Systematic Threats to Ethical Medical Practice : Analyzing the Interplay of violence, Medical negligence and Corruption in the Healthcare System.

Systematic Threats to Ethical Medical Practice : Analyzing the Interplay of violence, Medical negligence and Corruption in the Healthcare System.

Abstract :

Medical profession is an extremely vital and respected field that includes a wide range of professionals coming together to work for the purpose of providing high quality patient care and thereby ensuring the protection of public health and its further development. The medical practice includes several healthcare professionals such as Doctors, nurses and other allied specialists like technicians, Physiotherapists and Occupational therapists. There are a variety of emerging threats to ethical medical practice including human error, equipment failure, deteriorating mental health of healthcare workers and other legal regulatory challenges. But there are three major threats that affect the healthcare system the most. It includes violence against medical professionals, medical negligence and corruption in the healthcare system. Medical professionals are facing physical attacks ,injuries and even fatalities. Wrong information about healthcare,vaccines or treatments can lead to anger and aggression towards medical professionals. Emergency departments like ICUs and similar other high-pressure areas can be prone to such conflicts. Medical negligence by healthcare providers results in patient harm or injury. For example incorrect diagnosis leading to wrong treatment and mistakes during surgery. Corruption in the healthcare system is another major threat which can take many forms like paying and receiving bribes to access medical services, overcharging, misusing funds meant for healthcare, informal payments made to healthcare providers for the services that should be covered by insurance or even government programs and providing false information about the patient’s health condition in order to increase billing. This article aims to address these three major systematic threats affecting the healthcare system and also aims to provide practical solutions along with suggestions for the identified research problem.

Violence against medical professionals :

The increasing violence against medical professionals is a major global issue with many studies highlighting its prevalence and impact. A comprehensive research analysed 22 different studies from 2010 to 2020 revealing that emergency departments are most prone to violence. Physicians are most likely to face physical assaults and Nurses are mostly prone to sexual harassment. In certain intense situations verbal abuse is the most common form of violence against medical professionals. Terrible Incidents like these are often not reported due to lack of action and support. Younger and less experienced staff are often the easy targets to the offenders. Another interview with 63 healthcare providers across seven popular Indian hospitals revealed that 81.4 % experienced verbal abuse whereas 18.5 % faced physical assaults. Common perpetrators were the patient’s relatives or attendants. Factors contributing to these events include long waiting, miscommunication, and certain unrealistic expectations from the beneficiaries. Additionally the poor infrastructure, high costs and ineffective government policies also contribute to the causing of these offences. There’s a growing demand nowadays for comprehensive approaches, including better security for medical professionals and public education. Violence against medical professionals is a growing global concern and this affects the healthcare workers in both high-income as well as low-income countries. This violence takes various forms like verbal abuse, physical assaults including sexual harassment like the recent brutal rape and murder of a 31-year-old trainee doctor at India’s RG Kar Medical College situated at Kolkata, West Bengal. This tragic incident spotlighted the persistent threats faced by medical professionals and addressed the need for enhancing security measures and legal protections. In India, one of the studies states that 33 % are facing violence in the workplace like verbal abuse, Physical abuse, threat, aggressive gesture, blackmail and cyber bullying. Here the physical abuse includes any act of physical force against a healthcare worker intended to cause bodily harm, injury, or physical intimidation. For example hitting, slapping, punching, kicking, sexual abuse, throwing objects like medical equipment and chairs, use of weapons or sharp instruments. This results in causing physical injuries, fear and anxiety during working hours and even potential disability or loss of workdays. The next major category of violence is verbal abuse which refers to the usage of words and tone in an inappropriate manner with an intention to threaten, insult, or emotionally harm a healthcare professional. For example yelling, screaming, or name-calling, racial or gender based slurs, religious slurs, mockery of belittling of medical knowledge or skills, verbal threats of harm and intimidating tone or language. This results in emotional distress, anxiety, fear of further communication with patients, decreased performance and reduction in empathy. Both physical and verbal forms of abuse contribute significantly to poor workplace environments, increasing staff turnover and compromise in patient care. There’s no specific article in the Indian Constitution that particularly addresses violence against medical professionals but constitutional provisions and legal frameworks collectively protect them under broader rights and responsibilities. Article 21 of the Indian constitution deals with the Protection of life and personal liberty and it guarantees the right to life and personal security, which includes the right to work in a safe and secure environment. Any violence activities against doctors and other medical staff is a violation of their fundamental right to live with dignity. The new criminal law Bharatiya Nyaya Sanhita (BNS), 2023 ( replacing IPC ) includes specific provisions to punish those who assault or threaten medical professionals, especially on duty. The Section 115 of BNS deals with Assault on public servants ( including Doctors in Government hospitals ).

