Full Judgment Text
Reportable
2024 INSC 613
IN THE SUPREME COURT OF INDIA
CRIMINAL ORIGINAL JURISDICTION
SMW (Crl) No 2 of 2024
IN RE: ALLEGED RAPE AND MURDER INCIDENT OF A TRAINEE
DOCTOR IN R.G. KAR MEDICAL COLLEGE AND
HOSPITAL, KOLKATA AND RELATED ISSUES Versus
Signature Not Verified
Digitally signed by
Sanjay Kumar
Date: 2024.08.20
14:38:56 IST
Reason:
Page 1 of 16
O R D E R
1. On 9 August, 2024, a thirty-one year old postgraduate doctor at RG Kar
Medical College Hospital, Kolkata who was on a thirty six hour duty shift
was murdered and allegedly raped inside the seminar room of the hospital.
As horrific details have emerged in the course of media reportage, the
brutality of the sexual assault and the nature of the crime have shocked
the conscience of the Nation. The name and graphic images of the
deceased have been widely circulated on social media without regard to
her privacy or dignity.
2. Writ petitions were instituted before the Calcutta High Court seeking
among other things , a court-monitored investigation of the crime and the
conduct of the hospital authorities, including the role of the Principal of the
medical college and other officials by a special team of investigating
officers. It has been alleged that the parents of the deceased were initially
informed that their daughter had committed suicide; they were permitted to
see the dead body after several hours and a first information report in
regard to the murder was registered belatedly by the police after several
hours.
3. By its order dated 13 August 2024, the High Court transferred the
investigation to the Central Bureau of Investigation.
4. Following the incident, agitations and protests were called by doctors’
associations, student bodies and civic groups across the country. On the
eve of Independence Day, several areas in Kolkata saw protests spurred
by the ‘Reclaim the Night’ campaign. At 12.30 am on 15 August, when a
Page 2 of 16
protest was underway at the hospital, a large mob assembled at the
premises of the RG Kar Medical College Hospital and vandalized the
Emergency Ward and other departments of the hospital. Following the acts
of wanton destruction and vandalism, the Indian Medical Association (a
private and voluntary organization of doctors in India) called for a nation-
wide withdrawal of medical services, except emergency services, for
twenty-four hours on 17 August 2024.
5. In the aftermath of the brutal incident and the demonstrations which
followed, the State Government was expected to ensure the deployment of
the state machinery to prevent a breach of law and order. It was all the
more necessary to do so since investigation of the crime which took place
in the precincts of the hospital was under way. We are unable to
comprehend how the State was not prepared to deal with the incident of
vandalization of the premises of the hospital.
6. Nation-wide protests following the brutal incident in RG Kar Medical
College Hospital have brought the issue of the lack of institutional safety
for doctors to the forefront. Medical Associations have consistently raised
issues of the lack of workplace safety in health care institutions. Medical
professionals in the performance of their duties have been unfortunate
targets of various forms of violence. Hospitals and medical care facilities
are open throughout the day and night. Medical professionals - doctors,
nurses and paramedic staff - work round the clock. Unrestricted access to
every part of healthcare institutions has made healthcare professionals
susceptible to violence. Patients of relatives in anguish are quick to
attribute untoward results to the negligence of medical professionals. Such
Page 3 of 16
allegations are immediately followed by violence against medical
professionals. In May 2024, two on-duty doctors were allegedly attacked
by relatives of a patient who died during treatment in a hospital in West-
1
Bengal. In another incident in May 2024 in Bihar, following the death of a
twenty-five year old pregnant patient, a nurse was allegedly pushed off the
2
first floor of the building by the kin of the patient. In August 2024, a final
year resident in a hospital in Hyderabad was allegedly assaulted by a
3
patient’s attendants after the patient died due to medical conditions.
These incidents of violence are a few amongst the many that have been
unleashed against members of the medical community in the recent past.
They are portents of a systemic failure to protect doctors, nurses and para
medical staff in the confines of hospitals. With few or no protective systems
to ensure their safety, medical professionals have become vulnerable to
violence. With the involvement of systemic issues for healthcare across the
nation, this court has had to intervene.
