Consumer Protection Act & Medical Negligence Obstetrics & Gynecology How to protect Doctors from medico-legal litigations

1. Consumer Protection Act &
Medical Negligence in
Obstetrics & Gynecology
Dr Sharda Jain
Dr Sangeeta Gupta
Part-2

2. GYNAE can expect approx 2.5 liability claims over
his/ her career.
Around 80% can anticipate being sued in their career.
Over 25% obstetrician decrease their high risk obstetric practice
8 % quit obstetric practice altogether.
Medico- legal litigations among Specialties
Most vulnerable specialties
OBST and Gynae – 50%
followed by
Orthopedics ,Cardiology &Radiology

3. • Cosmetic surgery, hair transplant
• IVF , surrogacy and other ART
• Organ transplant
• Oncology
Medico-Legal Litigations in Emerging Specialties

4. Scope for litigation
• Wrong diagnosis,
• Wrong decision-making,
• Negligence,
• Poor supervision,
• Incomplete or improper consent,
• Intra operative complications, and
• Foreign body retention after surgery.

5. DMC / MCI /NMC experience
• PPH .. Undetected, shock, blood availability, facilities, ambulance and
transport. 50%
• Botched up MTP .. Legal issues, bleeding, perforation , shock etc.10%
• Antenatal USG  10%
• Still birth and Birth asphyxia  10 %.
• Retained swab. 10%
• ART ..ethical and legal issues 10%
• FEMALE STERLIZATION 1 %
Legal issues in Obs / Gynae  MY Experience

6. GYNAE :No Medicolegal Knowledge
Knowledge is power

7. • State Medical Council NMC
• Consumer forum
• Civil court
• NHRC
• Police  State Medical council
• CM / PM Office
Medico- legal litigations can be opened on many
fronts against Gynaecologists15

8. CPA 1986 & MEDICAL NEGLIGENCE

9. CPA 1986
• For Better Protection of the Interests of the
Consumers.
• On13th November 1995, Hon'ble Supreme
Court gave a verdict wherein medical
profession was put under ambit of CPA.
• C.P.A amended in 1993 ,2019

10. SERVICE PROVIDER, CONSUMER , COMPLAINANT & Complaint
SERVICE Provider – DOCTORS INCLUDED.
Does not include – free of charge service.
CONSUMER Consumer of Goods or who hires & avail any
service
All paid services at a health care facility, make
the beneficiary
a “consumer”.
“Consumer” is deemed to have entered into
a contract with the
service provider.

11. COMPLAINANT : Pt /relative
COMPLAINT . Any allegation in writing made by a complainant in
regard to Goods/Services Always in Writing ,
NO ORAL
RELIEF  Unfair Trade Practices, Deficiency of service,
Excess price
SERVICE PROVIDER, CONSUMER , COMPLAINANT & Complaint

12. Liability under CPA
Who is liable under CPA?
• Doctor with independent practice,
• Hospital – Private, Govt - free as well as
Charging(BOTH)
• Doctors/hospitals paid by insurance firms.
Who is not liable under CPA?
• Doctors in hospitals, who do not charge their
patients.
• Hospitals offering free services to all patients.
• Professional of J&K ??

13. Redressal for a Under CPA
Three-tier structure.
1.District level: Up to Rs 20 lakh.
A district judge and 2 other members
2. State level: Rs 20–100 lakhs
A high court judge and 2 other members
3. National level: Rs > 100 lakhs.
A supreme court judge, and 4 other
members.

