“Bruises, getting spat on the face, and blows across the face have become a part of my job,” said Narasimha Rajaram. No, he’s not a policeman fighting off some antisocial elements, nor is he one of those antisocial elements. He is a doctor at a rural public healthcare centre (PHC) in the Belagavi district of Karnataka.
And his is not an isolated case: Doctors across the country have to risk their lives on a daily basis as they face the threat of assaults, get punched in the face, and are humiliated, but continue to be targeted by patients’ families with no stringent law to protect them. Some that seem unable to cope with the pressure resort to even suicide.
“It is not something that I had anticipated. I realised this would be my everyday ordeal as soon as I joined this job at the PHC. I soon realised it is the story of every healthcare worker’s life, especially in government setups,” said Narasimha.
Therefore, when Union Health Minister Dr Mansukh Mandaviya recently asked all Centre-run hospitals in the national capital to suspend the services of marshals and bouncers, the move did not go down well with doctors and healthcare workers not just in Delhi but even in the southern states.
They claimed that the incidents of violence against them were continuing, and the Central government’s “ignorance” and attitude towards the protection of the medical community was infuriating. They have now demanded that Central Reserve Police Force (CRPF) personnel be deployed for their protection.
Taking to Twitter, doctors from the Resident Doctors Association of the Rammanohar Lohia Hospital in New Delhi said, “We respect Shri Mansukh Mandaviya ji for being proactive in reforming healthcare!….he removed Bouncers/marshalls from the security of the Hospital with personally having full blown security! We demand deployment of CRPF in Hospital! [sic]”
We respect Shri @mansukhmandviya ji Hon’ble health Minister GOI for being proactive in reforming healthcare!
Yesterday he removed Bouncers/Marshalls from security of Hospital with personally having full blown security!
We Demand deployment of #CRPF in Hospital!@ANI @DghsIndia pic.twitter.com/fe7cToGEuE
— RDA RML Official (@rda_rml) November 2, 2022
Several doctors reacted to this and expressed unhappiness over the health minister’s move.
Dr Dinesh Gora from AIIMS-New Delhi, said: “Sometimes, difficult to understand. We demand safety and security in the workplace…..What priority must be: “No violence with Health care workers.” Whatever way to be used. First, deploy additional security then remove existing ones. [sic]”
Sometimes, difficult to understand,
We demand safety& security in the workplace. Same time,we celebrate the removal of security.
What priority must be:
“No violence with Health care workers.”
Whatever way to be used. First, deploy additional security then remove existing ones.
— Dr Dinesh Gora (@DrDineshGora) November 2, 2022
Director C Nagaraj of the Rajiv Gandhi Institute of Chest Diseases in Bengaluru called violence in hospitals an “epidemic”.
He said while doctors were left alone to handle the mob, the attackers — usually often local residents — tend to get tremendous support from village panchayats and local leaders, who instigate the crowd rather than instead defusing the situation.
“Doctors are left alone to manage the ‘situation’. Many of them have chosen to resign from their profession due to this. They refuse to work in rural areas despite high payment, or prefer to have a private practice,” he added.
New law proposed, then shelved
A senior resident doctor from a government hospital in the Tumakuru district of Karnataka said about Mandaviya’s move, “This is the same Union Health Ministry that made attacks on doctors punishable when the Covid-19 pandemic was at its peak. So now, the Pandemic Act doesn’t exist and our security is ignored?”
While the Supreme Court recently sought responses from the Central government and others, including the Medical Council of India, to petitions alleging rising assault on doctors across the country and seeking the framing of guidelines to protect them during duty, the Centre’s response to an RTI query by Kerala-based opthalmologist KV Babu irked doctors across the country.
Babu told South First that in his RTI query he had asked the ministry whether the Central government planned to pursue the draft Healthcare Service Personnel and Clinical Establishments (Prohibiton of Violence and Damage to Property ) Bill of 2019.
The ministry’s reply, a copy of which is with South First, stated, “With regard to your RTI application, it is informed that it was decided not to pursue the draft legislation.”
After the suicide of Dr Archana Sharma — an accused in a medical negligence case — in March in Rajasthan, the medical fraternity demanded a stringent law to stop attacks on physicians and other healthcare workers. Subsequent news reports claimed that the Health Ministry was mulling such legislation.
Under this law, anyone assaulting doctors and healthcare professionals would be imprisoned for not less than six months, which could be extended to five years, and pay a fine of not less than ₹50,000, which might extend to 5 ₹5 lakh.