7. Women are at particular risk of sexual and non-sexual violence in these
settings. Due to ingrained patriarchal attitudes and biases, relatives of
patients are more likely to challenge women medical professionals. In
addition to this, female medical professionals also face different forms of
sexual violence at the workplace by colleagues, seniors and persons in
authority. Sexual violence has had its origins even within the institution, the
case of Aruna Shanbag being a case in point. There is a hierarchy within
1
https://medicaldialogues.in/news/health/doctors/mob-attack-2-surgeons-brutally-attacked-after-
patient-death-admitted-in-icu-128063
2
https://timesofindia.indiatimes.com/india/pregnant-womans-death-sparks-violence-by-kin-nurse-
thrown-off-1st-floor-of-bihar-nursing-home/articleshow/110475737.cms
3
https://indianexpress.com/article/cities/hyderabad/hyderabad-doctor-attacked-in-hospital-by-
attendants-after-patient-dies-8604280/
Page 4 of 16
medical colleges and the career advancement and academic degrees of
young professionals are capable of being affected by those in the upper
echelons. 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 realizing
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. As more and more women join
the work force in cutting edge areas of knowledge and science, the nation
has a vital stake in ensuring safe and dignified conditions of work. The
constitutional value of equality demands nothing else and will not brook
compromises on the health, well being and safety of those who provide
health care to others. The nation cannot await a rape or murder for real
changes on the ground.
Page 5 of 16
4 5 6 7
8. Several States, such as Maharashtra , Kerala , Karnataka , Telangana ,
8 9 10
West Bengal , Andhra Pradesh and Tamil Nadu have enacted legislation
to protect healthcare service professionals from violence and damage to
property. All these enactments prohibit any act of violence against medical
professionals. The offence is non-bailable and punishable with three years
of imprisonment. However, these enactments 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.
9. We have attempted to flag here the ground reality indicating the lack of
institutional safety standards in health care establishments. A non-
exhaustive formulation is set out below:
a. Medical professionals who are posted for night-duties are not
provided adequate resting spaces. More often, doctors rest in the
patients’ room or in available public spaces. Duty rooms are scant.
Separate duty rooms for male and female medical professionals are
conspicuous by their absence in most health care establishments;
4
See Maharashtra Medicare Service Persons and Medicare Service Institutions (Prevention of violence
and damage or loss to property) Act 2010
5
See Kerala Healthcare Service Persons and Healthcare Service Institutions (Prevention of Violence and
Damage to property) Act 2012
6
See The Karnataka Prohibition of Violence Against Medicare Service Personnel and Damage to Property
in Medicare Service Institutions Act 2009
7
See Telangana Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and
Damage to Property) Act 2008
8
See West Bengal Medicare Service Persons and Medicare Service Institutions (Prevention of Violence
and Damage to Property) Act 2009
9
See Andhra Pradesh Medicare Service Persons and Medicare Service Institutions (Prevention of
Violence and Damage to Property) Act 2008
10
See Tamil Nadu Medicare Service Persons and Medicare Service Institutions (Prevention of Violence
and Damage or Loss to Property) Act 2008
Page 6 of 16
b. 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 health care professionals from questioning
the absence of facilities for basic well-being;
c. 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 attenders. Open access to healthcare facilities leaves
medical professionals vulnerable to undesirable elements;
d. Medical care facilities do not have sufficient toilet. Most often there
is only one common toilet for medical professionals in one
department;
e. 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;
f. 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;
Page 7 of 16
g. The patients and their attenders have unrestricted access to all
places within the hospital, including Intensive Care Units and the
doctors resting rooms;
h. Lack of screening for arms and weapons at the entrance of the
hospitals;
i. Dingy and ill-lit places within the hospitals;
j. 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; and
k. Certain spaces within hospitals such as the Intensive Care Unit and
the Emergency Wards are prone to a greater risk of violence
because of the severity of medical conditions of patients in these
departments.
