Medicolegal aspects of healthcare


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A brief presentation on the Medicolegal aspects of healthcare initially intended for the students - Post Graduate Diploma in Hosp. Management (Medvarsity)

Published in: Health & Medicine, Business
  • Dr. Lovleen... I would like to thank you from the bottom of my heart as you have done really wonderful research on this topic. I am Jaimin Joshi. GNLU (LL.M.) passed out student. Currently I am Assist. Prof. at Gujarat Knowledge Village. Mem I would like to pursue my Ph.D. in this subject..It would be an honour for me if I get your valuable guidance in this topic.
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  • the information provided about medicolegal is very useful to me. kindly email your presentation to me
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  • Hi Dr.Rohit
    I personally didn't have to encounter any Therapeutic Waiver related issues.
    Though while studying medicolegal aspects I did go through the details and its applicability.
    Personally asked ,I believe Good Ethics starts with Good facts. If the purpose of consents is to increase the likelihood that patients are treated according to their preferences ,then it would be helpful to know how the patients and their relatives feel about waivers of consent. We will have an answer to how difficult it is to deal with its implications.
    The informed consent doctrine was conceived as a basis for allowing patients to meaningfully participate in the decision-making process. But soon it’s going to evolve into a formal, legal document that reflects a desire by physicians and surgeons to have patients execute “waivers of liability.” The process though has lost its educational value by shifting the emphasis to obtaining a “preoperative release” from an exchange of information upon which a patient can make important decisions about their healthcare choices. This is unfortunate because, so far in the process, both patients and physicians have suffered. Patients have become alienated from the informed consent process and, paradoxically, physicians and surgeons may have created more liability exposure through this alienation.
    In India , many are still unaware of such waivers which might have prevented the litigations to some extent. But the more we dig details it has been found to be medically sound but legally invalid when the debate of human rights is put on.It is though strongly believed that with this model we shall potentially experience improved healthcare outcomes. There may also develop an alliance between the patient and the physician or surgeon, such that the seeds of an antagonistic or litigious relationship will not be planted before treatment begins. But this is possible only where the legalistic approach to informed consent doesn’t get disconnected from the process of communicating in a clinical setting, and the “waiver of liability” approach should not be taken up as something detached from the unique rhythm of the clinical setting—something imposed on medicine by an uncomprehending legal system”.
    Informed consent is not an end in itself. It is just a means to safeguard the human rights.But in Emergency settings,in case of urgent resuscitation needs, unconscious patients physicians do need to make decisions based upon their judgement. They should proceed with what is in best interest of the patient. Still such decisions by the doctors have failed to serve the societal notion of consent. Waivers of consent in research on life threatening conditions seek to correct all such problems. More importantly it aims to improve the likelihood that a presently identifiable patient will be treated in a manner in which he/she would have approved if given an opportunity to consent. But when we talk about its legal safety, the data is too less to be able to debate as far as our nation is concerned. So the decisions lay with individual committees to implement policies that best suit their interest. :)
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  • Good effort to put some medioclegal facts. What about your experience of dealing with therapeutic waiver (an exception to informed consent).
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Medicolegal aspects of healthcare

  1. 1. MEDICOLEGAL ASPECTS A Kaleidoscopic view 1
  2. 2. Moral Principles Guiding Medical Practice Beneficence & Non-Maleficence Autonomy Justice Value and Sanctity of Human Life Truth and integrity 2
  3. 3. Application of LAW in healthcare Laws on various aspects of healthcare have been enacted from time to time to regulate the functioning of the hospitals assuming that their implementation will remove the inadequacies and malpractices. 3
  4. 4. INDIAN JUDICIARY & MEDICAL PRACTICE Civil Jurisdiction  Civil Courts  Consumer Protection Forum Criminal Jurisdiction Human Rights Commission Medical Council of India 4
  5. 5. You as an ADMINISTRATOR Duty of each and every hospital administrator to know his lawful rights and responsibilities w.r.t the hospital staff, employees, patients and visitors. It is necessary that one should have sufficient background and legal knowledge of hospital care in order to know when to seek Professional Legal Advice. 5
  6. 6. VICARIOUS LIABILITY 6 Latin Phrase, "Respondent - Superior". This means let the Superior be responsible. In other words a person may become liable to pay damages for amount of negligence committed by his employees or agents in the course of carrying out his duties as such employee or agent.
  7. 7. Must have basic knowledge on  Injury (Accidents)  Negligence–Civil, Criminal  Malpractice  Professional incompetency  Ethical issues in human experimentation  Organ transplants.  Sex determination & Genetic Counselling.  Euthanasia.  Ethical Issues in sexually transmittable diseases. 7
  8. 8.  Medical Termination of Pregnancy Act (MTP act 1971)  PCPNDT Act  Registration of Birth & Death  Medical Council of India Act  Organ transplantation act  Bombay Nursing Home Registration Act  Clinical establishment act  Labour Laws and the Medical Establishment  Shop & establishment act  Bio medical waste management act  Consumer Protection Act  Indian Penal Code 8
  9. 9. CONSUMER PROTECTION ACT On 24 December 1986 Govt. of India enacted the Consumer Protection Act 1986 to: Ensure Rights of Consumers Provide Remedies for deceived Consumers Check Unfair Business Practices & Restrictive Trade Practices. Quick Redressal 9
  10. 10. CPA 10 Revolutionary act Applied to medical practitioners since 1991 Made it comparatively easy for the patients to approach the courts against the doctors Now more than 10,000 cases are pending in front of various fora.