However, Babu said, “The Central government shelved the proposal as the Centre felt that a separate law was not needed in this regard. Interestingly, during the pandemic in 2020, the same government came out with an amendment to protect healthcare workers. If this could be done then, then why is it not considering the separate bill for healthcare service now?”
Where are the records?
Doctors across India, including those from southern states, condemned not only the move by Mandaviya but also the Centre’s reticence in bringing separate legislation to protect doctors and healthcare workers. Nagaraj from Bengaluru said, “This is one of the main reasons many of our PG doctors, and even specialists, do not choose to work in the government sector, and especially rural areas. You show me one place where police constables are attacked repeatedly. Will people easily dare to touch a policeman?”
Dr Narahari, a professor of paediatrics at the Nagarkurnool Medical College in Telangana, told South First, “The Central government must act towards separate legislation for doctors and other healthcare staff. There is a law in Telangana and Andhra Pradesh that prohibits any acts of violence against medical-service personnel, or even damaging of property in such places(including private hospitals). Any offender is liable to be punished with imprisonment for a period of three years, and with a fine that may extend to ₹50,000.”
However, he added, the attacks continue to happen as there was no stringent following of the law. “Such cases should be heard in fast-track courts and the guilty punished. Only then can something come out of the situation,” he said.
Dr Rahul Chakravarty, president of the Association of Resident Doctors at PGIMER Chandigarh. and also vice-president of FAIMA, said, “There are some states where there is such a law, but it is mandatory in every state that the doctor who was attacked has to approach the police, file a case, and follow up on the case on their own. No institution — government or private — backs them.”
However, if it is damage to property, then hospitals tend to file an FIR with the police against the attackers, he said. The fear of mob mentality and attacks on doctors have kind of been considered a “norm of the profession”, and this is very dangerous, he added.
Interestingly, despite several such cases happening on almost a daily basis, there is no separate registry to record these attacks. Doctors say that apart from police records, there is no separate registry maintained to note such complaints.
Despite having bodies like the National Medical Council, Indian Medical Association, and PG Residents Associations, there is no one place where such cases are recorded.
Dr Manish Jingra, Chief Advisor, FAIMA told South First: “It is unfortunate. We will soon take up this issue with the Union Health Ministry. We definitely need a separate bill to protect our medical fraternity.”
‘Specific legislation is a MUST’
Doctors said in unison that nothing but specific legislation towards this could prevent such attacks. “It is very important to have separate legislation on violence against doctors. There have been such attacks — both physically and mentally — on doctors every single day. We have continuously raised the issue; our association has even written to the Union home minister,” Dr Rohan Krishnan, president of the Federation of All India Medical Association, told South First.
Krishnan added that doctors were being blamed for any deficiency in healthcare, manpower, or even in instances when the lift of the hospital was not working. “Patients must know that doctors save lives, but can’t give life. We don’t want to be treated as God, but do treat us as human beings with dignity. Give us the bill that ensures any citizen deserves safety. We doctors deserve to know that when someone is harming us, the government is going to take the responsibility of protecting us,” he said.
Meanwhile, if there is no separate legislation towards this then more doctors would revert to defensive medicine, said Dr Venkat Raghav, the head of the department of Forensic Sciences at Bangalore Medical College. “Suppose they get an emergency case where they should operate — despite knowing the chance of survival was percent — but decide not to take up the case, fearing backlash from the patient’s kin. They would send the patient to another hospital. This is what is called defensive medicine,” he explained.
A history of violence
Dr Kiran Madhala, HoD of the critical care department at the Nizamabad Government Hospital in Telangana, said: “Rising out-of-pocket expenditure is the main reason for public agony, and the doctor is the nearest person to face the consequences. We need to strengthen public healthcare and control private healthcare to develop a cordial atmosphere in the hospital. It is multifactorial. We cannot simply control it with one legislation; a lot of study has to happen around this.”
He added that health was a state issue and every state needed to implement a law over violence against healthcare workers. “The Telugu states have ordinances controlling assaults dating back to 2005. Here, every medical student has been taught about ‘breaking the bad news’, which is very important, especially when dealing with a patient’s family.”
Doctors in India work in overcrowded settings, with a limited supply of essential equipment and personnel, claimed Dr Rajeev Jayadevan, former president of the Kochi chapter of the Indian Medical Association.
He told South First, “Newly graduated, inexperienced doctors are thrown into the deep end of the pool with no one to supervise them or back them up. Lack of sleep, no family close by, minimum communication skills, and language barriers add to their stress as they deal with angry mobs in rural setups.”
He added: “Without attempting to improve the infrastructure and manpower in government-run setups, it is not fair to blame the doctors who work in these areas.”