14. Redressal for a Under CPA
ADVANTAGE OVER CIVIL COURTS  TIME BOUND(3 months) ,NO FEE.
APPEAL to Higher commission  With in 30 days of decision
CDRF  State commission  National commission  Supreme
court.
• The complaint has to be filed within 2 years from the date
of commission of act/cause
• जब जागे तभी सवेरा

15. Why A Doctor is caught up
• In 80 % your doctor colleage is behind
• 50 % cases can be avoided by proper
consent , counseling & documentation
• 50 % bcz of NO legal knowledge
KING IN BOX PATIENT has
become SUPERKING.
• OPTIONS BEFORE HIM/ HER  endless

16. BREACH OF DOCTOR –PATIENT
RELATIONSHIP
Establishment of doctor-
patient relationship
Duty of providing quality
care are FOUNDATION of
our Profession

17. Medical negligence
“ Shortcoming in the service agreed to be rendered by medical
professional”
• “Omission to do something which a reasonable trained DOCTOR
would do,
• or doing something which a prudent and reasonable DOCTOR
would not do”.
Three essential components.
• Duty of doctor to meet a particular standard of care
• Breach /failure to perform such a duty
• A casual connection between DOCTOR duty failure and
consequent DAMAGE which needs to be
compensated.

18. SOME ACTIONS THAT AMOUNT TO MEDICAL
NEGLIGENCE
• Failure to attend the patient
• Not attending complicated delivery
• Not revealing H.I.V. positive status
• Injections wrongly given
• Foreign matter left in the abdomen
• Failed tubectomy operation
• Perforation of the uterus
• Contaminated blood transfusion
• Dispensing wrong drugs
• Improper Consent

19. • LAW says MEDICAL BOARD /EXPERTS –
SHOULD SCREEN THE CASE…before case is
filed in the court .
• So ideally every case should go via state
council –
• CPA courts are over smart. admit without
it .
What I LEARNT AS
Delhi medical council EXPERT

20. 1.Executive Committee
2.Disciplinary Committee
3.The Council
(1)Executive Committee :
5 members - all elected amongst members
• Chairperson – President DMC
• Experts.
All cases screened by committee assisted by Subject
Experts CASE file + ROL
PERSONAL HEARING – Doctors /+ FAMILY
D.M.C -Three TIER process

21. (2) Disciplinary committee 2
• Chairman elected amongst members of DMC
• President DMA or a nominee
• A lawyer
• A MLA
• An eminent person
• NGO Member
• EXPERTS OF CASE
D.M.C

22. (3)COUNCIL
Consists of : Chairman + elected members
has special powers to > or < punishment
What punishment ???
 out from DMC Register to practice in
Delhi.
D.M.C

23. How medico legal cases are
addressed
LAW can not teach us Medicine
“Jury’s perspective”

24. Some landmark Judgments
• Bolam test / Bolitho test
• Montgomery vs Lanarkshire health Board
• VP Shanta case v/s Cosmopolitan hospital v/s kerala SCDRC
• SURESH GUPTA V/S LAXMAN Balkrishna Joshi v/sTrimbak
Bapu Godbole1969 sc 128
Some legal Principles  Do no harm
How medico legal cases are addressed:!

25. Bolam Test
The Bolam’s test & Bolitho test :
TWIN Pillars of all assessment of MEDICAL NEGLIGENCE-
In the landmark Bolam case It was held that:
In the ordinary case which does not involve any special skill,
negligence in law means a failure to do some act which a
reasonable man in the circumstances would
DO , or NOT DO
if a doctor reaches the standards of a responsible body of
Medical opinion, he is NOT Negligent

26. • Fair ,reasonable competentence ,fair
degree of skill – recognized degree .
Higher degree does not offer greater
advantage.
• Nor doctor is expected to guarantee
cure
• Not to be found negligent simply bcz
one of the risks inherent occurs or
किताब में किखी complication occurs .
BOLAM Test & JURY

27. Montgomery vs Lanarkshire health board :
KEY message
• PATIENT IS BOSS  Rx has RISKS &
IMPLICATIONS / Alternatives
• Disclosure to patient is must
 criteria of informed
consent
• The doctor is under a duty to take
reasonable care to ensure that patient is
aware of risks involved in recommended
treatment ,and of reasonable alternative
or variant treatments available to treat .
Montogomery Principles

