Nair Hospital suicide: Experts say resident doctors need mental health check-ups

In spite of proposals like a 2016 notification that directed annual mental health check-ups be carried out for student doctors, no system of counselling or sensitisation is in place in government medical colleges.
Protesters demand justice for Dr Payal Tadvi.(HT File)
Protesters demand justice for Dr Payal Tadvi.(HT File)
Updated on Jun 01, 2019 12:27 AM IST
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Hindustan Times | BySadaguru Pandit, Mumbai

With Dr Payal Tadvi’s suicide highlighting the challenges faced by student doctors, resident doctors say authorities have dismissed work-related stress and other psychological issues.

In spite of proposals like a 2016 notification that directed annual mental health check-ups be carried out for student doctors, no system of counselling or sensitisation is in place in government medical colleges.

“Presently, we don’t have any mental health check-up system in place, but we are working to start a comprehensive counselling and sensitisation programme every six months,” said Dr Kalyani Dongre, current president of Maharashtra Association of Resident Doctors (MARD). “We have also proposed that every hospital should have a post of clinical psychologist to address mental health issues. We will send a proposal to the authorities soon,” she said.

The first challenge may be to ensure this proposal doesn’t suffer the fate of previous efforts like a 2016 notification by the Maharashtra University of Health Science (MUHS), which directed government medical colleges to carry out annual mental health check-ups for resident doctors. “Sadly, the check-ups never materialised,” said Dr Sagar Mundada, MD, psychiatry and former president of Central Maharashtra Association of Resident Doctors. Dr Dilip Mhaiskar, vice chancellor, MUHS, said he wasn’t aware that the 2016 notification wasn’t being followed and that he would call for a state-wide compliance report. He also said, “We are planning to introduce a fresh system where every student, upon joining will undergo a complete mental health analysis. An individual patient report file will be maintained for all three years of residency.”

One of the stumbling blocks facing such initiatives is the shortage of mental health professionals. For a population of 130 crore, India has 7,000 psychiatrists in both private and public sectors, according to the Indian Psychiatry Society (IPS), the largest association of psychiatrists in the country.

Another is the reluctance to admit to mental health issues. “There is a lot of stigma in approaching a professional psychiatrist to avail treatment for their mental health issues,” said Dr Mrugesh Vaishnav, president, IPS. “If these individuals seek timely medical help, we can identify and treat resident doctors like Dr Tadvi and avoid the loss of life,” he said.

Dr Tadvi committed suicide on May 22, a year after joining BYL Nair Hospital as a resident doctor. She had repeatedly complained to hospital authorities and her family of harassment by colleagues. Since the heads of the gynaecology department and Dr Tadvi’s unit allegedly dismissed her complaints, doctors at the hospital have demanded a sensitisation programme for senior faculty members.

“If it’s proved that the head of the unit and head of department failed to take action despite complaints, they are equally or more responsible than the three senior resident doctors accused with first hand harassment,” said Dr Deepak Mundhe, general secretary, MARD.

IMA forms panel to look at doctors’ suicides; report on Tadvi case soon

The country’s largest body of doctors, Indian Medical Association (IMA), has constituted a committee to evaluate suicide cases among doctors across India following the controversy surrounding the death of Dr Payal Tadvi, a trainee doctor at BYL Nair Hospital. The first case that this committee will probe is Dr Tadvi’s suicide. The report will be submitted in a week’s time to the IMA’s national president, Dr Santanu Sen.

The committee will comprise five senior IMA members who will talk to Dr Tadvi’s friends in and outside the medical college, family members and professors to understand the case. Dr Ravi Wankhedkar, a former national president of the IMA, and one of the committee members said this is the first time a committee is being set up by the IMA to evaluate such deaths among doctors. “It is a well-known fact that resident doctors in government hospitals carry an inhuman workload and suffer burn out and depression, often a reason for suicide among residents,” said Dr Jayesh Lele of IMA, Maharashtra. He said Dr Tadvi’s case stood out because of the allegations of caste-based discrimination driving her to commit suicide. “This is a big issue,” he said.

Although the IMA has no power to punish anyone, it can send recommendations to the government. In this case, the IMA may draw up a white paper to deal with caste-based discrimination within the medical fraternity. The committee will submit its report to IMA national president in a week’s time.

Three accused doctors sent to judicial custody till June 10

A special court on Friday refused to extend police custody of the three doctors arrested in connection with the suicide of 26-year-old Dr Payal Tadvi. The accused were remanded in judicial custody till June 10.

Dr Ankita Khandelwal, Dr Hema Ahuja and Dr Bhakti Mehare, all third-year students and resident doctors at BYL Nair Hospital, were arrested earlier this week and charged with section 306 of the IPC, sections of the Scheduled Caste and Tribes Atrocities Act, the Anti-Ragging Act and the IT Act.

On Friday, special prosecutor Raja Thakare and additional public prosecutor Veena Shelar sought an extension of police custody, arguing that the case had been transferred to the crime branch only on Thursday and the officers needed more time to examine the accused and look into the statements provided by witnesses. The plea was opposed by defence lawyers Aabad Ponda and Sandeep Bali, who said custody of the accused was not necessary for collection of evidence and to record statements of witnesses.

Special judge RM Sadrani observed, “Investigation was carried out for the last two days, but no substantial evidence is collected so that further police custody can be granted.” Sadrani said police custody can’t be “only for the purpose of confrontation between accused and witnesses.” The court also noted that so far, there was no evidence to substantiate the prosecution’s initial claim of foul play in Dr Tadvi’s death.

BMC corporators demand suspension of hospital dean

At the general body meeting of the Brihanmumbai Municipal Corporation (BMC) on Friday, corporators demanded the dean of the civic-run BYL Nair Hospital be suspended and strong action be taken against those accused of abetting the suicide of postgraduate student, Dr Payal Tadvi.

On May 22, Dr Tadvi, a 26-year-old, second-year student at BYL Nair Hospital committed suicide. Dr Tadvi joined the medical college in May 2018 and since December 2018 had complained multiple times of harassment by her colleagues. Her family has alleged Dr Tadvi was discriminated against on the basis of her caste.

Ravi Raja, leader of opposition in the BMC, said, “The hospital authorities were negligent and did not pay any attention to its management. This case should be inquired at a much higher level. A detailed report on the incident needs to be submitted to the general body.” Samajwadi Party’s Rais Shaikh alleged, “Not only are the authorities failing to upgrade these hospitals, they do nothing to understand and bring in reforms to the work culture.”

When the civic chief was asked to address these concerns at the meeting, Praveen Pardeshi said, “We have taken strict cognizance of the matter and people concerned were also suspended.” He said necessary steps are being taken to ensure such incidents do not happen in the future.

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