Medicolegal Issues in Medicolegal Issues in Clinical Practice Clinical Practice

Dr. Daljit SinghDr. Daljit SinghProfessor NeurosurgeryProfessor Neurosurgery

GB Pant Hospital, Maulana Azad Medical College( MAMC) N. GB Pant Hospital, Maulana Azad Medical College( MAMC) N. Delhi Delhi

Expert Member- NeurosciencesExpert Member- NeurosciencesDELHI MEDICAL COUNCILDELHI MEDICAL COUNCIL

DOCTORS are no longer considered as DOCTORS are no longer considered as Second GODSecond GOD

Business attitude of medical Business attitude of medical professionalsprofessionals

Justifications to Malpractices angle..Justifications to Malpractices angle..

Lack of proper communicationsLack of proper communications

Doctors at CrossroadDoctors at Crossroad

EETHICS / SERVICETHICS / SERVICE

EARNINGS & FAMILY

CONSUMERS & LEGALITY

COMPETENCE & KNOWLEDGE

Entire relationship between Doctor Entire relationship between Doctor and patients have changed….and patients have changed….

Patient is consumer and a potential Patient is consumer and a potential litigant until otherwise………..litigant until otherwise………..

Knowledge about lawKnowledge about law Misadventures in Medical Practice is Misadventures in Medical Practice is

inevitable………..inevitable………..

We should have some common We should have some common knowledge about provisions in our knowledge about provisions in our law as a self defense in such difficult law as a self defense in such difficult situationssituations

Guidelines for DecisionsGuidelines for Decisions MedicalMedical LegalLegal

ACTSACTS CPA 1986CPA 1986 IPC 1860- 202,267, 269 270 AIDS, IPC 1860- 202,267, 269 270 AIDS,

304A,304A,319,322,340319,322,340 IEA 1872IEA 1872 The Drug Controller Act 1950The Drug Controller Act 1950 The Drugs and Magic remedies Act 1954The Drugs and Magic remedies Act 1954 MTP ActsMTP Acts The Pharmacy ActThe Pharmacy Act MCI ActMCI Act NDPSNDPS 19851985 PNDT PNDT 19961996 RTIRTI ETCETC

CPACPA NegligenceNegligence Important JudgmentsImportant Judgments Role of RecordsRole of Records Check ListCheck List In case of ProblemIn case of Problem ………………………… Important Cases..Important Cases..

Important JudgementsImportant JudgementsIndian Medical Association v. V P Shantha Indian Medical Association v. V P Shantha 1995(3)CPR 412 SC1995(3)CPR 412 SC

Dr Suresh Gupta v. Govt of NCT , 2004 AIR ,Dr Suresh Gupta v. Govt of NCT , 2004 AIR , SCW SCW 4442:2004(6)4442:2004(6)

SCC 422:2004(6) scale 432SCC 422:2004(6) scale 432

Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Hon,ble Mr Justice RC Lhoti,Hon,ble Mr Justice RC Lhoti,CJICJI,G P Mathur,P K ,G P Mathur,P K Balasubramanyam JJ III(2005)CPJ(CS)Balasubramanyam JJ III(2005)CPJ(CS)

Martin F D,Souza v. Md. IshfaqMartin F D,Souza v. Md. IshfaqHon,ble Mr Justice Markandey Katju and G. S .Singhvi Feb 2009Hon,ble Mr Justice Markandey Katju and G. S .Singhvi Feb 2009

Indian Medical Association v.Indian Medical Association v. V P Shantha 1995(3)CPR 412 SC V P Shantha 1995(3)CPR 412 SC

13.11.1995 Three judge bench13.11.1995 Three judge benchHon,ble Justice Kuldeep Singh, Mr Justie S C Agarwal, Mr Justice B L HansariaHon,ble Justice Kuldeep Singh, Mr Justie S C Agarwal, Mr Justice B L Hansaria

Medical profession was brought in ambit of CPA…Medical profession was brought in ambit of CPA…

Exception to CPA isException to CPA is …totally free services to poor and rich …Govt or Private …totally free services to poor and rich …Govt or Private , Charitable ,except meager registration amount…., Charitable ,except meager registration amount….

Hospitals where both paid and unpaid services are covered,… even if Hospitals where both paid and unpaid services are covered,… even if complainant has availed free services.complainant has availed free services.

Consumer Protection Act 1986 Consumer Protection Act 1986 1995 SC1995 SC

Patients - consumersPatients - consumers Disease - demand /article / goodsDisease - demand /article / goods Doctors – service providers -ContractDoctors – service providers -Contract

COMPLAINANTCOMPLAINANT in CPAin CPA PatientPatient RelativesRelatives FriendsFriends Voluntary associations…Voluntary associations…

Consumer protection Redressal Consumer protection Redressal Agencies ..Agencies ..

