Doctor’s Day

Doctors Day is celebrated to recognise the contribution of doctors to individual life and communities. The date may vary from nation to nation. In our country it is celebrated on July 1 which is birth and Death Anniversary of the most famous physician of India Dr BC Roy.The annual celebration is to spread awareness about the contribution of doctors to the society. Although Doctors Day is supposed to be celebrated by patients to thank them but in reality it is usually celebrated by doctors themselves in India.The medical profession is one of the riskier professions. Knowingly doctors are taking risks of getting infected with dreaded infection like TB, AIDS, Hepatitis etc from patients and getting post radiation cancer from radiation exposure in performing their duties.

But taking that much risk and working in odd conditions and hours, they are being rewarded with verbal and physical violence. Verbal aggression or violence is so common that none of the doctors can claim that he has not encountered verbal abuse from the patient’s side for no fault.

Throughout the COVID-19 pandemic in many countries, doctors, nurses, and other health workers in the frontlines were praised as heroes for their efforts. Nevertheless, not all of them support their efforts. The news has also reported reports of healthcare workers suffering attacks since the beginning of this pandemic while commuting from and to medical facilities. Reports in India define the beatings, stoning, spatting, intimidation, and expulsions of health workers from homes. Unfortunately, it is no new practice of violent acts against medical workers. Such attacks were more and more documented in clinics and hospitals around the world before the COVID-19 pandemic. Violence must be condemned in all circumstances. It is the fact that health care staff respond to a crisis that affects all societies that are particularly frightful in the current attacks.

Background and current scenario :

Violence against doctors is not a new phenomenon in their workplace. However, recent studies have shown that doctors are thrashed by patients and family members in India as well as around the world, and the same is also shared on social media. Far too few doctors are educated to avoid or deal with such situations and almost every doctor is worried about violence in their workplace. Violence against doctors in India includes:

 (i) telephone threats;

 (ii) bullying;

(iii) oral/verbal abuse;

(iv) physical but not harmful attack;

(v) physical assaults that cause injury;

(vi) vandalism and arson.

Doctors facing violence have been known to develop depression, insomnia, post-traumatic stress, and even fear and anxiety causing absenteeism in India. More than 75% of doctors are exposed to abuse at work, according to a report by the Indian Medical Association. The husband of a pregnant woman who was admitted to the hospital in a serious condition killed a lady doctor in Tuticorin. She was taken to another hospital but passed away before she was able to be moved. With three accomplices, the husband entered the doctor’s consultation room and assailed her by a sword.

In 2014, after the death of a boy who was named a tertiary hospital, a medical clinic was burnt in Mansa district in Punjab, but died. Countless incidents of violence against doctors are reported almost every day in India, leading to serious injuries. Even the country’s leading medical institution i.e the All Indian Institute for Medical Science (AIIMS), New Delhi was not spared. Nineteen states of India have passed and notified acts of some kind in the past ten years by the Medicare Service and Medicare Service institutions. In compliance with the Right to Information Act (RTI), the Medicos Legal Action Group Trust (MLAG) demanded the following information from all senior police superintendents in Punjab and Haryana, two states where the Law on Drug Prevention has been developed over 8 years.

How many patient or attendant complaints have been reported under this Act by doctors or hospitals?

How many were punished by the law from 2010 to 2015 for those accused of assault?

The replies show that most complaints were not registered in the FIR, which is a binding process to be followed by all policemen, according to the judgment delivered in the case of Lalita Kumari vs Uttar Pradesh by the Supreme Court of India. The FIR was cancelled in some cases based on a complaint after the parties had reached a compromise and the local magistrate was given a cancellation report. Very few cases have entered courts since they filled Challan, but the Medicare services and the Medicare service institutions (Violence or Damage or Property Prevention) have not been penalized under the Act of Punjab and Haryana from 2010 to 2015 for the assault on the medicare establishment.

Causes of violence :

The inability by governments in certain countries to provide and properly maintain the resources in the sense of the pandemic leads to a constant danger for the life of health workers by taking care of COVID-19 patients without sufficient protective equipment and other safety measures at work. This situation in some places has generated violence against them, mainly for carrying out their work. The increase in violence against medical workers is attributed to multiple reasons but not limited to an increase in racism in society as a whole:

Budget for better health and low healthcare quality: The wretched conditions in which patients are treated in government hospitals are among other sources of violence against physicians in India. The population is overcrowded, there are no proper facilities, there are several visits and appointments taken by patients so that they can meet doctors, two or even three patients sometimes have to share beds, and lack of hygiene and sanitation also causes problems. Frustration is caused by structural issues in government hospitals, including the shortage of inadequate equipment and staff. Such issues are unlikely to improve in light of the low budget allocation to health in India. Of those 9,38,861 doctors who are registered for health care for a population of more than 120 crores, only 1,06,415 are employed by the Indian government. Just 27,355 of those centres (PHC), servant to rural residents, are working at primary health centres. Given the country’s increasing growth, the public health system is on the verge of failure with inadequate infrastructure and a little rise in the number of government doctors reported. Violence against the provider of medical care is just the symptom of this instability.

