[RG Kar Horror] Why Do Doctors Need A Central Law To Protect Themselves & Stricter Enforcement Of POSH Law At Workplace?

The brutal rape and murder of a trainee doctor at RG Kar Medical College and Hospital in Kolkata has thrust the issue of violence against healthcare workers into the national spotlight. This tragic incident has reignited calls from medical professionals across India for the enactment of a robust Central law to safeguard healthcare workers. Although a draft bill addressing this issue was prepared by the Central government in 2019, it has yet to be implemented, leaving the healthcare community vulnerable.

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[RG Kar Horror] Why Do Doctors Need a Central Law to Protect Themselves & Stricter Enforcement of POSH Law at Workplace?

BHARAT: The horrific violence experienced by the postgraduate trainee doctor in Kolkata is an extreme case that highlights a broader issue: the persistent violence that healthcare workers face. Typically, such violence arises when relatives of patients, overwhelmed by grief or frustration due to unexpected deaths, lash out at doctors and nurses.

Over the past two to three decades, these incidents have become increasingly common. Although 25 states in India have enacted laws to protect medical professionals, these laws have resulted in very few convictions.

The root causes of such violence are multifaceted, stemming from unrealistic patient expectations, high out-of-pocket healthcare costs, and poor communication between doctors and patients.

The Need for Increased Healthcare Spending and Systemic Reforms

According to the World Health Organization (WHO), every country should allocate at least 6% of its GDP to healthcare. Unfortunately, India spends less than 2% of its GDP on health, which exacerbates the challenges faced by the healthcare system.

The lack of adequate funding leads to overcrowded hospitals, insufficient resources, and a healthcare system that struggles to meet the needs of the population. Patients, often in distress, direct their anger toward the doctors who are seen as the face of the system.

To address this, India must increase its healthcare spending and strengthen the public health infrastructure to ensure that patients receive proper treatment, thereby reducing the likelihood of violence.

The Exploitation of Medical Trainees and the Need for Better Working Conditions

In many hospitals, particularly government institutions and medical colleges, interns, postgraduate medical students, and super-specialty students are the primary workforce. These individuals are often overworked, emotionally exploited, and subjected to verbal abuse. Despite being there to learn, they are frequently made to replace fully trained doctors, which places immense pressure on them.

A recent study by the National Medical Commission (NMC) revealed that a significant number of postgraduate students suffer from mental health issues, a situation that must be addressed.

Limiting working hours to eight hours a day and ensuring that postgraduate students are not overburdened are essential steps toward improving the healthcare system.

Enhancing Hospital Security and Safety Protocols

Improving communication between doctors and patients, implementing safety measures, and establishing a robust security protocol in hospitals are crucial for reducing violence. The NMC has already issued an advisory to medical colleges, urging them to develop and implement comprehensive policies to enhance the safety of students and healthcare professionals.

Additionally, every hospital should establish a hospital protection committee, install CCTV cameras, and employ security personnel who are accountable for the safety and security of all hospital staff, particularly healthcare workers.

The 2019 Draft Bill: A Missed Opportunity for Central Legislation

In 2019, the Central government drafted a bill titled ‘The Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill, 2019’.

However, despite widespread consultations and the involvement of multiple ministries, the bill never advanced to the Cabinet. The government later argued that existing state and central laws provided sufficient legal protection for healthcare workers and that enhancing hospital security was the only additional requirement.

This stance has left many in the medical community puzzled and frustrated. In 2017, the Ministry of Health had signed an office memorandum with the Indian Medical Association (IMA), promising to explore the possibility of a Central Act to protect healthcare workers from violence.

The abrupt change in the government’s position has raised questions about its commitment to addressing this critical issue.

What Was Proposed in the 2019 Draft Law?

In response to a series of violent incidents, particularly in West Bengal, a draft Bill was prepared in 2019 following consultations with various stakeholders, including resident doctors’ associations, the Indian Medical Association (IMA), and representatives from the Health, Law, and Finance Ministries.

The draft proposed penalties for violence against healthcare personnel, including imprisonment of six months to five years and fines ranging from Rs 50,000 to Rs 5 lakh. For incidents causing “grievous hurt,” the draft proposed harsher penalties, including imprisonment for three to ten years and fines between Rs 2 lakh and Rs 10 lakh.

Additionally, the draft included provisions for compensation, mandating payment of twice the fair market value of any damaged property.

The Fate of the 2019 Draft Bill

Despite the comprehensive nature of the draft Bill, it was ultimately rejected during consultations with the Home Ministry. Reasons cited for the rejection included redundancy with existing provisions in the penal code, insufficient stakeholder consultation, and concerns over the impact on the federal structure. Consequently, the draft Bill was never released for public consultation.

