Tuesday, October 3, 2023

Doctor, Heal Thyself?

In the face of repeated assaults by emotional relatives of patients, are healthcare professionals left to fend for themselves? Despite safeguards by the government, this issue is here to stay.

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Expressing concern over the rising incidents of assaults on doctors and other healthcare professionals in the state’s hospitals, the Kerala High Court on December 1 directed the police to register FIRs within an hour of receiving complaints of such violence.

A Division Bench of Justices Devan Ramachandran and Kauser Edappagath passed this order while hearing a petition by the Kerala Private Hospitals Association. The Court ordered that every Station House Officer concerned, to whom or to whose station a complaint of atrocity on any healthcare professional is filed—be it doctors, nurses, staffs, security or such other, or against the property of a hospital—shall record it as a first information and a case be registered within one hour.

The Court noted that S Gopakumaran Nair, senior counsel, made certain startling revelations, including that for a 12-month period from June 2021, the number of attacks recorded was in excess of 138 or so. This, said the Court, was distressing because, statistically, this means there are at least 10 or 12 attacks every month.

The Court said that it was more concerned because it had been issuing orders in the past under the hope that the official system would function faultlessly and that citizens would also be aware of the imperative requirement to treat the healthcare system with the respect it deserves.

The Court observed that discussions at the Bar clearly show that unless a sense of fear of the law is instilled in citizens, nothing could really change. Experience has shown that citizens are not fearful of law, but of apprehension in case of misconduct or infraction.

The Court further observed that it was perhaps because citizens get the impression that the processes of law are slow and that they would not be taken to task that such recurrent occurrences happen. The fact that the government hospital system is overwhelmed and the number of patients is escalating by the day is common knowledge. Unless doctors and healthcare professionals are able to act in peace and calm, it would be impossible for the system itself to sustain, warned the Court. Therefore, the Court required all stakeholders, including the government, to inform it of the steps that had been taken to ensure this.

S Kannan, senior government pleader, said that every step as ordered by the Court in earlier orders, including the establishment of police outposts in hospitals, had been implicitly adhered to by the government and it was willing to accept any other suggestions to be made, either by the Court or by the stakeholders.

Following its instructions of filing an FIR, the Court said: “Needless to say, swift action thereafter shall be initiated, including to apprehend the Offenders, as and when it requires so, leading to prosecution and such other, as the law warrants.”

As far as the government of Kerala is concerned, the Bench requested it to ensure that citizens are told, by appropriate methods, of the gravity of the offence of an attack on a hospital or healthcare personnel and the manner in which the Court proposes to deal with it in future.

Attacks on doctors have been increasing in recent times. In June 2021, Dr Seuj Kumar Senapati was on duty at a coronavirus facility in Udali Model Hospital in Assam’s Hojai, around 140 km from Guwahati, when he was mercilessly punched, kicked and pounded with metal trash cans and bricks by relatives of a Covid patient who died, allegedly due to oxygen shortage. A video clip of the horrific violence went viral, after which 24 people, including the main accused, were arrested in overnight searches.

Dr JA Jayalal, president of the Indian Medical Association, condemned the incident, while members of the Assam Medical Services Association demanded strict action against the culprits. Chief Minister Himanta Biswa Sarma had directed the police to investigate the attack and arrest those responsible. GP Singh, Additional Director General of Police, Assam, said a case had been registered and one person allegedly involved in the attack had been arrested.

Then there was an assault on a woman doctor at Thiruvananthapuram Government Medical College where a bystander kicked her on her lower abdomen in front of an ICU on November 23 night. CCTV visuals showed that she was surrounded by a group of bystanders. The Kerala Medical Post Graduate Association took up her cause and demanded justice.

As per Constitutional provisions, “health” and “law and order” are state subjects. State governments are expected to set up mechanisms to prevent violence against doctors, including imposition of penalties or setting up helplines to extend immediate help to those doctors who are victims of violence. While details of attacks on doctors are not maintained centrally, such violence against them is a criminal offence and needs to be dealt suitably by the state/UT governments under provisions in the IPC and CrPC so that doctors/clinical establishments discharge their professional pursuit without fear of violence.

In the wake of Covid, the central government notified the Epidemic Diseases (Amendment) Act, 2000, on September 28, 2020. The Act provides that acts of violence against healthcare personnel during any situation akin to the current pandemic would be cognizable and non-bailable offences. Commission or abetment of such acts of violence shall be punished with imprisonment for a term of three months to five years, and with fine ranging from Rs 50,000 to Rs 2,00,000.

In case of causing grievous hurt, imprisonment shall be from six months to seven years with fine ranging from Rs 1,00,000 to Rs 5,00,000. In addition, the offender shall be liable to pay compensation to the victim and twice the fair market value for damage to property.
The health ministry has, in order to prevent violence against doctors and for inculcating an effective sense of security among those on duty, taken several measures including issuing advisories to states/Union Territories to consider the following:

  • Security of sensitive hospitals to be managed by a designated and trained force.
  • Installation of CCTV cameras and round-the-clock Quick Reaction Teams with effective communication/security gadgets particularly in Casualty, Emergency and areas having high footfalls.
  • Well-equipped, centralised control room for monitoring and quick response.
  • Entry restriction to undesirable persons.
  • Institutional FIR against assaulters.
  • Display of legislation protecting doctors in every hospital and police station.
  • Appointment of a nodal officer to monitor medical negligence.
  • Expeditious filling up of vacant posts of doctors and paramedical staff in hospitals/ Primary Health Centres to avoid excessive burden/pressure on doctors and to maintain global doctor-patient ratio.
  • Better infrastructural facilities and medical equipment and provision of extra monetary incentives for doctors and paramedical staff serving in hard/remote areas as compared to major and metro cities with better career prospects, etc.

Will all these measures prevent further assaults on doctors?

—By Adarsh Kumar and India Legal Bureau

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