Violence against doctors: Urgent need for central law to protect healthcare workers

Doctors protesting violence against healthcare workers | Photo courtesy: @MedCrisis

On March 29, Dr Archana Sharma, a gynaecologist in a private hospital in Rajasthan’s Dausa, allegedly hanged herself and committed suicide following protests after the death of a patient. A murder case was registered against Dr Sharma, and in her suicide note, she had stated that the patient had died during a normal procedure.

Dr Rajas Deshpande, a neurologist from Pune speaks to The Probe

On April 8, a duty doctor in Maharashtra was assaulted by the relatives of a woman who was pregnant with twins but succumbed to postpartum haemorrhage (PPH).

Last year, Seuj Kumar Senapati, a doctor at the Covid care centre in Hojai district in Assam, was brutally attacked by a patient’s family members after he said that the patient brought to the hospital was unresponsive. A horrific video of the attack went viral on social media where the doctor could be seen being dragged, kicked and assaulted on the head with a bedpan.

Very recently, resident doctors of Lady Hardinge Medical College went on a strike after a patient’s relatives allegedly intimidated and assaulted the doctors on duty at the associated Kalawati Saran Children’s Hospital in Delhi after five-month-old twins had passed away at the medical centre within days of each other.

The rising instances of attacks on healthcare workers across the country prompted the World Medical Association (WMA) to write to Prime Minister Narendra Modi, requesting him to find solutions to secure the safety of India’s healthcare workers. The Covid-19 pandemic highlighted the selfless service of tens of thousands of frontline healthcare workers in our country who saved millions of lives by risking their own. But in the absence of concrete central laws to protect healthcare workers, doctors say they are the most vulnerable and targeted professionals in the country today.

“There are three or four categories of officials who have to give unpleasant news to the people. Like for instance, police officials, members of the judiciary, ministers or government officials. All these people have protection. But it is only the doctors who have zero protection. This must change. Doctors must get protection. The cases of attacks against the healthcare workers have been rising at an alarming rate,” said Dr Rajas Deshpande, a neurologist from Pune.

According to Dr Deshpande, political interference and indifference from government members are some of the primary reasons for rising attacks on healthcare workers. “We need stronger laws and stronger punishment and less political interference. We don’t want prominent members of the government to generalise and condescendingly talk against the healthcare workers. Whenever there is violence, in many cases, the assaulters have the support of the local politicians of the area in question. Vandalism is usually associated with patients who have access to local politicians or their cronies, and the politicians then start exerting their influence. There must be strict regulations to curb these practices.”

A PIL was recently filed in the Supreme Court seeking directions to the centre to prevent attacks on healthcare workers and ensure adequate safety and security for doctors, hospitals, and medical centres across the country. Advocate Sneha Kalita, who filed the petition on behalf of the Delhi Medical Association (DMA), told The Probe that the medical community has been requesting the centre to draft a central law since years but India still does not have a uniform law to protect medical professionals

“I have filed a PIL in the Supreme Court, the Guwahati High Court, and I have also approached the Human Rights Commission. The act to prohibit violence against medicare service persons and damages to the property in medicare service institutions has not been implemented effectively. The loopholes in the act are that there’s no compensation mechanism for the healthcare workers if they are abused, assaulted or lynched. The act says that the compensation has to be provided by the accused, but what can you do if the accused is absconding or is untraceable or convicted in the court proceedings. Until then, who will bear the expense of the healthcare worker? So, the government must take the responsibility and ensure that the victims are provided adequate compensation and timely relief.”

India still doesn’t have a centralised data system on statistics related to violence against doctors. According to Kalita, some organisations have been trying to compile information, but the government still doesn’t have concrete statistics. “Last year, I spoke to IMA and DMA about the records related to incidents of violence against health workers, but I was taken aback by the fact that they didn’t maintain the data and had no concrete details. There is a need to have a record of incidents of assault against healthcare workers in all states, which I think they have only started to maintain now. The health ministry should take the lead in ensuring that the data is maintained.”

According to the World Health Organisation (WHO) regulations, hospitals are required to put in place mechanisms for reporting incidents of violence involving medical professionals. The Indian Medical Association and other bodies have repeatedly been requesting the government to take the issue of attacks on healthcare workers seriously. The IMA has demanded the Prime Minister, Health Minister, and Home Minister to take the initiative and enact a central law containing sections of the Indian Penal Code to protect medical professionals.

Though a Public Health Bill was introduced in India in 2009, it was not passed as many states objected to the Bill, stating that health was a subject under the State List. Even when the Protection of Medicare Service Persons and Medicare Service Institutions (Prevention to Violence and Damage to Property) Act 2008 was enacted by nearly two dozen states in India, it is still not a deterrent to violence as it has not been implemented effectively. The law is also not part of the Indian Penal Code, and since the law differs from state to state, lack of uniformity and stringent implementation has resulted in the law not providing a reprieve to the affected healthcare workers.

Post Covid-19, the Epidemic Diseases Act of 1897 was revised to include sanctions for any violence against healthcare workers. However, this has not yielded the desired results as critics say doctors need holistic laws that can provide them protection beyond emergencies and ensure their everyday dignity while they carry out their service.

According to Dr GS Jaiya, a former IAS officer who had worked closely with several international bodies, including the WHO, the problem is multi-pronged. “It is not just a problem related to the absence of laws in the country. To address this issue, we need to follow a multi-pronged approach. For instance, the patient’s expectations from doctors are rising. Also, the number of medical establishments and doctors in the country is inadequate to handle the number of patients thronging healthcare centres. There is always a rush of patients in both government and private hospitals. Because of this, doctors cannot spend as much time with the patients as they used to in the past. So, the communication chain between the doctor and the patient is broken. When the breakdown of communication happens, such incidents of violence and assault occur.”

Dr Jaiya affirms that merely having a law in place is not enough. There is a huge need to create awareness amongst the patient community and their family members related to the pros and cons of the ongoing treatment. Dr Despande asserts that the centre should step in and not pass the buck to the states. “First, we need a strong central law. Second, not more than two attendants are ever required in a hospital with a patient. People should be made aware that those who resort to violence against doctors will have to face dire consequences. Third, ministers, politicians and reporters should not spread poison against the entire medical profession. They must consider that it is not a bad element among doctors who always get punished. Usually, the hardworking junior doctor in the casualty gets assaulted.”

A study conducted in 2019 on violence against doctors published in the Indian Journal of Psychiatry found that doctors in India and other Asian countries faced more violence than their western counterparts. According to a survey conducted by the Indian Medical Association, over 75% of doctors had faced violence within the premises of their workplace. Medical experts say that infrastructural facilities in the country must be revised, and more healthcare workers should be recruited in government hospitals across. According to experts, the grim situation will continue in the absence of a uniform central law that ensures the safety and security of medical professionals.