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1. Welcome to “EAST ZONE MEDICO LEGAL SERVICES PVT.LTD.”
“EAST ZONE MEDICO LEGAL SERVICES PVT.LTD” is a private ltd. company incorporated on 13-11-2013.
 It is classified as Indian Government Company and is registered under the company’s act.1956
(no. 1 of 1956) and that the company is private limited in Bihar.
 Registration certificate is verified by ministry website (www.mca.gov.in)
 East zone medico legal services pvt.ltd corporate identification number is (CIN)
U66000BR2013PTCO21441
Visit us:
 www.eastzonemedico.com
Medico legal consents free download http://eastzonemedico.com/download-2/
 www.eastzonemedico.in
Whatsapp: - 7033239999, 9472247096
 Dial No. – 9334777479
 Join us:-g+, Facebook, Twitter, Skype, Instagram, Viber, Telegram, Linked. in.
 Registered office address is.
 N.M.C.H PATNA-800007
Sub Address
 L O house room no. 12, 2nd floor near bansal tower exhibition Road, Patna
Our company having small financial sound but it has provide best granted service
It was Established on 13-11-2013 beyond an emerging brand “EAST ZONE MEDICO”
In the last two years of successful journey of the company we have laid these 3Ps (Principle,
People and Partnership)as our foundation
Our clear vision: - provide satisfied services medical federation and all practitioners.
Reachyourgoalwithus
WE AREAFAMILY

2. We are proud to be part of upcoming and challenging field of medico legal consulting.
We advise hospitals and doctors on various issues affecting the medical business.
We undertake litigation on behalf of doctors for medical negligence and advice hospitals on legal issue.
We have a dedicate support of doctors who have a legal background and who help us understand and
advice us on the complex issues relating to medical profession.
We also consents medico-legal audits and assist in drafting consents, case papers and promotional
material from the medico legal point of view.
We provide advance training to the staff and create awareness about medico-legal issues.
Our services include defending our clients in consumer courts, criminal litigations, medical councils,
human rights commission and various other courts and forums up to the supreme court of India, setting up
an internal grievance cell for clients, defending cases arising out of professional liability and providing
professional liability insurance.
Today’s medical practitioners are soft targeted.
Generally lot of medical practitioner and medical students are using online social and business related
networking website such as facebook, doc2doc and LinkedIn.
These rapidly involving and growing social media have potential to promote public health by providing
powerful instruments for communication and education. However evidence is emerging from studies,
legal cases, and media reports that the use of these new technologies is creating several ethical problems
for medical practitioners as well as medical student also.
It is a common observation that medical practitioners, hospital are being attacked by “Our society, Media
issue, Political issue, Government policy, Clinical establish act 2013, Consumer form, Human rights,
Medical tourism etc.“ even most of practitioner heated by family members of patient for alleged medical
negligence. The doctor-patient relationship is one of the most unique and privileged based on mutual trust
and faith, but there is a great decline in the doctor patient relationship. The reason may be communication
gap between them, commercialization of health services raising expectations from doctor’s increased
consumer awareness
. The most common errors associated with childbirth include the physician or obstetricians:
 Choosing not to anticipate birth complications because of the baby’s large size or because the
umbilical cord was tangled.
 Choosing not to respond to fetal distress that is identifiable by the fetal tracing monitor.
The most common emergency room mistakes are:
 Failure to completely evaluate and treat the patient’s condition;
 Delayed or misdiagnosis;
 Erroneous laboratory tests;
 Mistakes with blood transfusions, including mis-identifying blood types;
 Prescription errors;
 Failure to monitor the patient’s condition.
Negligence VS Doctors
Negligence is the relationship between the parties. Negligence cases are based on a non-contractual
relationship between the parties. The parties may be known to each other, as with a surgeon and a patient,
or they may be strangers, as with two drivers involved in a road traffic accident. Due to the lack of any
agreed relationship between the parties, the first question that arises in the case of negligence is that of

3. whether any relationship exists between them at all. If one party is to be held liable to another in
negligence, the relationship that must first be established is that of a duty of care.
Exam answers often state as a learned fact that liability in negligence is non-contractual, but it is worth
spending a little longer thinking about what it actually means. As a future accountant, you may find it
helpful to relate this point to professional negligence cases since these illustrate the extent to which an
accountant may be held liable in relationships where there may be no contractual obligation.
 The harm must be reasonably foreseeable
 There must be proximity between the claimant and the defendant
 It must be just, fair and reasonable to impose a duty of care on the defendant.
Note that for sever ability at this stage in the context of negligence is used to establish whether there is
any relationship between the parties; this is not necessary at this stage in contract since the contract itself
establishes that there is a relationship. (We will consider foresee ability again in relation to remoteness of
damage, which is discussed below.) Labor and Delivery Negligence
Most lawsuits arising out of labor and delivery negligence are brought against obstetricians/gynecologists,
labor and delivery nurses, anesthesiologists and other medical providers who are alleged to have been
negligent in the management of labor and delivery of a child is damaged in the process. Most of these
lawsuits do not include claims of negligence in prenatal or postpartum care. Labor and delivery
negligence can occur when a physician or medical provider in the labor and delivery process had not
correctly monitored the fetus during labor for signs of oxygen deprivation. In addition, cases of
negligence occur frequently where there is a preterm delivery.
Hospital Liability for a Doctor's Negligence
Under normal circumstances, subject to variations which exist in many states, a hospital is not usually
liable for the actions of a doctor practicing in the hospital. This is due to a variety of factors, but primarily
because most doctors are not employees of the hospital, but rather are independent contractors. If a non-
employee doctor commits malpractice in the hospital, then the injured party likely cannot hold the
hospital responsible. If, however, the patient is led to believe by statement, appearance or otherwise that
the doctor is a hospital employee or representative, some states may still find the hospital liable for the
doctor’s malpractice.
Nurses, medical technicians, and other medical personnel usually are hospital employees and, therefore,
the hospital has responsibility for their actions. All of this is a brief overview, subject to the law in your
state which may be different, to understand why the emergency room may require a different analysis:
The patient is going to an emergency room and not a specific doctor – The emergency room is under the
control of the hospital, which has responsibility to make sure that the medical personnel on duty in the
emergency room perform their duties in a reasonable manner;
Disclosure that a doctor is a non-employee – When a patient selects a doctor, part of the process and
paperwork usually involves a disclosure that the doctor is not an employee of the hospital, but merely has
privileges to practice there. Therefore, the hospital distances itself from responsibility for the doctor’s
actions. In an emergency situation, the patient is not choosing a specific doctor but a care center and the
hospital does not have the opportunity to inform the patient of the non-employee status of the doctor.
Hospital Malpractice and Negligence

