Legislation addressing violence against healthcare workers (VAHCW) in India has evolved in response to the increasing incidents of such violence, particularly in the wake of the COVID-19 pandemic. The key developments in this legislation can be traced through various laws, amendments, and policy measures as discussed in this article.
Violence against healthcare workers in India has become a significant and growing concern.
Reports indicate that incidents of aggression and physical assault are increasingly frequent, particularly in public healthcare settings.
This violence can range from verbal abuse to physical assaults, often perpetrated by patients’ relatives or other individuals frustrated by the healthcare system.
Violence against healthcare workers (VAHCW) in India
Key Points of Concern:
- Increasing Frequency: The number of violent incidents reported across India, particularly in public healthcare facilities, is rising. These incidents often involve doctors, nurses, and other healthcare professionals being assaulted by patients or their relatives.
- Vulnerable Groups: Young and female healthcare professionals are disproportionately affected by these violent incidents. Female staff, in particular, are often targeted due to perceived vulnerability.
- Public Healthcare Settings: Violence is notably more prevalent in public healthcare facilities, where resource constraints, overcrowding, and long wait times can exacerbate tensions. Patients and their families, frustrated by these conditions, often lash out at healthcare workers.
- Impact on Healthcare Services: The fear of violence can lead to a significant drop in morale among healthcare workers, affecting their ability to provide quality care. It may also deter new professionals from entering the field, exacerbating the existing shortages of healthcare workers.
Underlying Causes
- Overburdened Healthcare System: India’s public healthcare system is often under-resourced and overburdened, leading to delays and dissatisfaction among patients.
- Lack of Security Measures: Many healthcare facilities lack adequate security measures to protect their staff from such incidents.
- Communication Gaps: Poor communication between healthcare workers and patients’ families can escalate tensions, leading to misunderstandings and violent outbursts.
Legislation addressing violence against healthcare workers in India
State-Level Legislation (2008 Onwards)
- The Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2010 was one of the early laws that set a precedent for other states.
- Similar laws were enacted in states like Andhra Pradesh, Karnataka, and Tamil Nadu around the same period.
- Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Amendment Act of 2023 is also an example.
- These state laws typically included provisions for penalties and imprisonment for those who commit violence against healthcare workers or cause damage to medical facilities. However, the enforcement of these laws was often criticized as being weak and inconsistent.
National-Level Legislation (2020 onwards)
The Epidemic Diseases (Amendment) Act, 2020
- The COVID-19 pandemic highlighted the need for stronger protection for healthcare workers.
- In response to the rising number of violent incidents against health professionals, particularly during the early days of the pandemic, the Indian government introduced an ordinance that later became the Epidemic Diseases (Amendment) Act, 2020.
Key Features:
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- Stringent Penalties: The amendment made acts of violence against healthcare service personnel a cognizable and non-bailable offence. The penalties were significantly increased, with imprisonment ranging from 6 months to 7 years, depending on the severity of the offence.
- Compensation: Provisions were made for compensation to healthcare workers who suffered injuries, as well as for damages to property, such as clinics or ambulances.
- Time-Bound Investigation: The law mandated that investigations into such offences be completed within 30 days, and trials should be conducted expeditiously, ideally within a year.
Prevention of Violence Against Healthcare Professionals and Clinical Establishments Bill, 2022
- The Prevention of Violence Against Healthcare Professionals and Clinical Establishments Bill, 2022 is a legislative proposal aimed at addressing the increasing incidents of violence against healthcare professionals in India.
- The Bill was introduced in response to the rising concerns during the COVID-19 pandemic, where numerous instances of violence against doctors, nurses, and other healthcare workers were reported.
Key Provisions of the Bill:
- Definition of Violence: The Bill broadly defines violence as any act that causes harm, injury, or damage to healthcare professionals or property at clinical establishments. This includes physical violence, verbal abuse, and damage to hospital property.
- Protection for Healthcare Professionals:
- The Bill extends protection to a wide range of healthcare professionals, including doctors, nurses, paramedics, and support staff working in public and private healthcare facilities.
