goyal recommended could be performed on her. Or even like the tale of tragic Kishenlal, 65-odd, the light from whose eyes was snuffed out due to a corneal opacity left untreated despite a recommendation to the contrary as early as 1993. Even Kumar, quite obviously looking at the report for the first time in our presence, found it difficult to dissimulate, exclaiming: "Why wasn't he treated?" before lapsing into self-conscious silence.

Even as the damage-control operation was in full swing—six inmates were operated on within last fortnight, another five were allotted spectacles, one was sent home to relatives for treatment—a sordid saga of institutional mismanagement came to light. That of a mental hospital with an annual budget of Rs 4 crore where only six of the 14 doctors on the rolls happen to be psychiatrists. Where in flagrant contravention of all medical norms, the medical and deputy medical superintendent were also non-psychiatrists.

 Where the medical superintendent has come to work for only three months in a tenure spanning 18 months and is incidentally one who confesses his only reason for staying in the job is "convenience" because "my son is studying in the local medical college". It's also an institution where only 18 nurses look after 443 patients; where the directorate of health service officers themselves admit that the 377-strong paramedic and Class 4 employees are untrained, chronic arch-unionists, arm-twisting work shirkers.

Other flaws are more serious, points out Goyal. "Duty rosters reveal non-psychiatrists actually man outpatient departments, prescribe treatment/medication. This in a place that in 1997 alone has had 25,380 OPD patients." He goes on: "Psychiatry isn't even a separate subject in MBBS courses. How can they unleash such doctors, independent of any supervisory control, incapable of giving even rudimentary psychiatric care, on seriously ill patients?" Patients once diagnosed as manic depressives, schizophrenics, discovered Goyal, were condemned to be forever so. "Their diagnosis was never revised, no specific medicines were procured or prescribed for manic depressive psychosis which can be effectively treated. Even more effective, not necessarily more costly drugs for treating schizophrenia, are never prescribed or procured." The consequence? "Patients," says Goyal, "develop chronicity because they've never been effectively treated, never given adequate psychiatric facilities in terms of either quality or quantity." A grimmer consequence? Death. No less than 19 deaths reported in 1997 as opposed to 8 in 1993. Whether due to age or medical neglect remains a moot question in view of the facts now emerging.

The Mental Hospital administration's defence argument? Unconvincing. "Goyal's blowing things out of proportion," mutters medical superintendent Kumar. "We have monthly examinations of each patient." Then how come so many vision impairments weren't reported? "Must have been errors," is all you get as reply. Spirited defence follows. "Cataract is only operated once blindness occurs unless it's in working people whose work gets stalled," he asserts astoundingly. "In any case," says he, "we can't really operate without consent from relatives." But what of people like his inmates whom no relative has visited, written to in 20 years or so? Should they be allowed to go blind for want of a consent form signature or should the hospital assume responsibility, get them operated? "We can't," Kumar replies. "What if they die?" But cataract, you tell him on Dr Goyal's authority, is not a life-threatening operation. "Yes, but we can't risk it," he replies. Response to questions of whether he as ophthalmologist is qualified to head a mental institution? A sotto voce mutter. "I had no idea how a mental hospital was run. So many union problems, 450 patients..." followed by a spirited—"Of course, I'm qualified. Even the National Mental Health Programme trains doctors for 15 days and authorises them to treat psychiatric cases. Even Dr Bhatia, who's a leading psychiatrist and runs a clinic opposite our hospital, is an ophthalmologist by training." You ask: "But is it morally, professionally right?" The answer? A sheepish, "No."

Senior medical officer Ravinder Mohan Sharma's line of defence is offence. He fumes against his superintendent. "He doesn't know anything. Always puts his foot in his mouth," and proceeds to rubbish Goyal's report. "He had psychiatry under-grads diagnose eye ailments in out-patients." He triumphantly introduces us to Swaran Singh, Gursharan Singh and Jitender Kumar. "They were classified blind. All they needed was glasses. Goongi had retinitis pigmentosa, a genetic blindness condition..." Goongi they might have erred on but why were the other six not diagnosed, operated upon earlier? What of Balwant Kaur who died after being blind for years? Kishenlal with the corneal opacity which could have been operated upon? The answer is a facetious—"They were part of our backlog"—followed by a waving of 10-15-year-old records of the odd eye surgery once recommended/conducted, an eye camp once conducted in the hospital. "Everything takes time. We have procedures." Procedures that cost patients their vision, sometimes lives...

Responses to other allegations are equally cavalier. Why were diagnoses never revised? What ongoing psychiatric inputs were provided to patients who could get well, go home, be rehabilitated with that input? Indeed Goyal's report claims 35 of the 149 patients he examined needed to have their cases reviewed, 17 patients were partially recovered, that many of them could be normalised with proper treatment, therapy. "Nonsense," thunders Sharma, revealing an appalling attitude problem. "Psychiatry is for neurotics. Not for psychotics." So what is his line of treatment? "Roti, kapda aur makaan. That, and a place to die. That's what they all await: death," he concludes profoundly.

Both Kumar and Sharma project the Goyal report as a battle for turf. "The Teaching Services want administrative control of the medical college to revert to them from the Health Services. They want the 16 posts to go to them." A contention Goyal debunks. Sharma pleads further. "We need money—Rs 45 lakh as opposed to Rs 15 lakh we get annually to feed patients." For the rest he's cutting. "Misplaced idealists. Goyal only prints motivated damaging reports in papers." The Human Rights Commission is caustically dismissed. "Justice Khanna who heads it is a case of senile dementia," he confides in a whisper. With demented attitudes like these, it seems sanity will take a long time returning to the Amritsar Mental Hospital administrative block.