4. Hospital malpractice causes thousands of injuries and deaths every year. Cases of medical negligence
often involve complex issues regarding emergency room care, surgery, intensive care treatment, labor and
delivery and medication errors. These cases require extensive medical research, investigation and analysis
There's no question about it: hospitals can be dangerous places. Medical mistakes in the diagnosis and
treatment of hospital patients are unfortunately among the most common cases of hospital malpractice
seen by malpractice lawyers. Misdiagnosis of the patient's condition, improperly interpreted diagnostic
tests, negligently performed surgeries and medication errors are all examples of medical negligence and
can all have devastating effects on patients already admitted to a hospital with an illness or injury. This
can be considered hospital malpractice.
Understaffing of hospitals and overworking of hospital employees contributes to the dangers of a hospital
visit. Long delays in emergency rooms, as well as waiting for radiology tests and delays in performing
surgery can all permit a patient's condition to worsen. In addition, patients frequently arrive at the hospital
with one type of illness, and sustain an injury or infection in the hospital that they never had before. Often
these patients are in much worse physical condition leaving the hospital than when they went in.
Sometimes patients injured by a hospital in the case of medical negligence require extensive treatments or
multiple surgeries to recover.
Because hospitals often treat hundreds of patients at a time, serious medical mistakes can occur due to the
simple failure to check the wristband of a patient to make sure the patient is receiving the proper
medications or treatments. In addition, hospital staff is responsible for assessing each patient's risk of
falling, and for placing bedrails in the upright position for patients at high risk for falls. The failure to take
this basic precaution is hospital malpractice and if the patient falls out of bed or is otherwise injured as a
result, fractures, heart attacks, strokes and other life-altering injuries could result.
Medical negligence cases are not always the result of the negligence or mistreatment of illnesses or
symptoms contracted outside the hospital. Infections contracted in the hospital setting represent another
area of hospital negligence. Hospitals have infection control departments which set standards for infection
protection and treatment. An infection acquired in a hospital is called a "nosocomial" infection. These can
include pneumonia, staph infections, or infections of a surgical wound. Nosocomial infections should be
treated aggressively, especially in patients with compromised immune systems. Often this involves
intravenous antibiotic treatment, which may even continue once the patient is discharged from the
hospital. In cases of medical negligence, the failure to timely diagnose or treat an infection in the hospital
setting can result in systemic sepsis or worse.
Sending a patient home too soon is another common hospital mistake which can have tragic results.
Releasing patients who have exhibited signs of stroke, symptoms of heart attack, kidney problems, blood
disorders or untreated infections can also result in serious injuries, such as organ damage and death.
Injury during birth often stems from a lack of oxygen to the brain. A fetus suffering from intrauterine
asphyxia will almost always show signs of distress. Doctors, nurses, midwives and other labor and
delivery professionals are trained to recognize symptoms of fetal distress and react accordingly.
 If a healthcare provider falls below accepted standards in recognizing the signs of fetal distress,
irreversible injury can result.
 Technology, including an internal fetal heart rate monitor is a common tool in avoiding permanent
injury as a result of difficult or complicated labor.

5.  Our birth injury trial and settlement attorneys have handled hundreds of cases that involve an
allegation of secondary to negligent monitoring.
Police & Harassment of doctor.
An interesting order passed by the supreme court in case was a warning given to police officials not to
arrest or harass doctors the facts clearly come within the parameters. Laid down in Jacob Mathew’s Case.
Even a threat was given to policeman orders. They themselves have to face legal action.
D.O.T:- Doctor should well acquainted about duties in relation of operative case that not delegate duty to
operate another doctor, not to experiment without valid reason & without consent, inform the patient
about nature of operation & risk involved particular about site & extent of operation assistance by
qualified and experienced anesthetist only use only properly sterilized instruments, case not to leave any
post operative case, D.O.T should be followed by PM examination.
Awareness about consumer protection act:-
Among private practitioner & government hospital faculty members.
CPA has provided for three tiers quasi. Judicial consumer dispute mechanism.
1. District consumer dispute redressed forum
 Up to rs.20 lacks
 Appeal lies to the state commission within 30 days receipt of the order
2. State consumer dispute redressed forum.
 Rs. 20 lacks to 1 cores.
 Appeal lies to the national commission within 30 days of the order
3. National consumer dispute redressed forum
 Rs. 20 lacks to 1 cores.
 Appeal lies to the S.C court within 30 days receipt of the order.
Advantage of company
 Ethically and practically awareness up date day to day our website
 All social media almost India’s 1 lack+ followed currently having east zone medico
 Our teams young dynamic and hard working, we always works as one team and our interaction
with you will always be fair and balanced.
 We assured you that we are committed to ensure the best services which we can provide within the
time constrain, and as we continue to build a stronger partnership together.
 We are a team of industry specialists helping our customer in the insurance, legal and medical
sector do more business, more efficiency.
Our team has deal with all the section which comes under medical profession risk management.
For example:-
 Sec.29 Deals with documents.
 Sec. 52 Describe “good faith”.
 Sec.3 punishment of offences committed beyond ,but which by law may be tried within ,India
 Sec.90 Related to consent.
 Sec.176 Failure to inform police whenever essential.
 Sec.269-271 Related to spread of infectious disease and disobedience of a quarantine rule.
 Sec.272-273 Related to adulteration of food and drinks.
 Sec.274-276 Related to adulteration of drugs.

