Indian doctors’ leaders demand national law to reduce violence in hospitalsBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4303 (Published 19 June 2019) Cite this as: BMJ 2019;365:l4303
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In an attempt to protect on-duty doctors and healthcare professionals against violence, the government of India has recently proposed a new law seeking to treat such violence as cognisable and non-bailable offence, attracting jail term of up to 10 years and penalty of up to Rs 10 lakh (1 million).
The provisions are part of the draft legislation - Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill, 2019 - put up by the health ministry on Monday inviting public comments within 30 days.
Competing interests: No competing interests
Incidents of violence against doctors in the Indian subcontinent have recently increased. National newspapers constantly report doctors being abused, bullied, manhandled, and even killed by the patient’s relatives. In the last few decades, the doctor-patient relationship is not at its best and the trust between them has taken a beating. The ever-hungry media adds to fuel in damaging this delicate relationship by rapidly jumping to conclusions and publishing incredible stories of malpractice and medical negligence.
Most doctors in India, especially in the Government hospitals are extremely busy and hence it is inevitable that the quality of care may sometimes get compromised as they attend a significant number of patients, in a small window of time. Delay in attending to their patient or poor communication can easily drive them over an edge. Apart from these factors, high expectations of complete and quick improvement from the patient and their relatives are major contributing factors for increasing assaults.
The security of doctors at work is a major challenge in most government hospitals in India, due to lack of adequate security personnel. During the night hours, the doctor on duty has to perform the dual role of a doctor and a security guard. Due to the lack of an established protocol for tackling violence, the perpetrators often go scot-free. Thus, in cases of patient death, the public might take immediate revenge and seeking their ‘pound of flesh’ using physical means rather than taking the legal path. There exist no laws for the protection and safety of the medical community. It is amazing to note that in India, while it is a non-bailable offense to assault a uniformed public servant like a bus driver or a policeman, there is no clear penalty for hitting an on-duty physician in a white coat.
The need of the hour is to save this noble profession in India by formulating strict legal provisions to ensure the safety of health worker and these laws must be displayed prominently in the hospital premises so that the perpetrators are forced to think several times before committing this heinous act. Deployment of a sufficient number of police officers and security guards is necessary for every hospital. Assaulting a medical staff on duty should be made a cognizable offense, with serious consequences. The public must be made to realize that the hospitals are sanctums of healing and recuperation and any violence against the health workers could jeopardize the management of sick patients and hamper their recovery to health.] It is paramount that each hospital must ensure the safety of their doctors and should create an emergency protocol to deal with a major act of violence.
1. Vaishya R, Maini L, Vaish A. Making the Surgeons safe in India. Indian J Orthop 2018: 52:212-13.
Competing interests: No competing interests
A recently published letter titled “Concern regarding access to health care in Jammu and Kashmir, India” is misleading.
Sadly, a ‘reputed’ medical journal like the BMJ has not done any good to the people of Jammu and Kashmir by publishing such a biased article on the current scenario of healthcare in Jammu and Kashmir; it seems it will only help to inflame the sentiments of the affected Kashmiris.
Medical journals like the BMJ should not engage in publishing socio-political articles and must focus on the medical part only, as per their aims and scope. It has been realized that only some of the medical journals from Britain [1,2,3], out of the whole world, have been interested in publishing such non-medical articles. Such activities may help these journals to gain ‘cheap’ publicity in the media, but they are probably not liked by healthcare professionals, for whom these journals are primarily for updating their medical knowledge.
1. Concern regarding access to health care in Jammu and Kashmir, India.BMJ 2019;365:l4303.
2. Kashmir communications blackout is putting patients at risk, doctors warn. BMJ 2019; 366 :l5204.
3. Editorial: Fear and uncertainty around Kashmir's future. The Lancet. Published:August 17, 2019; 394 (10198): 542.
Competing interests: No competing interests
We wish to bring to your attention the current situation in Jammu and Kashmir which is leading to a violation of the right to life and to health care. The Government of India on the 5th of August, abrogated Article 370 and Article 35A of the Constitution of India through the provisions of which the state acceded to India and which give the state certain special provisions.
Anticipating widespread protests, the Government of India, from the night of 4th August 2019, put the state under lockdown and arrested nearly 500 political leaders and activists in the state, including two former Chief Ministers. All means of communication – landline telephones, mobiles, internet and cable television - have all been shut down and remain so at the time of writing.
The lockdown and snapping of all modes of communication has made it very difficult for people in the Kashmir valley to access health care. From various news reports that are available from Srinagar the capital city, the picture that emerges is grim. People are unable to call an ambulance to take a sick person to hospital – they need to be taken a private vehicle if they have access to one. These vehicles are stopped every few metres by security forces standing at concertina wire barricades to check identity and ask questions. Several patients have been admitted with pellet gun injuries, and some have been seriously injured. Only those who can make it to a hospital can get some care. Though hospitals are generally stocked with supplies, staff have found it difficult to reach the hospital. Hospitals that are usually overcrowded are largely empty now. Some doctors worry about their patients on dialysis as only a few patients requiring dialysis from Srinagar have been able to come for treatment, while those living outside have not been able to reach the hospital. Certain medications are out of stock in the local stores and there is at least one report of a person having to fly to New Delhi to purchase medicines for a sick relative. There are reports of other patients who have not been able to reach the hospital in time for their scheduled cycle of chemotherapy. The situation has also led to a lot of mental stress among a population already living with high levels of psychosocial stress. Some women due to deliver were moved closer to a hospital when the troop buildup began as they anticipated some trouble. There are likely to be many more women who are not able to get to a hospital for their delivery, or have got there very late.
In the current situation there is a blatant denial of the right to health care and the right to life. We call upon the Indian Government to ease restrictions on communication and travel at the earliest, and undertake any other measures that are required to allow patients to access health care without hindrance.
Competing interests: Jain Y is on the BMJ's Patients' Rights Committee as an email group member. All the rest have no competing interests.