Cure this malaise

by May 7, 2020 0 comments

The contemptible action of people to obstruct the dignified interment of doctors and violence against health workers battling the pandemic has outraged the medical fraternity and most citizens

A doctor contracted COVID-19 from a patient and succumbed to the virus on April 19 in Chennai. The funeral of the doctor was stopped by residents who assembled in large numbers to oppose it. The Madras High Court, taking suo moto cognisance of the despicable incident, said that Article 21 of the Constitution, which protects the life and personal liberty of all persons, includes within its ambit the right to a decent burial. The court said that this doctor was deprived of his right to have a decent burial.

In another incident in Meghalaya, the local governing bodies known as Durbar Shnong prevented the cremation of a COVID-19 infected doctor.  Consequently, the Meghalaya Bar Association filed a Public Interest Litigation (PIL) in the High Court, against the State and local bodies.  The court noted that the State authorities handled the matter in an inept way and the obstructive conduct of the Durbar Shnong would shock the conscience of every right-thinking individual.

The contemptible action of various groups to obstruct the dignified interment of doctors and other healthcare professionals has outraged the medical fraternity and all citizens with a conscience. On April 20, the Indian Medical Association (IMA) said that objections to proper funerals of doctors and other health workers, dying in the line of pandemic duty, is the last straw.  The IMA demanded a special Central law to take stringent action against those who indulge in violence against healthcare professionals and hospitals. The  IMA called for a “white alert” on April 22 and sought to declare April 23 as a “black day” if its demands to protect the serving medical fraternity were not met.

Soon after, the Union Cabinet passed the Epidemic Diseases (Amendment) Ordinance, 2020 which was then signed by the President. The Ministry of Health and Family Welfare intended the Ordinance to ensure “zero tolerance” to any form of violence against healthcare professionals and damage to property. Significantly, in 2019 the Healthcare Services Personnel and Clinical Establishments (Prohibition of Violence and Damage to Property) Bill, drafted by the Health Ministry to contain violence against doctors, was rejected by the Home Ministry, saying that there cannot be a separate legislation to protect the members of a particular profession.

Hopefully, this Ordinance will make up for the past errors and infuse confidence in the healthcare community, that is on the frontline in our war against the pandemic. Though the passing of the Ordinance itself is a positive decision by the Government, the moot question is whether the new law is adequate to protect doctors and other healthcare workers?

According to the Ordinance, an “act of violence” includes any of the following acts committed against healthcare personnel: Harassment impacting living or working conditions; harm, injury or danger to life; obstruction in the discharge of duties and  loss or damage to the property or documents of the healthcare personnel.

Property is defined to include: Clinical establishment; quarantine facility; mobile medical unit, and other property in which a healthcare worker has a direct interest. Further, “healthcare personnel” are people, who while carrying out their duties in relation to countering the epidemic, may come in direct contact with affected patients and thereby are at the risk of being impacted by such disease and include any public and clinical healthcare providers such as doctors, nurses, paramedical staff and community health workers. The Ministry claimed that while the citizens fully cooperated with healthcare personnel most of the time, there were sporadic incidents of violence that demoralised the medical fraternity fighting the contagion. Therefore, it was felt that separate and stringent provisions for emergent times were needed to act as effective deterrents to any such incidents of violence.

Though the Ministry makes tall claims of zero tolerance, with very high aspirations of pacifying a demoralised and shaken medical fraternity, the Ordinance does not address the issue of attacks on  healthcare workers in normal circumstances, after the pandemic is over. Assaults on them existed globally, long before COVID-19 reared its ugly head. Numerous pleas to protect medical staff have fallen on deaf ears. According to the IMA, over 75 per cent of doctors and other healthcare professionals have faced violence at work. 

In 2012, a pregnant woman with obstetric complications died in Tuticorin. In retaliation, the attending doctor was killed by the enraged husband. This triggered a call for a strike by the Tamil Nadu Government Doctors’ Association. The IMA has demanded that hospitals be declared as “protected zones” and called for strict implementation of laws in cases of violence against health professionals.

 In 2014, angry relatives of a 14-year-old boy, who was declared “brought dead” at a private hospital in Bathinda, Punjab, went on a rampage. They damaged the nursing home and burnt down the doctor’s house. The Punjab State Chapter of the IMA demanded strict action against those responsible for damaging the nursing home and the house of the doctor. Angry relatives of patients are not the only ones who oppress medical professionals, the Government set-up is also equally guilty. Dr Indranil Khan, an oncologist, faced harassment after he posted images of doctors wearing raincoats in a COVID-19 ward of a Government hospital on social media. Police detained Dr Khan, charged him with causing communal disharmony and criminal intimidation and confiscated his phone.

A writ petition against his harassment by the police was filed before the Calcutta High Court. Justice Prasanna Mukherji of the Calcutta High Court said that freedom of speech and expression, which is granted under Article 19 of the Constitution, has to be scrupulously upheld by the State. The court said that if an expression of opinion brings the Government into disrepute, it cannot defend the allegation by intimidation of the person expressing the opinion by subjecting him to prolonged interrogation, threatening arrest, seizing his mobile phone and SIM card. 

In another incident, Dr Piyush Pushkar Singh, who complained about the shortage of equipment and protective masks, was terminated by the Hindu Rao Hospital for bringing disrepute to the institution on April 15.  Clearly, the Epidemic Diseases Ordinance, 2020, which is stated to ensure the safety of healthcare professionals is not designed to protect Dr Khan and Dr Singh. 

Sadly, the COVID-19 outbreak led to a rash of attacks against doctors and other health workers. Healthcare personnel deployed in rural areas were beaten and stopped from entering the villages and for “violating” the lockdown while going to work. The hurried promulgation of the Ordinance appears to be a knee-jerk reaction by the Government. First, the Ministry’s claim that the citizens fully cooperated with the healthcare workers is belied by its own statement that incidents of violence have occurred which demoralised the medical fraternity.  Second, the Ordinance only “protects” healthcare personnel in an epidemic and not in general conditions.  Therefore, this Ordinance does not afford any protection to the medical fraternity in a non-epidemic situation.

According to the World Health Organisation (WHO), health workers must be provided with training on infection prevention, given Personal Protection Equipment and technical updates.  They must have a blame-free environment to report on incidents such as exposure to blood or bodily fluids or violence.

The right to health i.e. the right to live in a hygienic and safe environment,  flows from Article 21. According to Article 47 the improvement of public health is the primary duty of the State.  Justice Chandrachud said under Article 21, the right to life is meaningless unless accompanied by the guarantee of certain concomitant rights including, but not limited to, the right to health.  The right to health is understood to be indispensable to a life of dignity, well-being and includes, for instance, the right to emergency medical care and the right to maintenance and improvement of public health.  In the current situation, with the need to have a conducive and safe environment for medical professionals and the responsibility of the State to provide for public health, the Government will be well-advised to take all steps to protect the medical fraternity from any form of lawlessness. The Centre must consider enacting a stand-alone law that will enable hospitals and medical personnel to work in a safe environment at all times, so as to attain the Constitutional aspiration of right to health for all citizens. While social distancing is being advocated, medical professionals do not have the privilege of working remotely. The best form of applause to give the doctors and medical personnel is to give them a safe working environment.

(Writer: Robin R david; Courtesy: The Pioneer)

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