Crimes of Violence Against Healthcare Workers and Legal Remedies

What is violence against healthcare workers?

Violence against healthcare workers is defined as physical assault, threats, insults, psychological pressure, harassment, resistance to performing duties, or other unlawful conduct that compromises workplace safety, occurring during or because of the provision of healthcare services or the nature of their duties. This violence can occur against doctors, nurses, midwives, paramedics, emergency medical technicians, caregivers, security guards, medical secretaries, laboratory technicians, radiology technicians, ambulance personnel, or other staff working in a healthcare institution.

Violence in healthcare is not simply a physical altercation targeting one person. An attack on a healthcare worker also disrupts the safe delivery of public healthcare services, other patients' access to treatment, and the smooth functioning of the hospital. Therefore, Turkish law includes specific regulations regarding certain crimes committed against healthcare workers.

Article 12 of the Additional Provisions of the Basic Law on Health Services No. 3359 stipulates that in cases of intentional injury, threat, insult, and resistance to performing duties committed against healthcare personnel and auxiliary healthcare personnel working in public or private health institutions and organizations due to their duties, the punishment shall be increased by half, and the provisions for the suspension of imprisonment under Article 51 of the Turkish Penal Code shall not apply to these crimes; the Constitutional Court has also ruled that these regulations are not unconstitutional.

What actions against healthcare workers constitute a crime?

Violence against healthcare workers can constitute different types of crimes depending on the specific behavior. The most common crimes are intentional injury, threats, insults, and resistance to performing duties. Hospital information provided by the Ministry of Health also defines injury, threats, and insults suffered by healthcare workers while performing their duties as falling under the scope of violence in healthcare.

Intentional bodily harmarises from actions such as hitting, pushing, kicking, punching, strangling, pulling hair, throwing objects at, assaulting, or attacking a healthcare worker in a way that causes physical pain. There is a significant difference in the severity of the punishment depending on whether the injury is treatable with simple medical intervention or results in a bone fracture, permanent facial scarring, loss of organ function, or life-threatening injuries.

Threatscan occur when a healthcare worker is told things like, "I'll kill you," "You'll see what happens when you get out of the hospital," "I'll find your family," or "I'll tear this place down." The severity of the incident increases if the threat is made with a weapon, by multiple people, in an organized manner, or with the intention of preventing the healthcare worker from performing their duties.

Insultis defined as words, writings, messages, social media posts, or face-to-face statements that damage the honor, dignity, and reputation of a healthcare professional. This includes insulting doctors, nurses, or other healthcare personnel because of their work, using derogatory language, and making serious accusations targeting their professional reputation.

Resisting the performance of dutyis the use of force or threat to prevent a healthcare worker or public official from carrying out their duties. Forcing staff to disrupt the waiting line in an emergency room, obstructing a healthcare worker from providing treatment, or resisting a security or law enforcement officer are also considered separate offenses under this crime.

Increased Penalties for Violence Against Healthcare Workers

The most important special regulation regarding crimes committed against healthcare workers is Article 12 of the Annex to Law No. 3359 on Basic Health Services. According to this article, in cases of intentional injury (Article 86), threat (Article 106), insult (Article 125), and resistance to performing duties (Article 265) committed against healthcare personnel and auxiliary healthcare personnel working in public or private healthcare institutions due to their duties, the penalties determined according to the relevant articles of the Turkish Penal Code (TCK) are increased by half. Furthermore, provisions for the suspension of imprisonment do not apply to these crimes.

The aim of this regulation is to specifically protect healthcare workers. This is because healthcare workers often work under high stress in emergency rooms, intensive care units, outpatient clinics, ambulances, family health centers, or hospital wards, and are in direct contact with patients and their relatives. Normalizing violence affects not only the victimized healthcare worker but the entire healthcare system.

For example, if a doctor is assaulted by a patient's relative in the emergency room, the incident is not simply considered a minor injury. If the attack occurred while the doctor was providing healthcare services or because of their duties, the special aggravating provisions of Law No. 3359 come into play. Similarly, if a nurse is insulted because of their duties, or paramedics are threatened to prevent intervention, the provisions regarding violence in healthcare can be applied.

Are Private Hospital Employees Also Protected?

