1. HELPING THE HELPERS : THE
NECESSITY TO ESTABLISH A
LEGAL SYSTEM TOPROTECT
MEDICAL PROFESSIONALS
2. INTRODUCTION
Doctors heal individuals at times at the cost of their own lives, and even assist in making life-
saving medical decisions.They spend several years studying human existence in order to save
someone else's life in the future. Violence against healthcare professionals or other pandemic
employees was rarely reported in the news, and there was no debate or discussion about it in
medical publications in India around ten years ago, as there was rarely any act of violence, as is
customary in western countries. 60-70 percent of the time, the violence was in the form of verbal
abuse or aggressive behavior directed at doctors. Patients who were in psychiatric facilities and
were under the influence of alcohol and narcotics were frequently the ones abusing the doctors. A
doctor's life and profession has been the most hard and tough during the difficult days of the
famous and fatal Corona Virus, or COVID-19 virus. They are normal people, just like their patients,
and they are as susceptible to this illness as anyone else, but they risk their lives, their families, and
the time they could spend calmly with their loved ones.
3. PROBLEMS IN HAND
Although Violence faced by Healthcare workers and paramedic staff is not uncommon, the incidences in
India are on rise. Recently in Chennai one dentist was brutally murdered by one of his patients, after he
treated his patient and he was in pain. Even in this COVID-19 situation, when people need doctors the
most, when people need paramedic staff the most, there is not even a single act passed by the
government ofIndia except the Epidemic Diseases (Amendment) Act, 2020. This act only comes under
play when there is an epidemic or a big disease outbreak in the country. There is still a Bill approved by
Lok Sabha that includes only 12 Laws to protect the life of a Doctor, this bill is named as THE
PREVENTION OF VIOLENCE AGAINST DOCTORS, MEDICAL PROFESSIONALS AND MEDICAL
INSTITUTIONS BILL, 2018. But even after such increasing cases of violence on Doctors this bill is still
pending till date. There is no safeguard to even their properties, Doctors use their hard-earned money,
building and enjoying their life. They help others to live there life freely and with happiness. But using
their money to expand their livelihood is the biggest challenge, with increasing responsibilities, come big
problems too, Emergency wards; 75% of the hospitals and nursing homes do not allow visitors or family
members inside with the patient in an Emergency ward, but lack of awareness about the same changes
everything.
4. OBJECTIVES
The main goal of this study is to investigate measures to protect healthcare workers
and to demonstrate the need for a legal structure for them:
1. To identify the difficulties that doctors and paramedics confront in their line of
work;
2. To determine what steps may be done to curb the rise in violence against
healthcare
workers;
3. To determine the current legal framework that safeguards doctors from being
harmed.
5. HYPOTHESIS
Medical practitioners in India are not protected by Indian laws against assault and abuse.
1. Going through with the Prevention of Violence Against Doctors Bill, 2018, will help a
lot of medical professionals feel confidence and work in these perilous situations when
they may be injured and not receive justice;
2. Having a legal system in place for healthcare workers will inspire newer generations
to follow this career in a safe manner;
3. In legal matters, healthcare employees shall be treated fairly.
6. VIOLENCE AGAINST DOCTORS
-Healthcare in India:
India has a universal multi-payer health-care system that is funded by a combination of public and commercial health
insurances, as well as a portion of public hospitals that is virtually totally funded by taxes. Except for tiny, often symbolic
co-payments in someservices, the public hospital system is virtually free for all Indian residents. AyushmanBharat, a
national health insurance scheme introduced by the Indian government in 2018, is atthe federal level. This aimed to
cover the bottom half of the country's population (500 millionpeople) who work in the unorganized sector (businesses
with fewer than ten employees) and provide them with free treatment at both public and private hospitals. People who
work in theorganized sector (companies with more than 10 employees) and earn a monthly salary of upto Rs 21,000 are
covered by the Employee’s State Insurance social insurance scheme, which pays for their healthcare (along with pension
and unemployment benefits) in both public and private hospitals. Employers give health insurance coverage to people
earning more than that amount through one of the many public or private insurance organizations. By 2020, 300 million
Indians will be insured by group or individual insurance policies purchased from one of the public or private insurance
organizations by their employers. Unemployed people who do not have health insurance are covered by several state
funding systems for emergency hospitalization if they cannot afford it. In 2019, the government's total net healthcare
spending was $36 billion, or 1.23 percent of GDP. The public hospital system has been wholly funded by general taxes
since the country's independence.
