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LEGAL ASPECTS OF MEDICAL CARE DR.N.C.DAS
MEDICAL ETHICS AND CONDUCT Apart from his routine and usual “clinical” cases, a doctor will come across certain ‘Medico-legal’ issues at one time or the other during the practice of his profession.  Duties and obligations of doctors are enlisted in the laws of the land and different Codes of Medical Ethics and Declaration: Hippocratic Oath Declaration of Geneva Declaration of Helsinki on medical research International Code of Medical Ethics The Declaration of Geneva of the WMA binds the physician with the words, "The health of my patient will be my first consideration," and the International Code of Medical Ethics declares that, "A physician shall act in the patient's best interest when providing medical care."
  THE INDIAN MEDICAL COUNCIL ACT 1956 Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 envisages : Duties of a physician * to their patients * in consultation * to the public and to paramedical profession Responsibilities to each other Unethical acts & Misconducts
LEGAL RESPONSIBILITY OF HOSPITAL Hospital is a public institution  Deals with life and death  Hence carries specified responsibilities & liabilities within and outside the hospital.  4.Failure to comply invites legal action. 5.Legal responsibilities are bound to different category of people and institution by contracts.  Breach of any contract held the hospital legally responsible.  Laws relating to medical practice are increasingly complying.
HOSPITAL RESPONSIBILITY   SOCIETY WOMEN ORGN . YOUTH ORGN . OWNER LOCAL GOVT. RELATIVES PATIENT HOSPITAL  STAFF VISITOR POLICE
LIABILITIES OF THE HOSPITAL   To the owner to follow the rules & regulations for achieving the objective. To the staff to provide a safe, healthy, congenial atmosphere to work. Safety of the buildings & equipments and sanitary environment.  Contractual obligation to suppliers, service providers.  Adequate safety for the patient, relatives and visitors. Breach of legal obligation by any staff.  Maintenance of Law, order & adequate facilities for patient care.
LAWS GOVERNING THE MEDICAL ISSUES LAW CRIMINAL CIVIL Between society or individual Medico legal cases Imprisonment with or   without fiscal punishment .  Between two parties always  physical punishment with or  Without compensation .
CIVIL LAW LAW OF  CONTRACTS LAW OF TORTS ( Not covered by contracts) LAW OF  VICARIOUS RESPONSIBILITY EXPRESSED IMPLIED NEGLIGENCE INTENTIONAL INTERFERENCE COMMUNITY CARE RIGHTS MEDICAL  LAWS
LAW OF CONTRACTS   EXPRESSED IMPLIED Consent for examination verbal or written. Written consent for examination of private parts. Consent must be obtained before act. Written consent for surgery & procedures.  Consent to be obtained from competent authority.  The procedure & risk involved to be explained to  patient before consent. The procedure/ surgery undertaken be lawful and  in the patients interest.  Lady patient to be examined in presence   of another lady or family member. Provision of reasonable quantity  & quality of care within available resources.  Can be compared to services  of other institutions under similar circumstances. Examination of  medico legal cases. Unconscious patients Under life & death situation
MEDICAL NEGLIGENCE  CRIMINAL  NEGLIGENCE  CIVIL  NEGLIGENCE   When there is extensive damage.  Removal of healthy eye, healthy breast. Wrong limb amputation.  Operation on wrong individual.  Not taking adequate safety measures.  Leaving instruments inside abdomen. The negligence is so obvious it speaks for itself.  ( RES-IPSA-LOQUITOR ) Failure to attend in time.  In adequate communication to patient. Omissions & Commission.  Wrong medicine, wrong doss.  Incomplete record.  Compromise with patient safety. Hospital Infection  Deviating from hospital rules & norms.  The negligence has to be proved.  CONTRIBUTORY NEGLIGENCE Occurs when the party to which the duty is owed contributes to the injury or damage that is incurred. CONTRIBUTARY
INTENTIONAL INTERFERENCE   Acts with malafied  intensions.  Touching/ exposing of private parts with bad intension.  Operation without proper consent.  Intentional fielding with case record.  Refusal to discharge a patient.  Getting investigations/ drugs from outside with bad intention.  Forcefully discharging a patient, when there is risk to life. Making public confidential information.