District forum (9 District in Delhi)District forum (9 District in Delhi) 2yrs period for filing a case…2yrs period for filing a case…

State Commission -15 days condonable State Commission -15 days condonable for sufficient ground,20 Lakhsfor sufficient ground,20 Lakhs

National Commission -30days from the National Commission -30days from the date of order,20L- 1 crore date of order,20L- 1 crore

Supreme Court -30 days-more than 1 Supreme Court -30 days-more than 1 crorecrore

NegligenceNegligence Medical negligence resulting from Medical negligence resulting from

failure on the part of doctor to act in failure on the part of doctor to act in accordance with medical standards in accordance with medical standards in practice,practice,

Which are being practiced by an Which are being practiced by an ordinary competent man practicing in ordinary competent man practicing in same profession……same profession……

Reasonable degree of skill and Reasonable degree of skill and carecare

NegligenceNegligence CIVILCIVIL

CPA---CPA--- CompensationsCompensations

CRIMINAL CRIMINAL CPC 304ACPC 304A ImprisonmentsImprisonments

NegligenceNegligence Winfield negligence as tort Winfield negligence as tort

encompasses ofencompasses of 1 Existence of Legal duty1 Existence of Legal duty 2.Breach of legal duty2.Breach of legal duty 3.Damages caused3.Damages caused

Bolam’s testBolam’s test

Breach of Legal DutyBreach of Legal Duty Does some thing which an ordinary Does some thing which an ordinary

prudent man would not have done….prudent man would not have done….

Fails to do some thing which ordinary Fails to do some thing which ordinary prudent man would do……. prudent man would do…….

Proof of NEGLIGENCEProof of NEGLIGENCE Onus lies on the patientOnus lies on the patient Shifting onus..Shifting onus..

Expert evidence is to be brought in Expert evidence is to be brought in support of allegationsupport of allegation

Nagarmal Modi Sewa v. Anita Devi 2002(3)CPR 163Nagarmal Modi Sewa v. Anita Devi 2002(3)CPR 163

NegligenceNegligence Madras High CourtMadras High CourtDr CJ Subramnia v.Kumarswamy I .1994 CPJ 509 CCL 475

Huck v Cole 1968(118) Huck v. Cole New Law Journal Huck v Cole 1968(118) Huck v. Cole New Law Journal Philips India Ltd.v.Kunju Punn AIR 1975 Bom.306Philips India Ltd.v.Kunju Punn AIR 1975 Bom.306

Medicine is an Inexact science and it is unlikely that a reasonable Doctor Medicine is an Inexact science and it is unlikely that a reasonable Doctor would intend to give an assurance to achieve a particular result…….would intend to give an assurance to achieve a particular result…….

NO NEGLIGENCENO NEGLIGENCE ERROR OF JUDGEMENTERROR OF JUDGEMENT ACCIDENTS, THERAPEUTIC MISADVENTURESACCIDENTS, THERAPEUTIC MISADVENTURES ERROR IN DIAGNOSISERROR IN DIAGNOSIS UNAVOIDABLE COMPLICATIONSUNAVOIDABLE COMPLICATIONS INFECTIONSINFECTIONS COMPLICATIONS OF DRUGSCOMPLICATIONS OF DRUGS

DUTY TO DIAGNOSIS, ADVICE, TREATMENTDUTY TO DIAGNOSIS, ADVICE, TREATMENT

Contributory negligenceContributory negligence Patient has not followed the Patient has not followed the

instructionsinstructions

Took treatment/ measures elsewhere Took treatment/ measures elsewhere which may have affected outcome…which may have affected outcome…

Tear the records…Tear the records…

Two Schools of Thoughts..Two Schools of Thoughts.. The court could not do greater The court could not do greater

disservice to the community or disservice to the community or advancement of medical services than advancement of medical services than to place hallmark of legality in one to place hallmark of legality in one form of treatmentform of treatment……

Dr N T Subramanyam v. B Krishna Rao 1996 CP 3233(NC) Dr N T Subramanyam v. B Krishna Rao 1996 CP 3233(NC)

Second option of treatment is to Second option of treatment is to be given to patient……be given to patient……

Arrest of doctors 304A IPCArrest of doctors 304A IPC 304A IPC304A IPC CULPABLE HOMICIDE NOT AMOUNTING TO MURDER…..CULPABLE HOMICIDE NOT AMOUNTING TO MURDER….. Dr Suresh Gupta v. Govt of NCT , 2004 AIR , SCW Dr Suresh Gupta v. Govt of NCT , 2004 AIR , SCW

4442:2004(6)4442:2004(6) SCC 422:2004(6) scale 432SCC 422:2004(6) scale 432 1.When a patient agrees to a treatment or surgical option, every 1.When a patient agrees to a treatment or surgical option, every

careless act can not be termed as criminal. It can be termed as careless act can not be termed as criminal. It can be termed as criminal only if medical man exhibited a gross lack of competence criminal only if medical man exhibited a gross lack of competence or inaction….or inaction….

