On August 9, 2024, a horrific incident unfolded at R.G. Kar Medical College and Hospital in Kolkata. A young doctor was brutally raped and murdered, and her body discovered in the seminar room of the emergency building where she had been working. While this tragedy wasn’t directly related to the violence healthcare workers often face while discharging their duties, it casts a stark light on the ongoing vulnerabilities within hospital systems in India. It also brings into focus the pervasive issue of violence against healthcare workers (VAHCW) in the country.
Violence against healthcare workers is a disturbingly common occurrence in India. Statistics reveal a pattern of increasing aggression, particularly in public healthcare facilities. Over the last few months, several violent incidents were reported across various States, targeting healthcare professionals ranging from doctors to nurses and paramedics. For instance, in Andhra Pradesh, a nurse was assaulted by a patient’s relative with an iron rod, while in Agartala, a junior doctor faced threats and physical harm from an agitated group of patients’ kin. These incidents highlight the harsh reality that violence is more prevalent in public health facilities and disproportionately affects younger and female professionals.
Call for legal protection
Over the years, the healthcare community has consistently called for laws robust enough to deter such violence. However, no central law existed to safeguard healthcare workers nationwide. Instead, as of 2020, 19 States had implemented their statutes, each with varying provisions. Other States and Union Territories had no laws at all. This lack of uniformity meant protection was inconsistent, and the laws, though present, could have been more effective. In Maharashtra alone, between 2015 and 2020, there were 636 complaints and 1,318 arrests related to violence against healthcare workers, yet only four convictions were secured. The problem was not just in the law’s provisions but in the loopholes that allowed criminal lawyers to circumvent conviction, rendering the laws toothless.
Challenges in enacting a Central law
A central law has not been enacted because public health is a State subject, and VAHCW is primarily a public health-related issue. While the concurrent list allows for a central law, the central government has not prioritised this issue, leaving it to the States to manage.
Legal reforms in Maharashtra
In September 2020, efforts to strengthen laws protecting health workers began in Maharashtra with a public interest litigation (PIL). The Advocate General of Maharashtra made a statement in the High Court on 13-07-2021 which is reproduced below
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“We have further been informed in course of hearing today that the appropriate authority of the Government had discussions with the petitioner and a draft of the amendments required to be incorporated in the Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2010 has been prepared; however, Mr. Kumbhakoni submits that he has himself perused the draft and found the same to be clumsy. He, therefore, submits that the Government ought to be given the liberty of considering whether to introduce a new legislation or to amend the existing law, and for such purpose he has prayed for time.”
The Maharashtra government has not taken any further steps in last 3 years.
Legal reforms in Kerala
A PIL in the Kerala High Court, KPHA vs UOI which requested the State government to improve protection to doctors, and MLSI intervention requested to pass an act safeguarding health workers. On May 10th, 2023, a junior doctor named Vandana Das was killed on duty in Kerala, after being fatally stabbed 11 times in chest by a drunk schoolteacher using scissors on the dressing trolley.
The resulting “Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Amendment Act of 2023“ is one of the strongest State laws in India for protecting health professionals. This act extends protection to a wide range of healthcare workers, including doctors, nurses, paramedics, pharmacists, lab technicians, clerks, ministerial staff, and security guards.
The High Court of Kerala has directed that an FIR be filed within one hour after the incidence of violence. They called it the “golden hour” for the protection of doctors, much like the “golden hour” that doctors prescribe to treat heart attacks or strokes.
The Kerala Act also makes VAHCW a cognisable and non-bailable offence. It also allows for expedited delivery of justice by stipulating that an Inspector must complete an investigation into the offence within sixty days of filing an FIR. Once produced in court, the victims must be examined on consecutive days. This ensures that the court trial process is short and not drawn out. The Kerala Act has also given provisions for special sessions courts with a special prosecutor to try cases under this Act to ensure speedy justice delivery.
Legal reforms in Karnataka
Following recommendations by Karnataka Law Commission in 2018, Karnataka passed “The Karnataka Medical Registration and Certain Other Law (Amendment) Bill of 2024,” which amended the 2009 Act and made it even more potent than the Kerala Act in protecting healthcare workers. This act encompasses all the provisions of the Kerala Act and introduces additional measures to close significant loopholes that had previously hindered convictions.
The Karnataka Act shifted the burden of proof onto the accused from the victim. By doing so, it takes the pressure off of the healthcare professional to prove that an incidence of violence has occurred.
The other loophole that prevents conviction, of course, is when criminal lawyers of the accused argue that there is no ‘intention to hurt’ the health professional from the end of the accused but that it happened spontaneously due to an emotionally triggering event such as loss of patient or worsening of patient condition. Karnataka Act does not, however, provide safeguards for that loophole.
The required provisions for countering this loophole -section 3C - Presumption of offense and 3D Presumption of guilty mind were included by the Central Government in Epidemic Diseases Act 1897 as amended in 2020 during the pandemic. This was meant to provide protection to health workers during extenuating circumstances brought about by the pandemic. However, now that the pandemic has ended these provisions have become redundant.
After the WB incident, the Central Government has declared that it will form a high-level committee to review the 2019 bill tabled in parliament for making the Central Act for protection of healthcare workers.
By enacting these Acts, Kerala and Karnataka now provide their healthcare workers with the most robust legal protections in India. While any law is only as strong as its implementation, the provisions for ensuring an expedited trial in these Acts inspire confidence. It is now crucial for other States to follow suit and amend their laws, creating a unified front to protect healthcare workers nationwide. Until a central law becomes a reality, these State-level reforms represent a significant step forward in safeguarding those who dedicate their lives to caring for others.
Dr. Christianez Ratna Kiruba is an internal medicine doctor with a passion for patient rights advocacy. Dr. Rajeev Joshi is a paediatrician and geneticist. He is also the founder member of the Medico-Legal Society of India.