  11. 11. 1. Right to SAFETY against hazardous goods and services. 2. Right to be INFORMED about quality, quantity, purity, standard, price. 3. Right to CHOOSE from a variety at competitive prices. 4. Right to BE HEARD. 5. Right to seek REDRESSAL. 6. Right to CONSUMER EDUCATION 11
  12. 12. Consumer Disputes Redressal Forum Consumer Disputes Redressal Forums (District Forum)  Claims less than or equal Rs.5 lacs. Consumer Disputes Redressal Commissions (State Commission)  Claim more than Rs.5 lacs & less or equal to than Rs.20 lacs & appeals. National Consumer Disputes Redressal Commission (National Commission)  Claim above to Rs.20 lacs & appeals 12
  13. 13. CPA – “ A cakewalk’’ File WITHIN 2 YEARS of cause of action in the District Forum where the seller has his business or lives or where the cause of action arose. Submit 3 COPIES OF COMPLAINT ON PLAIN PAPER WITH SUPPORTING DOCUMENTS (receipt, bill etc.) NO LAWYER IS NEEDED. PRESENT YOUR CASE IN PERSON. MINIMAL FEE PAYABLE 13
  14. 14. 14 Some Landmark Cases
  15. 15. Dr. Laxman Balkrishna Joshi vs. Dr.Trimbak Bapu Godbole and another (1969) A patient had suffered from fracture of the femur. The accused doctor while putting the leg in plaster used manual traction Used excessive force for this purpose, with the help of three men Such traction is never done under morphine alone but done under proper general anaesthesia. This gave a tremendous shock causing the death of the boy. On these facts the Supreme Court held that the doctor was liable to pay damages to the parents of the boy. 15
  16. 16. Indian Medical Association vs. V.P.Shanta (1995) This landmark judgment decided that service rendered by medical professional comes under section 2(1)(0) of the act & hence the consumer protection act was applied to the medical practitioners It defined conditions such as  Who is a consumer ?  What is medical negligence ?  What is deficiency in service ?  What are the patent conditions under which medical practitioners can be held responsible ? 16
  17. 17. Poonam Verma vs. Ashwin Patel & Ors. (1996) The professional may be held liable for negligence on the ground that he was not possessed of the requisite skill which he professes to have. Thus a doctor who has a qualification in Ayurvedic or Homeopathic medicine will be liable if he prescribes Allopathic treatment which causes any harm. Negligence “ per se” 17
  18. 18. 18 MEDICAL NEGLIGENCE Legal term to achieve compensation for injuries caused. Derived from a latin word „Negligere‟ meaning „not to pick up‟ Failing to do what a reasonably prudent person would have done in similar circumstances Foreseeable risk/harm Breach of Legal duty to care 4 Ds : Duty, Deficiency, Direct Cause, Damages
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  20. 20. Dr.Louie vs. Smt. Kannolil Pathumma The National Consumer Commission held that Dr. Louie showed herself as an M.D. although she was only M.D. Freiburg, a German Degree which is equivalent to an M.B.B.S. degree in India. She was guilty of negligence in treating a woman and her baby who died. There was vacuum slip, and the baby was delivered in an asphyxiated condition (Misrepresentation of skills) 20
  21. 21. Spring Medows Hospital vs. Harjol Ahluwalia A child was admitted for typhoid fever. Nurse asked the father of the patient to get an injection Lariago which was administered by the nurse to the patient who immediately collapsed. Child suffered a cardiac arrest on account of the medicine having being injected which led to brain damage. The National Commission held that the cause of cardiac arrest was intravenous injection of Lariago of such a high dose. Both the doctor and nurse and the hospital were found liable and Rs.12.5 lakhs was awarded as compensation to the parents. (Liability of hospital & the employees) 21
  22. 22. Pt. Parmanand Katara vs. Union of India & Others 1989 The petitioner referred to a report published in the newspaper “The Hindustan Times” in which it was mentioned that a scooterist was knocked down by a speeding car. Seeing the profusely bleeding scooterist, a person who was on the road, picked up the injured and took him to the nearest hospital. The doctors refused to attend and told the man that he should take the patient to another hospital located 20 kms away authorized to handle medico-legal cases. The injured was then taken to that hospital but by the time he could reach, the victim succumbed to his injuries. (Emergency medical care, a must ! ) 22
  23. 23. A medico-legal case is a case of injury/illness where some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land. Simply put, it is a medical case with legal implications or a legal case requiring medical expertise Medico-Legal Case 23
  24. 24. Who can label a case as MLC Casualty doctor (emergency physician) attending the case. The doctor who has -First contact with patient should prepare an ML case report. In rape victims the examination and preparation of MLC is done by A female doctor. Indoor treating doctors can also make the case MLC if they think it should have been made but it wasn‟t made Patient or their relatives request to label a case MLC or not, shall have no effect on doctor‟s decision 24