2. Where death of patient results merely from an error of 2. Where death of patient results merely from an error of judgement or accident, no criminal liability should be attached to itjudgement or accident, no criminal liability should be attached to it

3. Mere inadvertence or some degree of want of adequate care and 3. Mere inadvertence or some degree of want of adequate care and caution might create civil liability…caution might create civil liability…

4. For every mishaps or death during medical treatment the 4. For every mishaps or death during medical treatment the medical man can not be proceeded against punishmentmedical man can not be proceeded against punishment

Dr Suresh Gupta v. Govt of NCT , 2004 AIR Dr Suresh Gupta v. Govt of NCT , 2004 AIR SCW 4442:2004(6)SCW 4442:2004(6)

5.Criminal prosecutions of doctors without adequate medical 5.Criminal prosecutions of doctors without adequate medical opinion pointing to their guilt would be doing a great injustice to opinion pointing to their guilt would be doing a great injustice to the community at large……..the community at large……..

6. For conviction of doctors for alleged criminal offence, the 6. For conviction of doctors for alleged criminal offence, the standard should be proof of recklessness and deliberate wrong standard should be proof of recklessness and deliberate wrong doing i.e. higher degree of morally blameworthy conduct.doing i.e. higher degree of morally blameworthy conduct.

7. The act of negligence or rashness must be of high degree so as 7. The act of negligence or rashness must be of high degree so as to indicate mental state which can be described as totally to indicate mental state which can be described as totally apathetic toward the patient…..apathetic toward the patient…..

SLPSLP Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005 Hon,ble Mr Justice RC Lhoti,Hon,ble Mr Justice RC Lhoti,CJICJI,G P Mathur,P K ,G P Mathur,P K

Balasubramanyam JJ III(2005)CPJ(CS)Balasubramanyam JJ III(2005)CPJ(CS) NON AVAILABILTY OFNON AVAILABILTY OF Oxygen cylinder in room Oxygen cylinder in room

Negligence in contest of medical profession necessarily Negligence in contest of medical profession necessarily calls for treatment with differencecalls for treatment with difference

Simple lack of careSimple lack of care Error of judgmentError of judgment AccidentsAccidents Failure to use special or extraordinary precautions Failure to use special or extraordinary precautions

are which might have prevented a particular are which might have prevented a particular happening can not be the standard for judging happening can not be the standard for judging alleged negligence …alleged negligence …

No proof of negligence

SLPSLPJacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Hon,ble Mr Justice RC Lhoti,Hon,ble Mr Justice RC Lhoti,CJICJI,G P Mathur,P K Balasubramanyam ,G P Mathur,P K Balasubramanyam

JJ III(2005)CPJ(CSJJ III(2005)CPJ(CS

Doctrine of Doctrine of Res Ipsa LiquitorRes Ipsa Liquitor..is only an evidence in civil court ..is only an evidence in civil court and does not prove to make a case of criminal rashness or and does not prove to make a case of criminal rashness or negligencenegligence

For non availability of O2 cylinder hospital may be liable For non availability of O2 cylinder hospital may be liable for a civil suit only and not 304A IPCfor a civil suit only and not 304A IPC

Even in civil jurisdiction the rule of Even in civil jurisdiction the rule of res ipsa loquitorres ipsa loquitor is not of is not of universal application and has to be applied with extreme care universal application and has to be applied with extreme care ……

SLPSLPJacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Hon,ble Mr Justice RC Lhoti,Hon,ble Mr Justice RC Lhoti,CJICJI,G P Mathur,P K ,G P Mathur,P K

Balasubramanyam JJ III(2005)CPJ(CSBalasubramanyam JJ III(2005)CPJ(CS Professional negligence vs. Occupational negligenceProfessional negligence vs. Occupational negligence Deviations from normal practice is not necessary evidence Deviations from normal practice is not necessary evidence

of negligence…..of negligence….. Std are to be compared at the time of treatment and Std are to be compared at the time of treatment and

not at the time of trialnot at the time of trial Between devil and deep sea situations choose the lesser Between devil and deep sea situations choose the lesser

evil depending upon facts and circumstances..evil depending upon facts and circumstances.. Higher the acuteness in emergency and higher the Higher the acuteness in emergency and higher the

complications, more are the chances of error of complications, more are the chances of error of judgmentjudgment

SLP SLP Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Jacob Mathew Dr .V.State of Punjab &ANR 5.8.2005Hon,ble Mr Justice RC Lhoti,Hon,ble Mr Justice RC Lhoti,CJICJI,G P Mathur,P K Balasubramanyam JJ III(2005)CPJ(CS,G P Mathur,P K Balasubramanyam JJ III(2005)CPJ(CS

