By M P Suresh

The macabre killing of a 25-year-old doctor at the Government Taluk Hospital, Kottarakkara in Kollam District in Kerala has sent shock waves among the healthcare fraternity and the people of the State. It all happened and culminated within a matter of minutes when an inebriated 42-year-old teacher, Sandeep,   brought to the hospital by the police for medical examination went berserk and turned grossly violent, and stabbed those around him with a nearby pair of surgical scissors kept on the table for dressing purpose with the police remaining helpless.  He stabbed those around him, and in the melee  Dr Vandana who tried  to escape  was trapped  in front of  the assailant, who went on  to mercilessly  stab her multiple times including in the chest that left her lungs punctured, head, abdomen, neck and spine. Though she was rushed to the nearby Vijaya Hospital, since her condition started worsening she was shifted to KIMS Hospital, Thiruvananthapuram at where she was put on ventilator, but ultimately declared dead.   The entire episode of stabbing spree and hospitalization lasted four hours. The need to take to Thiruvananthapuram would not have come up if districts like Kollam had major medical colleges or private hospitals with state-of-the-art facilities. In Vandana’s case, the precious golden hour needed to save her life was lost during the journey to transfer her to Thiruvananthapuram, which took more than two hours drive.

About Dr Vandana Das : The Victim Of The Attack

“Dr Vandana Das MBBS”, that’s what the name board at her house reads. Belonging to Kuruppanthara in  Kottayam district (near Ernakulam), Vandana right from her early days was passionate to become a doctor and being a bright student she got admission for medicine in Azeezia Institute of Medical Sciences and Research, Kollam and realized her childhood dream of becoming a doctor. Her friends remember her as an hardworking and dedicated always with aspirations, and  during the peak of Covid-19  pandemic she played an active role in spreading awareness about the disease and building intimate relationship with the patients. There were also occasions she used money from her pocket to help the patients need.

 

Background  Of Murderer Sandeep

A peep into the life of Sandeep aged 42, working as a teacher in the  nearby Upper Primary School, Nedumpara near Kundara in Kollam District, a Government Aided school,  said to have an history of substance abuse is surprisingly appalling. Having employed earlier in Upper Primary School in Vilangara in the same district, he was redeployed in the present position after a head teacher post became vacant  in December 2021 since his post in his earlier assignment was deemed excess. The reports are that Sandeep was already under suspension when he attacked Dr Vandana, and the accompanying policemen in the Hospital, though the authorities say that he was placed under suspension only after the incident.

He is said to be an alcoholic and had once undergone de-addiction therapy, and he had to be often escorted to his house when found in an inebriated state. The separation from his wife was said to be the result of his being a regular alcoholic and he often picks up squabbles at home with his wife.

The dismaying fact is that how being a teacher belonging to government sector survived all these years without any disciplinary proceedings despite having a poor history of discipline and character.

 

 

Did  Police Failed To React At The Spot?

Training their guns at the systemic failure of the police and the Government, a Division Bench of the Kerala High Court through a special sitting came down heavily on the failure of police on the spot of the incident and stated that when  the police knew that the man under their custody was acting abnormally, they should not have acted casually and should have restrained him from going out of control. The Bench also felt that it was the obligation of the police headed by him to ensure that the hospitals and the personnel; who man these are adequately and sufficiently protected on 24-hour time frames.

The major question asked was what the police did at the time of the incident in the spot of occurrence when Sandeep was on rampage with the scissors. Though the police per se could not be inferred ineffective or non responsive but not doing their level best, in this particular spot of incident the police failed to ensure protection to the young doctor and consequently  lost a precious life.

Lack of Protocols?

The Kerala High Court pointed out lack of protocol with respect to the manner in which persons in custody are to be presented at hospitals or before medical professional as part of the criminal justice system. They also called for evolving a firm protocol formulated to ensure protection of hospitals and healthcare staff in the future.

 Healthcare in Kerala

The killing of Dr Vandana Das  has exposed the glaring lapses of medical care in public health centres in Kerala, though Kerala’s healthcare sector has received many laurels, especially during the Covid times, but such incidents and negligible medical care and facilities in such  health centres available for the patients continue to haunt the health professionals. The inability to provide timely life support to Dr Vandana   soon after the incident in the Taluk Hospital at Kottarakkara brought the glaring deficiency of poorly equipped emergency   medical care facilities in most health centres in  Kerala.

Dr Vandana was said to be died due to pneumothorax.  Doctors feel that had she been given proper emergency care to her alarming bleeding injury at the Taluk Hospital itself, if the Government set up in the Hospital is adequate, her life could have been saved.

