Violence against doctors: Glaring Deficiencies in State Laws leaves medical fraternity disappointed

New Delhi: The recent announcement of the Union Health Minister Mansukh Mandaviya that the Government is not enacting separate legislation to prohibit violence against doctors and other healthcare professionals seems to have left the medical fraternity disappointed.

With the Central Government washing off its hand, now it is up to the States to ensure protection for doctors and other healthcare workers from violence at their workplace.

Violence against doctors and healthcare workers has been one of the most important and unsolved issues of the medical fraternity. Numerous incidents of violence have been reported over the years.

These instances reached their peak earlier last year when Rajasthan-based Dr Archana Sharma had committed suicide after being booked for the murder of a patient who had died due to Postpartum haemorrhage (PPH).

Doctors are being beaten up daily by unruly attendants but have got only limited relief in terms of law. Even though the doctors have demanded Central Doctors Protection Act, however the same has still been out of their reach.

Now when the Union Health Minister has confirmed that it is not bringing any separate law to ensure protection to the medical professionals have no choice but to turn to the State Governments for the sake of security.

Unfortunately, among the 28 States in India, altogether 7 States do not even have any specific rules in this regard. Even in the case of the rest of the 21 States, where legal provisions are available to address violence against doctors at their workplace, the rules suffer from glaring deficiencies.

Glaring Deficiencies in the State Laws: 

Among the 21 States which have legal provisions to address violence against doctors, Medicare Services have not been defined in 15 of them. While most of the States have made an effort to define a Medicare Institute, around 15 of them have not included Clinics, thereby leaving small doctors and private practitioners without any kind of protection.

Similarly, except for Madhya Pradesh, none of the States have included AYUSH doctors and physiotherapist in this regard. Most of the States also have not included Auxiliary Nurse Midwife, and Health visitor / Dai in the concerned State laws.

Further, many of the States are not defining the properties and are not providing any kind of graded penalty. Even though almost all the States have recognized the offences as cognizable and non-bailable, the punishment is not compoundable in most of them. It means that in case of repeat offenders, the amount of penalty will be the same.

Deficiencies in terms of Execution & Implementation: 

There are also glaring deficiencies in terms of Execution and Implementation. Most of the Acts have not clarified regarding the procedure and have not stated who will file the complaint, which rank of police will investigate the matter, and which court will consider the grievances. Similarly, Investigation time limit has not been specified in any of the 21 States.

While there are good clauses on recovery of losses and many of the States are saying that you have to double the cost of damages, the provision for video recording of damage and photographs as evidence has not been included in any of the State laws. The provision for rapid response teams has also not been included in the State rules.

Timely treatment to patients within prescribed norms of treatment without negligence and giving reason for referral have been prescribed only in Arunachal and Bihar Acts. Patient grievance handling mechanism is present in a few states but not in other Acts.

Only Goa and Kerala Acts recognize the importance of medical records, only Uttarakhand provides punishment for repeat offenders as well as frivolous complaints. Among the 21 States, only Arunachal has ensured that the identity of the doctor does not get revealed, thereby providing security. Graded Penalty has been defined only in Goa.

Therefore, while the Central Government has clarified that it is not enacting any uniform law to address the instances of violence against doctors, the State laws also seem to be deficient to provide the required protection to the medical professionals.

While commenting on the matter, Dr. Rajeev Joshi, a Pediatrician and the founder of the Medicolegal Society of INDIA (MLSI) told Medical Dialogues, "I have requested members and associations from All States to file public interest litigations in respective high Courts seeking guidelines from the Court for prevention of violence of doctors. The statement from the central government will help the Courts to understand that there is no protection to doctors in spite of continuously being at the line of fire."

"The sections applied under IPC are so weak that in today's world doctors are at tremendous risk of assault, perpetrator of which will go scot free. The epidemic diseases Act referred to is not applied in many cases.  The provisions u/s 3C and 3D of EDA i.e. presumption of offence and presumption of guilty mind must be imported in Acts passed by all states so that there is some control on the perpetrators of violence," he added.

"Central govt should at least send template for Acts to be made by states based on EDA during non pandemic situation so that accused will be punished," Dr Joshi further mentioned.

Recently, addressing the issue of violence against doctors, Senior Congress leader Shashi Tharorr demanded a comprehensive legislation to put a check on violence against healthcare professionals.

Making a special mention in the Lok Sabha, he said, "I wish to draw the attention of the Honourable Health Minister towards a rising incidence of violence against doctors and other healthcare professionals in recent years. There's no central data showing the number of assault cases against healthcare workers or health facilities. But the Indian Medical Association estimates that 75% of all doctors face some form of physical abuse during their service, with many cases of violence severely underreported. These are people who are selflessly serving our citizens and attempting to save lives."

"Currently, no national-level law comprehensively and categorically addresses this issue. State laws vary. The existing laws are weakened. Their implementation lacks the scope to protect all healthcare workers. In fact, eleven states and union territories have no laws at all. In 2019, this government introduced a draft bill titled the Healthcare Service Personnel and Clinical Establishments prohibition of Violence and Damage to Property bill which would have made such violence a non bailable and cognizable offense with a jail term of up to five years," he added.

"But this was withdrawn by the government before it could be considered by parliament without assigning any reason. Our healthcare professionals are neither adequately appreciated nor protected. And it's imperative to realize this is not just an issue for the medical fraternity. Violence against healthcare workers weakens our health system, sir. And affects the quality of services provided to patients, in turn leading to more risk of violence. Therefore, I urge the Health Minister, if necessary, the Home Affairs Minister, and the Law and Justice Minister to reintroduce comprehensive central legislation to put a check on violence against healthcare professionals at the earliest," he further mentioned.

Also Read: Doctors denied protection: Govt says No to bringing uniform law for violence against doctors