6.  Sec.304-A Deal with death caused by negligence, According to this sec. the offence is non-
boilable. This causes lot of hardship, bad reputation and mental agony to the doctors. In fact the
police should register the causes of death due to medical negligence under sec. 304-A of IPC, in
which the offence is boilable and the doctor can be released on bail. This judgment has been
passed by Bombay high court in criminal revision application no.282 of 1996 dated 28th
November 1998(3). The basic difference is that in sec. 304 there is intentional act of negligence
while in 304-A the act is never done with intention to cause death.
 Sec.306-309 Related with abatement of suicide.
 Sec.312-314 Related to causing miss-carriage, abortion and hiding such facts.
 Sec.315-316 Deals with act to prevent child being born alive or to cause it to die after birth.
Note: 312-316 of the IPC deal with miscarriage &death of severity and intention with which the
crime is committed, Penalties range from seven year to life imprisonment for fourteen year & fine.
IPC 1860 permitted legal abortion did without criminal. Intent & in good faith for express purpose
of saving the life of the mother. Medical Termination of pregnancy act was passed in July 1971.
Legally infanticide amounts to homicide and all legal provisions. Applicable to the offence of
homicide are applicable to infanticide.
Section 318 concealment of birth by secret disposal of the dead amount to culpable homicide.
 Sec.319-322 Related to causing hurt, grievous hurt, loss of vision, loss of hearing or
disfigurement.
 Sec.336-338 Deals with causing hurt by rash or negligent act.
 Sec.340-342 Related to wrongful confinement.
 Sec.491 Related to breach of contract.
 Sec.99 Related to defamation.
 Section 92 of the Indian Penal Code offers legal immunity for a registered medical practitioner to
proceed with appropriate treatment even without the consent of the patient in an emergency, when
the victim is incapable of understanding the nature of the treatment, or when there are no legal
heirs to sign the consent.
Legal aid:
Legal aid is no longer available for most clinical negligence claims, following the Legal Aid,
Sentencing and Punishment of Offenders Act 2012, which came into force on 1 April 2013. From
1 April 2013 onwards legal aid will only be available in clinical negligence cases where a child
suffers a neurological injury resulting in them being severely disabled during pregnancy, child
birth or the postnatal period (8 weeks).
Possible Complications and Injuries
The most common complications from anesthesia are:
Post-Operative Pain Nausea and Vomiting
Heart attack Death
Delirium or temporary mental confusion Sore throat and/or damage to the larynx
Nerve injury Respiratory difficulties
Pneumonia Brain damage due to lack of oxygen

7. Blood clots Stroke
Serious allergic reaction from the
anesthesia (known as anaphylaxis)
Tooth damage due to the placing of the
breathing tube (intubation) during the operation
Anesthesia awareness (meaning that the person regains consciousness during the operation)
As you can see, the list of major known complications from anesthesia is quite lengthy, and some risks
are very serious. Luckily, while minor complications such as post-operative pain, nausea, and vomiting
are not at all uncommon (as high as 40%), the most serious complications are relatively rare. For example,
the risk of waking up during surgery is about 0.2%. That amounts to about two out of every thousand
patients.
Major Errors in Administration of Anesthesia
The most common types of mistakes in administering anesthesia are:
 giving the wrong dosage of anesthesia, either too much or too little
 intubation the patient improperly (tooth damage due to the intubation is actually one of the most
common malpractice claims against anesthesiologists)
 failing to monitor the patient properly
 failing to recognize complications as they are developing
 accidentally or intentionally turning off the alarm on the pulse oximeter, which measures the
oxygen level in the patient’s blood
 failing to monitor the delivery of oxygen to the patient
 failing to give the patient the proper instructions on how to prepare for surgery, such as not eating
or drinking for a specified time before the surgery
 Finally, while this is not an administration of anesthesia error per se, it can amount to medical
negligence on the part of the anesthesiologist. During long surgery, the anesthesiologist is
responsible for ensuring that the patient is moved periodically to avoid putting too much pressure
on specific parts of the body. If the patient in the prone position is not moved periodically, the
optic nerve can be injured, and blindness can result.
Proving an Anesthesiologist’s Negligence
Medical malpractice can occur in many different ways, but the main cause of medical malpractice always
boils down to on the part of the defendant doctor or care provider.
In general, negligence means not exercising reasonable care, or doing something wrong. In medical
malpractice cases, courts often define negligence as a health care provider’s failure to exercise the degree
of care and skill of the average health care provider who practices the provider’s specialty, taking into
account the advances in the profession and resources available to the provider.
In order to prove that an anesthesiologist was negligent, your lawyer will hire an expert medical witness,
who will consider things like your pre-surgical risk factors for anesthesia and the surgeon’s and
anesthesiologist’s operative notes, to try to figure out what happened during the surgery. Then, a very
important consideration is the known complication rate of the type of anesthesia used during the surgery.
(For an overview on the legal issues you'd face bringing a medical malpractice claim,
When is a Hospital Liable in a Lawsuit?

