Every woman has the right to feel safe at the workplace: Dr R.V. Asokan

The IMA President calls for urgent action on workplace safety for women in healthcare.

The President of the IMA says the assault on medical professionals has been going on for the past two decades.  | Photo Credit: PTI

The rape and murder of a young woman doctor at R.G. Kar Medical College and Hospital in Kolkata sparked widespread public outrage, including within the medical community. The Indian Medical Association (IMA), the largest representative body of medical doctors, called for a 24-hour strike in all hospitals, both public and private. This call was widely heeded, with doctors in major cities, including the national capital, striking and protesting to demand a central law ensuring the safety and security of medical professionals. The IMA supports such a central law, although the government has been reluctant, claiming that the new Bhartiya Nyaya Sanhita adequately addresses assaults on medical professionals and health workers. A draft of a specialised law has been pending since 2019. The IMA also sought representation on the Supreme Court-constituted National Task Force (NTF). In an interview with Frontline, IMA President Dr R.V. Asokan explains the importance of a central law, the need for a patient-centric medical system, and the crucial role of increased government budgetary support.

Excerpts:

How do you view this incident and its implications?

The assault on doctors is not a new phenomenon—physical, non-physical, social media-driven, etc. That has been ongoing for the past two decades, and we have been tolerating it for several reasons. There has been some indifference from society and the government because the other party involves patients and families. But this has escalated to a crime.

We visited the family. She was the only daughter, born into a lower-middle-class family and was going to get married in November. She was on duty for 36 hours, had dinner at 2 am, and went to sleep for a few hours on the beds provided in the seminar hall by the department, adjacent to the ward.

This is all so cruel. How can women’s safety stoop to such a low? What is the message from this? Leave alone the fact she is a doctor. Every woman going to work is at a disadvantage now and has been compromised. The issue is that 60 per cent of doctors and 70 per cent of dentists are women. 95 per cent of nurses and a large number of physiotherapists are women. These are all available healthcare professionals. We must provide them with infrastructure and security.

We are asking for assurance of our lives, something that is available to all citizens in the country. We are not asking for something abnormal. Every woman has a right to feel safe in the workplace. It is unacceptable to say that female doctors will be withdrawn from night duty. We tell our young women to grow up and study. Now they have grown up, and we cannot deny them this right.

What are your views on the Supreme Court-constituted NTF (National Task Force)?

We are unhappy because those who have been at the frontlines of this issue are not a part of it. Those who are part of the NTF are senior members of the profession, but their strengths are different. Members of medical associations and junior doctors who have experienced violence in their lifetime may be best suited to be part of the NTF, to give it some shape.

We welcome the move, as there was nothing like an NTF before. We plan to brief, both formally and informally, the members of the NTF. The NTF will report to the Supreme Court, and there is an expectation that it will revamp the health sector.

We are planning to file an interlocutory application, which will give us another opportunity to place our views in front of the court. We also plan to express our views directly to the NTF. The Supreme Court spoke about preventive measures and stated that anything relevant to the issue can be raised.

Is this kind of crime taking place within a hospital’s premises rare?

 In recent years, yes. But in 2019, a similar situation arose, again in West Bengal. A male house surgeon was hit on the head with an iron bar and suffered from skull fractures and brain damage. Almost a similar level of upheaval happened. Even then many private hospitals joined in the protests. But public opinion was a little muted. This time, public opinion is with the doctors as many feel this is Nirbhaya 2. It has become a wider issue of the safety of women in the workplace.

The Supreme Court did observe that medical associations had consistently raised issues of safety of medical professionals at the workplace. How will medical associations place the issue in front of the NTF?

The Chief Justice of India (CJI) did say that the NTF should hear the views of the IMA. He made a special mention of it. I heard that he spoke about other medical associations as well in the subsequent hearing. It was a beautiful gesture, even though these were oral observations. It meant, “We are here to listen to you.”

The IMA and the protesting doctors have reiterated their demand for a central Act and the revival of the 2019 draft. Are you optimistic about a favorable outcome?

