T’puram: More than two years after the killing of young house surgeon, Vandana Das, inside the casualty of Kottarakkara taluk hospital triggered statewide protests by doctors and subsequent assurance of stronger hospital safety, official data show that Kerala’s response to hospital violence resulted in a partial expansion of security infrastructure alongside far weaker evidence of how the emergency response system meant to deal with violence is actually being used.Govt figures on hospitals under the directorate of health services indicate that CCTV cameras, security staff and public address systems were rolled out widely, particularly in major general and district hospitals. In contrast, the operational core of the Code Grey protocol — which outlines pre-emptive actions to ensure hospital, staff and patient safety, as well as procedures for security, reporting and follow-up in the event of a breach — remains patchy, especially outside urban centres. Code Grey protocol envisages enhanced hospital security and institutionalised emergency response systems.Across districts, major hospitals now report substantial CCTV coverage. Ernakulam general hospital tops the list with 130 cameras, followed by Kozhikode mental health centre (104), Sultan Bathery taluk HQ hospital (92), Punalur taluk hospital (82) and Kannur district hospital (70). Several other hospitals in Thrissur, Palakkad, Malappuram and Kottayam also report 40-60 camera counts, indicating a clear post-2023 investment push.However, the data also reveal sharp contrasts. At the other end of the spectrum are hospitals functioning with little or no surveillance. Thodupuzha district hospital, taluk hospitals at Irikkur and Nileshwar and Malayankeezhu THQH have no CCTV cameras while Nooranad leprosy sanatorium has just one. These gaps persist even as the same hospitals continue to provide round-the-clock emergency services.The presence of cameras has not automatically translated into monitoring capacity. A recurring feature across districts is the absence of designated command centres. In Thiruvananthapuram, only the general hospital reports a functioning command centre, despite multiple taluk and specialty hospitals listing between 10 and 40 cameras each. Similar patterns appear in Kollam, Kannur, Idukki and Ernakulam’s peripheral hospitals where surveillance exists but is not backed by a central control room to coordinate responses during emergencies.Written preparedness under Code Grey also remains uneven. While hospitals in parts of Thrissur, Palakkad and Alappuzha report completed protocols and use of plan funds for walkie-talkies, alarms and communication systems, many others mark the protocol as “partial,” “ongoing” or “not prepared.” In several cases, funds were received but not fully utilised, or equipment was installed without corresponding procedural clarity.District-wise contrasts are stark. Alappuzha emerges as one of the more consistent districts on paper, with most major hospitals showing CCTV coverage, command centres and security staff funded through hospital management committees. In contrast, hill districts such as Idukki and Wayanad show incomplete protocols, missing command centres and limited use of Code Grey funds, despite some hospitals reporting significant camera coverage. Kannur presents another imbalance: Strong investment in cameras and security, but widespread absence of command centres and incomplete protocol adoption.Doctors’ organisations say these gaps reflect deeper implementation issues. “More than two years after Code Grey was announced, its implementation remains incomplete, with compliance at around 60%,” said Kerala Govt Medical Officers’ Association general secretary Jobin G Joseph. “One of the biggest gaps is in security deployment. Under the protocol, security personnel are supposed to be ex-servicemen below the age of 60, but in many hospitals guards are either above 60 or not ex-servicemen at all.“He said the protocol was implemented largely on paper, but not in the manner envisaged. “We held protests in Nov and Jan and temporarily withdrew them based on assurances given by the govt,” Joseph said.He said the casualty department remains the epicentre of hospital violence, with overcrowding acting as the main trigger. Doctors demanded structured triaging in casualty into red, yellow, green and black categories, in descending order of urgency and the deployment of two doctors during peak hours to manage patient load. “The govt assured us these measures will be implemented at the earliest. If the assurances are not implemented immediately, we will be forced to resume the strike,” he said.The govt data also highlight the limited documented use of the protocol. Across the overwhelming majority of hospitals, the number of Code Grey events reported since April is either zero or marked as “not reported.” Only a few institutions break this pattern. Pala general hospital reports four activations, Ernakulam general hospital reports three, Nedumkandom district hospital reports two while GH Alappuzha, DH Mavelikkara, THQH Mallappally, TH Thamarassery and TH Bedadka report one or two each. Against over 140 hospital entries in govt records, these isolated entries underline how rarely the protocol is formally logged.