Yes. Regulations on violence in healthcare do not only cover personnel working in state hospitals or public institutions. Article 12 of the Annex to Law No. 3359 stipulates that personnel working in private healthcare institutions and organizations shall be considered public officials in the application of the Turkish Penal Code with regard to crimes committed against them in connection with their duties.

This regulation is very important because doctors, nurses, midwives, health technicians, or support staff working in private hospitals also perform an activity that serves the public interest while providing healthcare services. Therefore, attacks committed against healthcare workers employed in private hospitals due to their duties are also under special protection within the scope of criminal law.

For example, if a patient's relative threatens a nurse in a private hospital's emergency room with "I won't let you live here," or if a doctor is insulted at a private medical center or a private ambulance crew member is assaulted, the perpetrator cannot escape responsibility by claiming "this is a private hospital, you're not a public official.".

Arrest and Detention in Cases of Intentional Injury

There is also a specific provision regarding arrest for the crime of intentional injury against healthcare workers. According to Article 12 of the Additional Provisions of Law No. 3359, the crime of intentional injury committed against personnel working in healthcare institutions and organizations during or because of their duties is among the crimes for which arrest is presumed under Article 100/3 of the Code of Criminal Procedure.

According to the same article, individuals suspected of intentionally committing crimes against personnel working in healthcare institutions due to their duties are apprehended by law enforcement officers, the necessary procedures are carried out, and they are referred to the Public Prosecutor's Office. Furthermore, in the investigation of these crimes, the statements of healthcare personnel who are complainants, victims, or witnesses are taken at their workplaces; this practice also applies to crimes committed against personnel working in private healthcare institutions due to their duties.

This provision aims to prevent healthcare workers from having to go from police station to police station after an incident. Taking the statement of a healthcare worker who has been subjected to violence at their workplace is important for both the victim's work routine and psychological safety. If a physical assault has occurred, the perpetrator should be apprehended, referred to the judicial authorities, a forensic report should be obtained, and camera recordings should be preserved immediately.

What is Code White?

The White Code is a system established to report, record, and forward incidents of violence against healthcare workers in healthcare institutions to the relevant units and to follow up on the legal process. According to Ministry of Health sources, the White Code was created to monitor, intervene in, and forward incidents of violence occurring in all public and private healthcare institutions and organizations to the judicial authorities, and to take preventive measures through incident analysis.

In hospital settings, a White Code is typically 1111. The goal of this call is for security personnel to quickly arrive at the scene, neutralize the assailant, take them to the police station, and document the incident. Some hospital guidelines emphasize the need for security personnel to arrive at the scene promptly and to complete a White Code Incident Reporting Form.

Healthcare workers can also call the 113 White Code hotline, which operates 24/7 , or report the incident through the Ministry's White Code system. According to Ministry of Health sources, incidents of violence should be reported to the White Code Unit by institution managers via the 113 number, and simultaneously forwarded to the legal unit and judicial authorities; healthcare workers can also call 113 directly.

What should a healthcare worker do when they are subjected to violence?

When a healthcare worker is subjected to physical or verbal violence, the first step is to ensure their safety. If the incident continues, a White Code should be issued. Within the hospital, 1111 should be called, security and administration should be informed, and the incident should be immediately documented. The healthcare worker or institution manager should also report the incident to the 113 White Code hotline.

The second step is to prepare an incident report. This report should detail the date, time, and location of the incident, the perpetrator's identity or description, statements made, actions taken, how the attack occurred, the names of witnesses, information about the camera area, and any physical injuries sustained. Hospital reports under the Ministry of Health emphasize that the incident report must include the date and time, perpetrator information, the sequence of events, details of the attack, and the names and signatures of witnesses.

The third step is obtaining a forensic report. If there has been a physical assault, a medical report documenting the assault is absolutely necessary. Even if the injury appears minor, pain, bruising, scratches, swelling, cuts, fingernail marks, hair pulling, falls resulting from pushing, or psychological effects must be documented in the report. Even if the healthcare professional is a physician themselves, they must document their own injuries with a forensic report independent of the case file.

