Standard Operating Procedure to deal with violence against Medical Professionals laid in Karnataka
Incidents of violence against Medical Professionals and Medical Establishments are on rise, and despite that fact that most states have enacted some form of doctors protection law to prevent such violence from taking place, little implementation is being done due to lack of knowledge about the same.
In a recent standing order, the Director General & Inspector General of Police Karnataka State was seen acknowledging the issue, also accepting that here appears to be a lack of understanding on the part of the local police in handling of incidents of violence against Medical Professionals and Medical Care Establishments in the State. To have clarity in this regard, Standard Operating Procedures (SOP) to handle violence against Medical Professionals and Medical care Establishments has been issued to all members of the Karnataka Police.
The standing order apprises the police about the Karnataka Prohibition of Violence against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act - 2009. and stresses on what should be done incases of violence. Following are the important salient features of the order.
Nature of violence against Medical Professionals & Medical care Establishments:
Violence encountered against Medical Professionals and Medical Care Establishments can broadly be categorized as follows
1. Verbal abuse by the attendants of the patients.
2. Creating scary situations by the mob.
3. Intimidation
4. Assault on Medical Professionals and Medical Care Establishment staff.
5. Ransacking of the Medical Care Establishment.
6. Preventing Medical professionals from discharging his/her duties.
7. Creating problems/nuisance to the outpatients and inpatients.
8. Entering the restricted areas like Operating theatres, Intensive Care Units, Documentation office and other areas in the Medical Care Establishment.
9. Damaging the property and documents.
10. Refusal to take dead body by the attendants and to pay the bills.
11. Directly or indirectly putting pressure on the Medical Professionals and Medical Care Establishment staff/ extortion
12. Snatching the medical records/ documents
13. Forcing the Medical Professionals to treat unrelated treatment,
14. Revengeful act by the patients or their attendees.
15. Unnecessary intervention of media and pressure groups.
Precautionary and Preventive Measures to be taken by the Police:
1. Police personnel at the police station level shall have contact numbers and addresses of all Medical Professionals / Medical Care Establishments in their jurisdiction.
2. Under the new beat system, the Beat Officer shall have such numbers and addresses in his beat area.
3, Police Stations in-charge shall form a WhatsApp Group of the Medical Professionals along with beat officers so that there can be regular exchange of information pertaining to any incident of violence.
4. A WhatsApp group at SP/ DCP level may also be considered with the Medical Professionals / Medical care Establishments of the respective jurisdiction.
5. Sensitization of Police personnel about the provisions of the Karnataka Prohibition of Violence against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act, 2009.
Response by Police:
In case of violence against Medical Professionals and Medical care Establishments, response of the local police shall be as follows:
Relying on Hon’ble Supreme Court Judgments in this connection, the hon’ble High Court of Madhya Pradesh in its judgment in Dr.B.C.Jain V/S Moulana Saleem on 28-02-2017 has laid down the following guidelines:
i. That, all allegations relating to negligent conduct on the part of a Government Doctor for which a prosecution u/S. 304-A IPC and/or its cognate provisions or under such other law involving penal consequences is sought, the same shall be enquired into by a Medical Board consisting of at least three doctors, constituted by the Dean of any Government Medical College, upon the request of the Police, Administration or the directions of a Court/Tribunal/Commission, within seven days of such requisition.
ii. The doctor so selected by the Dean of the Medical College concerned to sit on the Medical Board, shall not be inferior in seniority and experience to that of an Associate Professor.
iii. The doctor against whom such negligence is alleged, shall be given an opportunity by the Medical Board to give his reply/explanation in writing and if the doctor so desires to be heard personally, he shall be given such an opportunity by the Medical Board. However, if the Medical Board is of the opinion that the request for personal hearing is with the intent of procrastinating the proceedings before the Board it may, for reasons to be recorded, waive the opportunity of a personal hearing and proceed to decide the case on the basis of the documents/treatment record and give its finding.
IV. The Medical Board shall endeavour to complete the exercise within sixty days from the date on Which it is constituted arid upon completion of the enquiry, submit the report to the Police, Administration or the Court/ Tribunal/Commission, as the case may be.