Negligence if a person did not possess a skill and professedNegligence if a person did not possess a skill and professed Or he did not exercise with reasonable competenceOr he did not exercise with reasonable competence Std would remain that of an ordinary competent person exercising Std would remain that of an ordinary competent person exercising

ordinary skill ( ordinary skill ( Bolams test)Bolams test) Charge of not using a particular equipment would fail if equipment Charge of not using a particular equipment would fail if equipment

was generally not available at particular time of incident..was generally not available at particular time of incident.. In negligence In negligence mens rea must be shown to existmens rea must be shown to exist Word gross was to be read in deciding negligence against Word gross was to be read in deciding negligence against

doctor for 304A doctor for 304A Private complaints should not be entertained unless supported by Private complaints should not be entertained unless supported by

other competent doctorsother competent doctors IO before taking an action for 304 A should obtain IO before taking an action for 304 A should obtain

independent and competent medical opinion …independent and competent medical opinion …

SLPSLP Doctor accused of rashness should not be Doctor accused of rashness should not be

arrested in routine manner simply as arrested in routine manner simply as charges have been leveled against charges have been leveled against him .Unless the arrest IO feel Doctor will not him .Unless the arrest IO feel Doctor will not be available to face the prosecutionbe available to face the prosecution

Martin F D,Souza v. Md. IshfaqMartin F D,Souza v. Md. IshfaqHon,ble Mr Justice Markandey Katju and G. S .Singhvi Feb 2009Hon,ble Mr Justice Markandey Katju and G. S .Singhvi Feb 2009

Before Issuing notice to the Doctor/Hospital-matter should be first Before Issuing notice to the Doctor/Hospital-matter should be first referred to competent Doctor or committee related to the field of referred to competent Doctor or committee related to the field of complaintcomplaint

Police not to harass unless under the purview of Jacob Mathew Police not to harass unless under the purview of Jacob Mathew case..otherwise face the legal action.case..otherwise face the legal action.

Simple negligence and gross negligence may be a matter of Simple negligence and gross negligence may be a matter of disputes even among expertsdisputes even among experts

Doctors can also make error of Judgments however indiscriminate Doctors can also make error of Judgments however indiscriminate proceedings against doctors are counter productiveproceedings against doctors are counter productive

Law is a watch Dog and not bloodhounds..Law is a watch Dog and not bloodhounds..

Frivolous complaintsFrivolous complaints Frivolous complaints -Imposition of Frivolous complaints -Imposition of

costcost

Chronic litigant Imposition of cost Chronic litigant Imposition of cost +10000/ penalty+10000/ penalty

Role of RecordsRole of Records….….

Treatment records are to be made Treatment records are to be made available…if demandedavailable…if demanded

Summary of Records for opinions from Summary of Records for opinions from other medical or otherwise…. other medical or otherwise….

MCI regulations 2002 ----Keep for at least 3 MCI regulations 2002 ----Keep for at least 3 yrs..yrs..

Fabrication and manipulation…..Fabrication and manipulation….. UPDATE RECORDS AS SOON AS POSSIBLE..UPDATE RECORDS AS SOON AS POSSIBLE..

Dr Shyam Kumar v. Rameshbhai, Harman bhai Kachhiya 2002(1CPR 320Dr Shyam Kumar v. Rameshbhai, Harman bhai Kachhiya 2002(1CPR 320

Heranbalal Das v. Dr Ajay Paul 2001(2) CPR 498Heranbalal Das v. Dr Ajay Paul 2001(2) CPR 498

Findings on RecordFindings on Record…… Put Daily notes …to support duty of carePut Daily notes …to support duty of care Serious patients should have notes at Serious patients should have notes at

least twice a day…least twice a day… Do not ignore pulse , RR, Pupils, BP, Sugar, Do not ignore pulse , RR, Pupils, BP, Sugar,

ECG, X ray chest…..ECG, X ray chest….. Court does not understand GCS etc..Court does not understand GCS etc.. Give information about the condition of Give information about the condition of

patient time to time and mention on case patient time to time and mention on case record…get record…get signatures time to time ..signatures time to time ..

ChecklistChecklist Inform Consent in writing -TWO SIGNATUREInform Consent in writing -TWO SIGNATURE Modify according to legal demandsModify according to legal demands Ordinary and reasonable skill vs. Special careOrdinary and reasonable skill vs. Special care Details record maintain , update , Details record maintain , update ,

preserve preserve 3 yrs3 yrs. Furnish on demand in . Furnish on demand in 72 72 hrshrs..