8. To make a medical malpractice claim, the first thing that you have to determine is whether the hospital, or
anesthesiologist, is liable. The most common ways for a hospital to be held liable for anesthesia errors are
the following:
 If the anesthesiologist is employed by the hospital, then the hospital will automatically be liable
for any negligence committed by its employee. This is called vicarious liability.
 If the anesthesiologist is an independent contractor, the hospital may be held liable for negligently
hiring and supervising the anesthesiologist.
 If the negligence occurred due to anesthesia equipment failure, the hospital may be independently
negligent in maintaining and repairing its equipment.
Outside of these scenarios, the anesthesiologist would typically be responsible, and:-
Liability When the Anesthesiologist is an Independent Contractor
A hospital is generally not legally liable for the negligence of physicians who participated in an operation
at the hospital, but were not employees of the hospital. Physicians are considered to be independent
contractors, and so, unless they are the hospital’s employees, the hospital is usually not responsible for
their negligence.
Determining whether an anesthesiologist is an employee or an independent contractor is a complex legal
issue that involves looking at things like the employment contract between the doctor and the hospital,
and how much control the hospital had over the doctor’s job conditions and performance.
As a general rule, the more control an employer has over the performance of a physician who claims to be
an independent contractor, the more likely it is that a court might find that the physician was actually an
employee. If it’s determined that the anesthesiologist acted independently of the hospital, the lawsuit
would name him or her as the defendant. Because this is such a complex issue, you should contact a
qualified medical malpractice lawyer in your state to as to the law on this issue in your state.
Important complications of general anesthesia
 Pain.
 Nausea and vomiting - up to 30% of patients.
 Damage to teeth - 1 in 4,500 cases.
 Sore throat and laryngeal damage.
 Anaphylaxis to anesthetic agents - figures such as 0.2% have been quoted.
 Cardiovascular collapse.
 Respiratory depression.
 Aspiration pneumonitis - up to 4.5% frequency has been reported; higher in children.
 Hypothermia.
 Hypoxic brain damage.
 Nerve injury - 0.4% in general anesthesia and 0.1% in regional anesthesia.
 Awareness during anesthesia - up to 0.2% of patients; higher in obstetrics and cardiac patients.
 Embolism - air, thrombus, venous or arterial.
 Backache.
 Headache.
 Idiosyncratic reactions related to specific agents - eg, malignant hyperpyrexia with suxamethonium,
succinylcholine-related apnoea.
 Iatrogenic - eg, pneumothorax related to central line insertion.
 Death.

9. Some specific complications ofgeneral anesthesia
Anaphylaxis:-
 Anaphylaxis can occur to any anesthetic agent and in all types of anaesthesia.The severity of the reaction
may vary but features may include rash, urticaria, bronchospasm, hypotension, angio-oedema, and
vomiting. It needs to be carefully looked for in the pre-operative assessment and previous general
anesthetic charts may help.
 Patients who are suspected of an allergic reaction should be referred for further investigation to try to
determine the exact cause.[]
If necessary,this may involve provocation testing or skin prick testing and
patients should be referred to local immunologists. Anaphylaxis needs to be promptly recognized and
managed and patients should be advised to wear a medical emergency identification bracelet or similar
once they recover.
Aspiration pneumonitis
 A reduced level of consciousness can lead to an unprotected airway. If the patient vomits they can aspirate
the vomits contents into their lungs. This can set up lung inflammation with infection. The risk of aspiration
pneumonitis and aspiration pneumonia is reduced by fasting for several hours prior to the procedure and
cricoid cartilage pressure during induction of anesthesia.
However, the evidence for the use of cricoids
pressure is not clearly documented and further investigation is required.[
 Other methods of reducing aspiration pneumonitis associated with anesthesia are the use of
metoclopramide to enhance gastric emptying and to increase the pH of gastric contents. The evidence for
the benefit of these methods appears promising
 Aspiration pneumonitis may also occur in spinal anesthesia if the level of spinal block is too high, leading
to paralysis or impairment of the vocal cords and respiratory impairment.
Peripheral nerve damage
 This can occur with all the types of anesthesia and results from nerve compression. The most common
cause is exaggerated positioning for prolonged periods of time. Both the anesthetist and the surgeons
should be aware of this potential complication and patients should be moved on a regular basis if possible.
The severity varies and recovery may be prolonged. The most common nerves affected are the ulnar nerve
and the common peroneal nerve. More rarely, the brachial plexus may be affected.[
 Injury to nerves can be avoided by prevention of extreme postures for lengthy periods during surgery. If
nerve damage occurs then patients should be followed up and further investigations such as
electromyography may be required
Damage to teeth
It is now common practice to check the teeth in the anesthetist’s pre-operative assessment. Damage to
teeth is actually the most common cause of claims made against anesthetists. The tooth most commonly
affected is the upper left incisor
Embolism
Embolism is rare during an anesthetic but is potentially fatal. Air embolism occurs more commonly
during neurosurgical procedures or pelvic operations. Prophylaxis of thromboembolism is common and
begins pre-operatively with thromboembolic deterrents (TEDS) and low molecular weight heparin
(LMWH)

