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City City Bang Bang, Columns

The law as lottery

One more accident caused apparently by gross neglect, mismanagement and an utter disregard for the value of human lives. The fire in a Kollkata hospita that killed over 90 helpless patients is a heartrending tragedy today, but going by past experiences (and there are so many of them), it is only a matter of time when it becomes a statistic. It seems that we never learn our lesson; every link in the chain that leads to an incident like this is flawed both in terms of efficiency and more worryingly, in terms of honesty of intent. The hospital management reportedly flouted rules knowingly even after an earlier episode and indeed on that occasion took action against an employee who called the fire department. Once the fire started the effort seemed directed at covering up the problem rather than helping those trapped. Most doctors and staff disappeared and people were actually prevented from helping those trapped inside.

The fire department was alerted late, and when it arrived found it difficult to manage the situation efficiently. VIPs came in and made things worse, since their needs always receive precedence over those of the victims and their families. It is clear that all significant elements of the system failed- beginning from the regulatory oversight that should have hauled up the hospital in the first place down to the disaster management apparatus that should have prevented the loss of so many lives.

On the face of it, the local government has reacted swiftly. The directors of the hospital have been taken into custody, compensation announced for the victim and the licence of the hospital has been cancelled. The media too has highlighted with its usual intensity, the horrific details of the accident and has mounted enormous pressure on the administration. The fire has also prompted other states to look at fire safety issues in their own hospitals; it would seem that some measure of introspection and improvement might come about in the aftermath of this tragedy.

Counter-intuitive as it may sound, the nature of the government reaction might be a part of the problem and not that of the solution. Every time a major accident happens, we see a familiar and distinctive pattern. The accident and its aftermath is by itself very poorly managed, but a massive show of action is mounted thereafter.

Compensation, often of a large nature, is announced swiftly (and is often disbursed with great tardiness), some flashy action is taken against all connected with the accident, a witch hunt is launched against anyone who might have something to do with it, however peripheral, more rules are created, for some time all installations, organisations or sites similar to the one that met with an accident are scrutinised, but in a few months time, everything slips back to normal. No permanent systemic change is attempted. At work are a set of principles used to manage the situation and perpetuate the problem without making any fundamental change.

The first step in this is to treat each incident as an independent aberration; the problem is individualised and made local. The problem is seen as one that is particular to the accident- in this case that means an obsessive focus on who is responsible. The punishment meted out is seemingly instantaneous and sweeping; due process is given a miss.

In this case, the licence of the hospital has been summarily cancelled. The problem with this is that no enquiry has been made, and the precise cause of the accident has not been determined. If it was so clear that the terms of the licence were being flouted, why was it not done earlier? And what about the other hospitals that might have similar problems or worse? Cancelling one licence, post-facto is not an act of reform; it is an act of tokenism that thwarts real reform. Also, why should action be restricted to hospitals? Just because a fire broke out in one does not mean that tomorrow the same could not happen in another public place? The tendency to think of each accident as an individual episode unconnected with a larger problem is at the heart of our reaction. Even after 26/11, security was tightened only in hotels. The idea that terrorists could strike only where they had already struck is absurd.

The truth is that the problem lies deeply embedded in every part of the system. The regulatory framework is cumbersome and archaic and encourages default; the people manning this system are often steeped in corruption and use regulation as a device to extract bribes and everyone knows that the way things work on the ground has little to with the way they are meant to work on paper.

In the absence of systemic belief and transparency, the law becomes a lottery. Out of the thousands who flout regulations, a few will become embroiled in accidents and pay an exaggerated price on behalf of the others. When everyone is at fault in some way or the other, the quest is never for an answer, but always for an excuse or alibi.

Without a belief in systems that work independently of individuals and that are unmindful of context, public administration will always be a messy affair, full of obfuscations and token action. The focus will always be on managing problems after they occur rather than prevent them from taking place in the first place. It will mean that we are forever applying little strips of band-aid on massive systemic failures and then wondering why our solutions don’t work.

Swift, seemingly decisive action at a point in time is easy; but accident prevention needs millions of small everyday things to go right every single time. As things stand, we are a very long way from such a scenario. For the law to work, we must first believe that it will. Otherwise the law will be used as a lottery and we will all continue to be the losers.

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