Preparation of MLC 2.  Notification of birth & deaths 3.  Notification of infectious disease 4.  Notification of unnatural deaths 5. Conducting medical examination 6. Issue of medical & fitness certificate 7. Conducting post-mortem Notification of all accidental cases Proper completion of case sheets. (Medical records) Age Determination by court orders.  Furnishing Medical Opinion on court direction.  LEGAL RESPONSIBILITIES  ( COMMUNITY CAREASPECTS) OF DOCTORS
STATE RESPONSIBILITY OF HOSPITAL   (LAWS GOVERNIING MEDICAL ACTS) 1. Compliance of MTP Act. 2. Compliance of PNDT Act. 3. Compliance of BMW Act. 4. Consumer’s Protection Act. 5. Right to Information Act. Issue of disability Certificates Organ Transplantation Act.  Artificial Insemination Act. Custody of Mentally ill patients.  PNDT (Sex Determination) Act. Food Adulteration Act.  Ethical  and other health regulations.
VICARIOUS RESPONSIBILTY VICARIOUS RESPONSIBILTY :   This is the liability on the part of the administrator for the negligence of the hospital staff if he fails in adequate supervision and this over all responsibility of the administrator on the responsibility of the individuals is knows as vicarious responsibility. ADMINISTRATION HAS TO ENSURE: Safety of the patient & staff all areas of the hospital. Control of hospital infection.  Cleanliness sanitation  Flaw less building structure  Drinking Water Supply.  Fire Control Measures.  Guidelines for safe procedures at different parts of the hospital.  Training, Orientation & Motivation of hospital employees.
LEGAL ASPECT OF MEDICAL CARE  Privileged Communication  is the communication made by a doctor to a proper authority, who has got legal, social & moral duty to protect the public and doctor is justified to disclosed the professional secret. The conditions in which the privileged secret can be communicated are: As a witness in the court on direction.  Moral or Social duty to the public. While safe guarding his own interests.  When servant is sent by master for medical examination.  Criminal cases.
MAKE SURE : SALIENT POINTS IN EXAMINATION  OF MEDICO LEGAL CASE This may be noted that all injury patients brought by the   police or somebody else must be made Medico Legal if not registered as M.L.C elsewhere.  The request of the patient or its relations to make the case M.L.C must be entertained. Police should be informed.  If any case has already been registered as Medico- Legal  case in another hospital or dispensary a fresh report may not be prepared but the case may be labeled as  Medico legal , mentioning the previous M.L.C number and record of further treatment should be kept as M.L.C.
EXAMINATION OF MEDICO LEGAL CASE 4.If a case is brought by police, several days after the incident, for Medico Legal examination. -The opinion regarding the case is to be given according to the present exam findings and present condition of the patient.  5.If a case has already been dealt as Non Medico Legal by the first examining doctor in the casualty, it can be made Medico Legal by the concerned treating unit doctor, if they suspect any foul play at any stage, while the patient is in the hospital.  They have to do all Medico Legal formalities in such cases.  6.Not registering a case as MLC by CMO shall solely depend on his assessment and not with anybody’s request or order. He will be held responsible if anything goes wrong.
PREPARATION OF MEDICAL LEGAL CASE SHEET For all the cases registered as Medico legal, the injury sheet must be filled up in duplicate, wherein all  the columns inside the sheet must be completed with the help of police constable deputed for the purpose.  Name and address of the person who brought the patient should be recorded in the case file. 3. While filling the injury sheet, special emphasis should be given to Name, Age, Sex, Date and Time of arrival and also on detailed exam. of the injury; like its number, its dimension, its position and margins.  4. If it is not possible to give opinion regarding nature of injury immediately case may be mentioned under observation .  5. The final opinion can be given on a later date. But it remains the responsibility of the CMO,  who saw the case first, to collect information and give final opinion. If specialist doctor has  attended any case, he will give final opinion i.e. simple/ grievous
PREPARATION OF MEDICAL LEGAL CASE SHEET 6. If patient is admitted it must be mentioned in the injury sheet, “Admitted For Detailed Examination and Management”.  7. Type of weapon (if possible) must be mentioned whether blunt or sharp, hard blunt, soft blunt, cutting weapon, stabbing weapon firearm on the basis of injury/ examination. 8. Nature of injury may be mentioned (either simple, grievous or dangerous/serious).  9. In case of suspected poisoning it must be mentioned as,” poisoning nature not known”, instead of “unknown poisoning”.
