The latest incident of a doctor in Assam being lynched by a mob following the death of a patient has triggered a fresh round of protests from the medical fraternity. In view of the continuous attacks on doctors during duty, the Union Health Ministry has released a Draft Bill – Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill, 2019. The Bill proposes a jail sentence of up to 10 years and a fine of ₹10 lakh for anyone found guilty of attacking medical professionals on duty.
An act can be just a deterrent
There are 21 states and one Union Territory that have laws to curb attack against doctors on the line of duty, points out Dr RV Asokan, honorary secretary-general, Indian Medical Association (IMA). He added, “The Act cannot be a solution. Are those who carry out attacks aware of the existence of a law that prohibits assault? These laws are needed as a deterrent to holding people culpable for such attacks, but they are not an end.” He also observes that the law is symbolic and a lot more needs to be done to put an end.
Existing laws a dead letter
Tamil Nadu has the Tamil Nadu Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage or Loss to Property) Act, 2008. It covers attacks against doctors, medical students, nurses, nursing students and paramedical staff on duty in medical institutions. The act states that the person who is responsible for violence against doctors shall be punished with an imprisonment for a term which shall not be less than three years but which may extend up to ten years with fine. It also states that the person shall be liable to pay compensation for the damage or loss caused to the property, as determined by the Court. However, in over 10 years, the acts of violence in the state have been dealt with more through mediation by the police, says Dr GR Ravindranath, general secretary, Doctors’ Association for Social Equality. He said, “Policemen, who can ensure the effective implementation of the law, do not file cases to pursue them. They are most often dealt with through mediation and reconciliation. Such an approach defeats the purpose of having a law.”
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The possibility of imprisonment has led to low convictions, says Dr K Senthil from the Tamil Nadu Government Doctors’ Association. Dr Senthil, who was instrumental in bringing about the law in 2008, soon after Andhra Pradesh enacted a law, said, “In every case of attack, we see the accused seeking a compromise due to fear of imprisonment. Going by the TN example, we have written to the Centre seeking emphasis on penalty rather than imprisonment, in order to make the law effective. A central law will also be more effectively implemented. At the moment, we see very little awareness even among police about the state law.”
Doctors also point to the poor doctor-patient ratio which is at 1 government doctor per 10.189 people, as against the World Health Organisation’s prescribed ratio of 1 doctor per 1000 people, implying a shortage of 600,000 doctors, as per a study by the Center for Disease Dynamics, Economics & Policy (CCDEP). The same study said that at least 65% of health expenditure is out of pocket and it pushes 57 million into poverty every year. Dr Asokan says that existing medical facilities are mediocre and the burden of healthcare is humongous as the private sector has taken over the medical care in a big way. “There is a mismatch between expectations and the actual facility they get. If there should be 24*7 quality care available, it takes as much money and investment from the government’s end,” he observed,
The crowded facilities and lack of beds put immense pressure on the public seeking quality healthcare. Dr Ravindranath added, “India needs more beds, the public health system needs to be addressed and we need to win the trust of the public.”