Necessary lab testsNecessary lab tests Specialist is required in case diagnosis Specialist is required in case diagnosis

not precisenot precise Drugs side effects are to be known INFORMDrugs side effects are to be known INFORM

ChecklistChecklist TT in case of TraumaTT in case of Trauma Do not go beyond your skillDo not go beyond your skill In case treatment is new, take In case treatment is new, take

inform consent with knowledgeinform consent with knowledge Give proper post op or discharge Give proper post op or discharge

instructions…instructions…write clear, legible and write clear, legible and comprehensive medical notescomprehensive medical notes. .

Do not entirely delegate duty to Do not entirely delegate duty to juniors, keep constant supervision..juniors, keep constant supervision..

Check listCheck list

Keep tags of implantable devices in Keep tags of implantable devices in record….record….

Do not give antibiotics without C/S…Do not give antibiotics without C/S…particularly in infection --- long particularly in infection --- long standingstanding

Check listCheck list Keep yourself informed latest Keep yourself informed latest

developmentsdevelopments Patient is priority over MLCPatient is priority over MLC 24 Hrs clinic should have competent 24 Hrs clinic should have competent

Doctors round the clockDoctors round the clock Never overstate your qualificationsNever overstate your qualifications Issue genuine Medical CertificatesIssue genuine Medical Certificates....

Jessical lalJessical lal DDADDA

Check listCheck list Always attend the patient when Always attend the patient when

called…called… Enquire previous drug allergy..Enquire previous drug allergy.. Preserve Radiology …deficiency in Preserve Radiology …deficiency in

serviceservice VP Shanta v. Cosmopolitan hospital 1997 CPR 377VP Shanta v. Cosmopolitan hospital 1997 CPR 377

ICU , CCU patient need special careICU , CCU patient need special care Take Indemnity Insurances…Take Indemnity Insurances…

BIG MOUTH SYNDROMEBIG MOUTH SYNDROME Do not criticize your colleagues….Do not criticize your colleagues…. Responsibility to your profession. Responsibility to your profession. Protect the interest of JuniorsProtect the interest of Juniors Talk about your complications as Talk about your complications as

frequently as your success…frequently as your success…Report in Journals. ….. to save Report in Journals. ….. to save others .others .

Duty of DoctorsDuty of Doctors Duty of Care ofDuty of Care of

Diligence, Knowledge, care and CautionDiligence, Knowledge, care and Caution RecordsRecords Notifiable diseases AIDSNotifiable diseases AIDS Consent and alternative treatmentConsent and alternative treatment Records to be given to patient/ Records to be given to patient/

familyfamily

In case of problemsIn case of problems BE CALMBE CALM Sympathies with patientsSympathies with patients Explain the realitiesExplain the realities Do not conceal and try to improve upon ..Do not conceal and try to improve upon .. Take Second Take Second medicalmedical opinion.. Document opinion.. Document Avoid confrontations.. Avoid confrontations.. Take legal experts opinionTake legal experts opinion Try to settle the caseTry to settle the case .. .. LACK OF COMMUNICATIONS…IS MOST LACK OF COMMUNICATIONS…IS MOST

OFTEN CAUSE OF COMPLAINTSOFTEN CAUSE OF COMPLAINTS

ConclusionsConclusions Patient is priority for all of us as we Patient is priority for all of us as we

conduct a noble profession …conduct a noble profession … Do what is best for the patient and not Do what is best for the patient and not

what is best for you….?what is best for you….? Ensure that your decisions and actions are Ensure that your decisions and actions are

scientific, humane, effective and in the scientific, humane, effective and in the best interests of the patient and his family. best interests of the patient and his family. Record them. Once this is done, you need Record them. Once this is done, you need not fear any individual, administrator or not fear any individual, administrator or tribunal." tribunal."

CASESCASES SCSC homepath abrtion death homepath abrtion death 1L1L Nihal Kaur v Director PGIMS 1996CPJ 112Nihal Kaur v Director PGIMS 1996CPJ 112 scissors scissors

abd 1.2 Labd 1.2 L

Gursevak Singh vs Dr Jaskaran Singh CPJ Gursevak Singh vs Dr Jaskaran Singh CPJ 300 1996, III Amputaion following injection 300 1996, III Amputaion following injection 1.25 L1.25 L

Anuradha ben D Kothari v. Navdeep Clinic III 1996 Anuradha ben D Kothari v. Navdeep Clinic III 1996 CPJ 605 Cardiac arrest during surgery 1LCPJ 605 Cardiac arrest during surgery 1L

CASESCASES SPINE SPINE Nuruddin Katubuddin Balativ Dr LN Vora 1995 (2)CPR 424 Nuruddin Katubuddin Balativ Dr LN Vora 1995 (2)CPR 424 Surgery on Myelogram L 4/5 , Failed back , MRI revealed no Surgery on Myelogram L 4/5 , Failed back , MRI revealed no

evidence of proper surgery as disc was still seenevidence of proper surgery as disc was still seen DISMISSED DISMISSED as only protruding disc was removed.as only protruding disc was removed. AkhilBhartiya Grahak Panchayat vDr Jog Hospital III 1993 CPJ 1447AkhilBhartiya Grahak Panchayat vDr Jog Hospital III 1993 CPJ 1447 Worsened following surgeryWorsened following surgery DISMISSEDDISMISSED

