R.G. Kar murder and rape case: SC issues slew of directions, some missing from the written Order

The Supreme Court had taken suo motu cognisance of the R.G. Kar murder and rape case. Today, it instituted a series of directions and formulated a National Task Force to form protocols on the issue of safety in hospitals.

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ON Tuesday, the Supreme Court took up a suo motu case in the aftermath of a brutal rape and killing of a young female doctor at R.G. Kar Medical College and Hospital of Kolkata and decided to form a National Task Force to formulate protocols governing safety and security of medical practitioners across the country.

A Bench comprising Chief Justice of India (CJI) Dr D.Y. Chandrachud and Justices J.B. Pardiwala and Manoj Misra observed that the nation cannot wait for a rape or murder for real changes on the ground.

The Bench also expressed its dismay at the conduct of the Kolkata police over the delay in lodging the first information report (FIR) and the delay of several hours in permitting the parents of the deceased girl to see the body of their daughter.

The Bench said it was unable to comprehend how the state government could not stop the vandalism at R.G. Kar Medical College in the aftermath of the brutal incident.

The incident which took place at the hospital has sent shock waves across the country and drew widespread protests and criticism against the West Bengal government by doctors' associations, student bodies and civic groups.

At 12:30 a.m. on August 15, when a protest was underway at the hospital, a large mob assembled at the premises of the R.G. Kar Medical College and Hospital and vandalised the emergency ward and other departments of the hospital.

Following the acts of wanton destruction and vandalism, the Indian Medical Association called for a nationwide withdrawal of medical services, except emergency services, for twenty-four hours on August 17.

Commenting on the vandalism, the Bench said the state government was expected to ensure the deployment of the state machinery to prevent a breach of law and order.

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"It was all the more necessary to do so since the investigation of the crime which took place in the precincts of the hospital was underway," the Bench said.

During the hearing, the Bench was informed that the police officials stationed at the R.G. Kar Medical College and Hospital ran away during the vandalism and hid in the nurses' dressing room when the mob was attacking the hospital.

The Bench was also informed that lady doctors were called by name and threatened that they would meet the same fate as the deceased. A complaint stating the same was given to the Bench in a sealed cover by doctors who wished to remain anonymous.

The Bench also expressed its displeasure at the disclosure of the name and graphic images of the deceased which have been widely circulated on social media without regard to her privacy or dignity.

While hearing a petition filed by two lawyers later in the day, the Bench directed all news and social media platforms to remove the name, photos, videos and other details of the deceased woman.

The Bench has asked the Central Bureau of Investigation (CBI) to submit a status report by August 22, 2024, on the progress in the investigation of the crime at the R.G. Kar Medical College and Hospital. On August 13, the Calcutta High Court had transferred the investigation to the CBI.

The Bench has also directed the West Bengal government to file a status report on the progress of the investigation of the acts of vandalism that took place at the hospital in the aftermath of the incident.

Importantly, the Bench ordered Central Industrial Security Force (CISF)/Central Reserve Protection Force (CRPF) cover for the hospital after many doctors fled from it following vandalism at the site. This direction, however, is missing from the written Order released in the afternoon.

During the hearing, CJI Dr Chandrachud also dictated that the West Bengal government exercise restraint against peaceful protests in connection with the rape and murder of a young doctor.

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He told the government to ensure that it does not unleash power to stifle legitimate protest. This direction is also missing from the written Order released in the afternoon.

Lack of institutional safety standards in healthcare establishments

The Bench flagged the ground reality indicating the lack of institutional safety standards in healthcare establishments. It said the lack of institutional safety norms at medical establishments against both violence and sexual violence against medical professionals is a matter of serious concern.

"While gendered violence is the source of the more malevolent manifestations of the structural deficiencies in public health institutions, the lack of safety is of concern to all medical professionals. Preserving safe conditions of work is central to realising equality of opportunity to every working professional. This is not just a matter of protecting doctors. Their safety and well-being as health providers is a matter of national interest," the Bench said.

The Bench took note of the fact that several states such as Andhra Pradesh, Karnataka, Kerala, Maharashtra, Telangana, Tamil Nadu and West Bengal have enacted legislation to protect healthcare service professionals from violence and damage to property.

It said that all these laws prohibit any act of violence against medical professionals. The offence is non-bailable and punishable with three years of imprisonment.

