Ministry of health and family welfare, Government of India sent consolidated instructions to all states

Ministry of health and family welfare, Government of India sent consolidated instructions to all states and UT administration vide letter number S-11014 /3/91 ME§ regarding implementation of Uniform Central Residency Scheme after the directives of the Supreme Court in its judgment dt. 25.9.87 in writ petition No. 348-352 of 1985, The instruction No.13 of this letter ‘Hours of Work’ it is mentioned that
“Continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time. The junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch subject to the condition that the working hours will be flexible as may be decided by the Medical Superintendents concerned keeping in view the workload and availability of doctors for clinical work.”
As we see, here total weekly hours of work (48 hrs/week) as well as the maximum hours in single stretch (12 hours) are clearly defined. Of course the authorities may remind us the flexibility given in above instruction. However
We would like to state the following.
a) Any flexibility given by law or constitution should only be used as a special measure and must not be used as ROUTINE. Today Medical colleges in India are forcing Junior doctors to work continuous 24 Hrs (!) and this is being practised routinely for last many years.
b) That flexibility is given for ‘Working hours’ & not for hours of work that is, while authorities are free to post any doctor in day or night or in holidays, they must stick to the norms of “hours of work” that is Maximum 48 hours in a week and 12 hours Finally even if the total no. of doctors posted (when all posts are filled) are not able to cope with work load under normal working-hours-limit then the no. of post must be increased. In no case junior doctors to be forced to work more than what is permitted by law and various recommendations. in a single stretch.
The International Labour Organization, Geneva (India being the member of the same) as early as in 1962 in its recommendation No.116 concerning Reduction of hours of work in its General principle No. 4 states as
PRINCIPLE 4: Normal hours of works should be progressively reduced, when appropriate with a view to attaining the social standard indicated in the Preamble of this recommendation without reduction in the wages of the workers as at the time hours of work are reduced.
PRINCIPLE 6 states as - Where normal weekly hours of work are EITHER FORTY EIGHT OR LESS, MEASURES FOR THE PROGRESSIVE REDUCTION OF HOURS OF WORK in accordance with paragraph-4 should be worked out and implemented in a manner suited to the particular national circumstances and the conditions in EACH sector of economic activity.
*Further in Determination of Hours of works 12(1) it states: The calculation of normal hours of work as on average over a period longer than one week should be permitted when special conditions in certain branches of activity or technical needs justify it.
Recently ILO in its Night Work Recommendation 1990 (No. 178) states that “the normal hours of work of night workers should generally be less on average than those of workers performing the same work to the same requirements by day.”
Considering that today in India in 5 days week most of the office workers perform a 42-43 hours/week and the maximum limit is set as 48 hours/week for all including the health sector, the total hours of work of doctor (especially Junior doctors , interns) per week must be less than this (i.e. 48 hours/week) as they perform most (all) of the night duties.
Further in this recommendation it is clearly stated that IN NO CASE should two consecutive full time shifts be performed, except in cases of FORCE MAJEURE (The allowed hours of shift in a single stretch is MAXIMUM 12 hours) & In No case further extension of this limit (12 hours) should be done. Presently, we Junior doctors are forced to work continuous 24 Hours (!) in a single stretch. In many departments weekly hours (Normal average) are 65-80 hrs/week & it crosses even 100(!)Hrs/week.
Further it states that at least 11 hours of rest period should be granted between two shifts (One must remember, shift are of Maximum 12 hours) as far as possible.
Presently Resident doctors (Post graduate students in Medical colleges) in India are forced to work 85-105 hrs/week in most of the clinical departments without the protection of any service rules because they are students. This is done under the instruction of the Head of the Departments concerned. Junior doctors pursuing their post graduation course, whose final assessment are in hands of these authorities, i.e. HODs. Therefore no one normally risks their career. This way exploitation of this floating population of junior doctors goes on and on the other hand patients suffer routinely and many times even die due to this forced negligence. While stretching duty hours our learned authorities simply forget the proven fact that errors and accidents increases sharply (An exponential graph) in mental and physical work, when duty hours are stretched beyond 10-12 hours continuous duty.
As the graph of errors and accidents increases steeply this 100% increase (24 hrs continuous duty in place of 12 hours maximum limit) in duty hours is sufficiently enough to do BLUNDERS AND ENDANGER human life.
“A doctor at his 20th-24th hour of continuous duty in Emergency ward, if not able to provide proper care to the patient for whom even a single minute can prove life saving or Fatal. This way if patients suffer than who will be HELD RESPONSIBLE, the Doctor on duty or the HOD or DME or the Govt.?”
Because doctor is performing unofficial extended hours, and he/she has the reason to state that doctor was not in his/her proper mental and physical condition due to chronic sleep deprivation and exhaustion. In fact this extended hour coincides with the mid night and early morning time, when all those patients who come to casualty irrespective of there diagnosis, feel that if
they will delay till morning it may be harmful/fatal to them and most of the times indeed these emergencies are life threatening. With great hope in mid night when they visit hospital for proper care, they find a drowsy, tired, exhausted doctor, who is not even able to examine properly. The general impression becomes that doctor has neglected him, where as patient hardly knows doctor’s real condition. After all patients do deserve the proper and efficient care, especially when there is no scarcity of doctors and this duty regime is artificially motivated. The finding of Justice Ranganath Mishra, former National Human Rights Commission, about delay and negligence in treatment of accident victims, are actually related with this illegal duty hour practice. Under growing public demands for health quality services the question which involves life of human beings, cannot be left unanswered.
After approximately eighteen hours of work Doctors have got the equivalent psychomotor dysfunction as having a blood alcohol level of .05. So not only at .05 you’re not allowed to drive but at the equivalent level of psychomotor dysfunction you’re allowed to look after patients. And by the time you’ve worked for twenty-four hours you’ve got the equivalent of having a blood-alcohol level of .1 and that’s just ridiculous.
In most of the countries there is a limitation on extra hours, the average over month or quarterly it must be with in norms, which varies 40 to 48 hours per week in different countries. In most of the states in India no duty hour’s norm exists. Most hospital authorities do not even bother how many hours a junior doctor has worked, and so it increases up to inhumane levels as high as 103 hours in a week.
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There is a law in place to regulate the working hours of resident doctors in India. Unfortunately, it isn’t followed anywhere.

The ministry of health and family welfare, Government of India had sent consolidated instructions to all states and union territories vide letter number S-11014/3/91 ME§ regarding implementation of Uniform Central Residency Scheme after the directives of the Supreme Court in its judgment dt. 25.9.87 in writ petition No. 348-352 of 1985,

With respect to working hours, the directive is:

“Continuous active duty for resident doctors will not normally exceed 12 hours per day. Subject to exigencies of work the resident doctors will be allowed one weekly holiday by rotation. The resident doctors will also require to be on call duty not exceeding 12 hours at a time. The junior Residents should ordinarily work for 48 hours per week and not more than 12 hours at a stretch subject to the condition that the working hours will be flexible as may be decided by the Medical Superintendents concerned keeping in view the workload and availability of doctors for clinical work.”

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