Strategies for Prevention of Violence in Healthcare

Reports of physical and verbal violence at healthcare institutes are regularly reported across India. In some instances, mobs have resorted to arson, destroying costly equipment. An Indian Medical Association (IMA) study found that over 75% of doctors have faced workplace violence. The ghastly rape and murder of a resident doctor at Kolkatta’s R.G. Kar hospital stands out as one of the most gruesome of these.

Despite the Union Health Minister’s promise of a central act to prevent such violence, no legislation has been enacted.

Violence against doctors is not exclusive to India. In the US, Dr. Michael Davidson, director of endovascular cardiac surgery at Brigham and Women’s Hospital, was killed by Stephen Pasceri, who blamed Dr. Davidson for his mother’s death. Similarly, violence against nurses in the US is commonplace. According to a study, nearly a million attacks, some extremely violent, against healthcare institutes are reported in China annually.

To prevent such violence, almost 29 states in India, including Maharashtra, Andhra Pradesh, Kerala, Punjab, and Delhi, have enacted legal provisions in the last few years. As per this Act, violence means activities causing any harm, injury, or endangering the life or intimidation, obstruction, or hindrance to any healthcare service person in the discharge of duty in the healthcare service institution or damage or loss to property in the healthcare service institution. The healthcare service persons include registered medical practitioners working in healthcare institutions (including those having provisional registration), registered nurses, medical students, nursing students, and para-medical workers employed and working in medical service institutions. The Act provides stringent punishment, including imprisonment and a fine, as well as double the amount of damage as compensation to the institute. These stringent legal provisions do not permit bail for the accused. The Act also allows patients to lodge criminal complaints against doctors if they feel aggrieved. The Acts have not effectively deterred attackers, with few convictions reported.

Dr. Neeraj Nagpal, Medico-Legal Action Group, argues that a central act alone will not suffice. He suggests changes in the Indian Penal Code. In his opinion, the arrest of doctors under Section 304A of The IPC is a part of the problem of violence against doctors because invariably cross-FIRs are registered by the patient party and the doctor, which results in an inevitable compromise.

In public general hospitals, violence is usually targeted against young resident doctors. Analysis shows that incidents often happen during emergencies when senior doctors are absent and medical equipment is unavailable or not working. In a few incidents, resident doctors were reported to be under the influence of alcohol and allegedly misbehaved with their relatives.

Given these repeated violent incidents, I was tasked with devising a scheme for medical colleges-cum-hospitals run by the State Government of Maharashtra and Mumbai Corporation. With the medical superintendents, we noticed that trouble ignites in the emergency departments, or if a patient dies. Our resolution involved deploying armed contingents from the Maharashtra Security Force (MSF), equipping them with training and communication tools, and installing CCTV cameras, and restricting access. These measures have improved safety and a better focus on treatment for resident doctors.

These measures are just the beginning of a comprehensive approach. In part 2, we will explore additional solutions, including advanced security protocols, the role of training, and innovative practices to protect healthcare professionals and institutions further.

(The writer is a former DGP of Maharashtra. Views personal)