CIVIL AND CRIMINAL NEGLIGENCE- PROBLEMS IN PRIVATE PRACTICE DR. A. K. KHANDELWAL MEDICAL SUPERINTENDENT Paramount Hospital CONSULTANT IN HOSPITAL MANAGEMENT NABH ASSESSOR
INTRODUCTION The Doctor patient relationship in our country has undergone a sea change in the last decade and a half. The lucky doctors of the past were treated like God and people revered and respected them. Aryans embodied the rule that, Vaidyo narayano harihi (which means doctors are equivalent to Lord Vishnu). We witness today a fast pace of commercialization and globalization on all spheres of life and the medical profession is no exception to these phenomena .
<ul><li>CPA, </li></ul><ul><li>Consumer awareness and </li></ul><ul><li>Commercialization has changed the scenario. </li></ul><ul><li>All these 3C has adverse effects on DOCTOR AND PATIENT RELATIONSHIP. </li></ul><ul><li>It's a common observation that medical practitioners, </li></ul><ul><li>hospitals are being attacked by family members of </li></ul><ul><li>patient for alleged medical negligence. </li></ul>
Section 304-A of IPC is a sword hanging above the doctor, working both in government hospitals and in the private sectors. Doctors are considered as soft targets by the law enforcing agencies and being harassed by unsatisfied patients. Moreover complainants often use criminal cases to pressurize medical professionals and to extract unjust compensation
Allegations of rashness or negligence are often raised against doctors by persons without adequate medical knowledge, to extract unjust compensation. This results in serious embarrassment and harassment to doctors who are forced to seek bail to escape arrest. If bail is not granted, they will have to suffer incarceration. They may be exonerated of the charges at the end; but in the meantime they would have suffered a loss of reputation
Public awareness of medical negligence in India is growing. Hospital managements are increasingly facing complaints regarding the Facilities, Standards of professional competence, and The appropriateness of their therapeutic and diagnostic methods.
Currently, approximately 10,000-15,000 medico-legal cases are pending in various courts of our country, a rise of almost 25 per cent in the last five years. (2005) Worldwide and in India, gynaecologists and obstetricians top the chart when it comes to the number of cases filed against medicos. Anaesthesiologists and ophthalmologists follow.
<ul><li>The severity of the punishment depends on whether </li></ul><ul><li>the case is civil or criminal. </li></ul><ul><li>Compensation range from a meagre Rs 10,000 to </li></ul><ul><li>several lakhs. The average compensation ranges </li></ul><ul><li>from Rs 4 lakh to Rs 5 lakh. </li></ul><ul><li>If it's a civil case, which most are, then if proven </li></ul><ul><li>guilty the State Commission might debar the doctor </li></ul><ul><li>from practice . </li></ul>
<ul><li>Around 10 per cent of cases are based on very </li></ul><ul><li>'gross' negligence </li></ul><ul><li>More than 20 to 30 per cent of cases fall into </li></ul><ul><li>mild or moderate category. </li></ul><ul><li>Ratio of relevant cases to the number of </li></ul><ul><li>frivolous cases is 50:50. </li></ul>
<ul><li>One in every four doctors has been sued in his lifetime in the US. </li></ul><ul><li>The US may be a consumerist country, but in India the consumer is no less powerful. </li></ul><ul><li>It's easy in India to file a case in the CC with a low litigation fee and because one can fight one's own case without the help of an advocate. </li></ul><ul><li>In the US, the litigation fee costs around $25,000. Also, in the US it is not easy to file a criminal case against a doctor, but in India it can be done under IPC 304-A . </li></ul>
A- AWARENES OF NEGLIGENCY B-BUILD STRONG STRUCTURE, PROCESS, C- COMMUNICATION D-DOCUMENTATION E-EMPHATHETIC ATTITUDE ABC FOR DEALING WITH COMPLAINT OF NEGLIGENCE
AWARENESS Healthcare institutions of today are complex matrix organisations. Errors are bound to occur in any complex human endeavour, and healthcare is no exception Around 100 000 patients a year die from preventable errors in hospitals in America . Medical error is the third most frequent cause of death in Britain after cancer and heart disease and kills four times more people than die from all other types of accidents Be careful and implement Risk Management Strategy to minimize error/negligency
BUILDING OF STRONG STRUCTURE Man power- Right Man at Right Place Method- Right Method Machine-Right Machine Material-Right and adequate
<ul><li>COMMUNICATION </li></ul><ul><li>This is the key to doctor-patient relationship . </li></ul><ul><li>Communicate effectively to prevent error. </li></ul><ul><li>communication failures is at the root of over 60% of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations </li></ul><ul><li>Communicate effectively to prevent dissatisfaction in patients and family members.- </li></ul><ul><li>Patients who are well informed about treatment options, the course of care ,expected out comes, and possible complications, more satisfied and less likely to file malpractices. </li></ul>
DOCUMENTAION ( l) A complete history with a description of the present ailment or injury, recorded as nearly as possible in the patient's words; (2) The report of a physical examination revealing objective findings regarding objective complaints and including significant negatives; (3) A record of diagnostic tests and all similar reports received concerning the patient;
( 4) An impression or a diagnosis (when a physician is able to form only an impression in the absence of additional diagnostic procedures, the word "diagnosis" should be avoided); (5) A record of treatment, with medications prescribed and procedures recommended or performed; and (6) The patient's response to treatment along with any indicated alterations in the treatment plan. (7)Please make sure that your handwriting is legible
EMPHATHY The human face of medical care decides the patient’s /attendant’s reaction towards on medical mishap/untoward reaction. The whole system of medical establishment should made courteous, and polite. The special training should be imported to staffs from HRD experts about dealing with patients/relatives under grievous mental stress due to some loss/injury.
DEALING WITH MEDIA Often doctors are hounded by the media for an alleged case of medical negligence. The first issue that needs to be addressed is when a reporter wants to have your version of alleged act(s) of negligence committed by you. The answers are not easy but some guidelines are possible.
<ul><li>BASIC GUIDELINES FOR DEALING WITH NEWS MEDIA </li></ul><ul><li>Be Honest </li></ul><ul><li>Be accurate </li></ul><ul><li>Be concise and professional </li></ul><ul><li>Be appreciative </li></ul>