BURN ON OT TABLEBURN ON OT TABLE Master PN Ashwin v. Manipal hospital . Compensation Master PN Ashwin v. Manipal hospital . Compensation 5 LAKHS5 LAKHS DM with Cataract DM with Cataract CMC v. A Shahajahan 2000, CCJ 554CMC v. A Shahajahan 2000, CCJ 554 25000/25000/ EMERGENCY SURGERYEMERGENCY SURGERY Dr T T Thomas v. Elisa AIR1987 ker52Dr T T Thomas v. Elisa AIR1987 ker52 Acute appendicitis – not operated as no consent – Died- Doc LiableAcute appendicitis – not operated as no consent – Died- Doc Liable

CASESCASES EPILEPSYEPILEPSY Murlidhar Eknath Masane v.Sushurusha Citizen Co op Hosptal Murlidhar Eknath Masane v.Sushurusha Citizen Co op Hosptal

1995(1)CPR 6061995(1)CPR 606 13yr, on Luminol, Zeptal, Eptoin. Given Largectil/ R/T feed/ Bed 13yr, on Luminol, Zeptal, Eptoin. Given Largectil/ R/T feed/ Bed

sore in 2 days / Died Expert opinion against- sore in 2 days / Died Expert opinion against- 3 L hostpital, 50K 3 L hostpital, 50K Doc.Doc.

FIRST AID TO PATIENTFIRST AID TO PATIENT Pt. Parmanad Katara v. Union of India AIR 1989 SC2039Pt. Parmanad Katara v. Union of India AIR 1989 SC2039 PILPIL Medical man should not be harassed for the purpose of Medical man should not be harassed for the purpose of

InterrogationInterrogation Patient first priorityPatient first priority Court -should not let them wait . Dates …Court -should not let them wait . Dates …

CASESCASES

NO BED SITUATIONNO BED SITUATION Ranjit Km Das v. ESI Hospital 2 LakhRanjit Km Das v. ESI Hospital 2 Lakh

ICU BedICU Bed Sir Ganga Ram Hospital v. D P Bhandari 1993 CCJ 261: II 1992 CPJ Sir Ganga Ram Hospital v. D P Bhandari 1993 CCJ 261: II 1992 CPJ

397 (NC)397 (NC) Patient could have been shifted to other hospitalPatient could have been shifted to other hospital Bed not available in ICU. State commission fined Rs 1 LakhBed not available in ICU. State commission fined Rs 1 Lakh National Commission – DismissedNational Commission – Dismissed Mere Omission on part of hospital that relations may if so desire Mere Omission on part of hospital that relations may if so desire

shift the patient to other hospital….shift the patient to other hospital….

CASESCASES Minor InjuryMinor Injury CDR Hospital v. Nirmala Manaseh 2001(2)CPR 69CDR Hospital v. Nirmala Manaseh 2001(2)CPR 69 Ampoule blisters in cheek- 30kAmpoule blisters in cheek- 30k PARAPLEGIA following Spinal AnaesthesiaPARAPLEGIA following Spinal Anaesthesia S RAMARAO V. Bantwal Sulochana Madhava Shenoy Trust 1997 S RAMARAO V. Bantwal Sulochana Madhava Shenoy Trust 1997

CPJ 301CPJ 301 Hernia surgeryHernia surgery Advised not to move without assistance Advised not to move without assistance Dismissed as no fault of SurgeonDismissed as no fault of Surgeon INJECTION PARALYSISINJECTION PARALYSIS Dr G D Jiladia v. Dharmishta Chhtubhai Goswami 2003 (2) CPR Dr G D Jiladia v. Dharmishta Chhtubhai Goswami 2003 (2) CPR

490490 Sciatic NERVE Injury 1.5 LakhSciatic NERVE Injury 1.5 Lakh

CASESCASES FORIEGN BODYFORIEGN BODY Abdominal sponges Abdominal sponges Chanchal oswal v santokhba Durlabhji Memorial Hospital 1995 CPJ Chanchal oswal v santokhba Durlabhji Memorial Hospital 1995 CPJ

4242 GAUGE WAS NEITHER PRESERVED NOR SEND FOR CHEMICAL GAUGE WAS NEITHER PRESERVED NOR SEND FOR CHEMICAL

NALYSIS . NALYSIS . DISMISSEDDISMISSED Aleyamma Vergese v. Dewan Bahadur 1997(1) CPR 310Aleyamma Vergese v. Dewan Bahadur 1997(1) CPR 310 Sponge count duty of nurse Hospital liable vicariouslySponge count duty of nurse Hospital liable vicariously