The fourth step is the preservation of evidence. Camera recordings, security reports, patient record system, phone messages, social media posts, WhatsApp conversations, voice recordings, call center records, witness statements, and incident report forms should be preserved. It is especially important to submit a written request to the hospital administration to prevent the deletion of camera recordings.

Is a complaint necessary?

Many crimes committed against healthcare workers in the performance of their duties are investigated ex officio because they concern public order. It is clearly stated in Ministry of Health sources that the prosecution of crimes committed during and because of public duty is not dependent on a complaint; it is a legal requirement for administrators to refer the matter to the judicial authorities even if the victim does not file a complaint.

This does not mean that a healthcare worker's complaint is unimportant. It is important for the victimized healthcare worker to explicitly state their intention to complain, request to participate in the case, present evidence, express their willingness to reach a settlement, and reserve their right to compensation. Especially in cases involving insults and threats, the exact words spoken must be recorded in the minutes.

Institution managers cannot close the case by saying, "the staff did not complain." In cases of violence in healthcare, reporting, legal proceedings, and internal record-keeping mechanisms must be implemented together. This is important both for addressing individual victimization and for preventing future incidents of violence within the same institution.

Does a Code White Application Replace a Criminal Case?

A White Code notification is an important mechanism that initiates or facilitates the legal process; however, it is not always sufficient on its own. Even if a White Code notification has been made, it is still necessary to file a criminal complaint with the Public Prosecutor's Office, obtain a forensic report, present evidence, and follow the process as a complainant/participating party.

The White Code system ensures that the incident is recorded in the Ministry and institutional records. Upon notification, it is investigated whether the incident has been referred to the judicial authorities, and the relevant legal units are informed. The Legal Aid Regulation stipulates that the Ministry will establish a system for reporting and recording acts committed against personnel during or as a result of providing healthcare services; that the relevant manager will report these acts to the judicial authorities and the Ministry's system; and that the victimized personnel can also make reports.

Therefore, the most practical approach is as follows: a "White Code" should be issued, an incident report should be prepared, a forensic report should be obtained, the prosecutor's office or hospital police should initiate the process, camera and witness evidence should be secured, and the victimized healthcare worker should also separately request legal assistance.

Legal Assistance for Healthcare Professionals

There is a specific regulation regarding legal assistance for crimes committed against Ministry of Health personnel. The purpose of this regulation is to determine the procedures and principles for legal assistance to be provided by the Ministry of Health and its affiliated institutions, upon the request of personnel or their legal heirs, in cases of crimes committed against personnel during the provision of health services or due to their duties within the Ministry of Health and its affiliated institutions.

Within the scope of legal assistance, the relevant legal unit contacts the victimized personnel, monitors whether the incident has been referred to the judicial authorities, collects necessary information and documents, follows the criminal investigation and prosecution, appeals against decisions of non-prosecution when necessary, and stands by the victimized healthcare worker throughout the litigation process. The Ministry of Health's Legal Services Directive also lists the duties of providing legal assistance to victimized personnel or, in case of death, to their legal heirs upon request, entering applications into the White Code system, following up on criminal investigations, and appealing against decisions of non-prosecution in cases falling under the scope of legal assistance.

The key point here is to request legal assistance. The victimized healthcare worker must inform the institution's manager, the Employee Rights and Safety Unit, or the relevant legal department that they require legal aid. If the healthcare worker wishes to pursue the process with their own private lawyer, this is also possible. Private legal support can be particularly important in cases involving serious injury, persistent threats, social media campaigns, mobbing, defamation, or claims for high moral damages.

Healthcare Workers' Right to Withdraw from Service

When a healthcare worker is subjected to violence or is at serious risk of violence, they may request to withdraw from service, except for services that must be provided urgently. According to the Ministry of Health's Circular on Ensuring Employee Safety, healthcare workers who experience violence while providing healthcare services may request to withdraw from service, except for urgent services; this request must be reported verbally or in writing to the authorized manager, who will evaluate the request without delay.

This right stems from the healthcare worker's right to self-defense. If a patient or their relative who is committing violence remains in the same environment, threatens the healthcare worker again, or makes it impossible for treatment to be carried out safely, the administration must take the necessary measures. However, in emergency and life-threatening situations, completely halting healthcare services may not be appropriate; in such cases, the administration should assign alternative personnel, take security measures, or refer the patient appropriately.

