mpty hallways and deserted check-in counters were a sight for the entire week in the Out Patient Departments (OPDs) of Lahore’s major public hospitals. The closure of OPDs resulted from a Punjab-wide call for strike by the Young Doctors’ Association (YDA) following an incident of violence at the Children’s Hospital Lahore (CHL), which had left a house officer seriously injured.

The strike was officially called off on June 7. The caretaker health minister, Dr Javed Akram, tweeted, “We are thrilled to announce the resolution of the ongoing strike in OPDs across Punjab.” Later, the minister announced “implementing legislation in the form of an ordinance” in order to enforce healthcare protection.

Dr Akram reiterated that a zero-tolerance policy would be adopted towards violence at hospitals to protect the dignity of healthcare providers.

The incident that led to the strike had occurred on May 31, when a patient expired due to post-measles pneumonia. Some members of the deceased’s family attacked the house officer in a fit of rage, causing him multiple injuries. The doctor was later admitted to the Lahore General Hospital with a fractured arm, dislocated jaw and CSF rhinorrhea (cerebrospinal fluid leak). The health minister visited the injured Dr Muhammad Saad to show solidarity.

In a message shared after the incident, Dr Akram assured all healthcare providers, “We consider this a personal challenge; we will do everything to provide all healthcare professionals protection and ensure their safety at work.”

Dr Ahmed Yar, the YDA-CHL president, told The News on Sunday that violence against care providers wasn’t uncommon. “Sometimes, when a patient dies, enraged relatives lash out at the attending doctor. However, most matters are resolved quickly.”

He added, “As healthcare providers, we are aware that heightened emotions can lead to unsavoury outcomes. This time a line was crossed. One of our colleagues was badly injured. He was not even the primary physician for the said patient.”

When asked if closing down OPDs and thereby not providing service to thousands of patients who depended on public hospitals for care was a solution, the doctor said, “Only the OPDs were closed, Emergency and Indoor Departments were open round the clock, and providing care.”

He also said, “Hospital visitors can be broadly divided into three categories: the very sick, who need immediate attention and require emergency-room care; the OPD visitors, with minor illnesses; and those who come in for follow-ups after their initial OPD visit.”

However, a senior healthcare professional, requesting anonymity, says that these not-so-sick patients suffer too. “A patient with valvular disease, for instance, coming to Lahore after having travelled eight long hours to get a check-up at a hospital that specialises in cardiac diseases expects to be provided care. When they find out that the OPDs are closed indefinitely, they are left in distress.”

There persists a sentiment that OPD closure across the province by the YDA is irresponsible and a breach of medical ethics. A young doctor says, “When people start believing that they can abuse and harm healthcare professionals, we have to take action.”

TNS spoke to a senior paediatrician who, on condition of anonymity, said, “The child was unvaccinated and had developed post-measles pneumonia, suffered pneumothorax and had to be intubated.”

According to the Centre for Disease Control and Protection (CDC), post-measles pneumonia is “the most common cause of death in young children.”

The incident that led to the strike occurred on May 31, when a patient expired due to post-measles pneumonia. Some members of the deceased’s family attacked the house officer in a fit of rage, causing him multiple injuries. The doctor was then admitted to the Lahore General Hospital with a fractured arm, dislocated jaw, and CSF rhinorrhea (cerebrospinal fluid leak).

The family had signed a Do-Not-Resuscitate (DNR) order, which meant that the doctors were not allowed to perform the cardiopulmonary resuscitation (CPR) in the event of a complication during intubation. “A DNR is a legally binding document that tells emergency responders and other healthcare providers not to perform CPR if the patient’s heart stops (cardiac arrest) or they stop breathing,” explained the senior paediatrician.

In a DNR order, the CPR usually refers to a) “Pressing on the chest or using electricity or medications to restart the heart; and b) Placing a breathing tube down the throat and connecting the patient to a ventilator.” In this case, however, the child was already intubated, and the DNR had been signed to prevent CPR initiation if the patient’s heartbeat began to drop while on support.

“The family had been counselled, and they had signed a DNR,” confirmed Dr Ahmed Yar. “The child remained in care for over a week at Medical Unit-1, but her condition kept deteriorating.”

Generally, “there are two types of consent forms [written in Urdu] we get signed by the patients’ attendants, in public hospitals. The first is signed upon admission and permits healthcare providers to draw blood for testing and perform treatments. The other is a high-risk consent form, signed under special circumstances after the families are counselled. It is required for high-risk procedures and treatments. And then there is the DNR,” said the paediatrician.

Medical negligence is a serious offence punishable by law in Pakistan. So is physically endangering a person’s life or threatening them with physical harm. The doctors’ association demanded that anti-terrorism charges be included in the FIR lodged against the perpetrators of violence at the CHL. The demand was met and the charges were included.

Barrister Fatima Shaheen, a legal expert and TV anchor, says, “Section 44 of the Pakistan Penal Code defines ‘injury,’ as denoting any harm, illegally caused to any person, in body, mind, reputation, or property.”

She was of the opinion that “whereas the patients’ affected family may pursue their case against the doctor/hospital in criminal law, they and/or the hospital as well as the aggrieved doctor may also lodge a complaint with the Punjab Healthcare Commission so as to investigate the matter further. Cases like these also attract the Prevention of Electronic Crimes Act, 2016, which regards taking a picture/video of any person and distributing it without their consent, in a manner that harms them, as an offence.”

In cases of suspected medical negligence, Dr Naeem Majeed, Technical Focal Person for Immunisation, Punjab, said the aggrieved could file a complaint with the Punjab Health Commission (PHC) which would then investigate the matter and punish the relevant party. This legislation was brought forth under the PHC Act 2010. “It was after the 2009 Iman-i- Malik case (where medical negligence led to the death of a three-year-old in a private hospital) that this legislation came into effect.”

In the CHL incident, the attendants decided to take matters into their hands without evidence of negligence or delay in treatment, said Dr Majeed.

The week-long closure of OPDs across the Punjab created difficulties for patients and the already overburdened Emergency and Indoor Departments of local hospitals. At the same time, violence against a medical professional in a hospital packed with people was very disconcerting. The safety of patients and healthcare providers continues to be a serious concern in Pakistan. The CHL incident is one of the many that occur rather frequently in overburdened hospitals with overworked staff and visitors (patients and attendants) struggling to access healthcare.

The writer is a staff member