Since then, private Members of Parliament have attempted to introduce variations of the Bill on at least three occasions—in 2019, 2022, and 2023—each proposing different levels of punishment and fines.

Notably, during the COVID-19 pandemic, the government issued an Ordinance in 2020 amending the Epidemic Diseases Act to include provisions for imprisonment of up to seven years and fines up to Rs 5 lakh for violence against healthcare workers.

How Do State Laws Compare?

Dr. Amrinder Singh Malhi, a member of the committee that drafted the 2019 Bill, pointed out that the proposed Central law had tougher provisions than any existing state law. While most state laws impose a maximum of three years of imprisonment,

Kerala’s law stands out with a provision for up to seven years in cases of grievous injury. However, despite these laws, the frequency of violence against healthcare workers remains high, underlining the need for more effective enforcement.

The Role of the Supreme Court and the Need for Deterrent Laws

The Supreme Court of India has now established a national task force to address the safety of healthcare workers, a move that has been welcomed by the IMA. The Court’s involvement is seen as a positive step, given its credibility and authority.

However, the task force’s mandate focuses primarily on safety, security, and working conditions, without addressing the need for a deterrent law to prevent violence.

Although there are 25 state laws aimed at protecting healthcare workers, the lack of convictions underscores the need for stronger enforcement. Kerala’s experience following the murder of Dr. Vandana Das in 2023 is instructive.

The state quickly enacted a stringent law and a Code of Grey Protocol, which led to a reduction in violence against healthcare workers. This model could be adapted at the national level to provide more comprehensive protection.

The Need for a Balanced Central Law

While there is a clear need for a Central Act to protect healthcare workers, such a law should not infringe on the rights of states or patients.

A well-crafted law could help reduce violence against healthcare workers, but policymakers must also address the underlying causes of such violence.

Strengthening the public health system, reducing out-of-pocket healthcare costs, and ensuring that patients receive free and fair treatment are essential steps in this direction.

Why Healthcare Professionals Are Demanding a Central Act

Incidents of violence against healthcare workers are alarmingly frequent across India. Doctors argue that a dedicated and stringent Central law could serve as a strong deterrent against such attacks. While existing laws provide mechanisms to punish acts of violence, healthcare professionals insist on the need for a separate, targeted law that imposes harsher penalties, including longer prison sentences and steeper fines, specifically for crimes against healthcare workers.

A report by the Vidhi Centre for Legal Policy documented at least 56 incidents of violence against healthcare professionals between January 2018 and September 2019, a period during which a central Bill was being drafted in response to a nationwide outcry. Supporting the recent protests,

70 Padma awardee doctors wrote to Prime Minister Narendra Modi on August 18, emphasizing the urgent need for such legislation. Dr. Harsh Mahajan, one of the signatories, highlighted the unique challenges faced by doctors, such as grueling 36-hour shifts, lack of proper resting facilities, and unsafe working environments, all of which justify the need for a specific law to protect them.

The Government’s Position on the Central Law

Officials from the Union Health Ministry have expressed skepticism about the effectiveness of a new Central law, arguing that existing state laws, which already criminalize violence against healthcare workers, have not significantly reduced such incidents.

They pointed out that the RG Kar incident involved a heinous crime that falls under existing criminal laws, and a healthcare-specific law would not apply in such cases.

The officials further noted that 26 states and Union Territories already have laws that make violence against healthcare professionals a cognizable and non-bailable offense, yet these have not been effective deterrents.

They argue that systemic issues, such as inadequate security, poorly lit hospital areas, and unrestricted access to hospital premises, need to be addressed to prevent such violence.

The Prevalence of Violence Against Healthcare Workers

Violence against healthcare professionals is disturbingly common in India. According to a survey by the Indian Medical Association, over 75% of doctors and healthcare personnel have experienced some form of violence, with 12% reporting physical attacks.

The Vidhi Centre for Legal Policy’s report highlights that in 70% of cases, the violence was perpetrated by patients’ attendants, often occurring in critical areas like ICUs or following surgical procedures.

Factors contributing to these incidents include poor communication, inadequate conflict resolution, and, in some cases, issues like drug addiction.

The Tragic Loss of a Young Doctor and the Urgent Call for Change

She was just 31, with dreams and aspirations that painted a bright future. Yet, the fateful night of August 9 snuffed out her life, leaving behind not just a void, but a resonating outcry that has echoed far beyond India’s borders.

The horrific rape and murder of a postgraduate trainee doctor at Kolkata’s RG Kar Medical College and Hospital is a stark reminder of the vulnerability faced by women in workplaces, particularly in the healthcare sector.