10. Important complications of regional anesthesia
Central regional anesthesia was first used at the end of the 18th century. It provided a method of blocking
afferent and efferent nerves by injecting anesthetic agents in either the epidural space around the spinal
cord (epidural anesthesia) or directly in the cerebrospinal fluid surrounding the spinal cord (i.e. in the
subarachnoid space called spinal anesthesia). All nerves are blocked including motor nerves, sensory
nerves and nerves of the autonomic system. Epidural anesthesia takes slightly longer than spinal
anesthesia to take effect and provides predominantly analgesic properties. With both, the need for muscle
paralysis and ventilation is not usually required but there is a risk that a high block will impair respiration,
meaning that ventilation will be necessary. Results from a review of 114 studies and a Cochrane
systematic review have shown that regional anesthesia is associated with reduced mortality and reduction
in serious complications in comparison with general anesthesia
Important complications ofregional anesthesia
 Pain - 25% of patients still experience pain despite spinal anesthesia.
 Post-Dural headache from cerebrospinal fluid (CSF) leak.
 Hypotension and bradycardia through blockade of the sympathetic nervous system.
 Limb damage from sensory and motor block.
 Epidural or intrathecal bleed.
 Respiratory failure if block is 'too high'.
 Direct nerve damage.
 Hypothermia.
 Damage to the spinal cord - may be transient or permanent.
 Spinal infection.
 Aseptic meningitis.
 Hematoma of the spinal cord - enhanced by use of LMWH pre-operatively.
 Anaphylaxis.
 Urinary retention.
 Spinal cord infarction.
 Anesthetic intoxication
Some specific complications ofregional anesthesia
Post-Dural puncture headache
 Post-Dural puncture headache is very common after spinal anesthesia and especially in young adults and
obstetrics. The headache results from CSF leak from the puncture site. It is enhanced by use of larger-gauge
needles and reduced by pencil-tipped needles. Presenting symptoms may include headache, photophobia,
vomiting and dizziness.[
 Post-Dural puncture headache is usually treated with analgesia, bed rest and adequate hydration. The
evidence does not suggest that bed rest prevents or changes the outcome.] [
Occasionally epidural blood
patch is used where 15 ml of the patient's blood are injected at the site of the meningeal tear. Caffeine is
also used and acts as a stimulant of the CNS and has shown benefit. Other medications with benefit include
gabapentin, theophylline and hydrocortisone.[
Subcutaneous sumatriptan, adrenocorticotrophic hormone
(ACTH) and epidural saline have not shown consistent benefits
Total spinal block
Total spinal block can occur with the injection of large amounts of anesthetic agents into the spinal cord.
It is detected by a high sensory level and rapid muscle paralysis. The block moves up the spinal cord so
that respiratory embarrassment may occur, as can unconsciousness. In these situations the patient needs
prompt assessment and may need to be intubated and ventilated until the spinal block wears off.

11. Hypotension
 Up to half of patients receiving spinal anesthesia will develop transient hypotension as sympathetic nerves
are blocked. This usually responds to prompt fluid replacement, usually starting with crystalloids followed
by colloids. Occasionally hypotension can be severe and may require vasopressors along with fluids
 Care must be taken in patients with a cardiac history, as they may develop myocardial ischaemia with
minor drops in blood pressure.[]
It is suggested that heart rate variability prior to spinal anesthesia
represents autonomic dysfunction and may help determine patients who are more likely to develop
hypotension.
 Cases of bradycardia with asystole leading to cardiac arrest have also occurred and it appears the
underlying etiology is complicated and not just related to autonomic dysfunction.
Neurological deficits
 Caudal equine syndrome may occur and can be transient or permanent. This is a common reason for
patients to refuse spinal anesthesia. There may also be traumatic injury to the spinal cord
 Adhesive arachnoiditis is a longer-term sequel of spinal anesthesia, occurring weeks and even months
later.]
It is characterized by proliferation of the meanings and vasoconstriction of spinal cord blood vessels.
This results in gradual sensory and motor deficits from ischemia and infarction of the spinal cord.
Important complications of local anesthesia
 Pain.
 Bleeding and hematoma formation.
 Nerve injury due to direct injury.
 Infection.
 Ischemic necrosis.
All forms of anesthetics are invasive to a patient and therefore consent should be obtained as for other
procedures. Ideally patients should be given a leaflet regarding anesthesia and then counseled regarding
the intended benefits and the risks of anesthesia. In a general practice setting it will be the responsibility
of the clinician who administers the local anesthesia to ensure good, non-coercive consent is obtained.
Labor and delivery lawsuits may arise claiming that the doctors and nurses were negligent in the delivery
process that led to the permanent brain injury to the child. Many of these cases are brought years after
birth to better identify the level of permanency of the birth injury which could include brain damage and
developmental, cognitive and behavioral problems of the child. In some of these cases, the doctors in
charge of labor and delivery misread signs and symptoms of fetal distress or are insistent on attempting to
induce labor with a synthetic hormone like Oxytocin.
 Misdiagnosis of breast cancer, colon cancer or another form of cancer
 Misdiagnosis of stroke or failure to recognize widely recognized warning signs
 Failure to diagnose heart disease, arrhythmia or another life-threatening cardiac condition
 Serious emergency room errors leading to catastrophic injury
 Improper prenatal care or negligence during labor and delivery, which may lead to permanent
birth and brain injuries
Clinical negligence may include:
 Failing to diagnose your condition or making the wrong diagnosis.
 Making a mistake during a procedure or operation.

