In February this year, in a written reply to the Rajya Sabha, the union Health Minister Dr Mansukh Mandaviya informed the House that the Central government has decided not to enact separate legislation to prohibit violence against doctors and other healthcare professionals. A draft bill for this, which had already been circulated, now stands withdrawn. In response to a question about the reasons for the withdrawal of the bill he was extremely evasive and stated, “Thereafter, it was decided not to enact a separate legislation for prohibiting violence against doctors and other healthcare professionals.” Yet the government found it prudent to introduce the Epidemic Diseases (Amendment) Ordinance in April 22, 2020 under which violence against doctors was made cognisable and non-bailable. This amendment prescribed a fine of Rs 50,000-2,00,000 and a jail term of up to 3 months for offenders. This remained if force for the duration of the Covid pandemic and lapsed once the epidemic was over. It provoked the sinister and pessimistic implication that, you may not beat up a doctor and destroy medical equipment during an epidemic, but it is acceptable once the epidemic is over.
Dr Rohan Krishnan, National Chairman of the FAIMA Doctors’ Association, pointed out that in spite of increasing incidences of violence the Union Health Ministry has not taken their request for a separate law to ensure the safety and security of doctors and healthcare workers seriously. He continued that the administration is not following through on its pledge to introduce a separate law to forbid violence against physicians and other healthcare professionals. He also added that the government has refused to speak with them verbally about this issue and has ruled out the possibility of passing a separate law in the future. He alleged that the government has failed doctors and other healthcare professionals physical and psychological safety and security.
The media reports with increasing frequency instances of medical personnel being stabbed, shot at, beaten up, abused and subjected to various forms of ignominy. The violence may not be only physical; it could be verbal abuse, psychological, or economical as in loss of reputation and resultant loss of practice. Even as this article goes into print, doctors in Jharkhand are protesting against violence they have to endure at the hands of the public in the course of executing their duties. Twenty-three States have enacted a law to tackle the menace of violence against doctors. Yet when professional associations approached the Home Minister for a Central law, he refused on the grounds that it was unnecessary.
This leads to the police dragging their feet in acting against the perpetrators of violence, because of political interference or the unsubstantiated allegation that the doctors were indeed negligent. There is no hesitation in arresting doctors for negligence, even though the SC and the HCs have repeatedly ruled that no doctor may be arrested for medical negligence unless a specially constituted medical board declares it so. We even had a doctor recently committing suicide because she was arrested on trumped up charges of negligence without any referral to any board. How many judgements do we need before the police act within the parameters of Court directives? How many suicidal hangings like that of Archana Sharma do we need, before the police accept that a doctor cannot be arrested unless a board has declared criminal negligence did occur?
The demand for a separate law is based on sound research by various medico-legal organisations. The IMA survey has indicated that 75% of doctors have faced some degree of violence in their careers. Whilst the WHO has stated that all countries have a problem with violence against doctors, India leads the world in this respect. A recent study in the US revealed that 32% of public healthcare workers experienced some form of violence, physical or otherwise with adverse effects on their health, particularly depression. Further, there has been a steady increase in the last five years. As a result, new federal legislation is in process called Safety from Violence for Healthcare Employees Act.
In India, of the 1,318 attacks across the country, there have been only four convictions in the last five years. Article 19(1)g gives a citizen the right to a profession; which right is violated when violence is inflicted. Article 21 in guaranteeing the right to life, also guarantees dignity, reputation and health; and the State has an obligation to take appropriate steps to maintain and even improve the quality of life of its citizens.
Even though States have their own laws, they differ in their rules and by-laws. A Central law would not only bring uniformity to such a law, it would also ensure inclusion in the IPC and therefore compel the police to pay more attention to filing FIRs. At present the tendency of the police is to ignore State laws, and fob off the complainant by saying that the doctor/hospital must have done something wrong. The courts mandate that a doctor is compelled to provide treatment in an emergency, but the police do not appear to be under any compulsion to act to protect the doctors against violence that may ensue in the event of the emergency treatment failing to achieve the desired outcome.
Violence in healthcare destroys the trust that is an integral part of treatment. But there is even greater fallout. It promotes defensive medicine, and reluctance to treat difficult and complicated cases. Medical professionals are opting out of the profession and talented youngsters are refusing to enter the profession. Ultimately society is the biggest casualty.
(The writer is a founder member of VHAG)