One of the most important issues facing Healthcare Establishments and health care professionals is the need for an efficient and effective mechanism to prevent violence against them. 

 

I have over my 40+ year tenure enabled Delhi State Govt and the Supreme Court of India in creating law and rules regarding the issue of criminality by the medical profession. This was based on experience as a core caregiver and an executive with a grasp of real operational and strategic challenges faced by the medical profession.

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• More than 75 percent of doctors in India have faced at least some form of violence, with 12 percent of such violence occurring in the form of physical attacks.

• Escorts of patients have committed nearly 70 percent of such violence .

• Nearly 50 percent of such violence has been reported from intensive care units (“ICUs”) or post-surgery.  

• Peak hours and the transfer of critical patients to other hospitals are most susceptible to violence.

• Even during pandemic incidents of violence continued.

 

A study published in 2018 analyzed reports on violence against doctors. It selected 100 cases, in all of which doctors had also resorted to a strike because of the violence. This study provided some information about the geographical and sectoral spread of violent attacks against doctors : 

• More cases at Government hospitals were reported in Delhi and Uttar Pradesh. 

• Maharashtra and Rajasthan had more reports of incidents at private hospitals. 

• The data analyzed showed that a majority of attacks were on male doctors and at private hospitals. 

• 51 percent of the incidents reported were during the night shift, while 45 percent were in the emergency ward. 

 

A study on violence against resident doctors at a tertiary care hospital in Delhi found : 

• That almost 80 percent of the 169 doctors surveyed and interviewed believed that poor communication skills were the most common physician factor that led to workplace violence, 

• While 56 percent felt that this could be attributed to poor conflict resolution skills. 

• Other factors included drug addiction among patients or their relatives, overcrowding in hospitals, shortages of medicines and other hospital supplies, and poor working conditions of doctors.

 

Another study again on violence against resident doctors at a tertiary care hospital in Delhi, asked resident doctors for their opinions on the cause of violent incidents :  

• The most commonly cited cause of the violence was ‘negative media publicity’, with 80 percent of the respondents naming it, followed by poor communication, dissatisfaction with the work of the doctor and nurse.  

• Lack of improvement in the patient’s condition. 

• Other causes cited by the respondents in this study include failure to meet the requirement of patients and/or their relatives  

•  Death of the patient and long waiting times. 

 

These have been classified into three broad categories : 

• Lack of capacity in terms of infrastructure and personnel.

• Quality of primary care.

• Inadequate communication skills.

 

Current Status : 

• Nineteen States have Prevention of Violence or damage or loss of property Acts passed and notified in the last 10 years.

• States of Rajasthan, Tamilnadu, Odisha, Delhi, Karnataka, West Bengal, Chattisgarh, Bihar, Maharashtra, Assam, Kerala, Gujrat, Punjab.

• Section 4 of The Karnataka Prohibition of Violence Act, 2009 provides for three years imprisonment.

• Current state – Poor Implementation of Acts.

• Epidemic Diseases Ordinance 2020.

• Acts of violence shall be punished with imprisonment of 3 months to 5 years and a fine of ₹50,000 to ₹2,00,000.

• In case of grievous injury, imprisonment term can be for up to 7 years, with a fine of ₹1,00,000 to ₹5,00,000.

 

CONTINUED ACTS OF VIOLENCE 

• Outrage against violent attacks on medical professionals reached a crescendo in June 2019, with the assault on two junior doctors at Kolkata’s NRS Medical College and Hospital.

• The nation-wide protests by doctors that followed this incident, as well as the lynching of a 73-year-old doctor in Assam

• Promoted the Ministry of Health and Family Welfare, Government of India, to propose the Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 (“Draft Bill”), specifically criminalizing violence against healthcare personnel. Dashboards for measuring Medical and Service quality

 

OUTCOME OF INTER MINISTERIAL CONSULTATIONS

During inter-ministerial consultations, however, the Ministry of Home Affairs opposed the enactment of a special law to deal with violence against members of a specific profession since existing provisions of the Indian Penal Code, 1860 were considered sufficient to deal with such acts of Violence.

 

WAY FORWARD TO SOLVE THE PROBLEM

When the Executive fails – Judiciary comes to our rescue. In 2005 the Supreme Court examined the issue of Criminality against doctors. Jacob Mathew versus State of Punjab and Anr. 

 

In the present situation, the proper implementation of existing laws would solve the problem : 

• File a writ petition in the High Court of Mumbai under Article 226 of the constitution of India seeking the direction of Hon’ble court under its writ jurisdiction. 

• All HCOs to display at vulnerable locations provisions of law. 

• Training of HCWs.