The Bench, however, highlighted that these laws do not address the institutional and systemic causes that underlie the problem.

"An enhanced punishment without improving institutional safety standards falls short of addressing the problem effectively," the Bench said.

In its Order, the Bench has highlighted the following concerns:

• Medical professionals who are posted for night duties are not provided adequate resting spaces. More often, doctors rest in the patients' rooms or available public spaces. Duty rooms are scant. Separate duty rooms for male and female medical professionals are conspicuous by their absence in most healthcare establishments.

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• 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 healthcare professionals from questioning the absence of facilities for basic well-being.
• The 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 attendees. Open access to healthcare facilities leaves medical professionals vulnerable to undesirable elements.
• Medical care facilities do not have sufficient toilets. Most often there is only one common toilet for medical professionals in one department.
• 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.
• 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.
• The patients and their attenders have unrestricted access to all places within the hospital, including intensive care units and the doctors' resting rooms.
• Lack of screening for arms and weapons at the entrance of the hospitals.
• Dingy and ill-lit places within the hospitals.
• 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.
• Certain spaces within hospitals such as the intensive care units and the emergency wards are prone to a greater risk of violence because of the severity of medical conditions of patients in these departments. 

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In order to address these concerns, and to formulate protocols governing these issues, the Bench has formed a multi-member National Task Force. It comprises:

1. Surgeon Vice Admiral Arti Sarin, AVSM, VSM, Director General, Medical Services (Navy).
2. Dr D. Nageshwar Reddy, Chairman and Managing Director, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad.
3. Dr M. Srinivas, Director, All India Institute of Medical Sciences (AIIMS), Delhi.
4. Dr Pratima Murthy, Director, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru.
5. Dr Goverdhan Dutt Puri, Executive Director, All India Institute of Medical Sciences, Jodhpur.
6. Dr Saumitra Rawat, Chairperson, Institute of Surgical Gastroenterology, GI and HPB Onco-Surgery and Liver Transplantation and Member, Board of Management, Sir Ganga Ram Hospital, New Delhi ; Member, Court of Examiners, Royal College of Surgeons, England.
7. Professor Anita Saxena, Vice-Chancellor, Pandit B.D. Sharma Medical University, Rohtak. Formerly Dean of Academics, ChiefCardiothoracic Centre and Head Cardiology Department at All India Institute of Medical Sciences (AIIMS), Delhi;
8. Dr Pallavi Saple, Dean, Grant Medical College and Sir JJ Group of Hospitals, Mumbai.
9. Dr Padma Srivastava, formerly Professor at the Department of Neurology, AIIMS Delhi. Currently serving as the Chairperson of Neurology at Paras Health Gurugram.

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In addition to these members, the Bench has directed that the cabinet secretary; the home secretary; the secretary of the ministry of health and family welfare, government of India; and the chairperson of the National Medical Commission and the president of the National Board of Examinations, will be ex-officio members of the task force.

The Bench has directed the task force to formulate effective recommendations to remedy the issues of concern pertaining to the safety, working conditions and well-being of medical professionals and other cognate matters flagged by it.

The Bench, in particular, has asked the task force to prepare an action plan that can be categorised under two heads:

(I) Preventing violence, including gender-based violence against medical professionals.

(II) Providing an enforceable national protocol for dignified and safe working conditions for interns, residents, senior residents, doctors, nurses and all medical professionals.

The Bench has directed the task to submit an interim report within three weeks and the final report within two months from the date of the Order.

The Bench has also summoned the following information from all the state governments and the Union territories:

• How many security personnel are employed at each hospital and each department.
• Whether there is a baggage and person screening mechanism in place at the entrance of the medical establishment. 
• The total number of resting/duty rooms in the hospital and specific details of the number in each department.
• The facilities provided in the resting/duty rooms.
• Information on whether all areas of the hospital are accessible to the general public and if so, with or without any security restrictions.
• Whether there are CCTV cameras in the hospital. If there are, how many and in which locations.
• Whether the institution provides medical professionals training to appropriately handle the grief of patients. If so, the details of the training must be provided.
• Whether social workers who specialise in handling the grief of families of the patients are employed at the hospital. If so, the total number of social workers must be provided.
• Whether there are police posts within the premises of the medical college campus.
• Whether an internal complaints committee in terms of the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 has been constituted.
• 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. 

It ordered that the information sought must be filed within one month from today.

Click here to read the Order.