10. We have in this backdrop formed the view that a national consensus must
be evolved - after due consultation with all stake-holders - on the urgent
need to formulate protocols governing the issues which this order has
highlighted. We have attempted to compose for this purpose a diverse
body of persons with experience in healthcare institutions. A National Task
Force (NTF) with the following members of the medical profession is
constituted:
a. Surgeon Vice Admiral Arti Sarin, AVSM, VSM, Director General,
Medical Services (Navy);
b. Dr D Nageshwar Reddy, Chairman and Managing Director, Asian
Institute of Gastroenterology and AIG Hospitals, Hyderabad;
Page 8 of 16
c. Dr M Srinivas, Director, All India Institute of Medical Sciences
(AIIMS), Delhi;
d. Dr Pratima Murthy, Director, National Institute of Mental Health and
Neurosciences (NIMHANS), Bengaluru;
e. Dr Goverdhan Dutt Puri, Executive Director, All India Institute of
Medical Sciences, Jodhpur;
f. 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;
g. Professor Anita Saxena, Vice-Chancellor, Pandit B D Sharma
Medical University, Rohtak. Formerly Dean of Academics, Chief-
Cardiothoracic Centre and Head Cardiology Department at All India
Institute of Medical Sciences (AIIMS), Delhi;
h. Dr Pallavi Saple, Dean, Grant Medical College and Sir JJ Group of
Hospitals, Mumbai; and
i. Dr Padma Srivastava, formerly Professor at the Department of
Neurology, AIIMS Delhi. Currently serving as the Chairperson of
Neurology at Paras Health Gurugram.
Page 9 of 16
11. The following shall be the ex-officio members of the NTF:
a. Cabinet Secretary, Government of India;
b. Home Secretary, Government of India;
c. Secretary, Ministry of Health and Family Welfare, Government of
India;
d. Chairperson, National Medical Commission; and
e. President, National Board of Examinations.
12. The NTF shall formulate effective recommendations to remedy the issues
of concern pertaining to safety, working conditions and well-being of
medical professionals and other cognate matters highlighted in the above
segments of this order. The NTF shall while doing so, consider the
following aspects to prepare an action-plan. The action plan may be
categorized under two heads (I) Preventing violence, including gender-
based violence against medical professionals; and (II) Providing an
enforceable national protocol for dignified and safe working conditions for
interns, residents, senior residents, doctors, nurses and all medical
professionals.
I. Prevention of violence against medical professionals and providing
safe working conditions
a. Ensuring due security in medical establishments:
i. Triaging departments and places within the hospital based on
the degree of volatility and the possibility of violence. Areas
such as the emergency rooms and the Intensive Care Units
are prone to a greater degree of violence and may possibly
need additional security in place to deal with any untoward
incident;
Page 10 of 16
ii. A baggage and person screening system at every entrance of
the hospital to ensure that arms are not carried inside the
medical establishment;
iii. Preventing intoxicated persons from entering the premises of
the medical establishment, unless they are patients; and
iv. Training security personnel employed at Hospitals to manage
crowds and grieving persons.
b. Infrastructural development:
i. Provision of separate resting rooms and duty rooms in each
Department for (a) male doctors; (b) female doctors; (c) male
nurses; (d) female nurses; and (e) a gender-neutral common
resting space. The room must be well-ventilated, have
sufficient bed spaces, and provide a facility for drinking water.
Access to these rooms must be restricted through installation
of security devices;
ii. Adopting appropriate technological intervention to regulate
access to critical and sensitive areas including through use of
bio-metric and facial recognition;
iii. Ensuring adequate lighting at all places in the hospital and, if
it is a hospital attached to a medical college, all places within
the campus;
iv. Installation of CCTV cameras at all the entrance and exit
points of the hospitals, and the corridors leading up to all
patient rooms; and
Page 11 of 16
v. If the hostels or rooms of the medical professionals are away
from the hospital, provision of transport between 10 pm to 6
am to those who wish to travel to or from their place of stay to
the Hospital.
c. Employment of social workers trained in grief and crisis counselling
at all medical establishments;
d. Conducting workshops for all employees of medical establishments
including doctors, nurses and helpers on handling grief and crisis;
e. Constitution of “Employees Safety Committees” composed of
doctors, interns, residents and nurses at every medical
establishment to conduct quarterly audits on institutional safety
measures;
f. Including additional requirement(s) on institutional safety measures
for medical professionals as a criteria for accreditation of healthcare
establishments by the National Accreditation Board for Hospitals &
Healthcare Providers; and
g. The possibility of establishing police posts in medical facilities
commensurate with the footfall, bed strength and facilities.
