Nurses strike at India’s top government hospital restrained by High Court

The nurses’ union at India’s iconic institution, the All India Institute of Medical Sciences, insists that arrears have been pending from as far back as 2006, while the hospital administration and government now say this claim is based on a misinterpretation

December 18, 2020 by Pavan Kulkarni

Nurses in India’s premier government hospital and medical college, All India Institute of Medical Sciences (AIIMS), New Delhi, were forced to call off their indefinite strike on Tuesday, December 15, following a restraining order by the High Court, a day after the labor action started.

The strike notice, served on November 13, put forth a list of 23 demands. These include the payment of what the AIIMS Nurses Union claims to be wage arrears dating as far back as 2006, restructuring of promotions system and a more accessible healthcare scheme for employees.

According to this notice, the indefinite strike was set to begin from December 16. However, on December 13, AIIMS issued a notification for walk-in-interview for recruiting nurses “on a contractual basis for a period of three months or till such time the alternative arrangements are made.” This notice was perceived by the union as an attempt to break the strike.

“So we had to embark on strike soon after we learnt about it,” Kishore, one of the striking nurses, told Peoples Dispatch. “Between 3 and 4 pm on December 14, nurses on evening shift downed tools and those on the night shift did not report to work.”

In a statement issued soon after the labor action began, Dr. Randeep Guleria, the director of AIIMS, said that “at this time when the country is going through a lot of hardships, when people are having to accept pay cuts and a loss of their jobs, the nurses union is asking for a pay hike.”

The union members feel such a claim is aimed at delegitimizing and misrepresenting their demands. This is not a demand that has been freshly raised by the union during the pandemic, but is an unresolved issue pending for more than a decade, argued a 32 year-old nurse, Rakesh, an executive member of the union, who has been working at AIIMS for 8 years.   

Arrears pending from as far back as 2006

According to the 6th Central Pay Commission (CPC) recommendations made in 2006, he explained, the basic pay (excluding allowances) of central government employees whose grade pay is Rs. 4,600 was fixed at Rs. 17,140. 

However, for some categories of workers on the same grade pay, including nurses, the basic pay was to be fixed at Rs. 18,460. Following this recommendation by 6th CPC, he adds, “some nurses of BHU [Banaras Hindu University] had approached the Central Administrative Tribunal [to seek its implementation] and earned a judgment in their favor.”

“But the recommendation of enhancing basic pay for nurses from Rs. 17,140 to Rs. 18,460 has never been actualized,” Rakesh said, reiterating that it is not a new pay hike but the payment of consequent arrears pending since 2006 that the nurses’ union is demanding. 

He recollects that for almost ten years, a number of communications were sent and meetings were held with the hospital administration and health ministry officials, in vain. Then, in 2016, the 7th CPC’s recommendations came into force. Nurses, who were already angry that the 6th CPC’s recommendations were not yet implemented, were further infuriated upon learning that the hikes recommended in 7th CPC were very low. 

“There were widespread agitations and protests by nurses all over the country, from down south to north. The AIIMS nurses union was under enormous pressure to participate in this agitation. But …instead of joining the country-wide agitations, they held an in-campus protest by taking a one-day mass casual leave,” Rakesh said. 

“At the time, the AIIMS authorities called the union for a meeting and promised to send a fresh request to the Health Ministry seeking a higher wage hike for the nurses in AIIMS, on the grounds that it is a premiere health institution. But literally nothing came of it,” he said.

Then, after three more years of futile requests, in October 2019, the AIIMS nurses went on a hunger strike for three days. Finding no satisfactory response, the union decided to march to the Health Ministry, whereupon the health minister met with the union and agreed to clear the arrears. 

A volte-face on interpretation

The authorities now claim that the union’s demand is based on a misinterpretation of the 6th CPC. In a recent meeting with the union, “the person who drafted the 6th CPC…was also present. And he explained to the nurses’ union that the interpretation is not correct,” AIIMS director said in his statement soon after the labor action began. He further added that the administration is willing to consider it “sympathetically” as a fresh demand.