28. Eg : IVF FROM UK
ONE CHILD 8 YRS  IVF
HAD BRAIN STROKE – 2 EPISODES
21 DEC, 23 JULY ( AC )

29. Eg : IVF –BMI 34 ,HT, DM
ONE CHILD 8 YRS  IVF
COMPLICATIONS BCZ MED ISSUES

30. DUTY OF OB/GY EXPERT
OUR Wealth  PATIENT TRUST
Our COMPETENCE & BEHAVIER
OPENNESS,INNOVATION &
HIGH STANDARDS OF INTEGRITY
& following SOP our USP

31. LAW CAN NOT TEACH US MEDICINE
NO LEGAL LAW BOOKS FOR DOCTORS

32. In absence of defined laws, landmark judgments
become guiding force. So Doctor has to have
Reasonable degree of competency / Degree
Reasonable degree of care
• Mostly EXPERTS go by peer review and
common sense
• Personal discretion of judges matter a lot
How Medico Legal Cases are Addressed

33. How Medico Legal Cases are Addressed
No specific medical Laws or Acts on medical negligence
A.Negligence Per Se  crosspathy  quack
poonam verma v/s Ashwin patel
NO FURTHER PROOF REQUIRED
B. Res ipsa Loquitur the thing speaks for itself ie MOP ,
Instruments left in Operation.
C. Misc
• Law of torts
• Relevant sections of IPC and CRPC
• MCI code of conduct 2002 2023
• All acts like MTP acts, PCPNDT act ,NEW ART ACT,NEW
SURROGACY ACT ,POCSO ACT etc.

34. • Parmanand Katara vs Union of India n others --.
• LIFE OF PT IS MOST IMPORTANT
( Scooter driver hit by speedy car )
LAND MARK JUDGEMENTS which each
doctor should know & keep for ready
reference

35. Negligence LUDHIANA Case terminal case of advance cancer
Medical board has to scrutinize before court admits the case
Jacob Mathew Vs State of Punjab Case

36. • Kusum Sharma vs Batra
hospital case
informed consent was
lacking in operation
case
LAND MARK JUDGEMENTS which each
doctor should know & keep for ready
reference

37. TECKI GOT PARAPLEZIA AFTER BIOPSY 
Message
JUDGEMENT OF ERROR—NOT MN
ERROR IN TREATMENT – NOT MN
DEATH / DAMAGE -- HAS TO BE
COMPENSATEEVEN IF U R QUALIFIED
Martin F D’Souza vs Mohd Ishfaq– NIZAM
INSTITUTE  SC

38. • Poonam Verma Vs Dr Ashwin Patel
crosspathy
• Prabha Manchanda vs Samira Kohli
consent
LAND MARK JUDGEMENTS which each
doctor should know & keep for ready
reference

39. •  fall from cot  surgery for fracture lt
neck of femur + Salivery gland
• MESSAGE: INFORMED CONSENT ,
BEFORE SURGERY for ALL procedures
• IMPLICATION & RISK NEED TO BE
INFORMED
VP Shanta v/s Cosmopolitan hospital

40. LAND MARK JUDGEMENTS
Suresh Gupta v/s ut Delhi
LESSON :Unexpected death & unable
to come to conclusion is NOT
construed as medical Negligence .
• Laxman Balkrishna Joshi v/s
Trimbhak Bapu Godbole 1969 sc 128
• 304A NO

41. Konal saha case  DR SUKUMAR
• USA doctors wife  calcutta hospital
,Beech Candy hospital
• 7.5 CR
• Highest penalty 11cr eg. Amri Hospital ,
• Beach Candy Hospital
Lesion learnt is documentation can save
you & hospital from penalty

42. Onus of proof is on the
person alleging
negligence, i.e. on
patient.
This burden shifts to the
defendant, i.e. doctor or,
where there is no free
access to the patient as in
OT, ICCU, etc.
Burden of Proof

