Why Gynaecologist face 50% of all doctors litigations in India (PART -1 ): Dr Sharda Jain & Dr Sangeeta Gupta

1. Why Gynaecologist face
50% of all doctors
litigations in India Dr Sharda Jain

2. Why A GYNAECOLOGIST is caught up?
• In 80 % your doctor
colleague is behind
• 50 % cases can be
avoided by proper
consent , counseling &
documentation
• 50 % bcz of NO legal
knowledge

3. GYNAE :No Medico legal Knowledge
Knowledge is power

4. High Expectations and Emotional
Nature of Case
Gynecologists deal
childbirth and infertility.
These cases are young ,healthy & family is
emotionally charged,
The expectations of patients and their families are often
high…touching the roof. 100 % NORMAL HEE CHAHIYE.
When outcomes don't meet these expectations, there's
a greater likelihood of dissatisfaction and legal action.

5. Complex and Risky Procedures
Gynecology involves a range of procedures that
can be complex and carry inherent risks.
Surgical procedures  cesarean sections is most
unpredictable & so are hysterectomies in
endometrisis /PID /Cancer, and fertility treatments
can often lead to complications.
If complications arise which are mentioned in
books patients may blame the Gynaecologist
and seek legal recourse.

6. Unpredictable Outcomes in Obstetrics
• Obstetrics, which involves pregnancy and
childbirth challenging due to the
unpredictable nature of outcomes in
pregnancy & labour.
• Labour related complications, birth injuries to
the baby, or maternal health issues , before &
during can lead to lawsuits if patients believe
that the care provided was substandard.

7. Communication IssueBig issue
Effective communication between healthcare
providers and patients is crucial for managing
expectations and preventing
misunderstandings.
Gynaecologists sometimes struggle to
communicate complex medical information
clearly, leading to dissatisfaction and potential
legal actions.

8. INFORMED CONSENT
PATIENT SIGNATURE
JO CONSENT LEE HAI  UTNA
KARNA HAI

9. Cultural and Societal Factors
• In India, cultural and societal factors can play
a role in medical litigation.
• Families might pressure Gynecologists to
deliver specific outcomes due to cultural
preferences, and dissatisfaction can escalate
into legal action if these preferences aren't
met.

10. Delayed Diagnosis or Misdiagnosis
Gynaecological conditions, including
• Cancers
• Reproductive health issues i.e.Ectopic
can sometimes be misdiagnosed or diagnosed
later than desired.
Such delays can lead to worsened health
outcomes and legal claims for negligence.

11. Informed Consent Issues
Is critical for any medical procedure.
Gynaecologists  May face legal challenges if
patients believe they weren't adequately
informed about the risks, benefits, and
alternatives before undergoing a procedure.

12. Medical Complications and Adverse Events
Can occur even when the gynaecologist is well
trained & provides the best care.
If patients experience adverse outcomes, they
might question the quality of care received.

13. Lack of Standardization
In some cases, there might be variations in the
opinion & quality of care provided by different
Gynaecologists due to a lack of standardization
in medical practices.
This can contribute to medical negligence
claims.

14. DEATH /DAMAGE
100%
UNACCEPTABLE
both for mother /child

15. Societal Awareness and Advocacy
Over the years, there has been an increase in
public awareness about
patient rights,
medical negligence
& so many legal options available.
↓
led more legal action if they believe they've
received inadequate care.

16. Sum Up :Why A GYNAECOLOGIST is
caught up?
• MONEY game
• OPTIONS BEFORE
HIM/ HER  endless
• Open WAR on 15
fronts

17. SUM UP
Why obstetrics litigation INCREESING
Dealing with two lives at a time.
Deviation from normal is retrospective phenomina.
acceptance of adverse outcomes is much less in public
Follow up lasts almost 46 weeks.
Patients are young and healthy.

18. MY EXPERIENCE
DMC/ MCI /NMC

19. Common areas of litigation.
IN Obstetrics
• Antenatal care of high risk pregnancy
• Errors or omission in antenatal clinical diag.
• Errors or omissions in USG screening and
diagnosis10 %.
• Perinatal deaths
• Birth asphyxia  20%
• PPH  40%
• Retained swab  10 %
Legal issues in Obs/Gynae

20. Gynae.
• Sterilization/ contraception failure
• Incomplete MTP
• Perforation during MTP
• Undiagnosed Ectopic pregnancy
• Improper indication of hysterectomy
• Retained foreign body or swab / Mops after surgery
• Delayed or wrong diagnosis of malignancy
Legal issues in Obs/Gynae

21. Common Medico legal issues
• Informed Consent: Ensuring that patients fully understand the risks and
benefits of medical procedures before giving consent…NOT FOLLOWED
• Medical Negligence : Addressing cases where the standard of care
provided by Gynaecologist falls below the expected level, resulting in
harm to the patient  difficult issue
• Obstetric Complications- Dealing with 15% Obstetric emergencies &
Legal concerns related to birth injuries, fetal distress stilbirths , CP and
maternal complication & DEATH during child birth DEVASTATING
• Reproductive Rights: Handling legal issues related to
abortion,STERILISATION ,contraception, and assisted reproductive
technologies.COMPLEX
• Confidentiality and Privacy: Protecting patient information and
maintaining confidentiality within the healthcare setting.

