Physical as well as verbal violence against healthcare institutes is regularly reported from some State or the other in India. On a few occasions, it becomes so violent that the crowd may indulge in arson of the hospital and destroy the costly equipments as well. Though the exact figures are not readily available, such skirmishes may be nearly thousand or so in a year. According to an expert, an ongoing study of the Indian Medical Association (IMA) revealed that over 75% of doctors have faced violence at the work place.
Violence against doctors is not restricted only to India. Recently in US, Dr. Michael Davidson, forty-four year old Director of endovascular cardiac surgery at Brigham and Women’s Hospital and father of three young children (Aged 9, 7 and 2) was killed in cold blood by gunman Stephen Pasceri. Dr. Davidson had treated Pasceri’s seventy-nine-year-old mother and apparently there had been some complication and she had died. Pasceri, blaming her physician walked into the hospital, sought Dr. Davidson out and shot him in cold blood in the very clinic where he used to treat patients. His friends and colleagues rushed him to the operating room, but unfortunately he succumbed to his injuries. Similarly, violence against nurses in US is also commonplace. According to a study, nearly million attacks against healthcare institutes are reported in China per year. Many of these are so violent that the crowd has lynched the doctors as well as nurses.
In order to prevent such violence, many states in India including Maharashtra, Andhra Pradesh, Kerala, Punjab, and Delhi have enacted legal provisions in the last few years. As per this Act, violence means activities causing any harm, injury or endangering the life or intimidation, obstruction or hindrance to any healthcare service person in discharge of duty in the healthcare service institution or damage or loss to property in healthcare service institution. The healthcare service persons includes registered medical practitioners working in healthcare institutions (including those having provisional registration), registered nurses, medical students, nursing students, para medical workers employed and working in medical service institutions. The act provides stringent punishment including imprisonment and fine as well as double the amount of damage as compensation to the institute. These stringent legal provisions do not permit bail to the accused. The Act also provides forum for the patients to lodge criminal complaint against the doctors if the patients feel aggrieved. Available details do not indicate that the Act has deterred the attackers so far. Hardly any person appears to have been convicted under these provisions. According to Dr Neeraj Nagpal, Medico Legal Action group, “only a central Act on lines similar to state Act will not give the desired results unless changes are also made in Indian Penal Code” In his opinion, the issue of arrest of doctors under section 304 A is a part of the problem of violence against doctors because invariably cross FIRs are registered by patient party as well as doctor which results in inevitable compromise.
The healthcare workers feel the problem gets aggravated as invariably, the relatives and friends of the patient who might have died, approach local politicians including a Corporator or Member of the legislative assembly, who in turn demands action against the healthcare workers.
Relatives and friends allege that the healthcare workers including doctors and nurses show total neglect towards attending the patient in emergency. They accuse doctors of fleecing the patients by forcing them to undergo several tests, which may or may not be relevant. On certain occasions, according to the relatives, the hospital authorities do not permit removal of the dead body until the charges are paid in totality.
Analysis of the problem and gravity of the situation indicates that the issue of violence against healthcare institutes is not simple to be tackled simply by legal enactment. It calls for determined efforts by everyone including hospital authorities and healthcare workers. The costs attached to such violence are very heavy in terms of money, morale of workers and reputation of the Institute.
US Department of Labor, Organizational Safety and Healthcare facilities’ Roadmap for healthcare facilities, has published Guidelines for Prevention of Violence in Healthcare and is available at www.osha.gov/SLTC/ workplaceviolence— Briefly, these include: • management commitment and employee participation, worksite analysis and hazard identification, hazard prevention and control, safety and health training and record keeping and program evaluation.
Realizing the gravity of the issue, training modules should be designed for healthcare workers including doctors, nurses as well as law enforcing agencies such as police, judicial officers and prosecutors highlighting case studies of such violence. The Indian Medical Association (IMA) should come up with standard operating procedures for establishing any healthcare facility in public as well as private field. Constant review should be made at least once in six months to find out aberrations and take corrective actions. International best practices should be made available as case studies for continuous guidance.
At present, IMA has suggested formation of ‘crisis management committee at each Taluka or District level. The committee shall include doctors, social workers, legal personalities, politicians, press reporters etc. The committee members may meet the police officers and request them for complete investigation of the incidence and to avoid prosecution of the healthcare worker including doctor till the guilt is proved. The committee can also request the press reporters not to give unnecessary publicity to such cases.’
The Supreme Court in “Martin D’Souza vs Mohammed Isfaq” case has issued stern warning to police officers against any harassment including arrest against doctors unless parameter laid down in Jacob Mathew’s case are followed.
Strict adherence of these directives and guidelines by all concerned as well as introspection by healthcare workers and improvement of their practices and monitoring of these periodically alone can create visible impact against such violence.