In fact, the government should not have hesitated. Even before asking, the government should have proclaimed an ordinance as a precursor for a central Act. We have demanded that the 2019 Health Care Service Personnel and Clinical Establishments (Prohibition of Violence and Property Damage) Bill be proclaimed as an ordinance, incorporating the amendment clauses of the Epidemic Diseases Act, 2020 and the Code Grey Protocol of the Kerala government’s ‘Prevention Management of Violence against Healthcare Workers’.

In 2017, a memorandum was signed between the IMA and the Health Ministry when the government agreed that a central law was needed. I can not understand why this cannot happen. The Home, Law, and Health Ministries were involved in drafting the Bill. It was a government Bill. The Supreme Court could have also given directions for a central Act in the manner it did in the case of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994.

Even today, the Supreme Court monitors it. But the presence of government officers in the NTF does not inspire confidence. They are the ones who are obstructing the central Act. As it is a policy matter, it comes under the domain of the government. We will raise it, but I am not very confident. We can appeal to the Supreme Court to give a direction to the government to consider. In the Jacob Mathews vs State of Punjab case, the Supreme Court acknowledged that doctors were a separate class due to the nature of their work.

Why do you think the demand for a central legislation has not been taken up?

There is some hesitation to acknowledge violence against health professionals. Till the acknowledgement is not there, a law cannot come about. When large-scale violence happened in Hyderabad after a COVID-19 death, the government brought in an ordinance to amend the Epidemic Diseases Act. The provisions of this Act can be brought into the 2019 Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill. After the Vandana Das murder in a Kerala hospital, the State government strengthened the laws.

It has had a salutary effect. There was a public outcry and all of Kerala wept when that incident happened. Some 25 States have their own legislation. There have been so many instances of violence against health professionals. There was only one instance of a conviction from Tamil Nadu. Conviction rates are very low. Only last month the Minister said in Parliament that the BNS was sufficient for the safety of health professionals. But our demand is for a central law, to declare hospitals as safe zones, define what safe zones are, and make it common to large hospitals in the government as well as private sector.

How can issues like overwork get addressed? Such issues were part of the order.

 The National Medical Commission is also part of the NTF. We hope they will address this. There is a glut of doctors but they do not get employment. Today, the National Health Mission—both Rural and Urban Health Missions—is in bad shape. It has a budget of Rs 36,000 crores. But a lot of medical staff is working on an ad hoc basis. The recruitment has to happen through the State public service commissions. Doctors, nurses, and other health workers are all recruited on contract. The NHM hires and fires not as per the laws of the land, bypassing all norms. It has been created to bypass norms. But in Tamil Nadu, young doctors are running Primary Health Centres. PHCs in Tamil Nadu are a role model. Care is provided 24 hours. 70 per cent of deliveries take place in the government sector and 30 per cent in the private sector. Ten years ago, it was different. The incident is a comprehensive opportunity to look at the entire healthcare system. The resident doctor’s issues are only the symptoms. We need to address the disease.

Private hospitals have an elaborate system of security in place, but government hospitals do not have similar arrangements. The Supreme Court also stressed the need for institutional safety standards. Most patients depend heavily on government hospitals. Who foots the bill eventually? Do you feel that budgetary allocations need to be increased for spending on safety infrastructure and other safety requirements for health professionals?

I think you hit the nail on the head. The investment in health is still 1.1 per cent of GDP, while the total expenditure on health is 4 per cent of GDP. Of this, 2.9 per cent is in the private sector (in the form of out-of-pocket expenditure) and 1.1 per cent is from the government. Of this 1.1 per cent, one-third traditionally came from the Central government and two-thirds from State governments. But in the most recent Union budget, the Central government’s contribution has decreased to one-fourth of the 1.1 per cent. Despite the economy growing to four trillion dollars, there has been no corresponding increase in health expenditure.

How does the situation in India compare with other countries concerning the safety of health professionals within the hospital?

There are cultural differences. In most cultures, the patients are alone. Our culture is such that if the grandmother gets sick, the entire family is present. It has its benefits. The patient is well looked after and is confident. We do not want to lose that as well. It is equally important that the healthcare professional is safe. How to address this is a tightrope walk. The family needs to be allowed as it helps but at the same time, anti-social elements should not have access, either for assault or crime. It cannot go on like this. We should have protocols like airports but we should be culturally sensitive and have a patient-centric approach. The medical community is one with the population. We owe the profession to our patients.