12.  Giving the wrong drug.
 Failing to obtain consent to treatment.
 Failing to warn about the risks of a particular treatment
 There is a clear obligation on a medical practitioner carrying out or arranging for the carrying out
of an operation, to inform the patient of any possible harmful consequence arising from the
operation, so as to permit the patient to give an informed consent to subject himself to the
operation concerned. The extent of this obligation must as a matter of common sense vary with
what might be described as the elective nature of the surgery concerned.
 The standard of care to be exercised by a medical practitioner in the giving of the warning of the
consequences of proposed surgical procedures is not, in principle any different from the standard
of care to be exercised by medical practitioners in the giving of treatment or advice.
 Where there is a question of elective surgery which is not essential to health or bodily well being,
if there is a risk - however exceptional or remote - of grave consequences involving severe pain
stretching for an appreciable time into the future and involving the possibility of further operative
procedures, the exercise of the duty of care are owed by the medical practitioner requires that such
possible consequences should be explained in the clearest language to the Plaintiff.
Clinical negligence glossary:
 Abortion: Most commonly, the purposeful removal or expulsion of a fetus from the uterus.
 Accidental nerve damage: The accidental damage of essential nerves during a medical procedure.
Examples of situations that may result in accidental damage include: accidental injection of certain
drugs, bleeding from a punctured artery or traction during manipulation of the back or neck.
 Action against Medical Accidents (Alma): The independent charity responsible for promoting
improvements in patient safety and justice for people who have been adversely affected by a
medical accident.
 Allergies: A hypersensitivity to certain drugs, foods or any other environmental substance. Failure
to confirm whether a patient has any allergies to commonly prescribed drugs may result in a
medical accident.
 Amenorrhea: The lack of a menstrual period in women of reproductive age.
 Antenatal: Antenatal literally means ‘before birth’, and is used to refer to the care a pregnant
mother receives in the run up to birth.
 Anterior Curiae Ligament: One of the four major ligaments in the human knee. The ACL is
integral to full and proper movement of the knee; injuries can therefore be extremely debilitating.
 Basal cell carcinoma (or rodent ulcer): A slow-growing, skin based tumor. The consequences of a
missed or a misdiagnosis can be grave.
 Benign: In a clinical negligence context, benign refers to a tumor which lacks the ability to
metastasize. This means the tumor cannot spread to new sites in the body.
 Birth injury: Can relate to an injury caused to the baby or mother during the birthing process.
Injuries suffered at birth can have long term consequences for both the child and the mother.
 Brain injury: damage to the brain caused by the negligence of a medical professional.
 Caesarean section: The surgical delivery of a baby. Surgeons make one or more incisions through
a mother's abdomen and uterus in order to deliver the baby.
 Carpal tunnel syndrome: The result of nerve entrapment in the wrist; symptoms include
intermittent numbness of the thumb, index, long and radial half of the ring finger, and if not
treated can lead to permanent numbness and muscular atrophy.
 Caudal Equine: A bundle of nerves located in the spinal column. Damage to the Caudal Equine
nerves can result in Caudal Equine Syndrome.
 Caudal Equine Syndrome: a serious neurologic condition; sufferers experience acute loss of
function of the lumbar plexus. Patients suffering from Caudal Equine Syndrome may require
treatment for lower limb dysfunction and obesity.

13.  Cerebral Artery Aneurysm: A weakness in the wall of an artery that causes the dilation or
ballooning of a blood vessel. Cerebral aneurysms can be extremely difficult to diagnose and, in the
most severe cases, can cause coma when they rupture.
 Cerebral Palsy: Cerebral Palsy is an umbrella term for a range of conditions which affect
movement, posture and coordination. It is caused by damage to the brain during or immediately
after childbirth.
 Cerebra-spinal fluid (CSF): A clear bodily fluid, the primary function of which is to act as
protection for the brain inside the skull.
 Coroner: A government-appointed official responsible for confirming and certifying deaths and, in
some instances, conducting investigations into the circumstances surrounding a death.
 Coroner’s inquest: When a coroner is tasked with investigating the circumstances surrounding a
death, a coroner’s inquest is launched. The inquest will look into who has died, and how, when
and where the death occurred.
 Deep vein thrombosis: A blood clot in a deep vein, most commonly in the legs. The consequences
of misdiagnosis can be severe, with the worst possible outcome a potentially fatal pulmonary
embolism.
 Diagnosis: The process of observing symptoms and identifying the nature of an illness.
 Diagnostic blood tests: Blood tests, carried out during the diagnostic process.
 Dispensing errors: Providing a patient with the incorrect medication.
 Drug interactions: A situation in which more than one drug has been administered and the two
medications affect each other in a positive or negative way. Sometimes, such interactions are the
aim of the medical professional however, when they occur by accident, they can have devastating
repercussions for the patient.
 Drug Side Effects: The unpleasant and debilitating results of taking a particular medication which
occur in addition to the drug’s desired effect.
 Ectopic pregnancy: a complication of pregnancy in which the embryo implants outside the uterine
cavity. As a rule, ectopic pregnancies are not viable and can have very serious repercussions for
the mother if not identified and treated immediately.
 Epilepsy: The name for a diverse set of chronic neurological disorders characterized by seizures
 Erg’s Palsy: Damage to the upper group of nerves in the arm, resulting in paralysis.
 Fetal abnormalities: A catch-all term for any unusual aspects of a fetus’s development; for
example, severe brain damage.
 Fetal Abnormality Screening: The process of screening unborn fetuses for any warning signs of
future physical or mental defects.
 Gallstones: The buildup of bile components in the gall bladder, forming a small ‘stone’. Once
formed, gallstones may pass into other areas of the body or remain in the gall bladder, causing
medical complications.
 Gastric band surgery: An operation which reduces the size of the stomach, meaning the patient can
only eat small meals. The aim of the surgery is weight loss.
 General Practice: GPs are on the front line of medicine in the UK, providing a complete spectrum
of care within the local community and dealing with problems that often combine physical,
psychological and social components.
 Gentamicin toxicity: A severe reaction to Gentamicin, an antibiotic used to treat many types of
bacterial infections. Symptoms can include difficulty balancing and ringing in the ears.
 Glaucoma: An eye disease which involves damage to the optic nerve. If left untreated, Glaucoma
can permanently damage a patient’s vision.
 Gynecology: the medical practice that deals with the health of the female reproductive system.
 Hiatus hernia: The protrusion of the upper part of the stomach into the chest cavity, caused by a
tear in the diaphragm. Hiatus hernias are notoriously hard to diagnose.

