Sunday, June 16, 2019

Assault on doctors and remedies against the same

Junior doctors in West Bengal are on a strike since Tuesday after two of their colleagues were attacked and seriously injured at the NRS Medical College and Hospital in Kolkata by the relatives of a patient who died. Showing solidarity with their colleagues in Kolkata, doctors across the country have joined the protest. The Indian Medical Association (IMA) has called a nationwide strike on Monday. 

Violence against doctors is unacceptable and needs to be condemned. The medical fraternity is very disturbed and concerned about the rising incidents of physical violence and assault or attack on doctors and their staff, clinical establishments, etc.

The government of India had constituted an Inter-Ministerial Committee, which had promised to soon enact a central Act for violence against doctors. But, sadly, this has yet to see the light of the day. It’s time that the medical profession unites and stand firm till the government brings a Bill for violence against doctors in the coming Parliament session.

If the doctors and other healthcare staff, etc. are always under a constant threat and pressure from the ongoing violence and assault then they will not be able to do justice with their profession and also they shall not be able to manage their patients who need emergency treatment and are therefore undergoing risk and danger of their life, properly and promptly.

It is therefore in the interest of public at large that such cases of physical violence against doctors must be condemned and controlled and must not be allowed to happen.

Persons committing such offences and crimes can be punished under the following laws:

Criminal law

The Act of physical violence, assault, attack on doctors, nurses, their staff, clinical establishments, etc. amounts to following criminal offences, which are punishable under the provisions of Indian Penal Code (IPC), 1860:

Criminal conspiracy: Section 120A and Section 120B of IPC

Offences against the public tranquility
Unlawful assembly: Section 141, 143 and 144 IPC.
Rioting: Section 146 IPC, Section 147 IPC and Section 148 IPC.
Affray: Section 159 IPC and Section 160 IPC.

Offences affecting the public health, safety, convenience, decency and morals
Public nuisance: Section 268 IPC, Section 269 IPC and Section 294 IPC.

Offences affecting human body
Hurt: Section 319 IPC, Section 323 IPC and Section 324 IPC.
Grievous hurt: Section 320 IPC, Section 325 IPC, Section 326 IPC and Section 326A IPC.
Act endangering life or personal safety of others: Section 336 IPC, Section 337 IPC and Section 338 IPC.
Wrongful restraint: Section 339 IPC and Section 341 IPC.
Criminal force and assault: Section 350 IPC, Section 351 IPC, Section 352 IPC and Section 355 IPC.

Offences against property
Theft: Section 378 IPC and Section 379 IPC.
Mischief: Section 425 IPC and Section 426 IPC.
Criminal trespass: Section 441 IPC and Section 447 IPC.

Offence of defamation: Section 499 IPC and Section 500 IPC.
Offences of criminal intimidation, insult and annoyance: Section 503, Section 504 IPC and Section 506 IPC.

Offences of outraging, insulting the modesty of women: Section 354 IPC, Section 354A IPC, Section 354B IPC, Section 354C IPC and Section 509 IPC.

If any person commits any of the above mentioned offence, then the doctors and their staff can lodge a police complaint under Section 154 of the Criminal Procedure Code and get an FIR lodged against the said offender.

Civil law

Doctors, hospitals, its staff, clinical establishment, etc. can also file civil suits like suit for permanent injunction, suit for damages and suit for defamation against the aforesaid Acts and offences of physical violence, assault, attack, etc.

Besides the above mentioned remedies under IPC or CrPC, around 15 States and Union Territories (UTs) in India have their respective State or UT legislations on the issue of physical violence or assault of doctors, for example: Delhi Medicare Service Personnel and Medicare Service Institutions Act, 2008; Bihar Medical Service Institution and Person Protection Act, 2011, etc. In all these legislations, punishment is imprisonment which may extend to 3 years or with fine up to Rs. 10,000/- or both and compensation of twice the purchase price of property damaged and loss caused to be recovered as arrears of land revenue on default. However, the said legislations framed by the 15 States or UTs are not effective and also there is no awareness about the same either amongst the doctors or the concerned police authorities.

Then there are laws relating to sexual harassment at the workplace. Women can file a complaint against the offence of sexual harassment at workplace as per the provisions of the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 (hereinafter referred to as Act, 2013).

As per the provisions of the Act, 2013, the hospitals, clinical establishments, etc. should constitute an Internal Committee for redressing the complaints relating to the sexual harassment at workplace made by any aggrieved women.

Some Remedies

Here are few suggestions to avoid doctor-patient disputes. More suggestions are welcome.

·           There is an urgent need to legislate a Central Act on prevention of violence against doctors while on work and duty. Any act of violence against doctors should be made a punishable, non-bailable offence with imprisonment of up to 14 years.
·           Also, the State Acts on violence against doctors should be advertised and also acted upon by the state government.
·           Workshops, seminars etc should be organize to educate the general public and doctors about the penal provisions in case of violence against doctors. This can be done by the government and professional associations.
·           Patients’ rights should be displayed in every hospital and clinic. Associations should educate their doctors about Etiquettes, conduct, ethics.
·           Patients should be educated about the significance of informed consent.
·           Patients should be educated about triage in emergency.
·           Patients should be sensitized that error of judgment does not automatically mean negligence.
·           There should be a grievance redressal mechanism for both patients and doctors in every health care establishment.
·           Right communication is the key to a strong doctor-patient relationship, based on mutual trust and respect.
·           The charges should be clear and transparent - there should not be a large difference between the estimated cost of treatment and the actual cost of treatment; there should be no hidden charges or kickbacks.
·           It is important to acknowledge the altered dynamics of doctor-patient relationship, which has undergone a paradigm shift from doctor’s right to take decision to patient’s rights to take decision.
·           Rational treatment, rational prescription, transparency in investigations and treatment
·           Hospitals should identify high risk areas and install audio-based CCTV cameras in all sensitive and high risk areas.
·           Bodies of deceased patients cannot be held as hostage for financial disputes.
·           Hospitals should make adequate security arrangements; protection to be given to doctors and nurses working the night shift in particular.
·           Provide transparent daily billing to avoid future disputes
·           CPR and first aid to be available everywhere
·           Briefing to the legal heirs
·           PRO in challenge and high risk areas
·           Nurses and paramedical staff to be trained about soft communication

Besides the doctors and patients who are direct stakeholders in this, the media and police too have an important role to play in preventing violence against doctors and hospital staff.

Guideline for media

·         No media trial
·         Negative news about the doctors should not be published
·         Name of the doctor and patient should not be published.
·         No news story should be reported without proper verification

Guideline for police officers

·           To be sensitized about the violence against doctors Act
·           To be sensitized about the guidelines as laid down by Hon’ble Supreme Court in Jacob Mathew case

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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