7. Public Healthcare:
Every Indian citizen has access to free public healthcare.1 “Outpatient care accounts for 18% of total outpatient care and inpatient care accounts for 44%
of total inpatient care in India. Individuals in India's middle and upper classes tend to use public healthcare less than those with a lower quality of life.
Women and the elderly are also more likely to use government services. The public health care system was created with the goal of providing
healthcare to all people, regardless of their socioeconomic level or caste.”2 However, state- by- state reliance on the public and private healthcare
systems differs greatly. The main reasonfor relying on the private sector rather than the public sector is the low quality of care in the public sector,
which is stated by more than 57 percent of households as a cause for a preference for private health care. Much of the public healthcare system serves
rural areas, and the poor quality stems from skilled healthcare provider’s reluctance to visit these areas. As a result, the majority of the public
healthcare system in rural and isolated places is reliant on untrained and uninspired interns who are required to spend time in public health clinics as
part of their curricular requirements. High distances between public hospitals and residential areas, long wait times, and inconvenient hours of
operation are all key factors.
8. Private Healthcare:
Since 2005, the majority of new healthcare capacity has been added in the
private sector or in collaboration with it. The private sector is responsible for
58 percent of the country's hospitals, 29 percent of hospital beds, and 81
percent of doctors According to one study, nearly 35% of poor Indian
households incur such costs, reflecting the current status of the Indian health-
care system. With government spending on health as a percentage of GDP
declining over time and the emergence of the private health care sector, the
poor now have fewer options for health care than they did previously. In
India, private insurance is available, as well as a variety of government-
sponsored health insurance plans.
9. Violence against Doctors:
According to legend, Zeus, the god of the gods, killed Asclepius, the Greek god of medicine, with a thunderbolt because he was worried that Asclepius
healing skills might make mortals immortal. Indian doctors have the same god-like prestige as Asclepius, but they are more afraid of the mortals who
worship them.
“Workplace violence is defined as situations in which employees are ill-treated, intimidated, or attacked in conditions related to their workplace,
including commuting to and from the workplace, involving an explicit or implicit challenge to their safety, well-being, or health, according to the WHO
framework Guidelines (2002).”5 Workplace violence among healthcare workers is four times higher than among all other workers, necessitating more
time away from work. Physical or psychological aggression, or a combination of the two, can be used. “Assault, abuse, bullying, mobbing, sexual, racial,
or psychological harassment, threat, and so on are all examples of harassment’
It can be found on all continents, from Asia to Australia, Europe to America, and Africa to Africa. According to statistics, one-third of healthcare
professionals in the United Kingdom have experienced workplace violence.7 In India, about seventy-five percent of doctors have faced with some type of
violence during their careers.8 In nearly half of the occurrences of violence reported in intensive care units (ICUs), the patient's relatives were actively
involved in 70% of the incidents.9 Similar instances were reported in Israel, Bangladesh, and Pakistan. In China, too, a faulty healthcare system has
resulted in a deterioration of the patient-doctor relationship. Between 2009 and 2015, the Chinese MedicalDoctor Association recorded more than 105
violent instances in which doctors were seriouslyhurt.
10. STUDIES SAYS
With a population of just over 1.36 billion people, India is the world's second most populous country. It is home to about 18% of the
world's population despite having only 2% of the world's surface area (of the world). Because it is a developing economy with increased
urbanization, rapid deforestation, little or no control over pollution levels, and its geographical location (which makes it more prone to
tropical diseases) combined with an equally dense population, it is only natural that the country's health situation is not ideal. The problem
is exacerbated by the rising expense of health and care services, as well as a scarcity of doctors and medical facilities. On average, there is
one doctor for every 1700 patients in this country. This is a national average, and the situation in rural regions is significantly worse. No
wonder; a common man's impulsive impulse of vengeance for his misfortunes is rarely directed towards a doctor in its fullness.
Over 75% of doctors in the country have been subjected to some type of violence, according to reports. Violence against doctors by
patients relatives or attendants has become a severe problem in recent years, prompting many physicians and medical professionals to go
on strike for days in order to protect themselves and their property. According to certain research, doctors suffer the most violence when
providing emergency services, with about 49% of such incidents occurring in ICUs or after a patient has undergone surgery. The causes of
this violence include a variety of issues such as the prescription of unnecessary investigations, a doctor's delayed and unsatisfactory
approach to treating patients, medical bills far exceeding the estimated expense, requests for advance payments to withhold a deceased
body until final billing is settled, and many others. In almost all cases, a common element contributing to conflict between doctors, medical
institutions, and patients is a lackof transparency and trust regarding treatments and pricing.
