In the wake of a recent attack on a doctor in West Bengal, medical practitioners under the banner of the Indian Medical Association (IMA) have intensified the demand for a central law against violence on hospital staff. Dr Paribaha Mukhopadhyay, a junior doctor of NRS Medical College and Hospital, Kolkata, was critically injured in an attack that took place following the death of a 75-year-old patient at the hospital. The treating staff were brutally attacked by the relatives of the patient and their supporters alleging medical negligence.
The incident invoked a strong reaction from medical practitioners across the country. Following the attack, doctors at NRS Medical College and Hospital and many other hospitals staged an indefinite strike demanding action against the culprits. In solidarity with the striking doctors of West Bengal, their counterparts in various hospitals across the country boycotted non-essential services for several days and took to the streets to demand strict action against the assaulters. In many states, hospital operations were hit due to the strike called by the doctors. “It’s a very brutal incident. The nation-wide protest against the incident by doctors was a natural reaction because every single doctor in the country has been affected by such incidents,” said Dr R V Asokan, Secretary General, IMA.
The incident also witnessed the resignation of hundreds of medicos in West Bengal in protest against the comments of Chief Minister Mamata Banerjee. Doctors under the banner of the IMA, a body representing over 3,50,000 doctors in the country, observed an all India protest day on June 14 and staged a nation-wide strike on June 17, 2019, demanding strong action against the assaulters. Extending support to the striking doctors, IMA strongly condemned the violence against doctors in West Bengal and demanded exemplary action by the West Bengal government. IMA stated that safety and security inside hospitals are matters of great concern and need to be addressed and ensured. “Even in times of war, hospitals are considered separate zones and not attacked. But here, doctors and other medical workers are being repeatedly attacked by relatives if a patient dies during the course of treatment,” said Dr N Sulphi, IMA Kerala state secretary.
Declare hospitals safe zones
IMA, which has been demanding a national law against attacks on hospitals and staff, has intensified the demand following the incident. It demanded that a national law in this regard should be introduced immediately. It also demanded that a minimum of seven years’ imprisonment should be given for hospital violence. In a statement, IMA said that in order to ensure that the cases are registered, culprits are arrested and conviction assured, appropriate mandatory provisions as provided in the POCSO Act have to be instituted. It also demanded that hospitals should be declared safe zones and the provision of necessary security should be made the responsibility of the state.
IMA further stated that violence in hospitals will adversely affect patient care. The body feels that hospitals will be reluctant to take up complicated and risky patients, which in turn will affect critical care. It noted that sound judgment regarding patient care will be compromised because of the increase in stress levels due to the threat of violence. Patient care and safety depend on the peaceful ambience in the hospitals, stated IMA. Dr Sulphi feels that such attacks may force the doctors to practice defensive medicine. “There are cases in which a patient’s life can be saved if the doctor makes an attempt. But fearing the attack, now the doctors may be forced to refer the patient to higher centres, which will delay treatment,” he said.
Dr Sulphi further stated that in hospital attacks, other patients and hospital workers are also being attacked. “When doctors are attacked, they may not be able to give adequate attention to other patients, which can delay treatment to other patients and lead to their death. Also, these kinds of incidents will result in doctors seeing patients with suspicion. It will also result in an increase in treatment cost, with doctors switching over from clinical medicine to evidence-based medicine. With doctors increasingly depending on tests, the role of doctor’s clinical acumen will also be reduced.”
Replace defunct laws
Dr R V Asokan stated that it’s not the first time that doctors are being attacked in the country. “There are countless incidents of doctors being beaten up brutally. Responding to the situation in West Bengal is important, but more important is the introduction of a central law to prevent such incidents. We have been appealing to the government for quite some time. Even as 19 states have enacted laws against violence in hospitals, it is not yet included in the Indian Penal Code (IPC). The law is not implementable on the ground: If it is not included in the IPC, it is not possible to implement it effectively,” he said.
A few years ago, IMA had submitted a memorandum to the union government demanding a central law against violence on hospitals. “An inter-ministerial committee of the union government in 2015 had proposed a central law against violence on hospitals. But there is no progress on the same even after four years,” said Dr R V Asokan.
Echoing the same views, Sulphi said, “The doctors are being attacked because they are soft targets. Though many states have enacted hospital safety laws, it’s not effective and there must be strong legislation to prevent attacks on hospitals. Hospitals should be made special protection zones. Hospital attackers will be punished only if it is included in the IPC.”
Meanwhile, Dr Harsh Vardhan, union minister for health, has asked all chief ministers to take stern action against people who assault doctors. In his letter to the chief ministers, Dr Harsh Vardhan said that incidents of assault on doctors are reported from different parts of the country and it’s a matter of deep concern. Such assaults lead to sudden strikes by doctors, gravely affecting healthcare services.
Stressing the need to avoid such incidents in the future, Dr. Harsh Vardhan said that the law should prevail so that doctors and clinical establishments can discharge their duties and carry on with their professional pursuits without the fear of any violence. “Strict action against any person who assaults them must be ensured by the law enforcement agencies,” he emphasized.
Protection – States’ duty
In his letter to the chief ministers, Dr Harsh Vardhan cited a communication sent by the union health ministry to all state chief secretaries, which contained the decision taken by an inter-ministerial committee constituted under the ministry of health to review the issues raised by IMA. The committee, in its report, recommended that the health ministry shall suggest to all the state governments that do not have specific legislation to protect doctors and health professionals to consider one to strictly enforce the provisions of special legislation wherever they exist or enforce the IPC/Cr.PC provisions with vigour.
Dr Harsh Vardhan has requested the chief ministers to consider enacting specific legislation for protecting doctors and medical professionals and has forwarded the draft act provided by IMA i.e. the Protection of Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage or Loss of Property) Act, 2017. He further said that doctors form an important pillar of the society and often work under stressful and difficult conditions. “Our doctors rank among the best in the world and work for long hours under stressful conditions, grappling with a huge load of patients. It is the duty of the state to ensure the safety and security of doctors who assure that the healthcare needs of the society are met,” he said.
In another development, the Supreme Court deferred a hearing on an impleadment application seeking the court’s intervention into the plea already filed, saying it has to look at the larger picture. “We understand it is a serious issue, but we can’t provide security to doctors at the cost of other citizens. We have to take a holistic view. We have to look at the larger picture. We are not against protection to doctors,” the bench said.