V. The police shall not register an FIR against such a doctor in the absence of the report of the Medical Board referred here in above and also only when the report by the Medical Board has held the doctor prima facie guilty of Gross Negligence and not otherwise.
Vi. If a complaint case has been preferred U/s. 200 Cr P.C, there shall be no order U/s. 156(3) Cr.P.C unless the complaint is accompanied by the report of the Medical Board adverted to in guideline I with prima facie finding of Gross Negligence on the part of the Doctor. However, if the complaint is not accompanied with a report of the Medical Board, the Court may ask the Police to enquire into the case u/s. 202 Cr. P. The police, if so directed by the Court, shall approach the Dean of the Medical College for the constitution of the Medical Board and thereafter place the report of the Medical Board before the Court concerned.
VII. If the opinion of the Medical Board is one of Gross Negligence on the part of the doctor, the Court concerned shall direct the police to seek sanction u/s. 197 Cr. P. C from the State Government. The State Government shall, within thirty days from the date of such request for sanction, either grant or refuse the same, which the police shall convey to the Court concerned. Thereafter, the Court concerned shall either dismiss the complaint case against the doctor by exercising jurisdiction u/s. 203 Cr. P. C or issue process u/s. 204 Cr. P. C and try the case in accordance with the law.
All the Commissioners of Police and district Superintendents of Police have been directed to ensure compliance of above instructions.
In a recent standing order, the Director General & Inspector General of Police Karnataka State was seen acknowledging the issue, also accepting that here appears to be a lack of understanding on the part of the local police in handling of incidents of violence against Medical Professionals and Medical Care Establishments in the State. To have clarity in this regard, Standard Operating Procedures (SOP) to handle violence against Medical Professionals and Medical care Establishments has been issued to all members of the Karnataka Police.
The standing order apprises the police about the Karnataka Prohibition of Violence against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act - 2009. and stresses on what should be done incases of violence. Following are the important salient features of the order.
Nature of violence against Medical Professionals & Medical care Establishments:
Violence encountered against Medical Professionals and Medical Care Establishments can broadly be categorized as follows
1. Verbal abuse by the attendants of the patients.
2. Creating scary situations by the mob.
3. Intimidation
4. Assault on Medical Professionals and Medical Care Establishment staff.
5. Ransacking of the Medical Care Establishment.
6. Preventing Medical professionals from discharging his/her duties.
7. Creating problems/nuisance to the outpatients and inpatients.
8. Entering the restricted areas like Operating theatres, Intensive Care Units, Documentation office and other areas in the Medical Care Establishment.
9. Damaging the property and documents.
10. Refusal to take dead body by the attendants and to pay the bills.
11. Directly or indirectly putting pressure on the Medical Professionals and Medical Care Establishment staff/ extortion
12. Snatching the medical records/ documents
13. Forcing the Medical Professionals to treat unrelated treatment,
14. Revengeful act by the patients or their attendees.
15. Unnecessary intervention of media and pressure groups.
Precautionary and Preventive Measures to be taken by the Police:
1. Police personnel at the police station level shall have contact numbers and addresses of all Medical Professionals / Medical Care Establishments in their jurisdiction.
2. Under the new beat system, the Beat Officer shall have such numbers and addresses in his beat area.
3, Police Stations in-charge shall form a WhatsApp Group of the Medical Professionals along with beat officers so that there can be regular exchange of information pertaining to any incident of violence.
4. A WhatsApp group at SP/ DCP level may also be considered with the Medical Professionals / Medical care Establishments of the respective jurisdiction.
5. Sensitization of Police personnel about the provisions of the Karnataka Prohibition of Violence against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act, 2009.
Response by Police:
In case of violence against Medical Professionals and Medical care Establishments, response of the local police shall be as follows:
- Once Police Control Room/ Mobile Police/ Police Station/ Higher Authorities receive information of such a violence, responsible police personnel shall immediately reach the place.