Flaws in  emergency medical care infrastructure in public health centres was exposed in the process, highlighting the need to overcome the flaws and to upgrade the public health care system especially at the lower levels. This in fact assumes importance following the launch of “Aardhram Mission” by Kerala government adding another  5400 centres in the second phase recently by the   Kerala Chief Minister.

Trauma Of  Healthcare Professionals : Attacks Continue

Cases of atrocities against healthcare practitioners, whether in private or public sector by relatives of patients and visitors are on the surge. In fact, the Kerala High Court while having a Special Sitting expressed serious concern over increasing instances of attacks against doctors and healthcare professionals and felt that at an average of 10 to 12 attacks takes place every month. Similar concern was also expressed by the Kerala Private Hospitals Association. In most cases of attacks the Station House Officer of the concerned police station fail to take cognizance of the issue within the stipulated time on which the case of attack is reported to him. The Division Bench of the Kerala High Court on this Special Sitting observed that a sense of fear of law is missing from the minds of attackers with the result the offences increases and that too the gravity of such offences. During a question hour in Kerala Legislature, the present Health Minister Veena George said that 140 incidents of attacks had been reported between June 2020 and June 2021. During 2022, there were 137 registered attacks on doctors. The Court has currently directed the police to register a case within an hour of receiving information about an attack on doctors and other healthcare professionals in Kerala. The irony of the fact is that the attack on health professionals increased exponentially in the years under the Left Democratic Front governments from May 2016 to May 19, 2021. It is understood 220 such cases were registered. The increase in attacks on health professionals was also alarming from 2021 to March 15, 2023 when 199 such cases were registered. All the cases were understood to be registered under the Kerala Healthcare Services Persons and Healthcare Service Institutions Act 2012.

Most of the attacks by relatives are emotional outburst against the doctors for their failure to save a loved one’s life, and also in circumstances for the slightest provocation. While most relatives show resilience in the face of such situations, a few react violently. Post-Vandana incident, surprisingly several incidents against healthcare professionals happened in Kerala.

The demand of health professionals is to declare the hospitals both private and government as “Violence Free Zones” and post armed reserve police at where emergency department operates from vandalizing the premises.

Alcohol Also Plays Spoilsport in Hospital Premises 

The increasing trend today is of  the criminals being brought under the influence of alcohol and drugs to a hospital without being handcuffed and most of such cases are found at night when these persons involved in street scuffles and brawls, get injured reach the hospitals in drunken state making things worse for the doctors to treat in the hospital premises and also for other patients. Even the by-standers and escorts of the patients calling at night in hospitals are seen to come drunk and fully intoxicated. In most cases the attackers belong allegiance to political parties and their release is facilitated by the party they belong to.

The very harm, intimidation, obstruction  or hindrance to a healthcare person in discharge of his duty is to be treated as violence and made a non-bailable offence as per Section 4(4) of the Act and prohibited under Section 3 of the Healthcare Act, but little was done by the police to register Case on these provisions and in some cases by the learned lower judiciary grant bail. Recently, a violent alcoholic intruder in government hospital in Kozhikode was granted bail but was cancelled by the higher Court on considering the gravity of the Case. .

 

Tipplers Calling In Hospitals Add To Woes 

The previous Congress-led United Democratic Front government in Kerala had envisaged total prohibition in phases in Kerala by 2025 and as a step towards it, it had closed down in 2014 all bars in hotels with a rating below five stars. Ever since LDF came to power in 2016 under Chief Minister Pinarayi Vijayan, the liberalisation started and additional licenses for Bars were slowly rolled out and majority of labourers and workers, including migrant workers, became susceptible to addiction to alcoholism. Even today new outlets are opened.

Though Kerala did not capture number one position in India in consumption of liquor, the per person consumption per year in Kerala is over 8 litre (1.76 gallons) which is well above the national annual average alcohol consumption of 5.7 litre (1.25 gallons) per person per year. Above all, studies in Kerala reveal that around 32.9 lakh people out of 3.34 crore population in the State consume liquor which includes 29.9 lakh men and 3.1 lakh women. In fact, Kerala is estimated to have around 1.6 million alcoholics, out of which almost 45 percent are chronic alcoholics. The major sources of income for the Government in Kerala is from liquor sales and during 2022-2023 it touched Rs 18500 crores. Currently, the increasing trend among youngsters is for drug abuse since liquor does not satisfy them anymore.