Vishakha and Others v. State of Rajasthan (1997)

• The Vishakha case is a landmark judgment by the Supreme Court of India that tackled the issue of sexual harassment at the workplace.
• The case deals with the brutal gang rape of Bhanwari Devi, a social worker from Rajasthan, who had initially attempted to stop a child marriage in her village.
• Despite the gravity of the incident, the accused were acquitted by the Rajasthan High Court. This incident exposed the absence of effective legal measures to protect women from sexual harassment in the workplace.

In reaction to this injustice, various women's rights groups collectively filed a Public Interest Litigation (PIL) under the name "Vishakha." They sought enforcement of fundamental rights under Articles 14 (equality before law), 15 (prohibition of discrimination), 19 (freedom of speech and expression), and 21 (protection of life and personal liberty) of the Indian Constitution. Acknowledging the legal vacuum in addressing workplace sexual harassment, the Supreme Court issued a set of guidelines known as the Vishakha Guidelines. These guidelines provided a definition of sexual harassment and established a framework for preventive measures and redressal mechanisms in work environments, directing all employers to comply with them until formal legislation was enacted. There are various other cases also that enumerate such cruel attacks in workplaces. The future scope of addressing this crisis includes several promising directions like policy reforms, legal reforms, improved security infrastructure, healthcare workers training and public awareness campaign which promotes respect and emphasises the importance of healthcare workers.

Medical negligence :

Medical negligence refers to the scenario where a healthcare provider fails to deliver the expected level of care, resulting in injury or harm to the patient. This can arise from actions such as incorrect diagnosis, surgical errors, or administering the wrong medication. The impact on patients can be serious, including physical suffering, emotional distress, and financial hardship due to additional treatment costs. Healthcare professionals responsible for such negligence may face legal consequences, professional disciplinary action, and damage to their careers and reputation. On a larger scale, frequent cases of medical negligence can weaken public confidence in the healthcare system and lead to the implementation of stricter laws and safety protocols aimed at protecting patients' rights and well-being. The Bharatiya Nyaya Sanhita (BNS), 2023 establishes a structured legal framework to address medical negligence, ensuring accountability through criminal penalties, financial compensation, and professional discipline. These provisions aim to protect patient rights while maintaining trust in the medical profession.

1. Criminal Liability

Section 106 of the BNS deals specifically with acts of medical negligence that result in a patient’s death. If a registered medical practitioner is found guilty of performing a medical procedure in a reckless or careless manner that leads to death without intent to kill they can face:

• Imprisonment for up to two years
• A monetary fine will be levied as directed by the court

For individuals who are not licensed medical professionals, but whose negligent actions cause death, the law allows for stricter punishment—up to five years in prison along with a fine. This differentiation recognizes the complexities of medical judgment while still ensuring legal accountability.

2. Monetary Liability

Beyond imprisonment, the BNS allows courts to impose financial penalties on the medical professional found guilty. These may include:

• Compensation to the victim or their family
• Coverage of expenses caused due to the negligence

The amount of compensation is assessed based on the seriousness of the case, the harm caused, and other relevant factors.

3. Disciplinary Measures

In addition to criminal proceedings, doctors may also face professional disciplinary actions. These are enforced by regulatory authorities like the National Medical Commission or State Medical Councils. Possible outcomes include:

• Official warning or reprimand
• Temporary suspension of the medical license
• Permanent removal from the medical register in serious cases

These actions are taken following an independent inquiry to evaluate the ethical and professional conduct of the practitioner. The BNS, 2023 takes a comprehensive approach to medical negligence by combining legal, financial, and professional consequences. This ensures that healthcare providers are held responsible for lapses in care, while also protecting the integrity of the medical system and reinforcing patient safety.

