INTRODUCTION
“The principle of ‘primum non nocere’, which translates to ‘first, do no harm’, is deeply rooted in every healthcare worker’s heart from the moment they choose this godly profession, which drives them by a commitment to serve humanity.[1] Yet, the innumerable threats and harms faced by them cannot be compared in any way to those of other professions. The countless incidents that substantiate the prior statement have simply been overlooked by the lawmakers of the country. In one such incident, which garnered some limelight recently, a 23-year-old final-year MBBS student, Dr Vandana Das from Kerala, tragically lost her life as she was fatally stabbed six times with a pair of scissors by an accused cum patient, who had been brought from police custody to the Ernakulam district hospital for treatment. It was shortly followed by the promulgation of an ordinance to amend the existing ‘Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act, 2012’.[2] Meanwhile, the accused has been dismissed from service, who was a government schoolteacher. As of now, that’s all that there is to it. But this is just one case out of a thousand, reported or unreported, and that too in one State. 11 out of a total of 36 States and Union Territories (UTs) in the country are devoid of accordant laws.
IMPACT OF VIOLENCE ON HEALTHCARE PROFESSIONALS
Workplace violence has a significant impact on the healthcare sector and its impact extends to many different areas. We can already notice a negative change in the attitude of doctors towards their profession, which casts a shadow over medical decision-making, causing some doctors to fear complex procedures and high-risk operations to protect themselves from possible backlash if the outcome turns out to be unfavourable.[3] “While there is no central data on the number of assault cases against healthcare workers or facilities, the Indian Medical Association estimates that 75 per cent of all doctors face some form of physical abuse during their service, with cases of violence severely underreported.”[4] “The underreporting of cases further hampers prevention efforts in two ways: undermining the need for prevention policies and designing policies with limited impact.”[5] Moreover, in a country like India, the immediate response to reported violence is often a collective action among the public, such as protests and strikes over the injustice, which might allow healthcare workers to voice their grievances but are usually met with consequences. Absenteeism, reduced staffing, psychological distress, compromised job satisfaction and poorer treatment are all consequences of workplace violence that cause significant setbacks in the health sector and strain an already challenging system. The overlaying of these influences can create a stimulating environment where dedication and commitment can be tested, perhaps discouraging the potential entry of aspiring doctors and nurses into the field. It is high time to address the issue holistically and implement measures that protect both the well-being of healthcare workers and the integrity of patient care.
CURRENT LEGAL FRAMEWORK: IS IT SATISFACTORY?
In the year 2019, the government introduced a draft bill titled ‘The Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damaged Property) Bill’, which would have made violence against healthcare personnel and institutions a non-bailable and cognizable offence with up to five years imprisonment, but it never moved forward and was withdrawn before it could be considered by Parliament. The reasons for the withdrawal were said to be concerns over potential future requests of other professions for similar bills and the existing provisions of the ‘Indian Penal Code (IPC)’[6] and the ‘Code of Criminal Procedure (CrPC)’[7] were deemed sufficient to address the increasing incidents of violence in the country.
During the COVID-19 crisis, the situation demanded lawmakers take immediate action and thus implemented the ‘Epidemic Diseases (Amendment) Act, of 2020’[8]. “However, it failed to recognize the multi-faceted threats that medical professionals face from the inside other than physical violence and property damage, such as lack of safety and hygiene, lengthy and inhumane working hours, delay in payment of salaries, cost of treatment in case of contracting the epidemic disease in the line of duty, etc. The law is silent on the inclusion of sanitation workers and Accredited Social Health Activist (ASHA) workers, provisions regarding funding salaries of healthcare service personnel as well as allied service providers addressing the high-priced procurement of essential medical equipment and provisions of funds to the State Governments to manage the epidemic.”[9] The post-COVID scenes of mistreatment highlight the growing concern for the safety of medical professionals and pose the need for a holistic legislative framework that would comprehensively and categorically address this issue.
Appearing recently in the Lok Sabha’s monsoon session, Mr Shashi Tharoor MP introduced a private bill, named ‘The Healthcare Personnel and Healthcare Institutions (Prohibition of Violence and Damage to Property) Bill, 2023’ to protect healthcare professionals and medical institutions against acts of violence. The bill seeks to make all acts of violence, including verbal abuse and damage to property of medical service institutions against any person associated with the healthcare sector a non-bailable and cognizable offence along with widening the scope of the definition of ‘healthcare personnel’ by including within its ambit paramedical students, workers, administrative staff of hospitals and healthcare institutions and ASHA workers. The bill sets a specified timeframe for the investigation of cases filed under the Act and the adjudication of the accused person(s). It provides for the establishment of designated special courts in every district for the timely and speedy completion of trials. “The proposed bill, if passed, will therefore act as an impediment to such violence at the earliest to promote a safe work environment for doctors and all healthcare personnel and serve as a model for state laws to follow.”[10]
COMPARATIVE ANALYSIS: VIOLENCE AGAINST ADVOCATES IN INDIAN COURTS
Innumerable cases of shooting of guns, explosions, knife stabbings, and assaults have occurred in Indian court complexes in recent times. The Supreme Court, in response to such occurrences, has outlined the need for a comprehensive security plan that includes permanently stationing Court Security Units (CSUs) in every judicial complex and specifying the strength and sourcing of manpower, including armed and unarmed personnel, plus appointing supervisory officers for every such unit. “Additionally, it specifies the minimum term and mode of deployment and duties associated, supplementing pecuniary incentives for such manpower which would ensure their willingness to put in work.”[11] Such incidents pose significant risks not only to judges but also to the safety of other legal personnel such as lawyers, court staff, litigants, legal interns and the general public who visit courts occasionally. “Furthermore, other priority measures need to be implemented, such as the deployment of police staff, the installation of CCTV cameras and vehicle security stickers, frisking, metal detectors, baggage scanners, entry passes for courts, and biometric devices, to increase security levels.”[12] As of late, Rajasthan became the first state to enact its law to protect advocates against various acts of violence. This was prompted by a month-long protest by advocates following the brutal murder of a lawyer in Jodhpur.[13] Following the trend, Karnataka is next in line to have its own Advocates Protection Act.