Crime of Insulting a Healthcare Worker

Insulting a healthcare worker is one of the most common types of violence in healthcare practice. Insults can occur not only through face-to-face conversations but also via phone, WhatsApp, social media comments, Google business reviews, email, patient complaint systems, or written applications within the institution.

Here, it is important to distinguish between the right to seek redress and defamation. A patient or their relative can report dissatisfaction with the service received to the relevant authorities. However, when exercising the right to complain, severe insults, derogatory remarks, accusations aimed at destroying the professional reputation, or social media lynching that target the honor, dignity, and respect of the healthcare worker cannot be considered lawful.

When a healthcare worker is insulted because of their duties, the special aggravating provisions in Law No. 3359 come into play. The Constitutional Court's decisions have also evaluated the existence and scope of regulations concerning increased penalties and the non-suspension of imprisonment in cases of insult and other offenses committed against healthcare workers because of their duties.

In defamation cases, evidence may include incident reports, witness statements, camera recordings (if available), message screenshots, social media links, notarized statements, hospital security reports, and White Code records. For social media posts, screenshots alone may not be sufficient; therefore, URL, date, user information, and notarized/verified evidence should be provided if possible.

Crime of Threatening a Healthcare Worker

The crime of threatening directly targets the safety and peace of mind of healthcare workers. Threats can be verbal, written, via message, telephone, or through body language. Statements such as "I'll kill you here," "I'm waiting outside," "I know where you live," "I'll harm your family," and "I'll storm this hospital" are considered threats.

In the crime of threatening, the perpetrator does not need to carry out the threat immediately. What is important is that the words or actions are likely to create serious fear and security concerns in the victim. If a healthcare worker is threatened because of their job, the increased penalties and the prohibition of postponement under Law No. 3359 become debatable.

In threat cases, messages, phone records, call center records, camera footage, witnesses, and incident reports are particularly important. If the threat continues, restraining orders, security measures, hospital security plans, law enforcement notifications, and prosecutor's office applications should not be delayed.

Physical Assault and Beating of a Healthcare Worker

Physical assault is one of the most serious forms of violence against healthcare professionals. Behaviors such as beating, pushing, slapping, punching, kicking, strangling, attacking with a sharp object, throwing medical equipment, or knocking a healthcare professional to the ground can constitute the crime of intentional bodily harm.

The crime of intentionally causing bodily harm to a healthcare worker during or because of their duty is included within the scope of offenses warranting arrest under Law No. 3359. Furthermore, the law stipulates that the suspect be apprehended by law enforcement, referred to the Public Prosecutor's Office, and that the victimized healthcare worker's statement be taken at their workplace.

The most important evidence in a physical assault is the forensic report. Healthcare workers should obtain a report immediately after the incident, and all findings should be recorded, even if the pain or injury appears minor. Bone fractures, facial scarring, psychological trauma, incapacity for work, sick leave duration, need for psychological support, and treatment costs are also of particular importance in terms of compensation claims.

Healthcare Workers' Right to Material and Moral Compensation

Violence against healthcare workers is not solely a matter for criminal prosecution. The victimized healthcare worker can also file a lawsuit for material and moral damages. While criminal proceedings aim for the perpetrator to be punished, compensation lawsuits aim to redress the harm suffered by the victim.

Compensation claims may include medical expenses, medication costs, psychological support expenses, loss of income due to disability, damages related to the period of sick leave, damage to clothing or belongings, transportation expenses, and, if there is a permanent disability, compensation for permanent incapacity for work.

Compensation for non-pecuniary damages is claimed by healthcare workers due to the fear, humiliation, loss of professional reputation, disruption of work peace, psychological trauma, public humiliation, anxiety experienced while performing their profession after the attack, and violation of personal rights. The non-pecuniary damage can be more severe, especially in cases such as assault in a public place, insults within a hospital, social media lynching, or threat campaigns.

The perpetrator's conviction in a criminal court constitutes significant evidence in favor of the victim in a compensation lawsuit. However, it is also possible to file a compensation lawsuit while the criminal case is ongoing. In serious cases, the outcome of the criminal case may be considered a preliminary matter.