  25. 25. Cases to be treated as MLC All cases of Trauma and Burns – The circumstances of which suggest commission of an offence by somebody. (Irrespective of suspicion of foul play). All vehicular, Industrial accidents or other unnatural accident cases specially when there is a likelihood of patient‟s death or grievous hurt. Electrocution. Suspected or evident sexual assault, criminal abortion. Unconsciousness where its cause is not natural or not clear. 25
  26. 26. Suspected or evident poisoning or intoxication. Referred from court or otherwise for age estimation medical examination. Brought dead with improper suspicion of an offence. Coma where cause could not be ascertained. Suspected self-infliction of injuries or attempted suicide. Starvation including “Hunger Strike”. Unclaimed newly born. Medical malpractice 26
  27. 27. Receiving a MLC Case brought by the police for examination & reporting. Person in question was already attended to by a doctor and a medico-legal case was registered in the previous hospital, and the person is now referred for expert management/ advice. If the doctor feels that the circumstances/ findings of the case are such that registration of the case as an MLC is warranted, he should immediately and inform the patient before converting the case into MLC. 27
  28. 28. 1985 „‟Decision Of The Committee‟‟ The committee under the chairmanship of the Director- General of Health Services had taken the following decisions Whenever any MLC arrives the hospital, the medical officer on duty should inform the duty constable, name, age, sex of the patient and place and time of occurrence of the incident, and should start the required treatment of the patient. 28
  29. 29. Zonalisation for the hospitals to deal with medico-legal case will only apply to those cases that are brought by the police. All government hospitals, medical institutes should be asked to provide the immediate medical aid to all the cases irrespective of the fact whether they are medico legal cases or otherwise. 29
  30. 30. Casualty Service Some of the cases may need immediate surgery and resuscitation measures. Essential to have in Casualty area :- 1.Sufficient numbers (in working condition) trolleys stretcher, wheel chairs, etc. 2. Sufficient number of observation beds. 3. Life saving drugs, IV fluids, monitors, etc. 4. Laboratory facilities, Radiological facilities. 5. MLC Registers -- properly maintained. 30
  31. 31. Important Precautions Consent Section 13, of the Indian Contract Act, 1872. Types of Consent:  Implied  Express  Informed 31
  32. 32. Exceptions  Medical emergencies (section 92 IPC)  Notifiable diseases  Immigrants  New admissions to prisons  Court Orders for examination and treatment  Under Section 53(1) of the CrPC  Members of Armed Forces – (Ministry of Home Affairs, Government of India, Letter No.8/179/71-GPA, dated 25th November, 1972. ) 32
  33. 33. Examination & Documentation By the doctor who examined (first contact) Complete HISTORY : Precise and to the point LEGIBALY/CLEARLY WRITTEN DOCUMENTS with assigned MLC number on all reports DETAILED DESCRIPTION of injuries AVOID ABBREVIATIONS WHEN IN DOUBT obtain consultation from seniors NO BACK DATED MLC 33
  34. 34. Collection & Preservation of Samples All relevant specimens / evidence should be collected, identified, labeled, sealed and preserved.  Section 201, IPC 34
  35. 35. Confidentiality & Privacy of Medical Records Policy & Procedure:  As an impersonal document  As a personal document Indian Evidence Act, 1872 35
  36. 36. Custody of MLC records  Preservation  Safety and security  Issue of records 36
  37. 37. Certifying Fitness  As a part of documentation of ML Case report or whenever the I.O requests the doctor for certifying fitness of the patient to make a statement the examining doctor will certify the same on the original MLC sheet. He/she will mention date and time clearly with signature, name in full with designation below the certification. 37
  38. 38. Information is given only to I.O or any person designated by I.O If the I.O. gives requisition for any clarification regarding certain points mentioned in the report given, answers are to be given in writing. MAINTAIN CONFIDENTIALITY If the I.O. demands an original document/ photocopy of the same , X-ray etc, of a MLC, it is given and a receipt obtained. 38
  39. 39. Register as early as possible Not informing the police of such cases may invite trouble to the doctor u/s 39 CrPC (cases wherein public is duty- bound to inform the police) Liable to be prosecuted u/s 177 & 201, IPC (giving false information & causing disappearance of evidence) 39
  40. 40. Other MLC related issues Dying Declaration (section 32 Indian Evidence Act) Admission & Discharge of MLC In case of death of MLC patient Brought Dead 40
  41. 41. CONCLUSION When we look at this fascinating spectrum of development of Indian Medical Law scenario one must say that in last 20 years it has now substantially matured. The judiciary is trying its best to produce a balance between the patients & doctors interests. Now is the time when medical organizations should also come forward to take this initiative further. 41
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