Ability to trust in the judiciary: The lack of faith in law and order machinery and the judiciary is another cause of violence against doctors in India. A plaintiff has little trust in the legal remedy processes. Sometimes there is a perception that doctors who are well connected will get away, and therefore there is a tendency to take the law into their own hands by resorting to violence. This is often assumed that the attendants of the patient who attack doctors will remain unpunished.

Security deficiency: Violence in Indian healthcare facilities is easily organized, partially due to the absence of funds among small and medium healthcare establishments (SMHCE), security personnel in the government and the private sector. With inadequate budgets, it would be impractical to expect adequate protection in Indian hospitals, even in a few corporate hospitals, to employ enough doctors and nurses.

Health expenses: The rising healthcare costs are the key reason why doctors and patients are separated. Also, the USA accounts for half of all financial bankruptcies in devastating medical expenses. Doctors earn 20% of all money for personal health in the US, but the bulk of the remaining expenditures are determined by their decisions. While the prices of all medical services are much lower in India than in the west, they are high enough to make many families indebted and fall below the poverty line. In a household where a daily meal is largely nutritious, it is understandable to lose frustration and sadness after investing more than what it should do, but it sometimes culminates in abuse. Whatever the provocation, justifying any violence, especially against a doctor who is trying to help in times of need, must be strongly condemned.

Poor physicians’ image and the media’s role: Physicians in India have historically been highly respected by society. The prevailing view of those of the profession’s private sector culture has resulted in a negative portrayal of physicians. One of the contributors to this bad physician image is the sensationalization of each news story that sometimes overlooks facts that gloss over daily specifics and exempts a doctor from suspected medical negligence. An illustration of this is that a TV reporter shouts at the medical superintendence of a hospital in Delhi under the influence of dengue patients that the patient who died of dengue was not given antimalarial drugs.

What Do Judicial Pronouncements Say?

Healthcare professionals include doctors and nurses, paramedical, mess boys, laboratory technicians, ambulance drivers, security professional and others.

In Azra Usmail and Others v. Union Territory of Jammu and Kashmir,  the High Court of Jammu and Kashmir pointed out that such violence highlights dangerous consequences like the spread of infection, imperilling the lives of healthcare professionals and damage to public property.

The Court observed:

“the professional engaged in the treatment of COVID 19 patients and prevention of the infection would be working beyond the call of their routine duties and also overtime… In order to ensure full attention of the professional addressing the COVID 19 issues, it is necessary that they are kept free of any personal tensions and needs”.

The Apex Court, in Jerryl Banait v. Union of India, dealt with a matter wherein the doctors who had gone to screen certain patients were attacked and faced stone-pelting. The Supreme Court observed and directed:

“The pandemic which is engulfing the entire country is a national calamity. In wake of calamity of such nature all citizens of the country have to act in a responsible manner to extend helping hand to the government and medical staff to perform their duties to contain and combat the COVID-19. The incidents as noted above are bound to instill a sense of insecurity in Doctors and medical staff from whom it is expected by the society that they looking to the call of their duties will protect citizenry from disease of COVID-19. It is the duty of the State and the Police Administration to provide necessary security at all places where patients who have been diagnosed coronavirus positive or who have been quarantined are housed. The Police security is also provided to Doctors and medical staff when they visit places for screening the people to find out the symptoms of disease.”

In another case, Sanpreet Singh v. Union of India, the High Court of Karnataka directed the Karnataka Government to ensure proper nourishment and necessary care to the healthcare professionals. Additionally, the Apex Court also directed District Magistrates to look into the grievances of these workers.

In Abdul Naser v. State of Kerala, the Kerala High Court observed that apart from subjecting doctors to agony and anguish, attacks and violence on them adversely affect the treatment of all patients. It practically leads to a halt in functions, jeopardising the health of many persons, which is a matter of grave concern.

Legislation To Deal With Violence Against Doctors :

For the first time, the Healthcare Service Professional and Clinical Establishments (Prohibition of Violence and Damage to Property) Draft Bill addressed violence against healthcare professionals at the national level.

It criminalised both the commission and incitement to commission of violence against healthcare professionals and damage to the property of clinical establishments.

However, it never saw the light of the day. The bill was stalled, citing reasons that the existing provisions under IPC already covered the elements of ‘violence’ as defined in the Draft Bill.

The Epidemic Diseases (Amendment) Act 2020 is an amendment to the Epidemic Diseases Act 1897. The principal Act comes under the State List under Schedule VII and is pre-independence legislation.

The 2020 Amended Act defines ‘acts of violence’ committed by any person against the healthcare service professional serving during an epidemic as one, which may cause, harassment, hurt, injury, a hindrance to services, damage to property or documents in custody.

The statute also defines ‘health care professional’ and ‘property’, providing a wide ambit for better protection. Section 2B provides that no person shall indulge in any act of violence against a healthcare service professional or cause any damage or loss to any property during the epidemic.

