Supreme Court order dated 20.08.2024 to formulate protocols governing issues in the health care sector and protection of Doctors and Healthcare staff.
The Hon'ble Supreme Court of India on 20.08.2024 passed order in suo motu registered a Petition SMW (Crl) No(s). 2/2024, In Re: Alleged Rape and Murder Incident of a Trainee Doctor in R.G. Kar Medical College and Hospital, Kolkata and Related Issues and flagged the ground reality indicating lack of institutional safety standards in healthcare sector. A non exhaustive formulation setout by the Hon'ble Supreme Court is as under:
a. Medical professionals who are posted for night-duties are not
provided adequate resting spaces. More often, doctors rest in the
patients' room or in available public spaces. Duty rooms are scant.
Separate duty rooms for male and female medical professionals are
conspicuous by their absence in most health care establishments;
b. Interns, residents and senior residents are made to perform
thirty-six hour shifts in conditions where even basic needs of
sanitation, nutrition, hygiene and rest are lacking. There is an
absence of uniformity in terms of a standard national protocol. The
fear of retribution prevents most health care professionals from
questioning the absence of facilities for basic well-being;
c. Lack of security personnel in medical care units is more of a
norm than an exception. More often than not, medical professionals,
which includes young resident doctors, interns and nurses are left
to handle unruly attenders. Open access to healthcare facilities
leaves medical professionals vulnerable to undesirable elements;
d. Medical care facilities do not have sufficient toilet. Most often
there is only one common toilet for medical professionals in one
department;
e. The hostels or places of stay for medical professionals are
situated far from the hospital. Doctors and nurses who have to
travel to and from the hospital are not provided transport
facilities by the institution. Even within the precincts of the
sprawling spaces of public hospitals there is either inadequate or
no transportation facilities for the safe commute of professionals;
f. There is an absence or lack of properly functioning CCTV cameras
to monitor ingress and egress to the hospital and to control access
to sensitive areas;
g. The patients and their attenders have unrestricted access to all
places within the hospital, including Intensive Care Units and the
doctors resting rooms;
h. Lack of screening for arms and weapons at the entrance of the
hospitals;
i. Dingy and ill-lit places within the hospitals;
j. Medical professionals have to shoulder the responsibility of
being both medical and 'emotional' caregivers to patients and their
relatives. There are no supportive facilities and no training in
communication skills; and
k. Certain spaces within hospitals such as the Intensive Care Unit
and the Emergency Wards are prone to a greater risk of violence
because of the severity of medical conditions of patients in these
departments.
The Hon'ble Supreme Court set up a National Task Force (NTF) to formulate protocols governing the issues.
The NTF shall formulate effective recommendations to remedy the
issues of concern pertaining to safety, working conditions and
well-being of medical professionals and other cognate matters
highlighted in the above segments of this order. The NTF shall while
doing so, consider the following aspects to prepare an action-plan.
The action plan may be categorized under two heads (I) Preventing
violence, including gender based violence against medical
professionals; and (II) Providing an enforceable national protocol
for dignified and safe working conditions for interns, residents,
senior residents, doctors, nurses and all medical professionals.
I. Prevention of violence against medical professionals and
providing safe working conditions
a. Ensuring due security in medical establishments:
i. Triaging departments and places within the hospital based on the
degree of volatility and the possibility of violence. Areas such as
the emergency rooms and the Intensive Care Units are prone to a
greater degree of violence and may possibly
need additional security in place to deal with any untoward
incident;
ii. A baggage and person screening system at every entrance of the
hospital to ensure that arms are not carried inside the
medical establishment;
iii. Preventing intoxicated persons from entering the premises of
the medical establishment, unless they are patients; and
iv. Training security personnel employed at Hospitals to manage
crowds and grieving persons.
b. Infrastructural development:
i. Provision of separate resting rooms and duty rooms in each
Department for (a) male doctors; (b) female doctors; (c) male
nurses; (d) female nurses; and (e) a gender-neutral common resting
space. The room must be well-ventilated, have sufficient bed spaces,
and provide a facility for drinking water. Access to these rooms
must be restricted through installation of security devices;
ii. Adopting appropriate technological intervention to regulate
access to critical and sensitive areas including through use of
bio-metric and facial recognition;
iii. Ensuring adequate lighting at all places in the hospital and,
if it is a hospital attached to a medical college, all places within
the campus;
iv. Installation of CCTV cameras at all the entrance and exit points
of the hospitals, and the corridors leading up to all
patient rooms; and
v. If the hostels or rooms of the medical professionals are away
from the hospital, provision of transport between 10 pm to 6 am to
those who wish to travel to or from their place of stay to the
Hospital.
c. Employment of social workers trained in grief and crisis
counselling at all medical establishments;
d. Conducting workshops for all employees of medical establishments
including doctors, nurses and helpers on handling grief and crisis;
e. Constitution of "Employees Safety Committees" composed of
doctors, interns, residents and nurses at every medical
establishment to conduct quarterly audits on institutional safety
measures;
f. Including additional requirement(s) on institutional safety
measures for medical professionals as a criteria for accreditation
of healthcare establishments by the National Accreditation Board for
Hospitals & Healthcare Providers; and
g. The possibility of establishing police posts in medical
facilities commensurate with the footfall, bed strength and
facilities.
II. Prevention of sexual violence against medical professionals:
a. The Sexual Harassment of Women at Workplace (Prevention,
Prohibition and Redressal) Act 2013 applies to hospitals and nursing
homes11 (including private health providers12). In terms of the
provisions of the Act, an Internal Complaints Committee must be
constituted in all hospitals and nursing homes;
b. The duties of an employer listed under Section 19 of the Sexual
Harassment of Women at Workplace (Prevention, Prohibition and
Redressal) Act 2013 which includes organizing sensitization
programmes and providing a safe working space must be discharged;
and
c. Ensuring for every medical institution a helpline number for
medical professionals which is open 24 x 7 and emergency distress
facilities.
The NTF is requested to submit an interim report within three weeks and the final report within two months from the date of this order.
Reports to be submitted by States and Union Territories
All State Governments and UT Governments, through their Secretaries,
in the Ministries of Health and Family Welfare and the Central
Government, through the Secretary, Union Ministry of Health and
Family Welfare must collate information from all hospitals run by
the State and the Central Government, respectively on the following
aspects:
a. How many security personnel are employed at each Hospital and
each department;
b. Whether there is a baggage and person screening mechanism in
place at the entrance of the medical establishment;
c. The total number of resting/duty rooms in the Hospital and
specific details of the number in each Department;
d. The facilities provided in the resting/duty rooms;
e. Information on whether all areas of the hospital are accessible
to the general public and if so, with or without any security
restrictions;
f. Whether there are CCTV cameras in the hospital. If there are, how
many and in which locations;
g. Whether the institution provides medical professionals training
to appropriately handle the grief of patients. If so, the details of
the training must be provided;
h. Whether social workers who specialize in handling grief of
families of the patients are employed at the hospital. If so, the
total number of social workers must be provided;
i. Whether there are police posts within the premises of the
Hospital or the Medical College Hospital campus;
j. Whether an Internal Complaints Committee in terms of the Sexual
Harassment of Women at Workplace (Prevention, Prohibition and
Redressal) Act 2013 has been constituted; and
k. Whether the employer of the establishment has discharged the
duties prescribed by Section 19 of the Sexual Harassment of Women at
Workplace (Prevention, Prohibition and Redressal) Act 2013. If so,
details of it.
The data as submitted shall be tabulated and filed with an affidavit
by the Union Government within one month of this order.