Acts of violence against doctors and other healthcare providers have been reported from different parts of the country in recent months, leading to outrage in the medical profession and strikes by doctors. The battering to death of a 73-year-old doctor by a frenzied mob, in the hospital of an Assam tea estate, was especially brutal and shocked the nation. Elsewhere, too, incidents of assault on healthcare providers and damage to hospital equipment have been frequently reported in different parts of India. Health professional associations have demanded a new law for their protection, extending beyond the deterrent punishments available in existing laws.
The government of India has responded by drafting a legislation which has been placed for public comment in September. This has a wide ambit, covering a broad range of healthcare providers, from doctors, nurses and paramedics to medical and nursing students to ambulance drivers and helpers and a wide array of settings, from hospitals and single doctor clinics to mobile medical units and ambulances. Administrative, security and sanitation staff employed in clinical establishments are not explicitly listed though they, too, are vulnerable to mob violence either because of a direct confrontation or as bystanders rushing in to protect doctors or nurses under assault. Stiff punishments have been proposed, ranging from six months to 10 years depending on the gravity of the offence. Heavy monetary fines, too, have been proposed, ranging from Rs 50,000 to Rs 10,00,000.
Why do healthcare service personnel (as the bill describes them) require a law beyond the provisions of existing criminal laws that protect all persons or property against assault, arson or vandalism? How are they different from the victims of road rage or a neighbours’ quarrel?
There is a strong rationale for making a distinction because when a healthcare provider is assaulted, disabled or even killed, the victims of crime also include other patients who are being cared for by that person or many others who have been affected because the services of that clinical establishment are disrupted by the violence and vandalism or stoppage of work by the aggrieved hospital staff or even widespread strikes by doctors. Therefore, the innocent victims of the violence are many. If the death or suffering of one patient sparks violence, the consequence can be the death or suffering of many more patients. The perpetrator of violence bears responsibility for those consequences.
India is not unique in witnessing the sad spectacle of violence against doctors and other healthcare personnel. Several other countries, too, have reported it. Early in this decade, the problem reached alarming proportions in China — 27.3 assaults per hospital were reported in 2012. Criminal law was amended in 2015 to address this problem which had by then attracted international attention. While extortionist gangs were responsible for some of these attacks, dissatisfaction with medical care was responsible for the majority of the incidents.
While assaults on healthcare personnel or establishments must be deplored and deterred, the multi-factorial causes of this problem must be recognised if we are to reduce the dissatisfaction and distrust that underlies such assaults. The crowded public system is under-resourced, under-staffed and constantly stressed while struggling to cope with the expectations of patients and families. Poor access, uncertain availability and variable quality of care diminish respect and arouse dissatisfaction. The heterogeneous private sector, ranging from the single practitioner to the large corporate hospital, attracts ire for poor quality care or exorbitant costs and exploitative practices. Developing an adequately resourced, widely distributed and well managed healthcare system is essential to reducing the level of public dissatisfaction.
A clear explanation of a patient’s condition on admission and periodic updates to anxious relatives build trust and respect. Comforting reports of progress, or consoling words of sympathy in case of setbacks and loss, will be well received if communication channels are maintained between the treatment team and the patient’s family or friends. Even if the medical staff are busy, trained medico-social workers or physician assistants can play the role of trust building communicators. All care providers, from doctors and nurses to support staff, must be trained, even as students, to develop and display the attributes of care, concern, courtesy and compassion. Developing effective and empathetic communication skills is as important as acquiring clinical skills.
Quite often, assaults on doctors occur following a patient’s death. Whether the death occurred due to a serious health disorder which had a poor outcome despite the best efforts of the treating medical team or there was an element of contributory negligence on the part of one or more members of that team can only be determined by a proper inquiry.
However, wanton violence perpetrated by an anguished and aggrieved relative arises as an instant reaction and does not wait even for an explanation from the treating doctor let alone an inquiry that follows a registered complaint. While effective security measures must be taken to prevent unrestricted intrusions and aggressive reactions, a strong communication link during the period of hospitalisation (even through periodic sms or Whatsapp messages) can create a relationship of trust and avert unpleasant outbursts.
Finally, it must be recognised that uncivilised aggression and mob violence against healthcare personnel will be difficult to curb if the law is seen to be soft or ineffective in curbing or punishing mob violence or lynchings which may be religious, regional, casteist, linguistic or gender based. If violence and aggression appear to get social sanction, healthcare personnel, too, will be among the victims. It is important, therefore, that healthcare providers must speak up against violence of any kind — especially mob violence — and not just when they are the victims.
It is the professional responsibility of doctors to decry any violence as a danger to the physical and mental health of individuals and of society. The 150th birth anniversary of Mahatma Gandhi is a good time for us all to work together to create a non-violent society where every citizen feels secure.
This article first appeared in the print edition on September 12, 2019 under the title “Doctors as victims”. The writer is president, Public Health Foundation of India, and author of ‘Make in India: Reaching a Billion Plus’. Views are personal