- Immediate protection shall be provided to the Medical professionals/ Medical Care Establishment staff/ property and other patients
- Police personnel on reaching the place, should first disperse the mob from the Medical care Establishment and control the situation. This is necessary as there are other patients in the Medical Care Establishments as well as doctors attending to them who would be disturbed unless the mob is dispersed. The police should therefore reach the spot with adequate force to do so.
- In case of death of a patient, the dead body should not be allowed to be kept in the Medical Care Establishment by the agitators as that would instigate further disturbance. The police personnel should talk to the relations/ attendants of the concerned patients to shift the body out of the Medical Care Establishments.
- Immediate steps shall be taken to shift the dead body to mortuary in event of death of a patient.
- Registration of case under the existing Karnataka Prohibition of Violence against Medicare Service Professional and Damage to Property in Medicare Service Institutions Act 2009 shall be taken up
- Protection shall be provided to the Medical Care Establishment till the situation settles.
- If the attendants of the patient do not have faith on the Medical Care Establishment about their competency in curing of the patient, the attendants of the patients should be asked to shift the patient to any other establishments instead of making a scene in the medical establishment.
- Any violence at the Medical care establishment shall be brought to the notice of Dy. Commissioner of Police/ Superintendent of Police immediately.
- In case of complaint against doctor by the patient or his relatives, Hon’ble Supreme Court's guidelines shall be followed. In case of deviance, disciplinary action shall be taken against concerned Police Officers
Relying on Hon’ble Supreme Court Judgments in this connection, the hon’ble High Court of Madhya Pradesh in its judgment in Dr.B.C.Jain V/S Moulana Saleem on 28-02-2017 has laid down the following guidelines:
i. That, all allegations relating to negligent conduct on the part of a Government Doctor for which a prosecution u/S. 304-A IPC and/or its cognate provisions or under such other law involving penal consequences is sought, the same shall be enquired into by a Medical Board consisting of at least three doctors, constituted by the Dean of any Government Medical College, upon the request of the Police, Administration or the directions of a Court/Tribunal/Commission, within seven days of such requisition.
ii. The doctor so selected by the Dean of the Medical College concerned to sit on the Medical Board, shall not be inferior in seniority and experience to that of an Associate Professor.
iii. The doctor against whom such negligence is alleged, shall be given an opportunity by the Medical Board to give his reply/explanation in writing and if the doctor so desires to be heard personally, he shall be given such an opportunity by the Medical Board. However, if the Medical Board is of the opinion that the request for personal hearing is with the intent of procrastinating the proceedings before the Board it may, for reasons to be recorded, waive the opportunity of a personal hearing and proceed to decide the case on the basis of the documents/treatment record and give its finding.
IV. The Medical Board shall endeavour to complete the exercise within sixty days from the date on Which it is constituted arid upon completion of the enquiry, submit the report to the Police, Administration or the Court/ Tribunal/Commission, as the case may be.
V. The police shall not register an FIR against such a doctor in the absence of the report of the Medical Board referred here in above and also only when the report by the Medical Board has held the doctor prima facie guilty of Gross Negligence and not otherwise.
Vi. If a complaint case has been preferred U/s. 200 Cr P.C, there shall be no order U/s. 156(3) Cr.P.C unless the complaint is accompanied by the report of the Medical Board adverted to in guideline I with prima facie finding of Gross Negligence on the part of the Doctor. However, if the complaint is not accompanied with a report of the Medical Board, the Court may ask the Police to enquire into the case u/s. 202 Cr. P. The police, if so directed by the Court, shall approach the Dean of the Medical College for the constitution of the Medical Board and thereafter place the report of the Medical Board before the Court concerned.
VII. If the opinion of the Medical Board is one of Gross Negligence on the part of the doctor, the Court concerned shall direct the police to seek sanction u/s. 197 Cr. P. C from the State Government. The State Government shall, within thirty days from the date of such request for sanction, either grant or refuse the same, which the police shall convey to the Court concerned. Thereafter, the Court concerned shall either dismiss the complaint case against the doctor by exercising jurisdiction u/s. 203 Cr. P. C or issue process u/s. 204 Cr. P. C and try the case in accordance with the law.
All the Commissioners of Police and district Superintendents of Police have been directed to ensure compliance of above instructions.
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