43. Rekha Gupta vs Bombay Hospital Trust CPJ NC
Hospital pleaded  it only provides facilities and treatment
responsibility lies with Consultant
Not accepted by the District Forum.
As hospital employs staff and deducts commission from doctors
fee, they are responsible too.
Coordination between various doctors and specialties sp in
area like ICU and OT is hospital responsibility.
If proper written advise by doctor and nurse is qualified than
doctor is not responsible for lapse.
VICARIOUS LIABILITY

44. Responsibility in a Unit system.
• JR minimum responsibility
• SR partial responsibility
• Consultant/Consultants full responsibility
• Department head no responsibility
• Hospital head Vicarious responsibility
VICARIOUS LIABILITY

45. Criminal Liability ..
Civil : Only monetary compensation awarded.
Criminal cases: Punishment may be awarded
Dr Suresh Gupta vs govt of NCT
Jacob Mathew Vs State of Punjab
304A “ whoever causes death of any person by
doing rash or negligent act not amounting to
culpable homicide, shall be punished with
imprisonment …..”
Negligence or recklessness being “gross” is not a
requirement. So can it be read separately for
doctor / complainant?
CRIMINAL LIABILITY

46. Arrest is very very rare
“Paper Arrest”
X No Panic please
in Medical Fraternity
 “No body can Put you behind bars”

47. An Appeal to the
Law Makers ,
Police
Citizens of the Country
DON,T DOUBT INTENSION OF DOCTORS !

48. Offence  304 for Doctors
Punishment for Culpable Homicide ,not
amounting to murder
INTENTION – NIL
CAUSE -DEATH
10 YRS JAIL ,or fine , both
NON - Bailable Jurisdictional Court

49. In majority Offence 304 A
Causing death by negligence
Alleged Charge :- Rashness / Negligent act
(DOT/ POST-OP/ Unnatural death)
Not amounting to culpable Homicide
Bailable
at the level of Police itself

50. Bailable offence
Can be granted by police officer
Rs. 950 Bail Money
(A Friend / Colleague)
20-30 minutes
304A

51. Bailable offence
JAIL -2 YRS OR FINE , OR BOTH
304A

52. Constitutional bench of Supreme Court..2
golden rules in Medico Legal cases
• Negligence has to be ‘Gross”
• Expert medical opinion before
proceeding is must

53. 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)

54. • 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)

56. How to protect Doctors from
medico-legal litigations
Dr Sharda Jain
Dr Sangeeta Gupta
Part-3

57. How to protect Doctors from medico-
legal litigations
Doctor’s Perspective

58. Every patient is a potential litigant.
Do take it in a positive sense ..
be updated and more careful.

59. • Registration
• Suffix
• Display of degree
• Charges
• Advertisement
• Certificate
Follow MCI/NMC code of ethics

60. • MCI/NMC code of Ethics 20022023
• Relevant laws, acts and judgements
• Indemnity insurance
• Communication
• Documentation
• Informed and valid consent
Be informed..

61. Be informed..
• Consumer Protection Act
• Pre-conception and Pre-natal
Diagnostic Techniques Act
• The Clinical Establishments
(Registration and Regulation) Act,2010
• Birth and Death Registration Act

62. Be informed..
• Medical Termination of Pregnancy Act
• Medical Council of India reg/ National
Medical Commission Act 2019
• P.O.C.S.O Act
• Biomedical Waste (Management and
Handling) Rules, 1998:

64. Better Safe Than Sorry
• MD + SPECIALISATION
• INSURANCE 1 CRORE
• OPD RECORDS : 99 % DOCTORS DON,T KEEP NMC
• MEMBERSHIP:IMA / FOGSI /LOCAL BODIES
DGF /NIGF  more the merrier
GOOD DOCUMENTATION IS GOOD DEFENCE
CONCENT /RECORD KEEPING+DOCUMENTATION
How to Call Police &
How to handle police investigations against the doctors