Union members feel this is a volte-face. Rakesh believes that the judgement of the Central Administrative Tribunal was in effect a validation of this interpretation. He points out that it was in line with this interpretation that three of the roughly 5,000 nurses in AIIMS had their basic pay hiked to Rs. 18,460, and arrears cleared. 

Another 150 nurses in the Postgraduate Institute of Medical Education and Research in the city of Chandigarh have also received this hike, in addition to the pending arrears backdated to 2006, depending on their date of joining. 

Another 1,000 nurses in the same institute, he added, were enlisted for the hike, but before they could receive it, the government has now brought up this argument of misinterpretation, 14 years after the recommendations were first made.      

“Those nurses whose pay had been hiked has also been reversed to previous levels,” he added.

The Director also claimed that most of the remaining 22 demands have already been fulfilled. The union contests this claim. For five to six years now, the union has also been demanding a restructuring to facilitate timely promotions. 

Under-staffing due to slow promotions

“A fresh recruit in AIIMS is designated as a Nursing Officer. Only after 10 years does she get promoted to Senior Nursing Officer, and then to Assistant Nursing Superintendent after another 10 years, followed by Deputy Nursing Superintendent and then to Nursing superintendent and so on,” Rakesh explains.

Ten years is an unreasonably long time for one promotion, he maintains. As a result of this slow promotion rate, AIIMS has only one Chief Nursing Officer (CNO) for its roughly 5,000 nurses. This is a tenth of what is recommended by the Indian Nursing Council, which prescribes one CNO per 500 nurses. The union has suggested that restructuring of the promotion system should be in a way that realistically facilitates the maintenance of this ratio.

“Another crucial complaint that the nurses have been raising for at least two years is about the unequal access to on-campus facilities. “There are several canteens in the premises that are designated as doctor’s canteens. The 5,000 nurses who are working round the clock in AIIMS are not even allowed to go inside these canteens to have food,” Rakesh said. “There had even been altercations with security officials when the nurses tried to enter. The administration has taken no steps to resolve this matter.”

Also, some allowances specific to AIIMS, which is available only to doctors, must also be extended to the nurses, he insists. This, he said, is one of the main recommendations in the Prof. Kusum Verma Committee report. This report, “which is more than 20 years old, has not even been considered, let alone implemented,” complained the union’s strike notice.”

 Despite these unresolved long-standing grievances, the nurses had continued to serve on the frontline in the battle against this pandemic, facing challenges unprecedented in their service so far, Rakesh reiterated. 

“Under such circumstances, when the nurses’ union serves a strike notice, the administration and the government must understand that these are genuine grievances and should at least give the nurses a reliable assurance that these will be addressed in a reasonable time span. There was sufficient time to do that in order to prevent a strike,” Rakesh argued. “Instead, the hospital sought to recruit nurses on contract to break the strike, forcing us to prepone the action by two days.”

An ‘appeal’ backed by a threat

Once the action began, the director, in his appeal to the nurses to call off the strike, said, citing Florence Nightingale, that “a real nurse would never abandon her patients.” Many felt this comment, which implied these nurses were not ‘real’, was offensive. 

The director’s appeal was backed by a threat from Rajesh Bhushan, the Union Secretary under the Ministry of Health and Family Welfare. Citing a High Order from 2005, he argued that AIIMS employees are prohibited from engaging in a “cessation of work for any reason whatsoever or the aiding, or abetting of such disruption or cessation.”

He further warned that the strike “will be treated as offense under the Disaster Management Act read with the Indian Penal Code and action will be taken against defaulting authorities/employees.”

The following day, on December 15, almost all of the clinical nurses refused to work. While many stayed home, others headed to the administrative block to stage a peaceful protest.

“Here we found our way blocked by barricades and a force of AIIMS security personnel and Delhi police,” said Kishore. “When we pressed ahead, the police responded with a baton charge. In the chaos that ensued, one staff nurse got injured in her knee and she had to be rushed to Safdarjung hospital.”

“Around 5 that evening, we were informed that the AIIMS authorities had gone to the High Court, which had issued a restraining order against the strike. We were not even provided with a prior intimation, so we could not even represent ourselves in the court when the order was given,” he said. 

The hearing is scheduled for January 18, 2021, when the union hopes to present its case before the judge.