The ongoing malaise of violence in healthcare settings

Healthcare professionals in Tamil Nadu are demanding better security measures after a doctor in Chennai was stabbed earlier this week; this comes just three months after the brutal rape and murder of a junior doctor in Kolkata

Chennai’s newest government health facility, the Kalaignar Centenary Super Speciality Hospital (KCSSH), stood witness to a brutal attack on one of its senior doctors on Wednesday, November 13, 2024, bringing to the spotlight, once again, the long-pending need to improve safety and security across hospital campuses.

The attack comes just three months after a 31-year-old woman resident junior doctor was raped and murdered at the RG Kar Medical College in Kolkata, an incident that led to nation-wide protests from the medical fraternity, even as it triggered agitations from multiple sections of society in West Bengal.

Last week, the National Task Force (NTF), appointed by the Supreme Court to prepare an action plan to prevent gender-based violence and ensure dignified working conditions for interns, and resident and non-resident doctors, submitted its recommendations for safety measures at hospitals across the country. The apex court ordered that the report be shared with Chief Secretaries of States and stakeholders. The order also stated that the counsel for junior and senior doctors’ associations could place suggestions on any lacunae in the report, and suggest a mechanism to monitor its implementation in the future.

Violence in healthcare spaces in India is not new: multiple incidents have unfolded across the years, in both government and private healthcare institutions, at both small clinics and large medical college hospitals. One of the demands, made by the Indian Medical Association (IMA), following the RG Kar incident was the enactment of a Central legislation on violence against doctors and hospitals (a Draft Bill from 2019 has not made any headway), and the declaration of hospitals as safe zones. Writing to the NTF, the IMA had said the absence of such a law had resulted in half-hearted actions by the police, and less than optimum investigations and prosecutions of these incidents. The declaration of hospitals as safe zones, it said, would entitle hospitals to security paraphernalia -- to be tempered based on patient needs and sensitivity to local culture. The IMA had also demanded improvements in the working and living conditions of resident doctors.

While some issues are common to hospitals across the country, others may be region-specific. Following the stabbing of the doctor in Chennai, the State’s health administrators have acknowledged that an increase in patient inflow to many government hospitals in Tamil Nadu, the unrestricted entry given to patient attendants and relatives, the lack of adequate safety measures at sensitive places such as the casualty department and Intensive Care Units (ICU) and manpower shortage, have been a cause of concern.

Tamil Nadu in fact, has a law in place: the Tamil Nadu Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage of Loss to Property) Act, 2008, but its implementation has remained poor. P. Saminathan, president, Service Doctors and Post Graduates Association, points out that since it came into effect, nearly 40 cases have been filed but only two have resulted in prosecution. “The police tend to delay the filing of FIRs on such complaints,” he says. 

In Kolkata, videos of multiple people in and around the location of the crime went viral after the rape and murder, raising questions about the investigation process, the safety of on-duty doctors in the State, and the role of the administration.

The guidelines issued by the Union Health Ministry following the RG Kar incident state that in the event of any violence against any healthcare worker on duty, the head of institution shall be responsible for filing an institutional FIR within six hours of the incident, says Dr. Saminathan. “This is why we are demanding a review of cases filed under the Act and action-taken reports during the monthly crime meetings held by the District Collectors and Superintendents of Police,” he says. 

It is also the contention of doctors that it is only after an act of violence, that administrators even take some action: a police outpost was set up at Chennai’s KCSSH only after the incident. This has been the case in Kolkata as well, where, along with their demand for justice for their murdered colleague, junior doctors across West Bengal also demanded that State-run hospitals be free of a ‘threat culture’, a central referral system for all hospital beds be immediately implemented, police protection be increased, CCTV cameras be installed, and the election to student council bodies take place.

Police protection is necessary, says K.M. Abul Hasan, president, Indian Medical Association-Tamil Nadu State Branch, at places where there is a large flow of patients and attendants and where emotions run high, such as at emergency departments and in ICUs. At these sensitive locations, CCTVs also need to be checked and functional, he says.

The case for CCTV and police protection was underscored in Kolkata, where, following the protests at RG Kar, a mob of 60-70 men barged into the premises of the hospital as the doctors there were preparing to participate in a ‘Reclaim the Night’ march. The mob vandalised everything in their line of sight including hospital wards, emergency rooms, the protest stage, police booths, and more. It was after this, that the demand to remove the Kolkata Police Commissioner, and Health Department officials was added to the list of demands made by doctors, but while the Commissioner and multiple Health Department officials were removed after negotiations between Chief Minister Mamata Banerjee and the doctors, N.S. Nigam, the Health Secretary held his post.

However, the central referral system has been started as a pilot project at five medical colleges and hospitals in Kolkata. Student body elections are also to be held by March 2025 as promised by CM Mamta Banerjee.

While laws against violence in healthcare spaces exist in several States, as Dr. Hasan points out, awareness among investigating officers, as is the case in T.N. remains poor. “As a result of low awareness, cases are not filed under sections of the Act. Many investigating officers are unaware of the provisions of the Act including non-bailable clauses and imprisonment for a term of at least three years. The Act came into effect after lots of efforts but the lack of awareness remains a cause for concern. The government should take steps to educate investigating officers,” he says.

This apart, laws, experts say, can only go so far: Kerala for instance, enacted a strong law last year for the protection of healthcare professionals -- but underlying issues such as the increasing costs of healthcare leading to high out-of-pocket expenditure for families, poor spending on health by the government and an overburdened and weak public healthcare system, a lack of trust in the system, compounded by communication issues between doctors and patients, and other factors, make this a complex issue that needs nuanced addressing at several levels, they say.

Published - November 16, 2024 08:00 am IST