The Gist Of The Recent Ordinance Of Kerala Government

Following the fatal incident in the Kottarakkara Government Taluk Hospital the Kerala Government brought out an Ordinance to amend the Kerala Healthcare Service Persons and Healthcare Service Institutions (prevention of Violence and Damage to Property) Act 2012.  The amendment is intended to ensure more protection to healthcare personnel with higher punishment, jail    sentence and ensures protection for all registered, both permanent and temporary medical practitioners and healthcare assists in centres. Protection to healthcare institutions and those instigate such violence are also brought under the amended ambit of the amendment with higher punishment.

Despite ample provisions available under Indian Penal Code and Criminal Code of Procedure, and also under of Kerala Epidemic Diseases Act 2021  cognizance of such incidents are not taken seriously by the police to  register timely FIR applying effective provisions of the relevant Acts in stern terms more so due to extraneous influence, which usually happens in most cases.

No tangible results were also seen in the absence of defined medico-legal protocols.

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COMMENTS OF KERALA  HEALTH MINISTER KICKED A ROW 

The terse remarks of Health Minister Veena George over the death of Dr Vandana, invited  criticism when she said that it was due to the result of  “ inexperience and that she had gotten scared” that she had succumbed to the murderous attack  and that had she been experienced in confronting such situation otherwise could have been escaped from the clutches of gruesome attack. The insensitive comment of the Health Minister from the Taluk Hospital in Kottarakkara was later twisted by the Minister herself saying that “the words were convoluted to create a controversy against her”.

Soon after her comment the social media was rampant with criticism and critics commented that it is not the victim who had inexperience but the Health Minister herself, who should have taken action to prescribe a protocol to handle such situations arising  in Hospitals in the light of the increasing incidents of attacks against health professionals seen in Kerala.

About the Health Minister

The 44-year-old Veena George a student politician entered the mainstream politics in 2016 winning the Assembly election but in 2019 Lok Sabha election she tasted defeat from the Pathanamthitta Lok Sabha seat. It was in 2021 Assembly election margin and secured a ministerial berth in the Health and Family Welfare Ministry, a portfolio dealt previously by K K Shailaja, who was praised globally for her meticulous handling of the Covid-19 and Nipah crisis in Kerala. Though the decision had raised many eyebrows within the party circles, Veena was picked up as  confidante of the Central leadership for the position.

Though a surprise entry into politics, Veena, a post-graduate in physics worked as a teacher for a while before becoming a journalist and anchor in Reporter TV, Kairali TV and later in Manorama News and Indiavision as Chief News Editor.

Veena made history when she became the first woman journalist-turned politician to become a minister in Kerala.

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AN EXCLUSIVE INTERVIEW WITH T. ASAF ALI, FORMER DIRECTOR GENERAL OF PROSECUTION KERALA: HIS OPINION MATTERS

How do you see the incident happened in Taluk Hospital, Kottarakkara and were there any lapse on the part of police on duty?

The murderous attack happened in the presence of Police. As per Kerala Police Act and Allied Laws (Section 49) the medical treatment of the accused in police custody should be under adequate police surveillance and observation. Further the treatment and custody of such person can be informed to such Magistrate without any delay and further action shall be taken in accordance with the order of the Magistrate. There is also a provision in Section 50 that the details of the incident and circumstances shall be furnished forthwith by Station House Officer to such Magistrate and a copy of the said report shall be given to the medical officer and the injured and proper acknowledgement obtained.

 

About the Police  discharge of duties during the incident in Taluk Hospital at the time of incident in the premises?

The police on duty seemed totally insensitive to the situation during the violent stabbing spree. Section 38 of Kerala Police Act specifically states that any Police officer shall lawfully interfere to prevent and stop to the best of his ability any offence going on or about to take place in his presence or vicinity. In short the Police is not properly attuned or sharpened to meet any eventuality of the kind.

In addition to, the police are not properly armed and since the accused was found behaving abnormally at the site of picking him up, they should have taken proper adequate steps to keep in check.

They could have invoked Indian Penal Code 353 to protect from duty the doctors.

Whether any new Acts or Laws would put an end to the issues against health workers?

The law has been in place since 2012 to protect health workers and hospitals from attacks but still the doctors are not safe and so too nurses and paramedical staff and medical students. What is found from experience is that it is common practice to save the accused by delaying the trial and not filing the charge sheet on time. In a recent case the High Court had to give direction to the police to register a case and arrest the accused within an hour of the attack, but nothing changed after that.

 

What is your suggestion per se to overcome the issue?

