Doctors need protection like everyone else

The recent mishandling of the doctors’ demands by the government of West Bengal led to a massive protest of doctors in Kolkata and other parts of West Bengal, that soon became even bigger as it spread to metropolitan cities in twelve other Indian states. There are reasons why the issue gathered a momentum of its own and the protest blew into a larger all India movement.

What happened last Monday in NRS Medical College and Hospital is a part of a string of incidents occurring in India for quite some time now, but this time, the lack of police action, the sluggish political reaction, the reluctance in standing with the doctors and protecting them and lastly, the arrogant threat laced ultimatum meted out by the West Bengal Chief Minister, served as the last straw for medical practitioners with their long accumulating list of grievances. The doctors all over the country rose up in support of the doctors in Kolkata, because most of them had faced similar predicaments and could relate to what had happened at NRS.

One wonders if there is any law in place to protect the doctors in the face of such security threats. There is. Nineteen states — including West Bengal— have passed what is called the Protection of Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, also known as the Medical Protection Act (MPA). The Act, covering doctors affiliated to institutions as well as independent practitioners, bans attacks on physicians and damage to their property. Offenders can get a jail term of up to three years and a fine of 50,000 Rupees. As strict as it sounds, the Act, actually fails to really protect doctors because it features neither in the Indian Penal Code (IPC) nor in the Code of Criminal Procedure (CrPC). This makes it difficult for victims to approach the police for help or for the police to file a complaint against suspects. “Without any provision in the IPC, filing a case can sometimes mean taking a copy of the Act to the police because she or he may not even know about it,” comments Dr. Neeraj Nagpal of the Medicos Legal Action Group in Chandigarh. “Police may not even be sure under which section to file such a case.”

With the increase in attacks against the medical practitioners, doctors throughout the country, are demanding a central law instead of a state law. In 2015, the Indian Medical Association (IMA), the national voluntary organization of doctors in India, released a study that found that 75% of doctors faced some form of violence while on duty. The number of doctor vis-a-vis the number of patients is already very low in hospitals across the country. The attending doctors skip meals and work without taking breaks to cater to patients. Resident doctors and those practicing in rural areas are most at risk of being violently attacked according to Dr. H.L Nag of AIIMS.

The legal barrier here is that the turf of health, including the protection of doctors is a “state subject”, which means only state legislatures can make laws on it. The central government does not intervene in health laws, generally. But, there have been exceptions before, like the 1994 Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act making prenatal sex determination illegal. The Central government had seen a unique problem that required a central law and that is the reason why the law was created. IMA sees the security of physicians as a similar country-wide problem and is expecting a central law instead of the state laws already in place, but are difficult to implement.

The demand of a central legislation to protect the doctors, however, is not a new one. The IMA raised it for the first time in 2015 following a series of attacks on doctors by the family members of patients. Then Union Health Minister J.P. Nadda formed an inter-ministerial committee with senior officials from Health, Home, Law and Consumer Affairs ministries to look into the IMA demand, but the recommendations of the committee were never made public and the effort died. Now, the IMA has renewed its demand to create a central legislature. IMA has called for a nationwide withdrawal of non-essential services in all health care institutions on June 17th in protest of what has happened and in demand of a central protection law.

Violence against doctors perpetrated by patient families is a superficial sign of a deeper systemic failure. Reactionary measures such as enhanced security at government hospitals, is unlikely to boost the flagging morale of the Indian medical workforce. India spent 1.4% of its GDP on health care in 2017-18, making it one of the lowest investors in the sector globally, with the World Health Organization placing it below both Iraq and Venezuela. The country that boasts of making big strides in economic and technological development, suffers from lack of infrastructure and an alarming shortage of doctors, particularly in its vast rural areas. The paucity of new investment in the ever-eroding primary care infrastructure has failed many patients, leading to their disillusionment and repeated aggression. The doctors working in this far from perfect set up, have had to unfortunately bear the brunt of public wrath.

An entire system cannot be corrected overnight but, the first step of creating a central law to protect the doctors has become a necessity now. Political willingness to implement it fairly is also crucial. Indian media also has an important responsibility to report correctly and not sensationalize health issues and hostile incidents. To prevent animosity between doctors and patients, there should be a better communication plan as well. Patient doctor relationship is the keystone of healthcare. The low doctor-population ratio in India puts a tremendous strain on the available medical facilities and restricts the time available for doctors to interact with patients. This is one of the reasons the doctors cannot explain in detail to the patient family the diagnosis, treatment plan or expected prognosis. But, perhaps some explanation of what is being done for the patient needs to be provided to the patient families to avoid misunderstandings and prevent violent attacks on doctors.