In addition to deploying armed teams with communication tools and installing cameras, we implemented further measures to address violence in the healthcare sector.
Telemedicine for Prison
Medical professionals and health workers in public hospitals and medical colleges remain under threat from dangerous prisoners who threaten the medicos to permit their long stay in hospitals. Instances of verbal abuse and even stabbings have occurred. To counter this while an advisor in medical education (2016–17), I implemented video links for prisons to connect with district courts and provide telemedicine services. This initiative, which ran from 2017 to 2020, allowed prison doctors to communicate prisoner grievances to specialists for counselling without incurring extra costs.
Digital Post-Mortems
To address demands from relatives to avoid post-mortems, digital or virtual post-mortems—like those used by AIIMS, New Delhi—can provide accurate findings and prevent fraud complaints.
Private hospitals
In private hospitals, relatives of deceased patients may pressure healthcare workers with threats or demands, sometimes involving local politicians. This has led some doctors to seek weapon licenses for protection.
Addressing violence requires more than legal measures or armed protection. It involves regular training for all staff, improved infrastructure, and strict security measures, including access control and CCTV. Limiting visitors, documenting incidents, and reporting to law enforcement are also crucial. Testimonies can be given via video conferencing to ease court-related burdens.
Dr. Sancheti, a prominent Pune orthopaedist, attributes violence against healthcare workers to mistrust between patients and doctors. He has avoided violence by thoroughly explaining procedures to patients and their families. Dr. Sanjay Gupte emphasises that recovery should be a collaborative effort between patient and doctor. Dr. Shrikant Kelkar has pioneered training modules for health workers, implementing them across various hospitals. Psychiatrist Dr. Mohan Agashe adds that lack of understanding fuels legal issues and stresses that healthcare workers need intelligence and empathy.
The US Department of Labor’s Organizational Safety and Healthcare Facilities’ Roadmap provides guidelines for preventing violence in healthcare, available online. These guidelines cover management commitment, employee participation, worksite analysis, hazard identification, prevention and control, safety and health training, record keeping and program evaluation. The Indian Medical Association (IMA) should implement standard operating procedures (SOPs) for public and private healthcare facilities and conduct semiannual reviews and rehearsals to address issues and implement international best practices.
Currently, the IMA recommends forming crisis management committees at the taluka or district level, including doctors, social workers, legal professionals, politicians, and press reporters. These committees would work with police to ensure thorough investigations and prevent premature prosecution of healthcare workers. They would also advise press reporters against sensationalising such incidents.
The Supreme Court’s “Martin D’Souza vs. Mohammed Isfaq” ruling warns police against harassing doctors unless Jacob Mathew’s case parameters are met. The Ministry of Transport has mandated that health workers prioritise treating Good Samaritans who report injuries, and police must not suspect informants but prioritise saving lives.
Strict adherence to these directives and guidelines by all concerned, as well as introspection by healthcare workers and improvement of their practices and monitoring of these periodically alone, can create a visible impact against such violence.
To address violence, the Core India Institute of Legal Medicine (CIILM) in Maharashtra, with retired police officers, has formed quick response teams. These teams, skilled in crowd control and mob psychology, train healthcare workers and defuse critical situations. Private hospitals should participate to ensure safety and peace of mind.
In conclusion, enacting laws alone won’t eliminate violence. Healthcare institutes must involve all stakeholders, be prepared for emergencies, establish clear policies and standard operation procedures (SOPs), and coordinate with law enforcement regularly.
(The writer is a former DGP, Maharashtra. Views personal)
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