Beti Bhai Saxena v. Dr S L MukherjiBeti Bhai Saxena v. Dr S L Mukherji Hip Surgery Hip Surgery Affidavit from second Doctor filedAffidavit from second Doctor filed NegligentNegligent

CASESCASES Wrong Blood TransfusionWrong Blood Transfusion PGI Chandigarh v.Jaspal SinghPGI Chandigarh v.Jaspal Singh 2 lakh 2 lakh

CASESCASES POST OPERATIVE FEESPOST OPERATIVE FEES BShekhar Hegde v.Dr Sudhanshu Bhattacharya II 1992 CPJ 449BShekhar Hegde v.Dr Sudhanshu Bhattacharya II 1992 CPJ 449 Bombay hospital, CABG-Bombay hospital, CABG- Not seen in post op as post surgery fees …Not seen in post op as post surgery fees … Died wound infection 2lakh +1000 costDied wound infection 2lakh +1000 cost SEPTECEMIA SEPTECEMIA Fakuruddin Abbas Bharmal v Dr B Das Guptaiii1998CPJ 677Fakuruddin Abbas Bharmal v Dr B Das Guptaiii1998CPJ 677 Hernia-DiedHernia-Died No Blood culture SENSTIVITY ReportsNo Blood culture SENSTIVITY Reports 3.85 Lakhs 3.85 Lakhs

LiabilityLiability PrimaryPrimary Vicarious (Secondary)Vicarious (Secondary)

Hospitals has primary liability for the Hospitals has primary liability for the deficiency in service….deficiency in service….

EquipmentsEquipments ICUICU Basant Seth vs. Regency Hospital Ltd.2002 (2) CPR62(NC)Basant Seth vs. Regency Hospital Ltd.2002 (2) CPR62(NC) Kannan VR VS. Sree Sudhendra Medical Mission 2002(2) CPR186Kannan VR VS. Sree Sudhendra Medical Mission 2002(2) CPR186

Vicarious LiabilityVicarious Liability For DOCTORS , Nurses, Technician For DOCTORS , Nurses, Technician

and paramedics , othersand paramedics , others

State Govt.State Govt.

JurisdictionsJurisdictions If a matter is already sub judice in a If a matter is already sub judice in a

civil court claim is not maintainable civil court claim is not maintainable in consumer forum..in consumer forum..

Savita Y Chaudhary v. Dr Ghanshyam G Kochage 1994(1) CPR 863 Savita Y Chaudhary v. Dr Ghanshyam G Kochage 1994(1) CPR 863

Two different kinds of negligence……e.g. Two different kinds of negligence……e.g. Motor Vehicle Act and CPA….Motor Vehicle Act and CPA….

Reasonable DegreeReasonable Degree Departure from normal established Departure from normal established

mode of treatment……..mode of treatment…….. Diagnosis, treatment, follow up Diagnosis, treatment, follow up

instructions, & records.instructions, & records. Not all deviations from established Not all deviations from established

mode can be labeled as negligence…mode can be labeled as negligence… Expert evidence plays a vital role…Expert evidence plays a vital role… Dr Laxman Blakrishanan joshi vs. Dr Trimbak Babu Godbole Dr Laxman Blakrishanan joshi vs. Dr Trimbak Babu Godbole

AIR1996 sc 128AIR1996 sc 128

Andhra Pradesh Ordinance Against the Andhra Pradesh Ordinance Against the Violence on Doctors and MedicalViolence on Doctors and Medical

EstablishmentsEstablishments December 18, 2007December 18, 2007 Any act of violence against medicare service person or damage Any act of violence against medicare service person or damage ProhibitionProhibition to property in a Medicare service Institution is hereby prohibited. to property in a Medicare service Institution is hereby prohibited. of violenceof violence 4. Any Offender who commits any act in contravention of Section 3, 4. Any Offender who commits any act in contravention of Section 3, penaltypenalty shall be punished with imprisonment for a period of Three years andshall be punished with imprisonment for a period of Three years and 5656 with fine, which may extend to fifty thousand rupees.with fine, which may extend to fifty thousand rupees. 5. Any offence committed under Section 3, shall be cognizable and non 5. Any offence committed under Section 3, shall be cognizable and non cognizance ofcognizance of Bailable. OBailable. Offenceffence 6.(1) In addition to the punishment specified in section 4, the offender 6.(1) In addition to the punishment specified in section 4, the offender recovery ofrecovery of shall be liable to a penalty of twice the amount of purchase price shall be liable to a penalty of twice the amount of purchase price loss for theloss for the of medical equipment damaged and loss caused to the property of medical equipment damaged and loss caused to the property damagedamage as determined by the Court trying the offender. as determined by the Court trying the offender. Caused to theCaused to the propertyproperty 6.(2) If the offender has not paid the penal amount under sub-section (1),6.(2) If the offender has not paid the penal amount under sub-section (1), the said sum shall be recovered under the provisions of the Andhrathe said sum shall be recovered under the provisions of the Andhra Pradesh Recovery Act, 1864 as if it were an arrears of land revenuePradesh Recovery Act, 1864 as if it were an arrears of land revenue due from him.due from him. 7. The provisions of this Ordinance shall be in addition to and not in 7. The provisions of this Ordinance shall be in addition to and not in Ordinance notOrdinance not derogation of the provisions of any other law, for the time begin in force. derogation of the provisions of any other law, for the time begin in force. in derogationin derogation of any otherof any other lawlaw