The police personnel on duty in such sectors shall be moulded on the lines of Central Industrial Security Force (CISF). I suggest that in a State where such incidents are shooting up, and as a protection to healthcare professionals and hospitals premises, the Government should consider forming an independent security force known as State Health Security Force, who are trained for this purpose and meet any such eventuality in the health security sector under  a separate inspector General drawn up for the purpose and the Director of Health Services as part of the advisory board.

 

You have been saying about differential approach in protection  of public and private health professionals. Could you please elaborate this point?

Private sector health workers are not getting adequate protection as could be seen with public health professionals. When a public servant becomes a victim of attack or public violence IPC 332 is applied and police can register a Case. At the same time, a private hospital health professional is not getting protection as a public servant and the violator is charged under IPC 323 and not taken as cognizable offence subjecting to lesser punishment of 1 year or fine of Rs 1000. At the same time both public and private servant comes under the ambit of the same rules and provisions of Prevention of Corruption Act. This patent anomaly in law needs to be removed, to make things more stringent for violators of crime against both public and private doctors equally.

 

Do you think a Bill proposed as Central Act in 2020  would be more useful than the State Bills?

Hospital is regarded as a State subject. It is felt that the State Act could be more effectively implemented, provided the law enforcers of the law take it more seriously and relevant provisions applied judiciously. All Acts and laws are in our books and what is required is not in increasing of penalty or punishments but applying the provisions of the Acts with better selectivity and accuracy to enforce timely punishment to obliterate unsafe atmosphere from the hospital sector.

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 AN EXCLUSIVE INTERVIEW WITH Dr SULPHY NOOHU, THE STATE PRESIDENT,  INDIAN MEDICAL ASSOCIATION 

How far the Ordinance bringing Amendment to the existing 2012 Act would be effective to curb violence against healthcare professionals?

The proposed Amendment is expected to bring down considerably instances of attacks against healthcare workers in Kerala. Today, even for the slightest provocation, health personnel are attacked and it is felt that this tendency to resort to violence would come down with the recent amendments to the Act. There is also need to publicize through media about the stringent action to reach the public.

 

 

Are there any shortcomings in the Amended Act and how to make it more effective?

Even though the Ordinance has come out with some effective clauses we believe that more stress must be given to some other aspects too.

1. Strong action must be taken against investigating officer if adequate measures are not taken on time and promptly.
2. Social media attacks also must be considered equal to physical violence and action must be taken
3. A time bound FIR is a must while dealing with incidences, and the entire procedures must be completed within 60 days.

What is most essential is effective implementation of the provisions in the Amended Act so that it becomes a faultless document..

Is it a fact that the provisions in IPC and CrPC can also be made more effective to tackle such violent approach against health workers?

 It is left to the officials who register the Case against the offender by application of mind to include effective and relevant provisions in the IPC and CrPC and make it really effective and foolproof. In such cases, even non-bailable provision under section 308 can be included by  giving adequate reasons.

 

 Are there any loopholes in the current FIR against the offender of Dr Vandana?.

There are loopholes and there is scope for the offender to escape and get some protection. A special Prosecutor must look into the issue very deeply and plug any glaring loopholes and deficiencies in the FIR clearly. This is essential.

 

Whether the Police failed to take adequate measures while producing the person before the Duty Doctor on the fateful day?.

It is obvious that the police failed to give adequate protection. Persons found behaving abnormally and having found violent in approach may be handcuffed. Police must also be present while such patients are examined but if the examining Doctor requests the police to keep away from the examination Room of the patient, he may comply with the request. The Police could be positioned in such a way that he can intervene at any point of time.

How is safety of healthcare professionals in Hospitals at present?

Hospitals must be declared as Special Protection Zone. Adequate security staff under the age of 50 must be available in all Hospital areas. There must be a Police Aid post in every hospital premises, in which the policemen must be available 24/7. There must also be an alarm system by which the security personnel, especially in Emergency or Casualty or even in ICU, can be alerted in case of violence inside the department or hospital premises.

 

How about having a Central law? Would it be more effective?

There is nothing wrong in having a Central law which could have sweeping powers.  But everything depends on the way we take the Act for implementation by our State. Though implementation of a Central Law may be difficult because “health” is within the Legislative purview of state governments, there is a Central  Act already in existence like Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act 1994. The Central legislation together with the existing state legislation is more likely to ensure safety and security for doctors.

There must also be collective efforts by the Government and non- governmental organisations and all other socially committed people to bring in safety in the hospital sector. Meanwhile, the doctor-patient communication skills should be up-skilled among health professionals.

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