The gruesome manner in which 23-year-old house surgeon Vandana Das was fatally attacked by her 42-year-old patient, Sandeep, a suspended school teacher, while performing her duty in a Kerala hospital on May 10 is shocking. According to news reports, police brought Sandeep, who was involved in a scuffle with his family members, to the Kottarakkara Taluk Hospital in Kollam District for treatment at about 5 am. He was reportedly in an inebriated state and wasn’t handcuffed. 

Sandeep, while being treated for his leg injury, became violent and initially he kicked his relative who was standing near the door, then grabbed a pair of scissors, stabbed the policemen and another person who tried to intervene. Vandana was stabbed by Sandeep multiple times. Although she was rushed to a Thiruvananthapuram hospital but having suffered multiple internal injuries on her back and abdomen, it proved fatal. The investigation into the case has been transferred from the Kottarakkara police to the Crime Branch as serious lapses were found on the part of the police. 

The day Dr Vandana was murdered a similar incident was reported in Kerala. The police brought Praveen (36), a construction worker, who was injured following a quarrel with his co-worker, to Nedumkandam Taluk Hospital in Kerala’s Idukki district. The in-charge of casualty tried to examine Praveen who had sustained severe head injuries; reluctant to undergo treatment, he turned violent and attempted to assault the doctor besides hurling abuses at other paramedical staff. He tried to rush out of the hospital but was soon overpowered and provided treatment with his hands and feet tied.

More recently, a final-year resident doctor from the nephrology department at the Nizam’s Institute of Medical Sciences in Hyderabad was beaten up in the early hours of May 11 by 10-12 persons after a 62-year-old woman died of medical complications. The mob barged into the ICU and tried to attack the female senior resident who was present there; when her senior intervened, and tried to explain the position and calm them down, one of them hit the senior on the shoulder, held his neck and tried to throttle him.

It is rather disconcerting that incidences of physical assault and verbal abuse on hospital premises are on the rise. A 2018 Lancet report, quoting the Indian Medical Association, states that nearly 75 percent doctors in India have faced either verbal or physical violence during their lifetime with junior doctors more exposed to violence as they are the first responders. Notably, most cases of violence are due to patients’ death, inflated bills and sometimes behaviour of the doctors. Over 40 percent of resident doctors in tertiary care hospitals in New Delhi reportedly faced violence at work. Over 80 percent of doctors are stressed out in their profession and nearly 56 percent don't sleep comfortably for 7 hours a day.

In 2022, Kerala reported 137 attacks on doctors. However, there is a ray of hope. The Kerala High Court which has taken suo moto cognizance of the matter pertaining to the untimely demise of Dr Vandana Das has issued a slew of directions in its interim orders of 10 and 11 May. Importantly, the State Police Chief has been directed to evolve protocols in order to protect doctors, healthcare professionals, students, interns, house surgeons and such others.  Similarly, sufficient and effective protocols have to be evolved with regard to persons in custody – be that accused or otherwise – as to how they are to be presented in hospitals and before medical professionals as part of the criminal justice system.

On December 1, 2022, a Division Bench of the Kerala High Court had ordered that every Station House Officer shall register complaints (FIR) of atrocity or attack or harm on any Healthcare Professional – be that Doctors, Nurses, staffs, security or such other, or against the property of a Hospital -- within an hour from the time on which such information is obtained or gathered. It further observed that swift action thereafter needs to be initiated to apprehend the offenders, as and when it requires so, leading to prosecution and such other actions as the law warrants.

Following Dr Vandana Das murder, among others, the State Government is to make necessary amendments to ensure the strict implementation of the Kerala Health Care Service Institutions (Prevention of Violence and Damage to Property) Act, 2012 to ensure health workers' safety. It will also clear an Ordinance in the next Cabinet meeting. Police check posts are to be set up in all major hospitals.

Hopefully with the proposed government initiatives, abuse and physical risk at the workplace especially in healthcare institutions would be curbed. This can go a long way in creating a calm work environment. Apart from robust safety protocols which merit strict enforcement, at the health institution level, support staff need to be adequately trained and re-trained so that they are not only able to recognise warning signs but accordingly de-escalate unsavoury situations. In handling unforeseen challenges, apart from effective communications systems, fool-proof security, closed circuit TV, alarms etc. are to be set up to handle unforeseen challenges thereof.

The crux of the matter is that a fear-inducing workplace has long-lasting negative effects. According to research, fear at the work place does more harm than good. Because fear creates an environment where people are less productive causing individuals and the organization as a whole to suffer, ensuring safe and stress-free work place environs is imperative. Enforcement of laws with zero tolerance is important. The certainty of the punishment is more of a deterrent than the severity of punishment.