Check listCheck list (e.g. effects of vigabatrin on visual (e.g. effects of vigabatrin on visual

fields, effect of phenytoin on teeth fields, effect of phenytoin on teeth and gums, effect of valproate on and gums, effect of valproate on weight and menstrual cycle), weight and menstrual cycle), interaction of antiepileptic drugs interaction of antiepileptic drugs (AEDs) with other medication (e.g. (AEDs) with other medication (e.g. oral contraceptive pill, warfarin), and oral contraceptive pill, warfarin), and teratogenic potential of AEDs. teratogenic potential of AEDs.

Delhi Medical Council DMCDelhi Medical Council DMC Statutory Body passed by Legislative assemblyStatutory Body passed by Legislative assembly DMC Act 1997DMC Act 1997 Functioning….Functioning….Maintain register of all medical Maintain register of all medical

practitioner etcpractitioner etc Receive the Receive the complaints from publiccomplaints from public against against

misconduct or negligence by medical misconduct or negligence by medical practioner…, inquest…decision etcpractioner…, inquest…decision etc

Suo motuSuo motu action in respect to misconduct action in respect to misconduct Take action against Take action against frivolously frivolously complaintscomplaints To provide To provide protection to its membersprotection to its members in in

discharging professional dutiesdischarging professional duties

DMC Act 1997DMC Act 1997

Disciplinary CouncilDisciplinary Council ChairmanChairman MLA nominated by speakerMLA nominated by speaker Legal Expert nominated by councilLegal Expert nominated by council Eminent public man nominated by GovernmentEminent public man nominated by Government Medical specialist in area of specialization Medical specialist in area of specialization

nominated by councilnominated by council Nominated member by DMA –PRESIDENT Nominated member by DMA –PRESIDENT All the inquiries conducted are deemed to be All the inquiries conducted are deemed to be

judicial proceedings within meaning of judicial proceedings within meaning of section 193,219,228 of IPCsection 193,219,228 of IPC

Actions under DMCActions under DMC Enforce attendance of any person to Enforce attendance of any person to

examine him on oathexamine him on oath Compel the production of documentCompel the production of document Issuance of commission for Issuance of commission for

examination of witnessexamination of witness Remove the name from register Remove the name from register

temporary or even permanenttemporary or even permanent

Neurosurgery Case List in DMCNeurosurgery Case List in DMC CAD Patient fell from Bed- ICH- CAD Patient fell from Bed- ICH-

Operated died.Operated died. RSA- No MLC made- fully conscious RSA- No MLC made- fully conscious

died 7 died 7thth day ( From MM) day ( From MM) Hydrocephalus – VP Shunt died- Hydrocephalus – VP Shunt died-

Incompetent Doctor as complaintIncompetent Doctor as complaint Thalamic mass dies following Thalamic mass dies following

surgerysurgery

Neurosurgery Case List in DMCNeurosurgery Case List in DMC Colloid cyst died following surgeryColloid cyst died following surgery HT hematoma died after surgeryHT hematoma died after surgery RSA died after months – Contrary RSA died after months – Contrary

post mortem reportpost mortem report RSA - Poly trauma dies after fracture RSA - Poly trauma dies after fracture

treatment- Different Post mortem treatment- Different Post mortem findingsfindings

SAH Died due to wrong diagnosis as SAH Died due to wrong diagnosis as TBMTBM

Neurosurgery Case List in DMCNeurosurgery Case List in DMC Stroke died- No CT/ MRI- Non Stroke died- No CT/ MRI- Non

availability of ambulance to transferavailability of ambulance to transfer Stroke died -Suction not Stroke died -Suction not

working, Electricity plug not working, Electricity plug not workingworking

CP Angle died- Option for Gamma CP Angle died- Option for Gamma Knife not givenKnife not given

Fabricated Consent as alleged..Fabricated Consent as alleged..

CPACPA Consumer protection councils Consumer protection councils Consumer Dispute Redressal Consumer Dispute Redressal

AgenciesAgencies