PREPARATION OF MEDICAL LEGAL CASE SHEET 10.  In very critical cases where management is the first priority the general findings may be noted and patient may immediately be admitted for immediate treatment and above facts must be mentioned on the injury sheet,  also that the case has been admitted for further detailed exam. and management.  11. A fresh injury sheet may not be prepared, if it had already been registered as Medico legal by some other hospital/ doctor. Only previous Medico legal registration number may be mentioned in the document labeling as Medico legal.
12.If decision is taken to make a medico legal case after admission, the treating unit doctor (not below the rank of S.R./M.O.) should prepare the injury sheet.  13.In Medico legal cases brought dead injury sheet must be prepared where all details about the case may be mentioned.  14.If a Medico legal case is referred to the specialty doctor and he wants to admit the case or send the case to home, he must inform the C.M.O. concerned about the same, after examination, so that such an entry may be made in the Medico legal Injury sheet. 15. All victims of alleged rape and criminal abortion should be shown to lady doctor  for examination and preparation of medico-legal injury sheet and other formalities. 16. Consent for medical examination should be taken unless he/she is arrested on charge of committing an offence and produced before C M O for medical examination.  17. If a person is below 18 years of age, consent of guardian is to be taken for private part examination.  PREPARATION OF MEDICAL LEGAL CASE SHEET
Consent not required: Medical Emergencies Notifiable diseases Immigrants New admission to prisons Court orders for examination & treatment Under section 53 (1) of Cr.P.C., a person can be examined on request of the police by use of force Members of Armed Forces on request of competent authority in writing. Consent is not required from relative for conducting medico legal postmortems.
18. Casualty duty officer or any other doctor dealing with a medico legal case must complete all the formalities before he is relieved from duty. It is mandatory on the part of CMO to put time of arrival of patient in the casualty register. 19. The attending doctor to put his legible signature full name in capital letter and designation for future reference . 20. A copy of the MLC to be handed over to police taking a receipt. “ NO MLC SHOULD BE BACK DATED”   ( THERE IS A SEPARATE PRESENTATION ON MEDICO LEGAL CASE RECORD)
HOSPITAL ADMINISTRATION MADE EASY http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS

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Legal aspect of medical care

  • 1. LEGAL ASPECTS OF MEDICAL CARE DR.N.C.DAS
  • 2. MEDICAL ETHICS AND CONDUCT Apart from his routine and usual “clinical” cases, a doctor will come across certain ‘Medico-legal’ issues at one time or the other during the practice of his profession. Duties and obligations of doctors are enlisted in the laws of the land and different Codes of Medical Ethics and Declaration: Hippocratic Oath Declaration of Geneva Declaration of Helsinki on medical research International Code of Medical Ethics The Declaration of Geneva of the WMA binds the physician with the words, "The health of my patient will be my first consideration," and the International Code of Medical Ethics declares that, "A physician shall act in the patient's best interest when providing medical care."
  • 3. THE INDIAN MEDICAL COUNCIL ACT 1956 Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 envisages : Duties of a physician * to their patients * in consultation * to the public and to paramedical profession Responsibilities to each other Unethical acts & Misconducts
  • 4. LEGAL RESPONSIBILITY OF HOSPITAL Hospital is a public institution Deals with life and death Hence carries specified responsibilities & liabilities within and outside the hospital. 4.Failure to comply invites legal action. 5.Legal responsibilities are bound to different category of people and institution by contracts. Breach of any contract held the hospital legally responsible. Laws relating to medical practice are increasingly complying.
  • 5. HOSPITAL RESPONSIBILITY SOCIETY WOMEN ORGN . YOUTH ORGN . OWNER LOCAL GOVT. RELATIVES PATIENT HOSPITAL STAFF VISITOR POLICE
  • 6. LIABILITIES OF THE HOSPITAL To the owner to follow the rules & regulations for achieving the objective. To the staff to provide a safe, healthy, congenial atmosphere to work. Safety of the buildings & equipments and sanitary environment. Contractual obligation to suppliers, service providers. Adequate safety for the patient, relatives and visitors. Breach of legal obligation by any staff. Maintenance of Law, order & adequate facilities for patient care.
  • 7. LAWS GOVERNING THE MEDICAL ISSUES LAW CRIMINAL CIVIL Between society or individual Medico legal cases Imprisonment with or without fiscal punishment . Between two parties always physical punishment with or Without compensation .