II. Prevention of sexual violence against medical professionals:
a. The Sexual Harassment of Women at Workplace (Prevention,
Prohibition and Redressal) Act 2013 applies to hospitals and nursing
11 12
homes (including private health providers ). In terms of the
11
See Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act 2013;
Section 2(o)(iii)
12
See Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act 2013;
Section 2(o)(ii)
Page 12 of 16
provisions of the Act, an Internal Complaints Committee must be
constituted in all hospitals and nursing homes;
b. The duties of an employer listed under Section 19 of the Sexual
Harassment of Women at Workplace (Prevention, Prohibition and
Redressal) Act 2013 which includes organizing sensitization
programmes and providing a safe working space must be discharged;
and
c. Ensuring for every medical institution a helpline number for medical
professionals which is open 24 x 7 and emergency distress facilities.
13. It is clarified that the phrase medical professionals used in this judgment
encompasses every medical professional including doctors, medical
students who are undergoing their compulsory rotating medical internship
(CRMI) as a part of the MBBS course, resident doctors and senior resident
doctors and nurses (including those who are nursing interns). The phrases
Medical Establishments/Hospitals/Medical Institutions are interchangeably
used.
14. The NTF shall be at liberty to make recommendations on all aspects of the
action-plan highlighted above and any other aspects which the members
seek to cover. They are at liberty to make additional suggestions, where
appropriate. The NTF shall also suggest appropriate timelines by which
the recommendations could be implemented based on the existing
facilities in Hospitals. The NTF is requested to consult all stake-holders.
Bearing in mind the gravity and urgency of the situation we have included
the heads of the National Medical Commission and the National Board of
Page 13 of 16
Examinations as Ex-officio members of the NTF. Bearing in mind the
national concerns which have been raised over the issue and the high
priority which must be given to the creation of safe working conditions in
healthcare institutions, we request the Cabinet Secretary to the Union
Government to associate with the work of the NTF. The Home Secretary of
the Union Government has also been made a member of the NTF in order
to facilitate proper co-ordination with the State Governments. The
Secretary to the Ministry of Health and Family Welfare of the Government
of India will be the Member-Secretary of the NTF. The Ministry of Health
and Family Welfare will provide all logistical support including making
arrangements for travel, stay and secretarial assistance and bear the
expenses of the members of the NTF.
15. The NTF is requested to submit an interim report within three weeks and
the final report within two months from the date of this order.
16. All State Governments and UT Governments, through their Secretaries, in
the Ministries of Health and Family Welfare and the Central Government,
through the Secretary, Union Ministry of Health and Family Welfare must
collate information from all hospitals run by the State and the Central
Government, respectively on the following aspects:
a. How many security personnel are employed at each Hospital and
each department;
b. Whether there is a baggage and person screening mechanism in
place at the entrance of the medical establishment;
Page 14 of 16
c. The total number of resting/duty rooms in the Hospital and specific
details of the number in each Department;
d. The facilities provided in the resting/duty rooms;
e. Information on whether all areas of the hospital are accessible to the
general public and if so, with or without any security restrictions;
f. Whether there are CCTV cameras in the hospital. If there are, how
many and in which locations;
g. Whether the institution provides medical professionals training to
appropriately handle the grief of patients. If so, the details of the
training must be provided;
h. Whether social workers who specialize in handling grief of families of
the patients are employed at the hospital. If so, the total number of
social workers must be provided;
i. Whether there are police posts within the premises of the Hospital or
the Medical College Hospital campus;
j. Whether an Internal Complaints Committee in terms of the Sexual
Harassment of Women at Workplace (Prevention, Prohibition and
Redressal) Act 2013 has been constituted; and
k. 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.
The data as submitted shall be tabulated and filed with an affidavit by the Union
Government within one month of this order.
Page 15 of 16
17. The Central Bureau of Investigation shall submit a status report to this
Court by 22 August 2024 on the progress in the investigation of the crime
at RG Kar Medical College Hospital. The State of West Bengal shall also
file a status report by 22 August 2024 on the progress of the investigation
on the acts of vandalism which took place at the Hospital in the aftermath
of the incident.
18. The matter shall be listed on 22 August 2024.
..….…….……………………………………CJI
[Dr Dhananjaya Y Chandrachud]
…….……………………………………………J
[J B Pardiwala]
…….……………………………………………J
[Manoj Misra]
New Delhi;
August 20, 2024
Page 16 of 16