14.  Hip dysplasia: A misalignment of the hip joint; hip dysplasia may be a birth defect, or can be
caused by outside influences such as overly restrictive baby seats.
 Hip-Slipped Upper Femoral Epiphysis (SUFE): A separation of the ball of the hip joint from the
thigh bone (femur) at the upper growing end (growth plate) of the bone. A relatively rare
condition, more common in obese children.
 Intra-uterine contraceptive devices (IUCD): Any female contraceptive device that is placed in the
uterus; such devices are typically long-lasting, yet reversible.
 Irritable Bowel Syndrome: A common disorder of the gut, characterized by abdominal pain, a
bloated feeling, diarrhea or constipation. There is currently no cure however treatments are
available to ease the symptoms.
 IVF: In Vitro Fertilization is the process by which an egg is fertilized by sperm outside of the
body.
 IVF mix ups: An administrative mix up during the In Vitro Fertilization process, which often leads
to the wrong sperm and egg being combined, leaving the parents with children fathered or
mothered by a parent outside their relationship.
 Kernicterus Bilirubinaemia: A form of brain damage caused by excessive jaundice in babies.
 Laparoscope: An instrument which allows surgeons to see inside the abdomen and pelvis, without
having to perform invasive surgery.
 Lasik Eye Surgery: Commonly referred to as Laser Eye Surgery, Lasik Eye Surgery is a type of
refractive surgery performed to correct sight problems, such as long and short sightedness.
 Liposuction: A type of cosmetic surgery, the aim of which is to remove fat from many different
sites on the human body, such as the abdomen, thighs and buttocks.
 Lumbar laminectomy: A surgical procedure to relieve pressure on the spinal nerves.
 Malignant: In medicine, typically refers to a tumor which demonstrates uncontrolled growth, is
cancerous, invasive, or metastatic.
 Medical / Clinical Negligence: A lack of appropriate care on the part of a medical, nursing or
midwifery professional, which leads to an injury or illness in a patient.
 Meningitis: Inflammation of the protective membranes covering the brain and spinal cord.
Untreated, bacterial meningitis is almost always fatal.
 Metastatic: the spread of a disease from one organ or area of the body to another non-adjacent
organ or area.
 Midwife: The branch of the healthcare profession responsible for caring for women during
childbirth and immediately after.
 Misdiagnosis: The incorrect identification of a disease, injury or illness by a doctor or healthcare
professional.
 Monitoring errors: Any error in the monitoring of a patient that leads to a worsening of their
condition.
 MRSA: Methicillin-resistant Staphylococcus aureus, a bacterium responsible for several infections
in humans which are notoriously difficult to treat. Especially troublesome in hospitals, prisons,
schools, and nursing homes.
 Neonatal nursing: The provision of nursing care for newborn infants up to 28 days after birth.
 Neonatal Hypoglycemia: A condition that occurs in children when blood sugar (glucose) is too
low.
 No Win No Fee: An agreement between a solicitor and their client that, in the event that the case is
lost, no legal fees will be taken.
 Obstetrics: The branch of medicine which specializes in caring for women’s reproductive systems
and their children during pregnancy, childbirth and immediately after.
 Obstetric Cholestasis: A rare complication of pregnancy, which manifests itself as a persistent itch
during the last third of pregnancy.

15.  Ophthalmology: The branch of medicine which handles the anatomy, physiology and diseases of
the eye.
 Orthopedic: Specialists in Orthopedics perform surgery to correct conditions affecting the
musculoskeletal system.
 Overdose: The application of a drug or other substance in quantities greater than recommended by
medical professionals. Drug overdoses can often lead to severe illness and death.
 Perineal Tear: A tear in the region of the perineum, which generally includes the areas surrounding
the genitals and anus. Perineal tears can occur as a complication during childbirth.
 Pressure sores: Also known as pressure ulcers, pressure sores are injuries to the skin and
underlying tissue which are the direct result of the affected area being put under too much
pressure. Such injuries are often the result of neglect combined with a lack of mobility.
 Preventive care: Steps taken to prevent a disease or injury from developing, rather than treating
and/or curing the after-effects.
 Prognosis: A doctor’s prediction as to the likely outcome of a medical procedure, illness or injury.
 Pulmonary embolism: A blood clot in the pulmonary artery, the blood vessel that transports blood
from the heart to the lungs.
 Retinal detachment: An emergency medical problem in which the retina detaches from its
supporting tissue; failure to treat the problem can lead to blindness.
 Scaphoid Fracture: The scaphoid is one of the smallest bones in the wrist, and is also the most
likely to break.
 Sciatic Nerve Damage: The sciatic nerve originates in the spinal cord and runs between the bones
of the lower back and the muscles of the buttocks. Damage to the nerve can cause leg pain,
tingling, numbness or weakness in the affected area.
 Secondary care services: The service tasked with providing and maintaining all in-patient hospital
facilities for those over the age of 65.
 Spastic Quadriplegia: A form of cerebral palsy which affects all four limbs (arms and legs);
sufferers experience extreme tightness and stiffness in their limbs and must work extremely hard
in order to use their limbs successfully.
 Spondylolisthesis: A condition in which a bone in the spine slips out of its proper position and
rests on the bone below it. Symptoms can range from almost non-existent to severe back pain and
stiffness.
 Stillbirth: The result of a foetus dying in the uterus. The mother may still experience contractions
and go through the childbirth process.
 Sub-Arachnoid Haemorrhage: A stroke caused by bleeding in, or immediately surrounding, the
brain.
 Suturing: A medical device used to hold tissue together following surgery or an injury.
 Temporal Arteritis: Inflammation and damage to blood vessels that supply the head area and can
lead to visual loss if not treated promptly.
 Testicular Torsion: When the spermatic cord is twisted, blood supply to the testicle and
surrounding structures within the scrotum is cut off. Symptoms include the sudden onset of severe
pain in one testicle. The condition is more common in adolescence and during infancy.
 Vasectomy: A permanent birth control procedure performed on men, effectively preventing them
from having any further children.
 Vesico-vaginal Fistula: An abnormal fistulous tract extending between the bladder and the vagina
that allows the continuous and involuntary discharge of urine into the vaginal vault. Vesico-
vaginal Fistula may occur as a complication of childbirth.
MCI guidelines in India regarding how long to written medical records. The hospitals follow their own
pattern written the records for varied periods of time. Under the provisions of the Limitation Act 1963 and
Section 24A of the Consumer Protection Act 1986, which dictates the time within which a complaint has