  • 8. CIVIL LAW LAW OF CONTRACTS LAW OF TORTS ( Not covered by contracts) LAW OF VICARIOUS RESPONSIBILITY EXPRESSED IMPLIED NEGLIGENCE INTENTIONAL INTERFERENCE COMMUNITY CARE RIGHTS MEDICAL LAWS
  • 9. LAW OF CONTRACTS EXPRESSED IMPLIED Consent for examination verbal or written. Written consent for examination of private parts. Consent must be obtained before act. Written consent for surgery & procedures. Consent to be obtained from competent authority. The procedure & risk involved to be explained to patient before consent. The procedure/ surgery undertaken be lawful and in the patients interest. Lady patient to be examined in presence of another lady or family member. Provision of reasonable quantity & quality of care within available resources. Can be compared to services of other institutions under similar circumstances. Examination of medico legal cases. Unconscious patients Under life & death situation
  • 10. MEDICAL NEGLIGENCE CRIMINAL NEGLIGENCE CIVIL NEGLIGENCE When there is extensive damage. Removal of healthy eye, healthy breast. Wrong limb amputation. Operation on wrong individual. Not taking adequate safety measures. Leaving instruments inside abdomen. The negligence is so obvious it speaks for itself. ( RES-IPSA-LOQUITOR ) Failure to attend in time. In adequate communication to patient. Omissions & Commission. Wrong medicine, wrong doss. Incomplete record. Compromise with patient safety. Hospital Infection Deviating from hospital rules & norms. The negligence has to be proved. CONTRIBUTORY NEGLIGENCE Occurs when the party to which the duty is owed contributes to the injury or damage that is incurred. CONTRIBUTARY
  • 11. INTENTIONAL INTERFERENCE Acts with malafied intensions. Touching/ exposing of private parts with bad intension. Operation without proper consent. Intentional fielding with case record. Refusal to discharge a patient. Getting investigations/ drugs from outside with bad intention. Forcefully discharging a patient, when there is risk to life. Making public confidential information.
  • 12. Preparation of MLC 2. Notification of birth & deaths 3. Notification of infectious disease 4. Notification of unnatural deaths 5. Conducting medical examination 6. Issue of medical & fitness certificate 7. Conducting post-mortem Notification of all accidental cases Proper completion of case sheets. (Medical records) Age Determination by court orders. Furnishing Medical Opinion on court direction. LEGAL RESPONSIBILITIES ( COMMUNITY CAREASPECTS) OF DOCTORS
  • 13. STATE RESPONSIBILITY OF HOSPITAL (LAWS GOVERNIING MEDICAL ACTS) 1. Compliance of MTP Act. 2. Compliance of PNDT Act. 3. Compliance of BMW Act. 4. Consumer’s Protection Act. 5. Right to Information Act. Issue of disability Certificates Organ Transplantation Act. Artificial Insemination Act. Custody of Mentally ill patients. PNDT (Sex Determination) Act. Food Adulteration Act. Ethical and other health regulations.
  • 14. VICARIOUS RESPONSIBILTY VICARIOUS RESPONSIBILTY : This is the liability on the part of the administrator for the negligence of the hospital staff if he fails in adequate supervision and this over all responsibility of the administrator on the responsibility of the individuals is knows as vicarious responsibility. ADMINISTRATION HAS TO ENSURE: Safety of the patient & staff all areas of the hospital. Control of hospital infection. Cleanliness sanitation Flaw less building structure Drinking Water Supply. Fire Control Measures. Guidelines for safe procedures at different parts of the hospital. Training, Orientation & Motivation of hospital employees.
  • 15. LEGAL ASPECT OF MEDICAL CARE Privileged Communication is the communication made by a doctor to a proper authority, who has got legal, social & moral duty to protect the public and doctor is justified to disclosed the professional secret. The conditions in which the privileged secret can be communicated are: As a witness in the court on direction. Moral or Social duty to the public. While safe guarding his own interests. When servant is sent by master for medical examination. Criminal cases.
  • 16. MAKE SURE : SALIENT POINTS IN EXAMINATION OF MEDICO LEGAL CASE This may be noted that all injury patients brought by the police or somebody else must be made Medico Legal if not registered as M.L.C elsewhere. The request of the patient or its relations to make the case M.L.C must be entertained. Police should be informed. If any case has already been registered as Medico- Legal case in another hospital or dispensary a fresh report may not be prepared but the case may be labeled as Medico legal , mentioning the previous M.L.C number and record of further treatment should be kept as M.L.C.
