Healthcare workers write down details of residents in a slum during a check-up camp for COVID-19 in Mumbai, June 2020. Photo: Reuters/Francis Mascarenhas
- The Indian government introduced an ordinance in 2020 that amended the Epidemic Diseases Act, but the changes will lapse once the pandemic ends.
- The government drafted a Bill in 2020 and placed it in the public domain to solicit comments, but was blocked by the Union home ministry due to concerns about redundancy.
- A former head of the National Health Systems Resource Centre said the real problem is not the absence of laws but deteriorating patient-doctor relationships.
New Delhi: Last month, a doctor in Dausa, Rajasthan, died by suicide. She hanged herself allegedly after she was booked for the murder of a pregnant woman who didn’t survive her delivery procedure. The doctor’s death prompted the state government to suspend two police officials, and then the issue promptly fell out of the news.
In 2019, the assault of a doctor in Kolkata triggered a doctors’ strike – first in West Bengal but which quickly snowballed into a nationwide affair. The doctor had been accosted by the relatives of a patient the doctor had been involved in treating but who later died.
These are not isolated incidents. There has been a steady trickle of news reports from around the country of doctors and other healthcare workers facing violence at the hands of people who recently lost a loved one, and blame healthcare personnel for improper care. A paper published in the Indian Journal of Medical Research (IJMR)1 last year said doctors’ strikes, prompted by violence against doctors, were reported from some state or other almost throughout 2018 and 2019.
This is a widespread problem – and the responses to it (strikes and protests) directly affect care-seekers as well as public healthcare. A 2015 study by the US Department of Labour reported that the incidence of violence in healthcare settings was four-times higher than in any other professional setting.
Yet India doesn’t have a centralised database on workplace violence in this community. In response to a question in the Lok Sabha in 2019, the Union government said “health” and “law and order” were state subjects, so it hadn’t maintained figures of its own. No state government maintains such a database either.
The Indian Medical Association (IMA) and other organisations of doctors have been demanding a comprehensive law to tackle such violence for many years. The pandemic provided temporary respite, when the Indian government introduced an ordinance called ‘The Epidemic Diseases (Amendment) Ordinance’ in 2020.
As its name suggests, the ordinance amended the Epidemic Diseases Act 1897, which the health ministry had invoked as the pandemic began. The change created a provision to levy those convicted of harassing or assaulting a healthcare worker a fine of Rs 50,000 to Rs 2 lakh and be imprisoned for three months to five years. In case the injury (inflicted on the worker) was serious, the convicted person would have to pay a higher fine and/or spend more time in prison.
The catch here is that the government will revoke the Epidemic Diseases Act once the pandemic ends – at which point there will be no national law to deter violence against healthcare workers.
Health is a state subject in India and at least 23 states have their own laws to protect healthcare workers – “but those laws tack teeth,” national IMA secretary Jayesh Lele told The Wire Science. “Also there is a wide variation in terms of punishment for the offence.”
As the IJMR paper also wrote:
“A study undertaken in two states of Punjab and Haryana revealed that no person was penalised under the Medicare Service Person and Institution Act between 2010 to 2015. In most cases, the FIR was not registered or cancelled [after] a compromise.
In Maharashtra, the police were not even aware of the Act. Sensitisation measures were initiated in 2017, while the [Medical Protection Act] was passed in 2010 in the state.”
The Indian government did draft the ‘Health Services Personnel and Clinical Establishments (Prohibition of Violence and Damage of Property) Bill’ in 2020. It placed the text in the public domain to solicit comments from the public. The health ministry was also keen to have the Bill passed in Parliament – but the Union home ministry stood in the way.
The home ministry said existing sections of the Indian Penal Code (IPC) and the Criminal Procedure Code (CrPC) would suffice to tackle healthcare workplace violence. The ministry also argued that passing a law particularly for healthcare workers would open the door to similar demands from lawyers and other professionals.
“But there are studies to say healthcare workers face more violence than others,” said Ajay Kumar, former president of the Bihar chapter of the IMA.
Taking a cue from the ‘Nirbhaya Act’ – the legal instrument that introduced amendments to the IPC and the CrPC to strengthen provisions against sexual offences – Kumar asked why the home ministry couldn’t see a similar route for violence against healthcare professionals.
In fact, the national IMA submitted its own draft of the law “more than five years ago” to the government, according to Lele. “The government just does not cooperate with us,” he alleged.
The IMA’s version contained more stringent punishments. It pitched for offenders to be imprisoned for at least six months “but which may extend to five years, and with fine, which shall not be less than fifty thousand rupees but which may extend to five lakh rupees.”
But the opposition to a separate law hasn’t been restricted to the health ministry. T. Sundararaman, a former head of the National Health Systems Resource Centre at the Union health ministry, is in the same boat. Instead, he believed it would be more fruitful to work on the other side of the problem: patient-doctor relationships.
“What has improved over the years is commercialisation in the healthcare sector, which is completely unregulated,” Sundararaman said. “What has rather not improved is the patient-doctor relationship.”
He – like Lele and Kumar – also pointed to the fact that poor healthcare infrastructure and human resources, especially in public health facilities, has contributed to the breakdown of the health system. And more often than not, doctors bear the brunt.
“It is pathetic that our governments still spend less than 1.5% of GDP on healthcare,” Lele said.
“The governments leave no stones unturned in advertising that diagnostics and drugs are free. But when they are available in the hospitals and doctors advise patients to purchase them from the market, people think we are doing it on purpose,” Kumar added.
The information asymmetry between doctors and the patients also adds to the distrust – a reflection of insufficient communication between them parties on the modalities of treatment.
“There has to be a proper grievance redressal mechanism of everything that goes wrong, in place, before you bring a law to settle scores with relatives of patients” Sundararaman advised.
A journal of the Indian Council of Medical Research↩