Poonam Verma vs. Ashwin Patel & Others (1996)

• This case revolves around a tragic incident of medical negligence. In July 1992, Pramod Verma who was the husband of Poonam Verma, fell severely ill.
• He sought treatment from Dr. Ashwin Patel, who was a registered homeopathic practitioner. Despite his qualifications in homeopathy, Dr. Patel administered allopathic medicines to the patient without conducting proper diagnostic tests.
• Instead of showing improvement, Pramod Verma’s condition worsened. He was eventually admitted to a hospital, where he passed away within a short period.

Believing that her husband’s death was due to medical negligence, Poonam Verma filed a complaint before the National Consumer Disputes Redressal Commission (NCDRC), alleging that Dr. Patel acted irresponsibly and beyond his professional capacity. But The NCDRC dismissed the complaint, prompting Mrs.Poonam Verma to approach the Supreme Court. The Court observed that Dr. Patel was qualified only in homeopathy and was not registered to practice allopathy. Administering allopathic drugs without the required qualifications and license is not only illegal but also inherently dangerous. The Court held that practicing a system of medicine in which one is not trained is a clear case of medical negligence. The Supreme Court allowed the appeal and set aside the NCDRC's earlier ruling. It held Dr. Ashwin Patel was liable for medical negligence and ordered a compensation of ₹3,00,000 to be paid to Poonam Verma. In one of a recent judgement on medical negligence, the Supreme Court awarded compensation amounting to Indian Rupees 11 Crores to a victim, which was to be paid by the doctors and the particular private hospital was deemed to be responsible for the death of the patient. Unlike other professional connections, The relationship between doctors and patients is built on trust, empathy and compassion. Medical negligence damages the reputation of healthcare providers and institutions thereby straining this valuable and essential Doctor - Patient relationship.

Corruption in healthcare system :

Corruption within the healthcare sector refers to the misuse of power, resources, or information by individuals or organizations for personal gain, often compromising the quality and accessibility of care. This corruption negatively impacts both public and private healthcare systems, driving up costs, fostering inequality, and diminishing public trust in medical institutions.In many healthcare systems, patients are forced to make secret payments for services that are meant to be free or subsidized. Healthcare providers may solicit bribes to expedite treatment or provide better services. Fraudulent Prescriptions and Kickbacks happen when Physicians are incentivized by pharmaceutical companies to prescribe certain drugs or order unnecessary tests in exchange for financial incentives, leading to inflated healthcare costs. Inflated Billing and False Claims is another major corruptive practice. Healthcare institutions may submit exaggerated or fabricated claims to insurance providers or patients, charging for services not rendered or inflating the cost of procedures and treatments. Resources allocated for healthcare services, such as medical equipment and medications, can be stolen and misappropriated. This deprives healthcare facilities of necessary tools to provide adequate care. Public funds may be allocated for healthcare staff or facilities that don’t exist or aren’t functioning, with salaries being paid to non-existent employees. Corruption in Licensing and Staffing is another dangerous corruptive practice destroying the healthcare system where the medical professionals may acquire licenses or positions through bribery rather than merit, leading to unqualified individuals being placed in critical healthcare roles. There are various root causes for these above-mentioned corruptive practices like a lack of effective regulation, monitoring, and accountability. Underpaid healthcare professionals, especially in low-income settings, may resort to unethical practices as a means of supplementing their income. Complex and cumbersome administrative procedures often lead to bribery as individuals seek to bypass delays and expedite services. Many patients lack the knowledge or resources to challenge corruption, making them vulnerable to exploitation and unable to report malpractice. Political interference in healthcare appointments, resource allocation, and policy decisions can result in inefficiencies and corruption, as decisions are made based on favoritism rather than merit. Corruption in any sector leads to drastic destruction of the particular field and the beneficiaries of it. When the same occurs in the medical field, the consequences are even worse.
Corruption leads to the diversion of resources and inadequate care, ultimately harming patients and increasing morbidity and mortality, particularly in underserved communities. When corruption is widespread, public confidence in healthcare institutions and professionals erodes, which can deter people from seeking necessary care. The hidden costs of bribery and inflated treatment charges add an economic burden, especially on those who can least afford it, leading to financial distress. Funds that should be used to improve healthcare infrastructure or access to essential medicines are misused or diverted, leaving public healthcare systems underfunded. Corruption exacerbates disparities in healthcare, with wealthier individuals or those in powerful positions receiving better care, while the poor remain marginalized and underserved. India is taking significant strides toward curbing corruption in its healthcare system through a mix of legal reforms, technological advancements, and stronger oversight. A key move in this direction is the implementation of the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) 2024, which enforces ethical conduct among pharmaceutical and medical device companies by prohibiting personal gifts to doctors and promoting transparent promotional practices. Legal modernization through the Bharatiya Nyaya Sanhita (BNS) and Bhartiya Nagarik Suraksha Sanhita (BNSS) is also reshaping the justice system by introducing tools like electronic FIRs and mandatory audio-video documentation during searches, making anti-corruption efforts more transparent and effective. On the digital front, the Ayushman Bharat Digital Mission (ABDM) is streamlining healthcare delivery by digitizing health records and assigning unique health IDs, significantly reducing opportunities for fraud. The push for cashless transactions in hospitals further limits the scope for under-the-table payments. Emerging technologies like artificial intelligence and blockchain are being adopted to enhance accuracy in diagnosis, secure patient data, and ensure traceability in areas such as drug supply and organ transplants. Initiatives like Ayushman Arogya Kendras in Punjab and Jan Aushadhi Stores in Andhra Pradesh aim to expand access to affordable healthcare and essential medicines, minimizing the role of exploitative middlemen. Although challenges like systemic inertia and resistance to reform remain, these collective efforts indicate a strong momentum toward a more transparent, accountable, and equitable healthcare environment in India.

