133 attacks in a year: How India is failing its health workers
Yash Kamath, Madhav Bansal, Siddhesh Zadey, Christina Wille, Rohini Haar
Contd from prev issue
During the pandemic, widespread fear, mistrust, and myths about COVID-19 further aggravated violence against healthcare workers.
The government of India has temporarily amended the Epidemic Diseases Act to mitigate the problem, but it lacks effective implementation. More importantly, this Act in no way can solve the larger systemic problem that Indian healthcare workers face.
Violence against healthcare workers is dealt with quite differently across Indian states and Union Territories (UTs). The offense is cognizable (i.e., a criminal offense where the police can arrest without a warrant to conduct an investigation with or without a court's consent) and non-bailable in 26 states and UTs. Of these, 25 states and UTs have implemented the Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008, and despite assault being a punishable offense under the Indian Penal Code, the process to seek remedy is not streamlined.
Can Stringent Laws Help?
Apart from these, Madhya Pradesh has implemented a special law, ‘The Madhya Pradesh Chikitsak Tatha Chikitsa Seva Se Sambaddha Vyaktiyon Ki Suraksha Adhiniyam', which makes violence against healthcare workers a cognisable and non-bailable offence. Jammu & Kashmir, Meghalaya, Mizoram, Nagaland, Sikkim, Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli, Daman & Diu, Ladakh, Lakshadweep have no laws at all. For 19 states, the penalty fine is Rs 50,000, and for 18 of them, there is a prison sentence of up to three years (excluding the state of Punjab, where imprisonment is up to one year).
Why Violence Against Docs Won’t Stop: Root Causes Stay Unaddressed
Arunachal Pradesh has a very high fine of Rs 5,00,000, whereas Himachal Pradesh imposes a fine as low as Rs 5,000. Laws in Haryana, Tamil Nadu, and the Union Territory of Puducherry do not specify a precise punitive sum while stating, "Liable to pay compensation for the damage or loss caused to the property". The law is ambiguous in the Union Territory of Chandigarh, which is a shared capital of Punjab and Haryana. Among several other reasons, it is possible that the existence of legislation that holds perpetrators of violence accountable has contributed to null or minimal recorded incidents in regions such as Goa, Manipur, Haryana, Arunachal Pradesh, Jharkhand, Chhattisgarh, Himachal Pradesh, and Puducherry.
In a recent article published in the British Medical Journal, we suggested that enactment of a central law and improved enforcement of existing state laws are the steps that governments must take to grant justice to healthcare workers who have experienced violence and abuse in the line of duty.
The pandemic has put a spotlight on the vulnerabilities of the health system and problems faced by healthcare workers. However, India faces systemic issues within a labour-intensive healthcare sector, marred by years of public under-funding with a social narrative calling out healthcare workers when economic and social determinants have been ignored by the government for decades.
We need to advocate for better policies on the matter. Back in 2019, the Ministry of Health and Family Welfare proposed the Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, which could impose jail sentences of up to 10 years and an indemnity penalty of up to Rs 10,00,000 on those assaulting healthcare workers. It also accorded healthcare workers a broad definition, including doctors, dentists, nurses, paramedics as well as medical students, diagnostic technicians and ambulance drivers.
However, this publicly popular Bill was repudiated by the Ministry of Home Affairs, citing that a special law for the protection of doctors is neither necessary nor appropriate. As pointed out here and at other places, there is enough and growing evidence that special protections are needed. Otherwise, we might soon see a day with no healthcare workers willing to work in our country.
It's critical to invest in developing stronger surveillance systems around violence against healthcare so we can measure and understand its scope and see where workers are most vulnerable. With increased surveillance and analysis of past incidents, we can have a better understanding of how to deal with this issue. We also need to think about prevention – along with prosecution – as a potential solution. By deconstructing data and understanding the different contexts of such attacks, there is potential to learn communication and counselling techniques, and also de-escalation strategies, at instances of conflict.
Almost every other day, there is a new report on assault against a healthcare worker in some part of the country. There is a critical role here for the citizens, with a clear incentive. If healthcare workers feel safe, they can provide better care to the patients.
Cracks in the 'Big Picture'
Beyond the HCW community, we need public action seeking reform from governmental agencies. Dr Rajeev Joshi, a practising paediatrician and former President of the Indian Association for Medical Informatics (IAMI), says:
"There is no citizen-led activism for protection of doctors from violence. I am not saying that there is no negligence or misbehaviour from doctors, but the remedy for the wrong is not violence.”
However, he also notes that actions that he and others like him have been taking: “The phenomenon of medical accidents is neither appreciated by patients, government, nor judiciary, which is the commonest cause of mishaps during medical treatment leading to an unexpected, undesired outcome. Jurisprudence teaches that duty comes with corresponding rights, so I decided to file a Public Interest Litigation requesting the Hon'ble Court to issue guidelines to protect doctors.”
As we emerge from the pandemic, let's zoom out and see the picture the way it is – broken.
(Siddhesh Zadey BSMS MScGH, is a co-founder of the non-profit think tank ASAR. Madhav Bansal is an MBBS student and a volunteer researcher at ASAR. Yash Kamath is also an MBBS Student and a research intern at ASAR. Rohini Haar, MD, is an emergency physician and a research fellow at the Human Rights Center at UC Berkeley’s School of Law. Christina Wille, PhD, is the director of Insecurity Insight, a Geneva-based not-for-profit organization.) The Quint