Dr Vandana Das | Illustration: Roopesh K, Mathrubhumi
The murder of house surgeon Dr Vandana Das at Kottarakkara Taluk Hospital in Kollam sent shockwaves across Kerala. The police and security officials are being blamed for not preventing the attack on the young doctor. On the flip side, it is crucial to analyse what transpired after the attack and how the immediate responders acted during the golden hour--the first hour of such emergencies when there is the highest likelihood that prompt medical and surgical treatment can prevent death.
It should be noted that the incident occurred at a taluk Hospital, which falls under the category of secondary care hospitals. These hospitals are not equipped to provide trauma care. Vandana was attacked in the chest and neck region, and first responders immediately rushed her to a nearby private hospital, where she received intubation. Her oxygen levels were reportedly dropping, and she was subsequently transferred to another private super-specialty hospital in Thiruvananthapuram. However, she ultimately succumbed to her injuries.
Many doctors argue that Vandana could have been saved if the golden hour had been handled more cautiously. Notably, there are no government hospitals in Kollam equipped to provide trauma care. There are private hospitals in the district that can offer such services. However, it remains unclear why she was taken to a super-specialty hospital in Thiruvananthapuram, which is several kilometers away. Additionally, the intubation process could have been performed at the Kottarakkara Taluk Hospital itself.
However, without precise details about the type of injury and Vandana's specific condition at the time, it would be incorrect to conclude that her life could have been saved. In this regard, Mathrubhumi English contacted the Kollam District Medical Officer's (DMO)office and the forensic department of Thiruvananthapuram Medical College. The officials concerned stated that they are not authorised to provide details regarding the DMO report on the Taluk hospital or Vandana's autopsy report. A police official involved in Vandana's murder investigation was also contacted, and he stated that he could not disclose details about the autopsy. However, he noted that the autopsy would not include any information about the golden hour. He suggested that such specific details would be available only if the government seeks an enquiry regarding the same.
Nevertheless, Vandana's death raises important questions about the trauma care facilities in government hospitals. According to data from the Directorate of Health Services (DHS), trauma care facilities are only available at three hospitals under its jurisdiction: General Hospital, Ernakulam, District Hospital, Kannur, and District Hospital, Palakkad. Meanwhile, the Directorate of Medical Education (DME) reports the existence of reliable trauma care departments in medical colleges in Thiruvananthapuram, Kottayam, Thrissur, Kozhikode, Kannur, Ernakulam, and Alappuzha. This indicates that only a few government hospitals have trauma care facilities.
Over the past two decades, successive governments have made claims about enhancing integrated emergency and trauma care facilities in hospitals, but progress has been limited. Insiders suggest that trauma care departments in existing government hospitals are overwhelmed. The presence of competitive private hospitals with trauma care facilities is a relief, although it is a burden for commoners to afford treatment there.
Meanwhile, Vandana's death also calls for a check on the contingency preparedness of medicos.
In most hospitals across the state, house surgeons are assigned to night duty, with senior doctors available only on call. However, house surgeons are not equipped to provide emergency care. Dr Ragesh S, Secretary of House Surgeons Association, GMC Kollam explained the situation. "Many people on social media claimed that timely intubation could have saved her life. Firstly, their judgement is made without knowing the specifics of her condition. Even if intubation could have saved her life, there is no guarantee that house surgeons posted at taluk hospitals can perform the procedure. Most house surgeons only have theoretical knowledge about the process. We lack practical experience, and the syllabus we follow does not focus on it. Alternatively, we should have standardized operating procedures (SOPs) for medical conditions, but we don't have those either. Therefore, our only option is to rely on our own judgment and experience."
Dr Ragesh explained the grey areas related to the incident at the hospital, saying, "Ideally, doctors should remain composed even in cases of mass casualties. While bystanders or patients may panic, doctors do not have that luxury. However, in Vandana's case, the doctors at the hospital panicked. They cannot be solely blamed. Even police officers fled the scene out of fear for their lives. How can doctors then be held responsible?"
He also highlighted systemic lapses in the healthcare system. "The workplace security of doctors should not be disregarded, especially at night when we may have to deal with intoxicated individuals and drug addicts. They are patients for us, but should we put our own lives at risk? Vandana's case received attention because of her death, but many similar attacks go unreported. In some hospitals, security personnel are not physically capable of providing assistance. There have been instances where doctors had to rescue security officials from being attacked. We need to reevaluate and review the system in place to prevent such tragedies."