- It also covers medical students and other trainees working in healthcare institutions.
- Penalties and Punishments:
- The Bill proposes stringent penalties for those found guilty of committing violence against healthcare workers. This includes imprisonment ranging from 6 months to 5 years and a fine of up to ₹5 lakh.
- In cases of grievous harm, the imprisonment term could extend up to 10 years, with a higher fine.
- Compensation for Damage: The Bill mandates that individuals responsible for causing damage to property in clinical establishments should compensate for the damage. The compensation amount would be twice the market value of the damaged property.
- Time-bound Investigation: The Bill stipulates that investigations into violence against healthcare professionals must be completed within a fixed time frame, ensuring swift justice.
- Bailable and Non-bailable Offenses: Offenses under this Bill are categorized as cognizable and non-bailable, indicating the seriousness of the crime and ensuring that offenders are not easily granted bail.
Rationale Behind the Bill:
- The Bill was introduced to address the vulnerabilities faced by healthcare professionals, particularly during public health emergencies like pandemics.
- It seeks to create a safer working environment for healthcare workers, ensuring they can perform their duties without fear of violence or retribution.
The then Union Health Minister, Dr Mansukh Mandaviya, informed the Rajya Sabha that while a draft of the Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill was prepared and circulated for consultations, it was decided not to pursue separate legislation.
Instead of giving a nod to the protection bill, the Epidemic Diseases (Amendment) Ordinance, 2020 was promulgated to address the issue.
Continued Challenges
- Enforcement Issues: Despite these legislative measures, violence against healthcare workers continues to be a significant problem in India. Many healthcare professionals have pointed out that the implementation and enforcement of these laws remain a challenge.
- Ongoing Advocacy: Various healthcare associations and unions continue to advocate for better implementation of the existing laws, the establishment of dedicated helplines for health workers, and the need for a more robust legal framework that includes provisions for the mental health and well-being of health professionals.
In news
August 2024: Union Health Ministry has directed that the Head of Institution will be responsible for filing an Institutional FIR within a maximum of six hours in case of violence against doctors.
- Director General of Health Services Atul Goel has written a letter to the heads of the central government hospitals and medical colleges in this regard.
- The direction came in the wake of the recent incident of the murder of a doctor in Kolkata and a protest by the resident doctors over the issue.
- In his letter, he said that recently it has been observed that violence has become common against doctors and other healthcare staff in Government Hospitals.
- Several Health workers suffer physical violence during their duty.
- Many are threatened or exposed to verbal aggression. Most of this violence is done by either the patient or the patient’s attendants.
Way forward
Preventing Violence against healthcare workers is of utmost importance and requires multi-pronged action.
- Enhanced Security: There is a pressing need for better security measures in healthcare facilities, including the presence of trained security personnel and surveillance systems.
- Improved Communication: Healthcare workers need better training in communication skills to handle difficult situations and de-escalate potential conflicts.
- Public Awareness Campaigns: Educating the public about the pressures faced by healthcare workers and the importance of mutual respect could help reduce the incidence of violence.
Conclusion
The persistence of violence against healthcare workers poses a serious threat to the sustainability of the healthcare system in India. Addressing this issue requires a concerted effort from the government, healthcare institutions, and the public.
In recent years, there have been calls for a more comprehensive national law that would offer uniform protection to healthcare workers across India, rather than relying on state-specific laws or amendments to existing legislation.
The evolution of these laws reflects the growing recognition of the importance of safeguarding those on the front lines of public health, but it also highlights ongoing challenges in ensuring these protections are effectively implemented across the country.
Alongside legislative measures, there have been efforts to increase public awareness about the importance of respecting healthcare workers, especially during crises like pandemics.
Frequently Asked Questions (FAQs)
Q. What is the Central Protection Act for doctors?
Ans: The proposed Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, 2022, was intended to protect healthcare professionals and medical facilities. It was drafted and circulated for feedback five years ago but has since been stalled.
-Article by Swathi Satish
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