Section 3(2) provides punishment for commission or abetment of commission of an act of violence. Section 3(3) deals with committing an act of violence against a healthcare service professional, causing grievous hurt as defined in section 320 IPC. Section 3A of the statute provides that the inquiry or trial must conclude within a year.

If not concluded within the given time period, the judge must record the reasons for the delay and extend the time period accordingly. However, this period may not be extended for more than six months at a time.

When prosecuting a person for causing grievous harm to a healthcare service professional, the Court will presume that person is guilty of the offence unless the contrary is proved.

In any prosecution for an offence under Section 3(3) requires a culpable mental state on the part of the accused, the Court shall presume the existence of such mental state. Still, it shall be a defence for the accused to prove that he had no such mental state with respect to the Act charged as an offence in that prosecution.

In addition to the punishment provided for an offence, the person so convicted shall also be liable to pay, by way of compensation, as may be determined by the Court for causing hurt or grievous hurt to any healthcare service professional.

Moreover, in case of damage to any property or loss caused, the compensation payable shall be twice the amount of fair market value of the damaged property or the loss caused.

Critical analysis :

The Government of India, by passing a required ordinance to protect HCW from violence during the COVID-19 pandemic, ultimately met the aspirations of Healthcare Workers (HCW) in India. Although violence against HCW in India is nothing new and has been taking place regularly, in front of all the public, the legislatures, the administrators, and the politicians, nobody has been serious enough to take serious notice of this violence and, as a result, the perpetrators of it have continued to rampage. The Government of India only came forth and took this prompt action because of the absolute and dire necessity of the HCW during this COVID-19 health crisis. While this regulation has included null tolerance for violence against the HCW, the effectiveness of its implementation is clear. The Government of India’s legal and moral responsibility to safeguard the HCW is imperative and strictly honour and protect those citizens who save the lives of others by jeopardizing their lives.

The Government of India amended the Antiquated Epidemic Diseases Act of 1897 and laid down the non-leasing offence of HCW attacks, the imposition of a jail sentence of up to seven years, as well as fines from Rs 2.00,000 to 5.00,000. The regulation covers all HCWs including doctors, nurses, paramedics, and social-health staff accredited. The decree is a positive step. However, strong law enforcement measures need to be added to this. It may not be so difficult to make an order, but its strict implementation will pose a major challenge for the Government of India, as a major gap in law enforcement has so often been seen. The Government of India and the Prime Minister of India praised HCW ‘s role and stressed that it was essential to combat the COVID-19. To be effective in India, the Government of India has to take some steps. They can do this in many ways like:

  1. Educate the public annually, through print and online media ads and often notify voters of certain new initiatives by the political parties.
  2. When carrying out screening operations, the Government of India must increase the presence of safety both with and without medical facilities. This will improve the morale and trust of the doctors and bring order to the hospital proceedings.
  3. HCW has called for security at home and while switching back and forth, a few overzealous resident welfare associations (RWA) office-bearers have shown hostility to HCW treating COVID-19 patients, while some have been attacked outside hospitals. Arrangements must be made for HCWs that need temporary accommodation and transport. Besides, a team of police, municipal and revenue officials will alert and prevent these RWA officials from any attempts to evict doctors from the premises of the company and, if necessary, take stern action. Such doctors should be provided with a helpline number to call in case of need.
  4. For that HCW who is at the head of this ‘war’ against the virus, a high-risk allowance in these unprecedented times should be provided. The Delhi Government, which announced Rs 1.00,000 for the family of a fallen corona warrior, not only doctors but also police and other people fighting against the pandemic, are welcome to do that. It’s awesome. Other countries should also emulate such a move.
  5. Anti-violence perpetrators against the HCW should be pushed through and strictly. It not only raises their conscience but dissuades others as well.

While the Epidemic Disease Act of 1897 has been amended by the new ordinance of the Government of India for this pandemic and similar outbreaks in the future, it should be further expanded and integrated into existing legislation to protect the HCW in non-epidemic situations to carry out its duties without fear for the benefit of patients who are ill or wounded.

Conclusion :

Violence against doctors is detrimental to society. All physicians must be aware that this can happen and take measures to prevent it. Doctors must persuade the government to compare a doctor’s attack with an officer’s attack. To provide effective deterrence and to avoid more cases of violence against doctors, the IPC and the Criminal Procedure Code (CrPC) must make required amendments urgently. But a coordinated effort is necessary for this to happen. We hope that healthcare staff will not lose their lives before their associations and the government starts an action.

Aishwarya Says:

I have always been against Glorifying Over Work and therefore, in the year 2021, I have decided to launch this campaign “Balancing Life”and talk about this wrong practice, that we have been following since last few years. I will be talking to and interviewing around 1 lakh people in the coming 2021 and publish their interview regarding their opinion on glamourising Over Work.

If you are interested in participating in the same, do let me know.

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