Conclusion :

A strong and fair healthcare system is built on ethics—on doing the right thing for patients and treating them with care, honesty, and respect. But today, problems like violence, medical negligence , and corruption are seriously hurting the trust and values that medicine should stand for. These issues don’t just happen on their own and they are often connected and make each other worse, creating a cycle that weakens the entire system.Violence in hospitals or clinics, especially against doctors and nurses, shows a serious breakdown in the relationship between the public and healthcare workers. This anger often comes from poor communication or from bad experiences due to delays or mistakes in treatment. Medical negligence, or careless mistakes by healthcare workers, can cause great harm. While some of it happens because of personal errors, many times it’s due to larger problems like lack of training, too many patients, or poor facilities. It’s unfair to only blame individuals when the system itself sets them up to fail. Corruption, such as bribery, favoritism, or overcharging, is perhaps the most damaging issue. It takes away resources from the people who really need them, adds to costs, and creates unfairness in how patients are treated. Together, these three problems form a dangerous loop that makes patients lose trust, healthcare workers feel unsafe or helpless, and the system less effective. Fixing them means going beyond small changes and we need a bigger shift in how we run and think about healthcare. The system must be built around fairness, honesty, and respect for both patients and medical staff.

A few suggestions for providing solutions for the existing research problem includes setting up fair and independent committees to look into complaints and making sure any investigation into medical negligence issues is honest and balanced. Medical students must not only be taught just science, but also communication and ethics. Providing regular workshops and learning sessions for doctors and nurses would be much helpful. And when it comes to fighting corruption, Usage of digital systems to manage money, equipment, and patient records to stop bribes or cheating will be a significant step. People who report wrong practices within hospitals must be given protection. And finally violence against healthcare workers should be handled effectively by setting up patient help centers to solve issues early and calmly before the situation goes beyond the control. Strong laws must be passed and the existing legal protections must be implemented properly and immediately.

Fixing these deep-rooted issues is not just about new rules or policies. It’s about changing the whole approach by bringing back trust, fairness, and care into the heart of medicine. With teamwork, honesty, and strong will, we can build a system that works better for everyone.

References :

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10898135/
2. https://www.researchgate.net/publication/319577229_VIOLENCE_AGAINST_HEALTH_CARE_WORKERS_A_RETROSPECTIVE_STUDY
3. https://nmji.in/workplace-violence-against-physicians-in-intensive-care-units-in-turkey-a-cross-sectional-study/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8156516/
5. https://ijirl.com/wp-content/uploads/2022/06/AN-ANALYSIS-OF-MEDICAL-NEGLIGENCE.pdf