[Editorial] Shielding Doctors from Violence

What is the current status?

  • Doctors are increasingly facing ‘malicious prosecution’ and violence.
    • A doctor in Dausa, Rajasthan committed suicide after an FIR alleging misconduct and negligence was registered against her.
    • Following this incident, senior police officers were transferred and the Station House Officer was suspended.
    • In 2019, following an assault of a doctor in Kolkata, the doctors started a strike in West Bengal. This soon snowballed into a nation-wide protest. The doctor had been assaulted by the relatives of a patient who had died.
  • Many of these incidents could have been avoided and these aren’t isolated incidents either. There is a steady trickle of reports of violence against doctors and other healthcare personnel from across the country.
  • The violence is especially from people who had lost loved ones under medical care and blame the personnel for medical negligence.
  • According to an article, published in 2021 in Indian Journal of Medical Research, doctors’ strikes were reported from one state or the other almost throughout the period between 2018 and 2019.

What has been done to address this?

  • Notably, India doesn’t have a centralized database on workplace violence. In response to a Lok Sabha question, the government held that ‘health’ and ‘law and order’ are state subjects and hence, the central government doesn’t maintain such figures. The state governments don’t have such databases either.
  • Doctors’ organizations, such as the Indian Medical Association, have been calling for a comprehensive law to address violence against medical personnel.
  • In a 2018 Law Commission of India report, titled ‘Wrongful Prosecution (Miscarriage of Justice): Legal Remedies’, suggested a draft law that covers criminal remedies. However, it was mostly compensatory and barely touched upon preventive aspects.
  • Some 23 states have their own legislations for protecting healthcare workers. However, these lack teeth and there is no uniformity in terms of punishment.
    • An IJMR study in Punjab and Haryana showed that no one was penalized under the Medicare Service Person and Institution Act in the period between 2010 and 2015. Most of the cases were either cancelled after a compromise or not even registered.
    • The paper also noted that the Maharashtra police weren’t even aware of such a law. The state’s Medical Protection Act was passed in 2010, while the sensitization measures were started in 2017.
  • A temporary break came during the pandemic in form of the ‘The Epidemic Diseases (Amendment) Ordinance, 2020’:
    • This ordinance amended the 1897 Epidemic Diseases Act.
    • It provided for fining (50,000 to 2 lakh INR) those convicted of harassing/ assaulting healthcare personnel. It also provided for a prison term of 3 months to 5 years.
    • In case of an assault resulting in serious injury (on the medical personnel), the convicted person is liable to a higher fine and more prison time.
    • The catch is that the government would revoke the ordinance at the end of the pandemic– going back to square one.
  • In 2019, the Union Health Ministry drafted the ‘Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage of Property) Bill’ and invited public comments.

Provisions:                                    

    • It sought to prohibit violence against healthcare personnel– including medical students and ambulance drivers. It also sought to protect clinical property– like ambulances- from damage.
    • It made such offences cognizable and non-bailable. These cases are to be investigated by officers, not below the rank of Deputy Superintendent of Police.
    • It provides for a fine of up to 5 lakh INR and a prison term of 6 months to 5 years (more in case of grievous hurt). The convicted person is also required to pay compensation to the affected parties.

 Status:

    • The Home Ministry opposed the Bill, saying that the existing provisions under the IPC and CrPC would suffice in tackling the issue.
    • It argued that is such a profession-specific law were to be passed, other professionals (such as lawyers and police) would also demand similar laws.
    • The Health Ministry has now withdrawn this draft legislation.

What can be done?

  • In response to the Home Ministry’s argument, IMA has highlighted how several studies say that healthcare workers face more violence than other professionals do.
  • The IMA has even submitted its own draft of the law with more stringent punishment.
  • However, other experts- even at the Health Ministry- call for working on the other side of the issue i.e. patient-doctor relationship. The information asymmetry between doctors and patients contribute to the general distrust. Improving communication on the modalities of treatment can address this to a certain level.
  • Having proper grievance redressal mechanism to address people’s issues with the healthcare setting would help reduce violent incidents.
  • Professional bodies like bar associations should take disciplinary actions in cases of tutoring and abetting false charges.
  • Medical bodies could create a corpus to fund legal representation in cases of violence, vandalism of healthcare premises and disruption of healthcare functions. This will enable quick conviction.
  • There is also a call to regulate the commercialization of the healthcare sector.
  • Another area of focus is the poor healthcare infrastructure and insufficient human resource contributing to a breakdown of India’s healthcare system. Governments spend less than 1.5% of GDP on healthcare.
  • Such strikes and protests have a direct impact on patients and public healthcare. At the same time, a 2015 study by US Department of Labour noted that violence in healthcare settings is 4-times higher than in any other professional setting.
  • Instead of demanding for a separate legislation, medical pressure groups would be better served by calling for more effective use of available legal provisions under the IPC and CrPC.
  • The Law Commission has been looking at provisions include IPC Sections 182 and 211 (for public servants and private complainants) and Section 166-A (for public servants) as possible remedies against malicious prosecution and tutored reporting.
  • Section 211 could be an effective tool against false charges to injure a person (including reputation). It provides for a prison term of up to 7 years.
  • While the practice is still rampant, there is a silver lining- Jhunjhunu trial courts in Rajasthan have recently convicted 52 people for malicious prosecution under a special drive.

Conclusion:

Rather than introducing new legislations, making effective use of the available legal provisions and addressing the gaps in the healthcare system could be a better way of addressing the issue of violence against doctors.

Practice Question for Mains:

Comment of the issue of violence against doctors in India. What can be done to address the issue? (250 words)

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