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Tough jail terms for assaulting doctors proposed to stem India's epidemic of hospital violence

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India’s largest doctors’ association has welcomed proposals for tough new jail terms for people who assault medical staff but warned that there must be a more 'comprehensive response' by the government to prevent violence towards medical professionals in the country’s hospitals.

In September, the Ministry of Health and Family Welfare published the draft Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill 2019 that seeks to introduce new offences to punish those who assault doctors and other medical staff with jail sentences of up to 10 years.

The draft bill will prohibit all acts of violence against healthcare service personnel – such as registered doctors, nurses, midwifes, para-medical workers, ambulance staff and medical students. It will apply while healthcare workers are undertaking their duties in ‘clinical establishments’, such as hospitals, nursing homes, clinics and mobile ambulances.

Dr Santanu Sen from the Indian Medical Association pays tribute to murdered Dr. Deben Dutta. Photograph: Indian Medical Association
Dr Santanu Sen from the Indian Medical Association pays tribute to murdered Dr. Deben Dutta. Photograph: Indian Medical Association

The bill defines the new offence of violence as any act “which causes or may cause harm, injury, hurt, grievous hurt, intimidation to, or danger to the life of” a healthcare worker while they are carrying out their medical duties.

The new offence of violence also covers acts which cause, or may cause, “obstruction or hindrance” to a healthcare service worker while they are discharging their duties in a clinical establishment. The proposed law also defines the new offence of violence as loss of or damage to any property or documents in a clinical establishment, such as where people cause damage to hospitals and ambulances.

Under the proposals, anyone convicted of the new offence of committing, abetting or inciting violence against a healthcare worker – or committing, abetting or inciting damage to any property of a clinical establishment – will face a term of imprisonment of at least six months and up to five years. They could also be ordered to pay a fine of at least INR 50,000 (50,000 Indian rupees) and up to Rs 5 lakh.

However, anyone convicted of causing or inciting more serious ‘grievous hurt’ to a doctor or a healthcare worker will face a tougher term of imprisonment of a minimum of three years and up to 10 years. They could also face a fine of at least Rs 2 lakh and up to Rs 10 lakh.

Grievous hurt is defined under Section 320 of the Indian Penal Code 1860 as serious injuries such as the loss of eyesight and permanent disfigurement to the face or head.

In addition to jail terms and fines, individuals convicted of the new offences of causing or inciting violence against healthcare workers – or damaging property in a clinical establishment – could be ordered to pay compensation to the affected parties. This will be a payment of twice the amount of fair market value of the damaged healthcare property (as decided by the court); Rs 1 lakh for causing hurt to a healthcare worker; and Rs 5 lakh for causing grievous hurt to a healthcare worker.

If the convicted person fails to pay the compensation, the court will have the power to order the sum to be recovered from them as an arrear of land revenue under the Revenue Recovery Act 1890.

The new offences of violence to healthcare workers and damage to property in clinical establishments will be ‘cognisable’ and non-bailable. This means that a police officer will have the power to make an arrest without a warrant and to start an investigation into an allegation of violence to a healthcare professional or against a healthcare premises without the permission of a court. It also means that those accused of the specific new offences of violence will be held in custody until they face trial.

Once a healthcare worker has submitted a written complaint about an allegation of violence against them to the person in charge of the clinical establishment, the person in charge will have a legal obligation to inform the police officer in charge of the local police station about the alleged offence of violence against the healthcare worker.

Any case of alleged violence against a healthcare worker registered with the police under the proposed new law must also be investigated by a police officer of the rank of deputy superintendent or above.

The launch of the proposed new offences and punishments follows increasing public and media focus on the scale of violence to doctors and other medical workers in India.

In the most recent widely publicised incident, a 75-year-old doctor died after he was allegedly attacked by workers at the Teova Tea estate in Jorhat, Assam, in August. According to newspaper reports, workers at the tea estate blamed Dr Deben Dutta for not being present at the local hospital when a co-worker was admitted in a critical condition. Dr Dutta arrived at the hospital shortly after the patient had died, at which point the workers and the deceased patient’s relatives allegedly attacked him.

Following the killing of Dr Dutta, doctors at hospitals in Assam staged a 24-hour strike in protest against rising levels of violence against medical staff.

In June 2019, hundreds of thousands of doctors across India took part in demonstrations and strikes calling for better protection for medical staff against violence from patients and their families.

The protests were called by the Indian Medical Association (IMA), which represents over 300,000 doctors across India.

The IMA said that, even with the introduction of the proposed new tougher punishments for people who assault doctors and other medical staff, “such a heavy deterrence may not work in such an atmosphere of mob violence”.

Following the killing of Dr Dutta, the IMA wrote to the prime minister Narendra Modi, demanding a “comprehensive response from the Union Government to eliminate violence in hospitals”.

The IMA told the prime minister: “The brutality of his [Dr Dutta’s] murder allegedly by relatives of the deceased patient is a new low in violence on doctors and hospitals.

“The medical profession of the nation is aghast at the level of violence prevailing in the community against doctors. It defies reason.”

The IMA has long campaigned for the government to increase investment in healthcare services so that medical professionals can provide better care to patients. Insufficient numbers of doctors and poor medical facilities in hospitals are often seen as one of the causes of violence and aggression towards doctors and medical workers from patients and their families.

In June this year, the IMA wrote to the government minister for health and family welfare, Dr Harsh Vardhan, calling for immediate steps to be taken to boost the level of security provided in hospitals. The IMA urged the government to introduce measures such as closed circuit television and restrictions on visitors entering hospitals to help protect medical staff from the risk of violence.

“Healthcare violence has its origin in high expectations [of patients’ families], lack of infrastructure and inadequate human resources [hospital staffing],” wrote the IMA’s honorary secretary general, Dr R.V. Asokan. “IMA expects the Government of India to provide for each of these components.”

In a statement issued following the government’s announcement of the proposed new punishments for assaulting medical staff, the IMA’s national president, Dr Santanu Sen, said: “The safety of doctors is really important and the central government should consider it as a national issue.

“Doctors go all out to save the lives of their patients and it is shameful that a few rough elements of our society are ready to attack and even kill doctors.”

The draft bill can be found here.

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