Forcible discharge of TB patients

On August 31, 2000, the Union Health Minister announced a “fervent resolve” to reach health care to every family in the country (1). The same day, a group of Indore residents submitted a memorandum to the minister against the forcible eviction of 70 out of 75 patients in a well-attended TB sanatorium in Indore, to make the land available for an Indian Institute of Management.

The next day, the finance minister left for the US for, among other things, a “routine kidney ailment” (2). The TB patients have been less lucky following their “non-routine” discharge. At least one of them is untraceable, and one – a sputum positive, multi-drug resistant case – was last seen living (or dying) on a railway station platform.

The move to close down the sanatorium — and the agitation against this — goes back to 1998 (3). At the time, the state government gave an undertaking not to transfer the land to the IIM “without first fully establishing (the TB sanatorium) in its new premises, which will be equal to or better than the present ones”. Despite this undertaking, in November 1998, the government directed sanatorium authorities to discharge all patients and vacate the land and building — without setting up any alternative facility. Its efforts were thwarted by residents of the adjoining village who later also had the support of a court order maintaining the status quo.

This year, as pressure for expediting the IIM built up, sanatorium admissions were stopped despite the stay. On August 11, ambulances arrived to remove the female patients, but they refused to leave and complained at the local police station. Still, from August 12 to 17, 51 patients were discharged -simply by declaring they were OK or writing “discharged on request” in English on their discharge slips (in a sanatorium where most patients cannot read English) — and escorted off the premises. Even as villagers obtained another court stay and prominent citizens submitted a memorandum to the collector, police arrived at the sanatorium to “facilitate” further discharges out of the 24 remaining patients. On August 18, only 5 patients remained.

The villagers sought action against this contempt of court, and on September 8, the court ordered re-admissions. However, sanatorium authorities plead their “inability” to admit patients since they had not received official instructions following the latest court order.

On September 14 – nearly a week after the court directed re-admissions and in the midst of extensive media coverage on Vajpayee’s knee and Kumaramangalam’s diagnosis – 45-year-old Bhagwandas, one of the patients discharged in August, died just inside the sanatorium. He had been camping outside the gates for three days, but had been refused admission by the sanatorium management. He had been moved “just inside” the previous evening, because he was gasping for breath and crying for help. At dawn, Bhagwandas died.

The sanatorium is still in the local news. One section of the medical community is saying that TB sanatoriums are irrelevant.

The administration, which is mandated to take care of public health and public health institutions, says the sanatorium is just an old building. The IIM is threatening to leave Indore if it is not quickly given its land free of “encumbrances”. It promises plans for rural development and primary education but not unglamorous health care for TB patients. (4)

While much of the national media has maintained a studied silence on the matter, a leading national daily stated: “IIM Indore being killed by TB sanatorium.” (5)

What, then, shall we say killed Bhagwandas? TB compounded by contempt of court and all round callousness?

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