Frame strict law to safeguard healthcare workers

THE rape and murder of a resident doctor at the state-run RG Kar Medical College and Hospital earlier this month has triggered widespread outrage and shaken the conscience of people. The post-mortem report indicates a Nirbhaya-like brutal assault. Shocking as it is, the incident occurred on the premises of the medical facility while she was on duty. To make it worse, the hospital authorities tried to cover it up.

This was not an isolated case. Last year, a 22-year-old doctor was stabbed to death in Kerala in the presence of cops. These two cases are extreme instances of violence against medical professionals, something that has been going on for years. Just a couple of months ago, doctors at a hospital in Raichur were thrashed by relatives after a patient’s death. And earlier, in January, a doctor was assaulted at a taluk hospital in Karnataka.

Violence against doctors falls into two categories. First, there is violence by the relatives or attendants of a patient over perceived negligence or billing disputes. And then there is violence by criminal elements. The Kolkata incident is a case of crime against a woman. Doctors at bigger, private hospitals are relatively safe, thanks to restrictions on the entry and number of attendants, the presence of CCTV cameras and adequate infrastructure.

However, at government hospitals, the entry of outsiders goes mostly unchecked. Besides, there is a shortage of security personnel, corridors are poorly lit, duty rooms are not adequate, and there is often little electronic surveillance. Currently, most Class III and IV employees are hired on contract, and their antecedents are not verified. The victim in the Kolkata case had gone to a seminar room to take rest, perhaps because of the unavailability of a proper duty room. The culprit is said to be a ‘civic volunteer’, who would ostensibly help patients get admitted to government hospitals, in all likelihood, for a commission.

But it is not only doctors who are at the receiving end; other healthcare workers (HCWs) also face violence. The most gruesome incident was the sexual assault on a nurse by a hospital lift operator at Mumbai’s KEM Hospital in 1973. The victim suffered brain damage and remained in a vegetative state for over 40 years. Nurses and other female employees are the most vulnerable segment at hospitals.

The WHO defines workplace violence in the healthcare sector as incidents in which a staff member is abused, threatened or assaulted in circumstances related to their work. Lancet surveillance yielded 225 violent incidents against HCWs in 2020 and 110 in 2021. Though India contributes less than 1 per cent of global HCWs, it accounted for 3.4 per cent of all such incidents. The incidence of violence against HCWs in India was 57 times that in the UK and 850 times that in China, countries that have taken legal action against violence. According to an estimate, there is at least one case of violence against an HCW in the national capital every day, with a majority going unreported.

The Indian Medical Association has been demanding a separate law to ensure the safety and security of doctors and other HCWs. Following reports of violence against HCWs during the Covid-19 pandemic, the Epidemic Diseases (Amendment) Ordinance, 2020, was promulgated to supplement the Epidemic Diseases Act, 1897. The Ministry of Health and Family Welfare had released the Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill in September 2019 to address violence against healthcare professionals and damage to property. But it was rejected by the Ministry of Home Affairs on the grounds that the Bill would set an improper precedent for others seeking such exclusive protections for their respective professions. Subsequently, in September 2020, the Epidemic Diseases (Amendment) Act, 2020, was passed, but its provisions fall short of the doctors’ demands.

Since law and order is a state subject, there are state laws in 25 states (including West Bengal) and union territories called the Medicare Service Persons and Medicare Service Institutions Act. Under the Act, violence against HCWs is a non-bailable offence in most states, but there is no uniformity in its provisions in different states. Moreover, there is apathy and a lack of awareness about it among law enforcement agencies. The reply to an RTI petition filed by the Chandigarh-based Medicos Legal Action Group (MLAG) with the Punjab and Haryana police about the punishment meted out under the Act revealed that not even a single person was booked under it between 2010 and 2015. Also, as per an affidavit in a public interest litigation filed by Dr RD Joshi in the Bombay High Court, out of the 1,381 violent incidents against HCWs between 2016 and 2021, just 636 were reported, 504 people were chargesheeted, merely 32 cases decided, and only four of the accused were convicted.

The ongoing nationwide doctors’ strike is not the first one on the issue. In 2018-19, 10 states witnessed strikes over violence against HCWs. MLAG convener Dr Neeraj Nagpal says that if and when a police complaint is lodged, the patients’ relatives tend to lodge a counter complaint, forcing the doctors to retract under pressure from cops or politicians.

It took the rape and murder of a junior doctor for the government to acknowledge the inadequacies repeatedly pointed out by doctors regarding workplace security at medical colleges and hospitals. The National Medical Commission recently issued an advisory to all medical colleges to ensure a safe work environment through CCTV monitoring, proper lighting in corridors and adequate safety steps. However, merely issuing an advisory is not enough. Apart from laying down guidelines, there is a need for the authorities to change their mindset. Funds must be released to ensure the implementation of the regulations. No workforce in any other domain is as vulnerable as the HCWs, particularly those serving in the public sector.

The Kolkata horror is a manifestation of a depraved society, corrupt police, hypocritical politicians and a lax judicial system. Doctors and other HCWs have to be protected. Violence against them must stop. Society has to own up to its responsibility, the government must be accountable, and the police should follow the law. But first, a stringent HCW protection law has to be framed and implemented. There is a need to ensure a time-bound trial and exemplary punishment.