11. Overview of the Bill:
The Prevention of Violence against Doctors, Medical Professionals and Medical Institutions Bill, 2018104 by Dr.
Shrikant Eknath Shinde (Member of Parliament) to provide for the prevention of violence against doctors,
medical professionals and medical institutions in the most amicable manner.
12. Prohibition of Violence:
At all levels, any act of violence against a doctor, medical practitioner, or medical facility must be prohibited and mitigated.
Cognizance of Offence:
Any offence committed under this Act is cognizable, non-bailable, and triable by the Court of Judicial Magistrate of the First Class.
Penalty & Compensation:
“Whoever, commits or attempts to commit or abets or incites the commission of any act of violence in infringement of the provisions of Clause 3, shall be punished
with imprisonment which shall not be less than six months but which may extend up to five years and with fine which shall not be less than rupees five thousand but
which may extend up torupees five lakh in addendum to recovery of the entire damage to the property or belonging of all concerned including the witnesses if any.“If
the accused does not pay or is financially incompetent to pay the penalty at that time it shall be recovered as if it were an arrear of land revenue and any property
belonging tohis immediate relatives (as per the existing provisions of the Indian Penal Code 1860), maybe attached in recovery of the said penalty.114”
Financial Memorandum:
The Bill's clause 7 calls for the formation of a district-based committee to give timely aid to victims of medical malpractice. Clause 8 states that the Central Government
shall provide necessary money for carrying out the purposes of this Act from time to time when appropriate appropriations have been granted by Parliament by law. As a
result, if the Bill is passed and implemented, it will necessitate expenditure from the Consolidated Fund of India. The Consolidated Fund of India is expected to incur
recurring expenditure of Rs. 50 crore every year. It's also expected that a one-time investment of around Rs. 100 crore will be required.
Memorandum Regarding Delegated Legislation:
Clause 12 of the Bill gives the Central Government the authority to enact rules to carry out the Bill's objectives. Because the rules will only deal with minor details, the
transferof legislative power will be standard.
13. The Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage
to Property) Bill, 2019:
In light of recent attacks and acts of violence against medical practitioners, as well as a growing demand for protection in this area,
the Central Government is considering taking steps to ensure that healthcare professionals and clinical establishments are protected by
making such acts punishable by law. The Department of Health and Family Welfare (Medical Services Division) of the Ministry of
Health and Family Welfare, Government of India, proposed draft legislation titled The Healthcare Service Personnel and Clinical
Establishments (Prohibition of Violence and Damage to Property) Bill, 2019 after numerous meetings with doctors and other stakeholders.
The Bill is intended to address the issue of violence resulting in injury or threat to the lives of Healthcare Service Personnel while
performing their responsibilities on the premises of a clinical establishment or elsewhere, as well as damage and loss to CE property.
Furthermore, the Bill defines obstructing/causing impediment to an HSP in the performance of their duties, whether on the CE's premises or
elsewhere, as an act of violence. The public comment process on the bill is presently open for thirty days, ending on October 2, 2019.
•
14. Why is this Law Needed?
Even though 19 Indian states have enacted the Medical Protection Act to protect healthcare
workers, it has been a failure because it is not codified in the IPC or Cr.P.C, making it impossible
for those who have been wronged to contact or register a complaint with the police. As a result, a
centralized law is urgently required. Our neighboring country, China, has adopted similar
measures to stop attacks on its doctors.
15. Conclusion:
A variety of providers provides services in allopathy and alternative systems of medicine such as Ayurveda, Homoeopathy,
Unani, and Siddha in India's health workforce. The doctor-to-population ratio is 1:1456 as of January 2020. The nurse-to-
population ratio is currently 1.7:1000. There is a considerable scarcity of trained nurses in the country due to the poor
quality of training provided by various institutions that have sprung up over the years, limited career opportunities, and
poor working conditions, particularly in the private sector. Furthermore, there is a disparity in the distribution of doctors
and nurses around the country. In comparison to rural areas, urban areas have four times as many doctors and three times as
many nurses. Nurses and ASHA workers are underpaid, especially in rural areas, and have few opportunities for
advancement. Medical lab technicians, optometrists, and radiologists are among the allied health professionals (AHPs) who
are in short supply. In terms of specialists, there are a lot of open positions all around the country. According to projections,
India need an additional 0.5 million professionals. Ayushman Bharat has sparked a demand for even more human resources
in the health sector (HRH). In addition, there is a severe scarcity of medical faculty.