16. to be field, it is advisable to maintain records for 2 years for outpatient records and 3 years for inpatient
and surgical cases. However the provisions of the Consumer Protection Act allows for condoning the
delay in appropriate cases. This means that the records may be needed even after 3 years. It is important
to note that in pediatric cases a medical negligence case can be field by the child after acquiring the age of
majority.
Medical records are acceptable as per Section 3 of the Indian Evidence Act, 1872 amended in 1961 in a
court of law.
The provisions of specific Acts like the Pre Conception Pre-natal Diagnostic Test Act, 1994 (PNDT),
Environmental Protection Act, etc. necessitate proper maintenance of records that have to be retained for
periods as specified in the Act. Section 29 of the PNDT Act, 1994 requires that all the documents be
maintained for a period of 2 years or until the disposal of the proceedings. The PNDT Rules, 1996
requires that when the records are maintained on a computer, a printed copy of the record should be
preserved after authentication by the person responsible for such record.
Bombay High Court held that doctors cannot claim confidentiality when the patient or his relatives
demand medical records] With the enforcement of the MCI Regulations, 2002 it has been held without
confusion that the patient has a right to claim medical records pertaining to his treatment and the hospitals
are under obligation to maintain them and provide them to the patient on request.
Article 21 of the Constitution of India has been interpreted in a highly dynamic manner to protect the
rights, life and liberty of the citizens, by also incorporating the principles of natural justice.
Medico legal case:
1. All injury cases, circumstances of which suggest commission of offence by someone.
2. All burn injuries due to any cause.
3. Suspected or evident homicide, suicide including attempted.
4. Suspected or evident criminal abortion.
5. Unconscious cases where the cause is not natural or not clear.
6. Cases brought dead with improper history creating suspicion of an offence.
7. Cases referred by Courts or otherwise for age estimation.
8. Dead on arrival cases, or patients who die shortly after being brought to the Casualty and before a
definite diagnosis could be made.
9. Any other case not falling under the above mentioned category but has legal implications.
10. Patients dying suddenly after parenteral administration of a drug or medication.
11. Patient falling down or any mishap in the Hospital, sustaining injury in the Hospital.
12. Death on Operation table.
13. Unexplained death after surgery or Interventional procedure.
14. Unexplained ICU death.
15. Patient treated and then referred from a private hospital or other Government hospital with
complications of surgery or delivery or bleeding, where the cause of death is unexplained.
16. Relatives of the patient assault the treating doctor or other staff of the hospital.
17. Relatives of the patient create a law and order problem in the hospital
18. Pathological Autopsy is to be requested when death is due to unexplained disease process or in
cases that are rare or in cases which have academic interest

17.  Non-Cognizable offence police cannot arrest the accused without the court order, but in
cognizable offence a police officer can arrest without any court orders IPC is the primary panel
law of India, which is applicable to all offences, except as may be provided under any other law in
India
1. Under Section 436 of the Cr.P.C. In case of boilable offences, the Police are authorized to give
bail to the accused at the time of arrest or detention.
2. Under Section 437 and 439 of the Cr.P.C. It is important to note that the grant of bail in a non-
boilable offence is subject to judicial discretion of the Court, and it has been mandated by the
Supreme Court of India that "Bail, not Jail
3. Under Section 438 of the Cr.P.C. means that a person who apprehends arrest on a wrong
accusation of committing a non-boilable offence, can apply before a competent court for a
direction to police to immediately release such a person on bail in the event of arrest. However,
the grant of anticipatory bail is discretionary and dependant on the nature and gravity of
accusations, the antecedents of the applicant and the possibility of the applicant fleeing from
justice. Cognizable Offence/case, has been defined under Section 2 (c) of Cr.P.C. as an
offence/case in which a Police Office can arrest without a warrant
 Non-cognizable Offence/case, has been defined under Section 2 (l) of Cr.P.C. as an offence/case
in which a Police Officer has no authority to arrest without a warrant
India has a well-established statutory, administrative and judicial framework for criminal trials. Indian
Penal laws are primarily governed by 3 Acts:
1. The Code of Criminal Procedure, 1973 (Cr.P.C.);
2. The Indian Penal Code, 1960 (IPC);
3. The Indian Evidence Act, 1872 (IEA).
Here we would like to thank all our partners, team members and our clients for their valuable support. We
fully recognize that your support and the continued trust that you place in us is the foundation of our
success.
REGARDING: - EAST ZONE MEDICO TEAM.