  • 17. EXAMINATION OF MEDICO LEGAL CASE 4.If a case is brought by police, several days after the incident, for Medico Legal examination. -The opinion regarding the case is to be given according to the present exam findings and present condition of the patient. 5.If a case has already been dealt as Non Medico Legal by the first examining doctor in the casualty, it can be made Medico Legal by the concerned treating unit doctor, if they suspect any foul play at any stage, while the patient is in the hospital. They have to do all Medico Legal formalities in such cases. 6.Not registering a case as MLC by CMO shall solely depend on his assessment and not with anybody’s request or order. He will be held responsible if anything goes wrong.
  • 18. PREPARATION OF MEDICAL LEGAL CASE SHEET For all the cases registered as Medico legal, the injury sheet must be filled up in duplicate, wherein all the columns inside the sheet must be completed with the help of police constable deputed for the purpose. Name and address of the person who brought the patient should be recorded in the case file. 3. While filling the injury sheet, special emphasis should be given to Name, Age, Sex, Date and Time of arrival and also on detailed exam. of the injury; like its number, its dimension, its position and margins. 4. If it is not possible to give opinion regarding nature of injury immediately case may be mentioned under observation . 5. The final opinion can be given on a later date. But it remains the responsibility of the CMO, who saw the case first, to collect information and give final opinion. If specialist doctor has attended any case, he will give final opinion i.e. simple/ grievous
  • 19. PREPARATION OF MEDICAL LEGAL CASE SHEET 6. If patient is admitted it must be mentioned in the injury sheet, “Admitted For Detailed Examination and Management”. 7. Type of weapon (if possible) must be mentioned whether blunt or sharp, hard blunt, soft blunt, cutting weapon, stabbing weapon firearm on the basis of injury/ examination. 8. Nature of injury may be mentioned (either simple, grievous or dangerous/serious). 9. In case of suspected poisoning it must be mentioned as,” poisoning nature not known”, instead of “unknown poisoning”.
  • 20. PREPARATION OF MEDICAL LEGAL CASE SHEET 10. In very critical cases where management is the first priority the general findings may be noted and patient may immediately be admitted for immediate treatment and above facts must be mentioned on the injury sheet, also that the case has been admitted for further detailed exam. and management. 11. A fresh injury sheet may not be prepared, if it had already been registered as Medico legal by some other hospital/ doctor. Only previous Medico legal registration number may be mentioned in the document labeling as Medico legal.
  • 21. 12.If decision is taken to make a medico legal case after admission, the treating unit doctor (not below the rank of S.R./M.O.) should prepare the injury sheet. 13.In Medico legal cases brought dead injury sheet must be prepared where all details about the case may be mentioned. 14.If a Medico legal case is referred to the specialty doctor and he wants to admit the case or send the case to home, he must inform the C.M.O. concerned about the same, after examination, so that such an entry may be made in the Medico legal Injury sheet. 15. All victims of alleged rape and criminal abortion should be shown to lady doctor for examination and preparation of medico-legal injury sheet and other formalities. 16. Consent for medical examination should be taken unless he/she is arrested on charge of committing an offence and produced before C M O for medical examination. 17. If a person is below 18 years of age, consent of guardian is to be taken for private part examination. PREPARATION OF MEDICAL LEGAL CASE SHEET
  • 22. Consent not required: Medical Emergencies Notifiable diseases Immigrants New admission to prisons Court orders for examination & treatment Under section 53 (1) of Cr.P.C., a person can be examined on request of the police by use of force Members of Armed Forces on request of competent authority in writing. Consent is not required from relative for conducting medico legal postmortems.
  • 23. 18. Casualty duty officer or any other doctor dealing with a medico legal case must complete all the formalities before he is relieved from duty. It is mandatory on the part of CMO to put time of arrival of patient in the casualty register. 19. The attending doctor to put his legible signature full name in capital letter and designation for future reference . 20. A copy of the MLC to be handed over to police taking a receipt. “ NO MLC SHOULD BE BACK DATED” ( THERE IS A SEPARATE PRESENTATION ON MEDICO LEGAL CASE RECORD)
  • 24. HOSPITAL ADMINISTRATION MADE EASY http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS