Violence to doctors: the problem continues

In May, a 23-year-old female doctor was stabbed to death at a taluk hospital in the Kottarakkara area of Kollam district in Kerala by a drunk patient. The patient, a school teacher who had been suspended from his job, had been brought to the hospital by police after being involved in a fight with members of his family.

According to Kottarakkara police officials, while Dr Vandana Das was dressing an injury on the man’s leg, the patient – identified as G. Sandeep – suddenly became violent and attacked her using a surgical scissors and scalpel.

“He had consumed alcohol and was violent when we took him to the hospital,” a police officer said, according to news reports. “He was alone with the doctor as we are not allowed into the room when a patient's wound is being dressed.

“Suddenly, there was a commotion, and the doctor ran out screaming for help followed by the man who was carrying a scissor and a scalpel and was shouting ‘I will kill you’,” the police officer said, adding that it was not clear why the patient had become violent and attacked the doctor.

Photograph: iStock, credit Sujay_Govindaraj

When the police officers at the scene tried to stop the accused man, he attacked them as well. As well as the fatally injured doctor, four other people were injured by Sandeep, who also vandalised some areas of the hospital, the police officer added. “He [Sandeep] was later subdued with much difficulty and taken into custody,” the officer said.

Das, who succumbed to her injuries a few hours later at a private hospital in Thiruvananthapuram, bore the brunt of the attack, although the police officers who had brought the suspect into the hospital were also injured.

Expressing his sympathies over the doctor’s murder, the chief minister of Kerala, Pinarayi Vijayan, said the incident was “shocking and extremely painful”.

“Assaulting health workers in the line of duty is unacceptable,” added Vijayan. “A thorough investigation will be conducted into the incident. The [Kerala] government will take strong action against attacks on doctors and health workers.”

Widespread protests
Shortly after the gruesome murder, Kerala-based doctors who are members of the Indian Medical Association (IMA) and the Kerala Government Medical Officers’ Association (KGMOA), staged widespread protests across the state calling for immediate action to protect doctors from violence and aggression from patients and patients’ families.

The KGMOA, in a statement issued by its president Dr T N Suresh, urged the Kerala state government to strengthen security in hospitals, ensure suitable safety and security measures are in place when the police bring people held in custody into hospital for examination by medical staff, and urgently implement a triage system.

“Such incidents should not take place,” an IMA official said, adding that the doctor was a house surgeon at Azeezia Medical College Hospital and was at the taluk hospital as part of her training.

“We [doctors] cannot continue working in such an unsafe environment,” added the IMA official. “It is unacceptable that our lives are in danger when we are trying to save lives and doing our duty. We have in the past raised our objections to such attacks on health workers. We are angry and sad over the murder.”

Tougher jail terms to be introduced
Following the statewide protests, in early May the Kerala government introduced an ordinance (a proposed legal amendment) aimed at strengthening the state’s existing Hospital Protection Act to better protect healthcare workers from violence from patients and their families in hospitals and other healthcare establishments.

The government’s decision, which was taken in a high-level meeting chaired by Kerala’s chief minister Pinarayi Vijayan, came hours after the Kerala High Court said the incident that led to the killing of the young medical professional had been the result of “systemic failure”.

On 23 May, Kerala governor Arif Mohammed Khan signed an ordinance to the Kerala Healthcare Service Workers and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act of 2012 that provides for more stringent punishment – including imprisonment of up to seven years and a maximum fine of Rs 5 lakh – for those found guilty of causing grievous bodily harm to those working in the health services sector in the state.

The ordinance also provides that anyone who commits, or attempts to commit, or incites or inspires an act of violence against healthcare workers or those working in healthcare institutions shall be punished with imprisonment for a term of not less than six months and up to five years and with a fine between Rs 50,000 and Rs 2 lakh.

Before the amendment, any act of violence against a healthcare service worker or damage to the property of a medical institution was punishable by up to three years in prison and a fine of up to Rs 50,000 under the Kerala Healthcare Service Workers and Healthcare Service Institutions (Prevention of Violence and Damage to Property) Act 2012, according to a report by the PTI news agency.

As well as introducing stronger punishments for those who assault healthcare workers, the ordinance states that the trials of suspects lodged under the Act must be completed in a timely manner, and that special courts will be designated in each district to ensure speedy adjudication. 

The ordinance also states that cases registered under the Act have to be investigated by a police officer not below the rank of Inspector and the probe has to be completed within 60 days of registration of the FIR (first information report). 

Furthermore, the ordinance extends the protection under the Act to paramedical students, security guards, managerial staff, ambulance drivers and helpers who are posted and working in healthcare institutions, as well as any health workers who are notified (announced) in the official government gazette from time-to-time. 

Previously, the protection from violence under the Act was only available to registered and provisionally registered medical practitioners, registered nurses, medical students, nursing students and paramedical staff working in healthcare institutions. 

Police to be stationed in hospitals
Vijayan also instructed the Kerala government’s health and home departments to jointly take additional measures to better protect health workers from violence and aggression. Security systems will be strengthened by dividing hospitals into three categories.

For the first category of hospitals – medical colleges, district hospitals, general hospitals, women’s and children’s hospitals – police aid posts will be set up and staffed; something doctors’ associations have long called for in a bid to better protect healthcare staff from patient violence.

Following a meeting chaired by the chief minister – which was attended by the state police chief and others, including Kerala’s chief secretary VP Joy – the chief minister said he had instructed the health and police departments to conduct security audits in hospitals every six months, working under the supervision of the district collector.

Vijayan added that he had asked for additional closed-circuit television systems to be installed in hospitals and requested the health minister examine whether two doctors can be provided in emergency departments at night in government hospitals. The government also intends to have discussions with health workers’ organisations about how to better protect healthcare staff, and will consider various petitions and suggestions for reducing violence from organisations representing doctors and medical students.

Meanwhile, following the media reports of the incident, the Kerala State Human Rights Commission initiated a case into the fatal attack and requested a report about the incident from the District Police Chief of Kollam.

Political row
The incident also led to a very public political row after Kerala’s health minister Veena George gave a statement to the media saying the victim was a house surgeon and therefore inexperienced and became scared when the attack happened.

Criticising her comments, K Sudhakaran, president of Kerala Pradesh Congress Committee, the state level unit of the Indian National Congress Party, questioned what the minister meant by the doctor being inexperienced.

“Does she mean the doctor was inexperienced to counter or defend against an attack by a man addicted to drugs and alcohol? The statement is a joke,” he told reporters.

V D Satheesan, leader of the opposition in the Kerala Legislative Assembly and senior Indian National Congress leader in Kerala, said the young doctor’s killing had shaken everyone in Kerala society.

He stated it was a dangerous situation that hospitals are not safe places and claimed that the doctor was killed due to “negligence of the police”.

Union minister of state for external affairs and parliamentary affairs, V Muraleedharan, expressed his shock and concern over the tragic incident, adding that it was a shame that doctors and healthcare professionals were not safe in Kerala.

He claimed that the “apathy and callousness” of the Pinarayi Vijayan government and its “misgovernance” was spoiling the state’s public image and bringing it into disrepute.

“Shocked to learn about the brutal murder of Dr Vandana Das and attack on hospital staff in Kottarakkara,” he tweeted. “Atrocious that dreaded criminals are cut loose, endangering the lives of life savers. Deeply concerned about the safety of doctors and healthcare workers in Kerala.

In further tweets he stated: “Shame that doctors and healthcare workers are not safe in Kerala, which is a renowned global destination for medical tourism and has a rich legacy of various streams of medicine and healthcare. The apathy and callousness of @pinarayivijayan and the misgovernance of @CPIMKerala is tarnishing that image and bringing disrepute to the State. It’s a disgrace that @pinarayivijayan government can’t keep our doctors safe.”

Echoing Muraleedharan’s thoughts, Satheesan claimed it was deplorable that Kerala’s state government had done little to ensure the safety of healthcare workers.

He claimed there were widespread issues in the health department and in each case only high level probes were announced and beyond that nothing else happened.

Giving details of what transpired in the hospital, an officer of Kottarakkara police station said the man had called the emergency helpline to save him from his family members following a fight with them.

When police arrived at the scene, they found him injured and took him to the hospital for medical examination and treatment.