Forensic medicine medical negligence


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Forensic medicine medical negligence

  1. 1. <ul><li>Medical Negligence </li></ul><ul><li>Dr. Ab Halim bin Hj. Mansar </li></ul>
  2. 4. <ul><li>       Medical malpractice. </li></ul><ul><li>     Irregular medical practice. </li></ul><ul><li>     A dispute between doctor </li></ul><ul><li>and patient over the </li></ul><ul><li>standard of medical care. </li></ul>
  3. 5. In Law <ul><li>No difference from any other type of negligence. </li></ul><ul><li>Negligence or otherwise is a civil wrong known as ‘tort’ </li></ul><ul><li>A breach of contract if his professional behavior falls short of the requirement of the contract between him and the patient. </li></ul>
  4. 6. For negligence of any kind to be proved it must be shown that: <ul><li>i. The defendant (doctor) owed a duty of care to the plaintiff. Ii. That the defendant was in breach of that duty. iii.That the plaintiff suffered damaged as a result. </li></ul>
  5. 7. Negligence <ul><li>Any person can be guilty of negligence for a person to be judged negligence: </li></ul><ul><ul><ul><li>      He must owe a duty to another person. </li></ul></ul></ul><ul><ul><ul><li>      He must have committed a breach of duty. </li></ul></ul></ul><ul><ul><ul><li>       As a result the person to whom the duty was owed must have suffered some damage.   </li></ul></ul></ul>
  6. 8. Medical Negligence <ul><li>1. The person must be the doctor’s patient (the doctor accepts responsibility of medical care of a person). 2. The doctor must have done something which is not approved by medical practice or have omitted to do something which is accepted in the circumstances. 3. As a result of the action or omission the patient has suffered injury. </li></ul>
  7. 9. In medical situation <ul><li>Medical negligence is the breach of duty owed by a doctor to his patient to exercise reasonable care and or his skill resulting in some bodily, mental or financial disability. </li></ul><ul><ul><li>The doctors must have a reasonable degree of proficiency and apply the proficiency with a reasonable degree of diligence.   </li></ul></ul>
  8. 10. Contd. <ul><ul><li>No doctor is expected to possess all current medical knowledge or being able to apply all known diagnostic or therapeutic techniques but a doctor of a particular standing as regards to his degree and experience is expected to have a standard of knowledge and capability commensurate with his status. </li></ul></ul>
  9. 11. Essential ingredient of negligence   <ul><li>       Willingness to examine </li></ul><ul><li>       Willingness to diagnose </li></ul><ul><li>       Willingness to treat </li></ul><ul><li>  As a result damaged suffered by the patient:: </li></ul><ul><li>The patient must suffered some loss which can be measured and compensated for in term of money.      </li></ul>
  10. 12. Contd. <ul><li>e.g. - loss of earning </li></ul><ul><li>(absence from work) (impair of his ability to carry job </li></ul><ul><li> expenses). </li></ul><ul><li>- Expensed (nursing home expenses) </li></ul><ul><li>(special treatment). </li></ul><ul><li>       </li></ul>
  11. 13. <ul><li>Medical Negligence can only occur when a doctor-patient relationship is established. </li></ul><ul><li>The doctor has a duty to exercise skill and </li></ul><ul><li> care. </li></ul><ul><li>e.g. in acute emergency (ED) once a doctor approaches an ill or injured person with the objective of assisting or treating him, than a completely valid relationship is setup (even the patient is unconscious or unaware the doctor present. e.g. in MVA a doctor is not negligence if he does not offer his services in an emergency to a person. </li></ul>
  12. 14. 10. When is duty owned? <ul><li>  -  from the moment that the doctor undertakes advice or treatment whether under contract or gratuitou </li></ul><ul><li> e.g. at the scene of accident. </li></ul>
  13. 15. 11. Standard of duty <ul><ul><li>-         No doctor is expected to be perfect or infallible. -         Standard of competence which the patient is entitled to expect is that of an ordinary competent practitioner on the grade or specialty to which the doctor belongs. -         e.g. a GP performing major surgery will be expected to exercise the degree of skill of an average surgeon unless to act in an emergency when no surgeon was available </li></ul></ul>
  14. 16. Breaches of duty <ul><ul><li>Approved practice -         e.g. failure to take X-ray or to give antisera </li></ul></ul><ul><ul><li>A ccurate diagnosis or misdiagnosis -         e.g. failure to examine the abdomen in acute appendicitis </li></ul></ul><ul><ul><li>Risk of treatment -         not negligence if reasonable care to avoid </li></ul></ul><ul><ul><li> mishap. -         e.g. broken needle </li></ul></ul><ul><ul><li>Communication with other doctor’s </li></ul></ul><ul><ul><li>Attendance on patient </li></ul></ul><ul><ul><li>Reips a laquitor -         “the thing speaks for itself” -         e.g. swabs forceps left in the abdomen.   </li></ul></ul>
  15. 17. <ul><li>Medical Record -         the principal evidence in allegation of negligence action.   ¨      e.g. The house surgeon is not expected to have the same skill as a consultant surgeon but he is expected to confine his activities except in emergencies to a level of medical care which is within his competence.   </li></ul>
  16. 18. Contd. <ul><li>¨      A house surgeon electing to perform a major surgical operation not in urgent medical emergencies might be held guilty of negligence if damage ensues even though he could not be expected to posses the same experience as a senior consultant who should have performed the operation.   </li></ul>
  17. 19. Contd. <ul><li>      e.g. A brilliant surgeon may be negligence it he fails to apply his skill as well as inexperienced surgeon may be negligence even if he claims himself to possessed of sufficient competence.   . </li></ul>
  18. 20. Contd. <ul><li>Degree of competency is not a fixed quality. It varies according to the states of doctor from new graduate, senior consultant. However there is a minimal level of competence for all doctor which is guarded by the medical council </li></ul>
  19. 21. Cases
  20. 24. Second case
  21. 27. Third case
  22. 29. TYPES OF OFFENCES DEALT BY M.M.C <ul><li>Convicted in Malaysia or elsewhere of any offence punishable with imprisonment fine or both. </li></ul><ul><li>Guilty of infamous conduct in any professional respect </li></ul><ul><li>Obtain registration by fraud or misrepresentation </li></ul><ul><li>Not at any time of his registration entitled to be registered </li></ul><ul><li>Removed from the register of medical practitioners outside Malaysia. </li></ul>
  23. 30. DISCIPLINARY INQUIRY OF M.M.C ON PRACTITIONERS <ul><li>(1985-1989) </li></ul><ul><li>Total inquired-36 </li></ul><ul><li>Guilty as charged-21 </li></ul><ul><li>Charges dismiss-15 </li></ul>
  24. 31. PUNISHMENT <ul><li>Deregistered: 1 </li></ul><ul><li>suspended: 13 </li></ul><ul><li>1 month: 4 </li></ul><ul><li>2 months: 1 </li></ul><ul><li>3 months: 1 </li></ul><ul><li>6months: 5 </li></ul><ul><li>1 year: 2 </li></ul><ul><li>reprimanded:7 </li></ul><ul><li>Suspended action: 4 </li></ul>