65. Dead lines for reply
• Ask for colleagues or seniors advise in difficult cases
• If wish to refer :Refer early
• Keep knowledge updated. Keep notes of academic
activities
• Preserve records sp medico legal, complicated and
controversial cases
• Give guarded prognosis when in doubt
• Good to have second opinian in difficult cases 
create echo system
General precautions

66. General precautions
• Do not admit patient at places with inadequate facilities
• Do not employ unqualified persons , you will held liable
for their misconduct
• Do not prescribe without examining the patient
• Use suffix honestly, Do not misrepresent
• Do not use unrecognized degrees MCI RECGNIZED
• Do not indulge or patronize cuts and commissions
• Do not take favors from pharma companies
• Do not succumb to pressure of targets by big hospitals

67. • Majority cases issue is not medical or
technical but misunderstanding or
anger  80% (COMMUNICATION )
• More likely those who are hurried,
uninterested, or unwilling to listen
and answer queries.
• Less likely who are perceived as
concerned, accessible, and willing to
communicate
• NO RULES WORK THESE DAYS
Legal issues in Obs/Gynae

68. Scope for Litigation in ART
• COSTLY Tt
• EXPECTS 100% Results-
ZERO TOLERANCE
• HOW you council –secret is
here .

69. Case -1
• Antenatal pt called doctor telephonically, complains of
headache.
• Dr advised her analgesics.
• Not relieved , she throws convulsion.
• Admitted with eclampsia, delivers still birth.
• Sues doctor for failure of diagnosis and proper care.
Legal issues in Obs/Gynae
AGAINST

70. Case -2
• Antenatally booked Patient calls doctor at
middle of night.
• Not answered.
• Goes to another hospital.
• Sues the doctor.
Legal issues in Obs / Gynae
favour

71. Case -3
• Obs prescribes USG/ Doppler to a primi with free floating head.
• Pt did not get investigations done.
• Goes in spontaneous labor.
• Stuck at second stage as head was not descending.
• Vacuum assisted delivery was done after informed and documented consent.
• Two loops of cord around the neck.
• Birth asphyxia.
• Pt sues the doctor.
Legal issues in Obs / Gynae
AG F

72. Case-4
• Pt with 6 months amenorrhoea and positive pregnancy test.
• Obst does usg herself, no intrauterine pregnancy visualised.
• Performs D n E supposing IU pregnancy, however pregnancy continues.
• Presents 1.5 months later with ruptured communicating rudimentary
horn.
• Case of bicornuate uterus.
• Sues the doctor.
Legal issues in Obs/Gynae
A--F

73. Case -5
• Ovarian cyst diagnosed on USG andadvised surgery, but hysterectomy
performed without proper consent.
• No pathology detected in uterus.
• Courts ask for justification of removing uterus.
• Doctors argues that as child bearing age was over and uterus could have
developed some pathology in future.
• No proper consent documented for hysterectomy.
Legal issues in Obs/Gynae
AGAINST

74. Case -6
• Cervical biopsy reports squamous cell carcinoma.
• Hysterectomy performed with no post op
radiotherapy or chemotherapy advised.
• Pt develops stage 4 carcinoma within 6 months.
• Pt sues the doctor.
Legal issues in Obs/Gynae
AGAINST

75. Case -7
• Un-booked full term with severe PIH reaches a nursing home.
• Nursing home refuses admission for lack of facility to handle
complications.
• Pt insists.
• Doctors admits after explaining and written consent.
• Pt develops complication (Stillbirth ) and sues the doctor.
Legal issues in Obs/Gynae
FAVOUR

76. Be careful..
• Be updated; laws
• Practice contemporary, evidence-based
medicine.
• Show compassion and good communication
skills.
• Consent & counselling
• Be prepared to defend with all documentations.
Legal issues in Obs/Gynae --SALAH

77. 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)

78. • 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)