Safety of healthcare workers: Call for uniform central law to protect doctors, nurses from violence

Hyderabad: After the barbaric rape and murder of the resident doctor in RG Kar Medical College and Hospital in Kolkata, the demand for a Central Protection Act (CPA) has intensified.

While health falls under the ambit of State administration as per the Constitution, the safety of healthcare workers (HCWs) has been lost due to the ambiguity in the roles of the States and the Union government in protecting HCWs.

Attacks on healthcare workers have been on the rise since 2011, seeing a spike in escalations post-2020, despite the existence of several acts implemented by some State governments and two Central acts.

This exposed the lack of effective implementation of the existing acts, even as the responsibility of protecting the healthcare workers falls directly on the State governments.

Nurses at high risk, doctors at risk

As per the ‘Joint Programme on Workplace Violence in Health Sector’ published in 2002 by the International Labour Office (ILO), International Council of Nurses (ICN), World Health Organisation (WHO) and Public Service International (PSI), nurses and ambulance workers are considered to be at 'extremely high risk', doctors at 'high risk' and other allied professionals at 'risk' in their respective workplaces.

Non-uniformity in State laws

As per the information available, 25 State governments so far have enacted legislation to ensure the protection of HCWs and hospitals. Similarly, two Central acts – the Clinical Establishment Act, 2010 and the Prevention of Violence and Property Act 2008 – ensure the safety of HCWs.

However, the acts implemented by the States fail to define violence for HCWs uniformly, besides providing a lack of sufficient prosecution and punishment for the offenders.

“The definition of violence varies across the States and the attacks on HCWs and hospitals should be made non-bailable offences. Damage to properties should be compensated by the offenders and timely completion of the cases needs to be ensured,” said Dr Kiran Madhala, secretary general of the Telangana Teaching Government Doctors Association (TTGDA).

‘India ranks next to Afghanistan in the number of attacks on HCWs’

A Lancet study has revealed the worsening of attacks on healthcare workers (HCWs), particularly doctors after the Covid-19 pandemic.

The study found that in 2020, 225 incidents of violence were reported in India, and 110 attacks were recorded in 2021, with junior doctors and grassroots workers facing the ire of the patients and their relatives.

Dr Kiran Madhala said, “Three violent incidents have been recorded per 10,000 HCWs in our country. We rank second, next only to Afghanistan, in the number of attacks on doctors and other HCWs. This has to be changed by enacting suitable acts and its effective implementation by the State governments.”

Violence against HCWs in India is 57 times higher than in the UK and 850 times higher than in China as per the Lancet study, exposing the magnitude of the amounts of violent attacks.

Need for a Central Protection Act to cover States uniformly

Disparities in defining the nature of attacks, which include damage to properties, underscore the need for a Central Protection Act (CPA) by the Union government to be implemented across the country by the States and Union Territories uniformly.

Dr PK Jameela, former director of health services of the Government of Kerala said, “A Central act is highly essential and the States must ensure its effective implementation uniformly. Kerala has made enormous changes in the acts ensuring protection to HCWs even before the murder of Dr Vandhana Das.”

Violence against HCWs, even outside the workplace, has also been incorporated in The Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Amendment Bill, 2023 implemented by the Government of Kerala, given the sporadic incidents being reported.

“Earlier, the number of reported attacks on HCWs was much less. Now, every attack is being reported and cases are being filed to prevent further incidents. While the attacks were considered a routine affair earlier, the attitude of the organisations has changed recently,” Dr Jameela said.

CPA can eradicate disparities

The perpetrators of these attacks have more chances of escaping the law as every State has its own provisions defining and handling the attacks, in the procedures for filing cases, and subsequent prosecution and punishment.

“Through the CPA, implementation of a national portal to register the attacks would help prevent these incidents. The definition and punishment would be uniform to ensure the culprits are not let off easily. Despite so many struggles and strikes, we don’t even have a helpline to alert the system, whether it is violence against doctors, HCWs or hospitals,” Dr Kiran Madhala said.

The formation of the National Task Force (NTF) by the Union government has rekindled the hope for a CPA.

Women healthcare workers are more at risk

Women working in the healthcare sector, particularly nurses and junior doctors, have always been more prone to facing the sudden rage of patients and their relatives.

Even as recently as August 25, at Sri Venkateswara Institute of Medical Sciences (SVIMS) in Tirupati, Andhra Pradesh, a junior resident doctor was assaulted while on duty in the emergency ward. CCTV footage being widely circulated among the medical community shows a patient violently pulling the medical student’s hair and slamming her head against a table.

“The safety of women workers has not been addressed enough by organisations including the Indian Medical Association (IMA) until a few years ago. However, such crucial issues are given primary importance now after several incidents of violence. We had to fight internally to make the organisations speak for the safety of women,” Dr Jameela said.

Need for increased spending on healthcare

The continuous weakening of public health institutions is considered a reason for the increase in attacks on HCWs.

Dr Raveendranath, general secretary of Doctors Association for Social Equality (DASE) from Tamil Nadu said, “We have to ensure that the enactment of a CPA should not infringe on the rights of the State governments and its people. After privatisation and commercialisation of healthcare in India, people are slowly losing hope in the system.”

The DASE has been demanding increased spending in the public health system through higher budgetary allocations.

“Several organisations fail to speak from the perspective of common people who depend on government institutions for their healthcare. We have to rebuild their confidence through a social outlook. Their anger against the system is resulting in the violence against the healthcare workers,” Dr Raveendranath said.