This incident has not only shocked the nation but has also underscored the glaring deficiencies in safety protocols that, if followed, could have prevented this tragedy.

A Reflection of Rampant Inhumanity Across Sectors

The brutality of this crime highlights a disturbing level of inhumanity that seems to permeate campuses and workplaces, transcending sectors and disciplines.

This case serves as a chilling example of the dangers that women face daily, not just in healthcare but across all professional fields.

The big question now is: What steps must be taken to prevent such heinous acts in the future?

The POSH Act: A Step Forward, But Is It Enough?

In 2013, India took a significant step by enacting the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, commonly known as the POSH Act. This legislation was a direct response to the horrific Nirbhaya case of 2012 and was intended to ensure a safe working environment for women, along with a robust mechanism for addressing cases of sexual harassment.

The POSH Act mandates the establishment of Internal Complaints Committees (ICC) in workplaces with ten or more employees, aimed at handling complaints confidentially and fairly.

However, despite these provisions, the effectiveness of the POSH Act is under scrutiny. A recent report by the Business Standard, citing National Crime Records Bureau (NCRB) data, revealed that over 400 cases of sexual harassment at workplaces were reported between 2018 and 2022, with an average of 445 cases annually.

These statistics suggest that the problem persists, raising questions about the implementation and reach of the POSH Act.

Addressing the Loopholes in the POSH Act

Advocate Nashrat Majid from Guwahati points out several loopholes in the POSH Act that undermine its effectiveness. For one, the Act places a significant burden on employers to establish and manage ICCs, which may not be feasible for smaller organizations.

Additionally, there is a risk of bias or mishandling of cases due to inadequate training of ICC members.

To strengthen the POSH Act, Advocate Majid suggests that the conciliation process before an inquiry should be more accessible to victims to prevent them from feeling pressured.

There should also be clear penalties for non-compliance by employers and the establishment of a centralized authority to oversee the Act’s implementation across sectors.

Shifting the Focus to Prevention

Jahnabi Goswamee, a law student from Gandhinagar, recalls a similar incident from almost a decade ago at Assam Medical College and Hospital, where a junior doctor was murdered by a ward boy in the ICU.

She emphasizes that while redressal mechanisms are crucial, the focus should shift towards prevention to ensure women’s safety in the first place.

This means stringent enforcement of the POSH Act and proactive measures to prevent such incidents before they occur.

The Need for Sensitization and Education

Dr. Kasturi Sharma from SUM Hospital in Bhubaneswar stresses the importance of sensitization campaigns on the POSH Act within workplaces. She advocates for regular workshops and training sessions to educate employees about the importance of the Act and the rights it guarantees.

Dr. Sharma, deeply affected by the incident at RG Kar Medical College, highlights the personal fear that such crimes instill in female doctors, who see themselves in the victim’s place, knowing that they too are vulnerable.

Collective Outrage and a Re-evaluation of Existing Laws

Dr. Ritwik Sharma, a healthcare worker from Guwahati, calls for collective outrage and a serious re-evaluation of the legal system in response to such atrocities. He argues that laws like the POSH Act must be more stringent and enforce severe consequences for crimes of this nature.

Moreover, Dr. Sharma emphasizes the urgent need for heightened security measures in medical institutions, including stricter scrutiny of visitors and attendants, to protect healthcare workers who are constantly exposed to volatile situations.

Conclusion

The government has been reluctant to acknowledge the extent of violence against healthcare professionals in India.

However, the reality is undeniable, particularly in government hospitals and small to medium-sized private hospitals, which are most vulnerable to such violence. While there is no shortage of laws in India, their implementation remains a challenge.

The experience in Kerala shows that with the right legal framework and enforcement, the incidence of violence can be significantly reduced.

As India grapples with this complex issue, it is crucial that both the government and the medical community work together to ensure the safety and security of healthcare workers. A combination of legal reforms, increased healthcare spending, and systemic improvements is needed to protect those who dedicate their lives to caring for others.

The ongoing protests and demands for a Central law to protect healthcare workers underscore the urgent need for systemic reforms in India’s healthcare sector. While the government remains cautious about introducing new legislation, the medical community continues to advocate for stronger legal protections tailored to the unique challenges they face.

Addressing both the legal and systemic issues is essential to ensuring the safety and well-being of healthcare professionals, who play a crucial role in the nation’s healthcare system.

The horrific incident at RG Kar Medical College is a grim reminder of the urgent need for systemic changes to protect women, particularly in vulnerable professions like healthcare. While the POSH Act was a step in the right direction, its implementation and enforcement need significant strengthening.

As the nation grapples with this tragedy, it is crucial that both legal reforms and practical safety measures are put in place to ensure that women can work without fear, and that such an incident is never repeated. The time for change is now.