22. Common Medico legal issues
• Maternal - Fetal Conflict : Addressing ethical and legal dilemmas
when the health of the mother and fetus is in conflict.
• Forensic Gynecology : Handling cases of POCSO /sexual assault,
domestic violence, and other forensic aspects within gynecology-
POOR TRAINING.
• Fertility Treatments: Addressing legal concerns surrounding assisted
reproductive technologies, such as surrogacy and egg/sperm
donation./CPR COMPLEX ISSUE  COUNCELLING IS IMPORTANT
• Wrongful Birth and Wrongful Pregnancy: Dealing with claims related
to the failure to diagnose or disclose genetic conditions/BIRTH
DEFECTS during prenatal care.

23. Conclusion
Though 50% of litigation cases, but only a small number of
cases go for valid claims of medical negligence.
Many gynaecologists provide excellent care, but the complex
and emotional nature of their field, young healthy pt
combined with various external factors (colleagues
initiated 80%), can lead to a higher incidence of legal claims.
Efforts to improve consents , communication, patient
education, documentation, and adherence to best practices
can help mitigate these issues and reduce the frequency of
legal cases

24. 1. Fondly known as Teacher of Teachers
2. Director Lifecare Centre & Lifecare IVF
3. Founder & Secretary general of Delhi Gynaecologist forum , a body of over 2500 members .
4. Founder & Chairperson of North India Gynaecologist forum (NIGF) , body cover 8 stats + 2
union territory  Delhi & Chandigarh
5. NMC / MCI : Ethical committee member ,an apex body of 14 lacs modern Medicine doctors
since 2018 till date
6. Business World : Included her in Top 20 Most Influential women in Healthcare in INDIA
(8/03/22)
7. DMC Expert since 2009 to till date
8. Passionate medical activist..has given leadership role in removing Female Feticide ,
Movement of Anemia, Save Uterus Campaign, Save ovary Campaign and Every Mother
Counts etc and now focusing on Zero mortality PPH, AMB , CCMB, Examination of
Survivor Sexual assault / rape & POCSO cases.
9. Given concept of JANANI SURAKSHA YOJNA & ASHA WORKER to GOI.
10. Spearheading movement of Doctors safety /Medico legal Awareness /Unity
of North India Gynaecologists
11. Decorated with many Lifetime achievement & Living Legend Award from many bodies
including LHMC AA, FOGSI ,DMA ,DGF , WOW India, Delhi ISAR, Cloudnine , Bharat Vishva
parishad
Dr. Sharda Jain
M.D. (PGIMER),
MNAMS,FICOG,FIMSA,DHM, QM
&AHO
PGDMLS (SYMBIOSIS)

25. • Consultant and Ex H.O.D, Deptt of Obstetrics &Gynaecology, E.S.I.Post Graduate
institute of Medical sciences and research, Basaidarapur, Delhi
• Founder secretary DELHI GYNAECOLOGIST FORUM.
• Member Safe motherhood comm. FOGSI(2011-2013)
• FOGSI Faculty for “Maternal Mortality Workshops” held at different parts of North
India
• Competent Trainer for H.M.S., FOGSI fast track initiative and conducted many
workshops all over North India in basic management of PPH and PE/E.
• Co-Chairperson-Safe motherhood comm. of Association of obstetricians and
gynaecologists of Delhi (2013-2015) & (2015-2017).
• Executive member of Association of obstetricians and gynaecologists of Delhi since
2006. Member Delhi Gynae Endoscopic society. Member Gynae Endocrine Society of
India.
• Member of women wing IMA (2006) and actively participated in workshops on women
and child trafficking all over India.
• Awarded WHO fellowship in Gynaecologic Oncology in 2001(AIIMS)
• Received training on Assisted Reproduction Techniques from AIIMS, Delhi
• “Eliminating preventable Maternal Mortality” field of interest.
• A recognised teacher and has many publications in international and national journal s
of repute.
Dr. Sangeeta Gupta
M.B.B.S, M.S.(1984)