VIOLENCE AGAINST THE DOCTORS IN INDIA: IS THIS A WAKE UP CALL TO SAVE THE MEDICAL PROFESSION?

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On the night of 10th June 2019 after Mohammed Shaheed, a 75-year-old patient from Tangra, Calcutta, passed away at NRS Medical College, eleven relatives of the deceased were upset over the patient's death and alleged that he died due to medical negligence. A mob reached NRSMCH at around 11 pm and fought with the junior doctors. The clashes turned the premises into a "battleground" at night and the morning after as doctors at the facility alleged that over 200 people arrived on trucks to assault doctors and destroy hospital property. Two intern doctors, Paribaha Mukhopadhyay, and Yash Tekwani were injured in the ensuing clashes. Yash was admitted at NRSMCH with Paribaha being admitted in an intensive care unit at the Institute of Neurosciences in Kolkata after they both suffered head injuries.

What followed was a total of 119 doctors of North Bengal Medical College and Hospital in Darjeeling have resigned, various medical bodies called doctors' strike across the country as a mark of protest over the rising violence against their fraternity. The Indian Medical Association (IMA) called for a nationwide withdrawal of non-emergency services including OPD on 17th June to protest against the assault on a junior doctor in Kolkata and sought a central law for ensuring protection to doctors against violence in hospitals. Interestingly there was political angle brought into the picture whereby Chief Minister of West Bengal Mamata Banerjee had asked agitating junior doctors in the state to resume work within four hours. She branded the striking doctors as ‘outsiders’ and attributing the strike as a political motive to out throw her government. At the end Chief Minister of West Bengal Mamata Banerjee, unconditionally, accepted all demands of the doctors ensuring them of steps like getting police protection at hospitals, a grievance redressal system, having helplines, and also restricting the entry of persons in government hospitals especially with patients.

This unfortunate incident raises questions such as- Are the doctors and medical profession truly respected and protected in India? Does this profession continue to have the same respect as it had earlier? Are doctors today “servants” fitting in the bracket of “contract of services” rather than the usual “contract for services”? Do doctors have no rights and laws to protect themselves from the wrath of the people? What is the fate of the medical profession in India? And importantly does beating the doctors remedy the wrongs and therefore the solution to all the problems?

There are many causes for the increase in violence against medical personnel in India. Some of them are elaborated as under. 

Poor image of doctors and the role of the media: In India, doctors have traditionally been regarded highly by society. The present impression of private business-mindedness of some in the profession has led to a poor image of doctors. One of the factors that contribute to this poor image of doctors is the sensationalization of every news item, often ignoring information that would gloss over mundane details, exonerating a doctor in an incident of alleged medical negligence. 

Meager health budget and poor quality healthcare: Among other causes of violence against doctors in India are the pathetic conditions in which patients are treated in government hospitals. There is overcrowding, long waiting time to meet doctors, absence of a congenial environment, multiple visits to get investigations done as well as consult doctors, sharing a bed by two and sometimes three patients and poor hygiene and sanitation. There is frustration with systemic problems of government hospitals, from dysfunctional equipment to shortage of staff. Given the poor budgetary allocation for health in India, these problems are unlikely to change. 

Lack of faith in the judicial process: A person with a grievance does not trust the mechanisms of redressal provided by law. There is sometimes a perception that doctors being well connected will get away and hence there is a tendency to take the law into their own hands by resorting to violence. There is also a belief that the patient's attendants who assault doctors will go unpunished.

Mob mentality: Mob mentality frequently snowballs into a violent crisis in hospitals. In India, emotional turmoil due to the death of a loved one is sometimes used by local politicians as an opportunity to demonstrate their political relevance by orchestrating violence at the clinical establishment. The 2-minute of fame and news coverage drives these antisocial elements to often damage the social fabric during a medical accident. Unique to India, the unfortunate death of a patient is sometimes given religious and caste color by some miscreants, especially if the doctor belongs to a different caste or religion than the patient.

Lack of security: Violence is easily orchestrated in Indian healthcare establishments partly because security staff in the government and private sectors is non-existent due to lack of funds. With meager budgets, not sufficient to hire enough doctors and nurses, it would be unrealistic to expect adequate security in Indian hospitals except in a few corporate hospitals.

The violence against doctors in India comprises in the form of (i) telephonic threats; (ii) intimidation; (iii) oral/verbal abuse; (iv) physical but non- injurious assault; (v) physical assault causing injury: simple and grievous; (vi) murder; and (vii) vandalism and arson. These actions have a huge impact on the Doctors. Studies show the doctors facing violence have been known to go into depression, develop insomnia, post-traumatic stress, fear, and anxiety. 

Speaking about the laws in India for the medical institutions and doctors, there are various laws dealing with it. Of all the laws they can register a case under the special law- Protection of Medicare Service Persons and Medicare Service Institutions (Prevention Of Violence And Damage To Property) Act, also known as the Medical Protection Act (MPA). The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws attacks against physicians and damage to their property. Offenders can get a jail term of up to three years and a fine of Rs 50,000. This Act is in operation in about 19 States in India. However as stringent as it sounds, the Act, however, fails to really protect doctors because it features neither in the Indian Penal Code (IPC) nor in the Code of Criminal Procedure (CrPC). This makes it difficult for victims to approach the police for help or the latter to file a complaint against suspects. 

Hence the doctors take recourse of going on strike to let their voices be heard. It is unfortunate that instead of answering to their demands and hearing their grievances, people question their morals, ethics and remind them of their “duty as a doctor” and the “Hippocratic oath”. Nobody questions the assaulters and reminds them of their morals. This attitude and unruly behavior of the public is pushing the doctors in a helpless state which is not beneficial to the profession and for the society as a whole. It is important that the Government- both Central and State step up to protect and provide safety for the doctors and medical institutions. There are reports which show that the condition in the government hospitals are poor and the doctor has to attend nearly 35-50 patients. Add to it there is a lack of medical infrastructures and facilities. Therefore a failure or shortage of the equipment should not be dumped upon the shoulders of the doctors nor should they made to be paid for it. 

One can safely say looking at the present scenario that the profession is under danger. In the near future there may come a time where out of fear of the reaction of people, nobody will opt for this profession. Definitely, nobody likes to work in an uncertain and unsecured environment where threats are giving of killing and raping because of the unsuccessful results.