Employer and Hospital Administration Responsibility

Even though the perpetrator in cases of violence against healthcare workers is the direct aggressor, hospital administration and employers also have responsibilities regarding employee safety. Healthcare institutions should monitor incidents of violence through their employee rights and safety units, report applications, initiate regulatory and preventive actions, follow up on White Code notifications, and provide psychosocial support to healthcare workers who have experienced violence, if requested.

The employer's liability may also arise if the hospital administration failed to take security measures despite previously known risks, if no action was taken despite reports of threats from an aggressive patient or their relative, if the camera system was not working, if there was insufficient security personnel, if the White Code system was not activated, or if the incident was covered up.

In private hospitals in particular, employers have an obligation to ensure that employees work in a safe environment, within the framework of occupational health and safety responsibilities. In public hospitals, however, the administration's obligation to ensure employee safety may be considered a service defect.

How should evidence be collected?

In cases of violence against healthcare workers, gathering strong evidence determines the outcome of the trial. The first piece of evidence is the incident report. The report should be as detailed as possible, including the perpetrator's exact words, a description of how the physical assault occurred, signatures from witnesses, and the date and time of the incident.

The second piece of evidence is camera footage. Recordings from cameras in hospital corridors, emergency rooms, outpatient clinics, waiting areas, security checkpoints, parking lots, or ambulance entrances should be requested promptly. A written request must be submitted to the hospital administration to prevent the deletion of these camera recordings.

The third piece of evidence is the forensic report. If there was a physical assault, a medical report documenting the assault should be obtained; if there was a psychological impact, a psychiatric referral should also be recorded. The healthcare worker's sick leave certificate, treatment records, and prescriptions should be kept for compensation purposes.

The fourth type of evidence is digital records. Threat and insult messages, social media posts, phone call records, emails, and patient complaint platforms must be preserved. Digital evidence should be secured, if possible, through notarization or technical examination.

Participation in and Monitoring of Criminal Proceedings

Healthcare professionals can request to join a criminal case when one is filed. This request allows the victim to actively pursue the case, present evidence, call witnesses, and appeal or challenge the verdict. Ministry lawyers can also participate in the process as part of legal assistance.

In criminal proceedings, the court must consider the specific aggravating circumstances related to violence in healthcare when delivering a verdict against the perpetrator. Therefore, the indictment must clearly state that the crime was committed against a healthcare worker in the performance of their duties. If this is missing from the indictment, the victim or their representative should request the application of Article 12 of Law No. 3359 during the trial.

If a decision is made that there is no ground for prosecution, the aggrieved healthcare worker or their representative can appeal this decision. The Ministry of Health's Legal Services Directive also lists appealing against decisions of no grounds for prosecution issued by the Public Prosecutor's Offices as one of the duties of legal aid units.

Conclusion: Violence in healthcare should be pursued through criminal, legal, and administrative channels

Violence against healthcare workers is not merely an individual attack. These actions directly affect the safe delivery of healthcare services, the right to treatment of other patients, the professional well-being of employees, and public order. Therefore, Turkish law includes special provisions stipulating that penalties for intentional injury, threats, insults, and resistance to performing duties committed against healthcare workers due to their duties are increased by half, and that imprisonment is not suspended.

Healthcare workers who are victims of violence must first ensure their own safety, activate a "White Code" alert, ensure that the incident is reported to the 113 hotline or the institution's system, prepare an incident report, obtain a forensic report, preserve camera and witness evidence, follow the prosecution process, and seek legal assistance. Institution managers are obligated to report the incident to the judicial authorities and the White Code system, regardless of whether the victim has filed a complaint.

Healthcare professionals can seek not only punishment for the perpetrator but also compensation for the material and moral damages they have suffered. Compensation claims should be considered separately in cases involving physical assault, threats, insults, social media lynching, defamation targeting professional reputation, or incidents causing psychological trauma.

A robust case file regarding violence against healthcare professionals is created by combining a White Code record, incident report, forensic report, camera footage, witness statements, digital evidence, institutional correspondence, and criminal file. A swift, documented, and decisive legal process in the face of violence against healthcare workers protects the rights of the victimized healthcare professional and increases deterrence in healthcare institutions.