Incidence of crime against women is increasing at an alarming rate and going virtually unchecked in our society. There is an urgent need for a serious review of the situation and implementation of effective measures to check the menace.
The matter of safety of women is of special importance in institutions like hospitals where the chances of crime against women and children are far higher because of the following reasons:
1. Females and children constitute more than 50% of the strength of staff and patients in any hospital.
2. While examining, treating, nursing and handling the patients, physical contact with the patient’s body is quite natural and the patients don’t mind that assuming it is a medical necessity. However, a rogue staffer or doctor may cross the thin line between examining/caring and fondling and misuse that healing touch for molestation or rape.
3. A large number of staff (security, house keeping etc) is outsourced and the management may fail to verify their credentials/antecedents.
4. A large number of vulnerable patients (women and children) may be too sick to defend themselves against any assault.
5. The danger to vulnerable patients as well as staff becomes further pronounced at night or early hours of morning when it is all dark and quiet, the staff presence is thin, and nurses, Aayas, lady doctors may be posted all alone on duty at lonely places. Empty rooms, corridors, lifts, toilet blocks, basements do encourage criminal behaviour.
In such situations, if the administration fails to foresee the threat to safety of females and does not take pro-active measures, it may act as an open invitation to crime against women. Administrator of every hospital must understand that safety of patients, staff, attendants and public within the hospital premises is the responsibility of management who are accountable for any harm that may visit the staff, patients, attendants or visitors because of any negligence in safety precautions on the part of management. Court Judgments, such as given below, are very clear on the subject.
- Judgment by Delhi High Court (in 2003) in the case of Ms XYZ Vs Shanti Mukund Hospital, Delhi
- High Court Judgment dated 01 Oct 2008 in the case of Govt of NCT of Delhi and Others Vs Sudha Devi and Another
- Punjab High Court Judgment in Jasbir Kaur Vs the state of Punjab
Some of the safety measures that can effectively prevent crime against women and children in hospitals are outlined below.
I. Safety of Female Staff
1. No female staff should be posted alone at night. Wherever there are male employees/patients, the female staff should be posted in pairs as far as possible. In a ward if there is only one sister, an Aaya or female sweeper may be posted with her.
2. Compliance with provisions of Delhi Shops and Establishments Act, 1954 (or similar Acts in other states) must be ensured. Section 14 of the Act prohibits employment of vulnerable groups such as women and young persons between 9 pm and 7 am during summer season and between 8 pm and 8 am during winter season. Any shop or commercial establishment (such as hospital), wishing to employ women during such unsafe hours, has to seek exemption from Secretary (Labour), Govt of NCT of Delhi on the basis of a written commitment that:
- Their workplace is made secure and safe for them.
- Door to door pick up and drop facility is provided by the employer to ensure safe transit from home to work place and vice versa.
Timing for the shift change should be arranged keeping in mind the safety of female staff while commuting to and from the hospital or the above precautions must be taken to ensure their safety.
3. Lady doctors, nurses other female staff may avoid moving alone in secluded areas of the hospital at night.
4. Hospital should have effective alarm / call bell system at various nursing stations / other places, to call for assistance (control room, security, reception, casualty) in case of any emergency. The arrangement should be such that a single press on the button may alert all the sections without causing undue panic among the patients.
5. Emergency help should be available from control room / security / reception / casualty on ringing up or by shouting for help.
6. Female staff is advised not to go outside the hospital premises alone at night. If a female staff has to go outside the hospital at night while on official duty, she should be accompanied by another female staff and official transport should be provided.
II. Safety of Female Patients and Attendants
7. Male and Female patients should not be kept in the same room/ward except in ICU, Dialysis centre I Recovery ward / Casualty or Day care.
8. Except in rooms (where attendants are allowed 24 hours) female patients should not be kept alone in a room. If it is unavoidable, an attendant should be allowed with her at all the times. If she does not have an attendant she should be encouraged to be in the ward with other patients or adequate arrangement should be made to ensure her safety.
9. Male staff should not enter a room that is occupied by a female patient unless accompanied by a nurse / other female staff. It is a desirable practice to seek permission by knocking at the door before entering the room.
10. Female wards should have only female housekeeping staff for servicing the beds of female patients.
11. Procedures such as medical examination, USG (Ultrasonography), Echocardiography, X-ray, CT scan, Physiotherapy, ECG (Electrocardiography), EEG (Electroencephalography) etc. should not be carried out without the presence of a female staff or patient’s attendant, or another female patient, unless it is an emergency.
12. If a female patient is to be sent outside the ward for investigations or procedures, the sister-in-charge ward should ensure that a female staff or the patient’s attendant is sent along with her. In an emergency situation where neither a female staff nor the attendant is present, another female patient may be requested to be present during the procedure.
13. Needless to say that the patient’s permission (express/informed, depending on the procedure) must be obtained before starting the procedure. In any case the procedure room should not be locked from inside.
14. No male attendant should be allowed to stay in the female ward beyond the visiting hours. Security guards should check the wards and ensure compliance.
15. Female patients/attendants should avoid visiting dark / secluded areas of the hospital at night.
16. Staff (nursing / housekeeping / security) should remain vigilant to prevent any unauthorized person from entering the rooms occupied by female patients.
III. Actions by the Security Staff
17. At night the security supervisors should keep their location informed to Reception and Casualty so that they can be contacted immediately in case of an emergency.
18. They should ensure that no vacant room remains unlocked at night. Vacant/open/dark spaces spell trouble at night.
19. They should ensure that the security lights are on and adequate in all areas/passages likely to be used by the attendants/patients/staff at night.
20. Security staff should keep a strict watch over unauthorized/suspicious movement of any person at night.
21. Security supervisor on night duty should make periodic visits to every department on every floor to check from the staff in case there is any problem.
22. Security staff should be groomed to address the safety/security of females with sensitivity and speed to instil confidence.
IV. Police Verification of Outsourced Staff
23. Before allowing the housekeeping, security and other outsourced staff to work in the hospital premises the HR department must ensure the process of credentialing (verification of qualifications and police verification of character and antecedents) in respect of every individual.
V. Grievance Redressal Mechanism
24. Any (genuine) case of sexual assault/harassment of female staff/patients/attendants may be reported to the administrator at the earliest.
25. The complaint should be investigated by a standing committee, composed of members, preferably ladies, and chaired by a senior staff with a good reputation and standing for being upright, impartial and sensitive to the issues. The committee should act without any delay and submit their report with recommendations within 48 hours to the administrator for further action.
26. Local “Helpline” telephone numbers of the “Cell For Crime Against Women” (if there is any, as in Delhi), should be displayed at the reception, the casualty and in the wards, prominently.
VI. Actions By the State/District Health Authorities
27. The state and district health authorities must ensure that all hospitals under their command are fully sensitized to the issue of safety of women and have documented SOPs (Standard operating procedures) on the subject, well known to and implemented by, all the staff in every hospital.
The above measures, if implemented in all sincerity, can make hospitals much safer and effectively prevent crimes against women in hospitals.
Dr S K Joshi
MBBS, MHA, DNB, QMAHO, MAHA, MIPHA
Consultant Hospital Administration / Quality Management in Healthcare
Assessor for NABH Accreditation of Hospitals
Visiting Faculty for PG Courses in Hospital/Health Management
Author: “Quality Management in Hospitals”
“Law and The Practice of Medicine”
“Safety Management in Hospitals”