Violence against doctors: laws that protect clinics The state Medicare Service Persons Acts, the 2020 epidemic law, and whether your OPD is covered.

Two kinds of law protect doctors from violence at the clinic beyond the ordinary criminal law: a state law on violence against medicare service persons, which several states have passed, and the Epidemic Diseases Act, 1897 as amended in 2020, which applies only during an epidemic. The state Acts make violence against doctors and damage to the institution's property a cognizable and non-bailable offence and let the court order compensation for damaged equipment. Whether your clinic is covered depends on the definition of "medicare service institution" in your state's Act, and in the four we read, a private OPD clinic is not named.

What do the state Medicare Service Persons Acts say?

They follow one pattern. Each prohibits violence against medicare service persons and damage to property of medicare service institutions, sets a prison term and fine, makes the offence cognizable and non-bailable, and lets the court order the offender to pay for damaged property, recoverable as arrears of land revenue if unpaid. Each also says it is in addition to, not in derogation of, any other law. We read four, from the Gazette text as first published:

"Violence" is defined widely. Tamil Nadu's definition, for example, covers "activities of causing, any harm, injury or endangering the life or intimidation, obstruction or hindrance to any medicare service person while discharging his duty in the medicare service institution or causing damage or loss to the property." Intimidation and obstruction count, not only physical assault. Rajasthan's definition also includes harm to a patient in the institution.

Is a small OPD clinic covered by these Acts?

Not by name in the four Acts we read. Tamil Nadu, Rajasthan and Karnataka define a medicare service institution as institutions under the control of the State or Central Government or local bodies, "including any private hospital having facilities for treatment of the sick and used for their reception or stay", any private maternity home, and any private nursing home "used or intended to be used for the reception and accommodation of persons". Each of those private categories turns on admitting or accommodating patients. Odisha's 2009 Act goes further the other way: it defines medicare service institutions as "a medical college, a hospital by whatever name called or such other institution providing Medicare Service to the people, which is established and managed by, or under the control of, the State Government or Central Government or any local authority".

The person side has a similar limit. The Acts define medicare service persons "in relation to a medicare service institution", and Rajasthan and Karnataka describe registered medical practitioners as those "working in Medicare Institutions". A doctor attacked in a hospital where she also consults is inside the words; a doctor attacked in her own OPD clinic may not be, unless the clinic admits patients or the current text has been widened.

This does not leave a clinic doctor without remedy. Each state Act says it is in addition to, and not in derogation of, any other law, so the general criminal law still applies to an assault in an OPD. What the special Acts add, where they apply, is a fixed punishment, non-bailable status and the compensation formula for equipment. If you run a day-care or observation set-up where patients stay, read your state's definition against it, and ask your state medical association how the police in your district have applied it.

What does the Epidemic Diseases Act add?

A national law, but only during an epidemic. The Epidemic Diseases (Amendment) Act, 2020 (No. 34 of 2020), deemed in force from 22 April 2020, inserted section 2B into the 1897 Act: "No person shall indulge in any act of violence against a healthcare service personnel or cause any damage or loss to any property during an epidemic."

• Who is protected: a person who, "while carrying out his duties in relation to epidemic related responsibilities, may come in direct contact with affected patients", including "any public and clinical healthcare provider such as doctor, nurse, paramedical worker and community health worker" (s.1A(b)).
• Where: the definition of an act of violence covers harm, injury, intimidation, obstruction or hindrance "either within the premises of a clinical establishment or otherwise" (s.1A(a)). "Property" includes a clinical establishment as defined in the Clinical Establishments (Registration and Regulation) Act, 2010 (s.1A(c)).
• Punishment: three months to five years and a fine of ₹50,000 to ₹2 lakh for violence or damage (s.3(2)); six months to seven years and a fine of ₹1 lakh to ₹5 lakh where grievous hurt is caused (s.3(3)).
• Procedure: cognizable and non-bailable, investigated by an officer not below Inspector, investigation to be completed within 30 days of the FIR (s.3A).
• Compensation: as determined by the court for hurt; for property, "twice the amount of fair market value of the damaged property or the loss caused" (s.3E).

The limit is in the words "during an epidemic" and "epidemic related responsibilities". Outside an epidemic declared under the 1897 Act, these sections do not apply, and the state Act and the general criminal law are what remain.

What should a clinic do after an attack?

Each law above makes the offence cognizable. What helps the case is evidence collected on the day:

1. Call the police and ask for an FIR. Name your state's Act, and the Epidemic Diseases Act if an epidemic is in force, in the complaint. Keep a copy of the FIR.
2. Save the CCTV footage before it is overwritten, with the camera's date and time. Copy it to a second device the same day.
3. Write down the names and phone numbers of staff and patients who saw it, while they are still at the clinic.
4. Photograph damage and keep the purchase invoices of damaged equipment. The Rajasthan and Karnataka Acts tie the penalty to twice the purchase price, Odisha to not less than the purchase price, and the Epidemic Act to twice the fair market value.
5. Record the incident in the clinic's own register with time and names, and note which patient's visit it related to. Patient details go to the police only as the law requires; see police or court asks for patient records.
6. Tell your indemnity insurer if a claim or complaint may follow; see our post on professional indemnity insurance.

If the incident began with an injured person brought in after an accident or assault, our post on medico-legal cases in the OPD covers that part. A clinic is also a workplace for its staff, and the POSH Act for small clinics covers harassment of staff by anyone, including patients.