CONCLUSION
In essence, it is imperative to realize that the issue at hand goes beyond the medical fraternity. To put it concisely, drawing parallels between the threats and violence against healthcare personnel and legal professionals imperatively suggests that the safety of legal personnel is as important as that of healthcare personnel as they strive to safeguard the very place where justice ought to be administered and preserve its sanctity. “In 2021, a meticulously crafted Advocate Protection Bill was proposed by the Bar Council of India, but currently, there has been hardly any news.”[14] “Similarly, the enactment of the ‘Delhi Advocates (Protection) Bill, 2023’ recently finalized by the Bar Council of Delhi still remains unclear.”[15] Hence, the need for centralized legislation should be the pressing priority of the legislature to secure professionals who spare no effort in ensuring the well-being of individuals and society as a whole from unsafe work conditions, violence and hazards in their line of work. Ultimately, both professions are literally at ‘gun or knife point’ until and unless the prescribed bills get sanctioned and they must encompass both dimensions of workplace conditions to create a holistic and comprehensive framework for covering all potential threats, otherwise, there cannot be any genuine peace and security in the workplace.
Author(s) Name: Lalima (Presidency University, Bengaluru)
References:
[1] Robert H. Shmerling, ‘First, do no harm’ (Harvard Health, 22 June 2020) <https://www.health.harvard.edu/blog/first-do-no-harm-201510138421> accessed 11 August 2023
[2] ‘Cabinet approval for Hospital Protection Act Amendment Ordinance’ (17 May 2023) <https://keralacm.gov.in/2023/05/17/cabinet-decisions-17-05-2023/> accessed 12 August 2023
[3] Kumari A, Kaur T, Ranjan P, Chopra S, Sarkar S, Baitha U, ‘Workplace Violence Against Doctors: Characteristics, Risk Factors, and Mitigation Strategies’ (J Postgrad Med, 14 July 2020) <https://www.jpgmonline.com/text.asp?2020/66/3/149/289768> accessed 11 August 2023
[4] Murali Krishnan, ‘What’s behind violence against doctors in India?’ (Deutsche Welle, 9 June 2023) <https://www.dw.com/en/whats-behind-violence-against-doctors-in-india/a-65869189> accessed 13 August 2023
[5] Kumari A, Kaur T, Ranjan P, Chopra S, Sarkar S, Baitha U, ‘Workplace Violence Against Doctors: Characteristics, Risk Factors, and Mitigation Strategies’ (J Postgrad Med, 14 July 2020) <https://www.jpgmonline.com/text.asp?2020/66/3/149/289768> accessed 11 August 2023
[6] Indian Penal Code 1860
[7] Code of Criminal Procedure 1973
[8] Epidemic Diseases (Amendment) Act 2020
[9] Ramya Boddupalli, Greetika Francis, ‘Epidemic Diseases (Amendment) Bill, 2020: A Missed Opportunity’ (2020) ILI Law Review <https://ili.ac.in/covid/ramya.pdf> accessed 11 August 2023
[10] Dr. Rajeev Joshi, ‘Private Member’s Bills for Prevention of Violence against Healthcare Professionals and Institutions’ (Medical Dialogues, 11 August 2023) <https://medicaldialogues.in/articles/private-members-bills-for-prevention-of-violence-against-healthcare-professionals-and-institutions-115718> accessed 12 August 2023
[11] ‘Supreme Court Issues Slew of Directions for Beefing Up Court Security Pan-India’ (Millenium Post, 12 August 2023) <https://www.millenniumpost.in/nation/supreme-court-issues-slew-of-directions-for-beefing-up-court-security-pan-india-529111 <https://www.millenniumpost.in/nation/supreme-court-issues-slew-of-directions-for-beefing-up-court-security-pan-india-529111> accessed 13 August 2023
[12] ibid
[13] Ratna Singh, ‘Rajasthan passes Advocates Protection Bill; first State to pass law for lawyers’ safety’ (Bar & Bench, 21 March 2023) <https://www.barandbench.com/news/litigation/rajasthan-passes-advocates-protection-bill-first-state-law-protection-lawyers> accessed 13 August 2023
[14] Vritti Jain, ‘Critical Analysis of The Advocates Protection Bill, 2021’ (BnW Journal, 1 July 2022) <https://bnwjournal.com/2022/07/01/critical-analysis-of-the-advocates-protection-bill-2021/> accessed 13 August
[15] Prashant Jha, ‘Bar Council of Delhi prepares draft Advocates Protection Bill’ (Bar & Bench, 27 April 2023) <https://www.barandbench.com/news/litigation/bar-council-of-delhi-prepares-advocates-protection-bill> accessed 14 August 2023
