The document discusses various medico-legal aspects related to anesthesia and critical care practice. It covers topics such as: - The extent to which doctors are subject to law and their responsibilities. - Common problems faced in anesthesia practice like litigation for negligence or deficiency of services. - Principles of medical ethics like non-maleficence, autonomy, and beneficence. - Types of medical negligence like civil negligence, criminal negligence, and ethical negligence. - Landmark court judgments related to medical negligence and a doctor's duty of care. - Guidelines provided by the Supreme Court for adjudicating complaints against doctors. - Preventive steps doctors can take to avoid litigation

1. MEDICO-LEGAL ASPECTS
OF ANESTHESIA AND
CRITICAL CARE
DR AASHISHKUMAR R PATNI
MBBS, DA, MBA(HCA)

2. MLC-RELEVANCE IN ANESTHESIA PRACTICE.
• Everybody is subject to Law.
• Law is both restraining & liberating.
• To what extent Doctor is subject to Law?
• Where does Doctor stand in terms of power, responsibility & accountability?
• Are the restraints fare, clear & reasonable?
• Is the Law sufficiently facilitating & liberating for Doctors?
• Law should create conditions to benefit patients & to the protection of Doctors.
• Law should be comprehensive, balanced, flexible & facilitating.

3. Are Doctors easy target???

4. BASIC PRINCIPLES OF MEDICAL ETHICS
• Nonmaleficence: Doctors abide by the doctrine of ‘do no harm’ to their
patients.
• Autonomy: The patient is an independent being who can make fully
informed decisions regarding his/her own health care and coercion is
unethical.
• Justice: Anesthesiologists should be fair when providing their services to
surgical patients.
• Beneficence: While the principle of nonmaleficence is based on ‘do no
harm, beneficence requires physicians to ‘do good’ for the patient in every

5. COMMON PROBLEMS FACED IN ANESTHESIA
PRACTICE
• Litigation U/CPA for deficiency of services
• U/ CPA. Sec. 2 (1) (o)
• I.M.A. Vs V.P.Shantha
• (1995,6, SCC 651,P 672)
• Litigation for civil negligence
• Criminal case for criminal negligence
• For morbidity
• For mortality.

6. Parmanand katara vs union of india
(1989ACJ,1000SC)
directing every doctor whether in govt.
Service or otherwise has the professional
obligation to extend his services with due
expertise for protecting life of a patient,
brought in emergency. No patient should be
denied first-aid treatment in emergency.

7. Negligence is the breach of duty caused by the
omission to do something which a reasonable man,
guided by those considerations which ordinarily
regulate the conduct of human affairs would do, or
doing something which a prudent and reasonable man
would not do.
The definition involves three constituents of negligence:
(1) A legal duty to exercise due care on the part of the
party complained of towards the party complaining the
former's conduct within the scope of the duty; (2)
breach of the said duty; and (3) consequential damage to
complainant
…………. (law of torts by ratan lal & dhiraj lal).

8. WHAT CONSTITUTES MEDICAL NEGLIGENCE?
• Medical Negligence is the omission to do something
which a reasonably competent doctor guided by
prevailing standard of medical knowledge & practice
which regulate the conduct of a doctor, would do or
doing something which such a doctor would not do,
causing harm to the patient.

9. THE COMPLAINANT HAS TO PROVE
1. Duty: that the anaesthesiologist owed him or her a duty.
2. Breach of Duty: That the anaesthesiologist failed to fulfill his
or her duty.
3. Damages: That actual damage resulted because of the acts
of the anaesthesiologist.
4. Causation: That a reasonably close causal relationship exists
between the anaesthesiologist’s acts and the resultant injury.

10. TYPES OF MEDICAL NEGLIGENCE
• Civil Negligence
• Criminal Negligence
• Ethical Negligence
• Medical Mal occurrence
• Therapeutic Misadventure
• Corporate Negligence
• Contributory Negligence
• Composite Negligence

11. EARLIEST RECORDED ACTION AGAINST
SURGEON
• In 1374 a Surgeon, J. Mort, was brought before the King’s Bench concerning his
treatment of an injured hand. He was tried. But the Court ruled that if such a patient
proved negligence, the Court would provide a remedy. The Court also held,” If the
surgeon does so well as he can, & employs all his diligence to the cure then, it is not right
that he should be held culpable.
• In 1838 C.J Tyndall said” Every person who enters a noble profession undertakes to bring
to the exercise of it a reasonable degree of skill and care.

12. Civil negligence is a form of negligence in which a
patient brings an action for damages in a civil court
against his doctor for an injury suffered. The burden of
proving negligence rests on the patient. Damage suffered
is a measure of the liability.
• A doctor is in breach of his duty when he fails to come up to the
standard of skill & care expected of him. In the case of Bolam Vs
Friern Hospital, J.Mcnair held that it is sufficient if the medical
practitioner exercises the ordinary standard skill, practiced in the
medical field. He would not be held guilty if he had fallen short of
the standard reasonable care.( J. Streatfield)

13. DR.L.B.JOSHI VS DR.T.GODBLOE
(AIR 1969 SC 128)
A medical person owes certain duties to patients
1) A duty of care in deciding whether to undertake a case
2) A duty of care in deciding what treatment to give
3) A duty of care in administering that treatment.
• “Reduction of fracture Femur without giving anaesthesia, possibility
of fat embolism was not considered, resulting in death of the patient”. A
letter of apology was produced on record.

14. “ACTIONABLE NEGLIGENCE”.
• Jacob Mathew Vs State Of Punjab
(SCCL COM 456,Cr.Appeal No 144-145)
• Decided by the Supreme Court on 5/8/2005.
• This historic landmark Judgment of Justice Lahoti, CJI, has clearly defined the role of
medical professionals & dealt at length on the arrest of doctors.

15. DISTINCTION BETWEEN NEGLIGENCE IN
CIVIL LAW & NEGLIGENCE IN CRIMINAL
LAW U/IPC SEC 304-A
• Judgement of Sir Lawrence Jenkins in case of
Emperor Vs Omkar Ramprtap ( 4Bom,LR 679).
• To impose criminal liability U/IPC Sec.304-A, it is necessary that death should
have been the direct result of a rash & negligent act of the accused and that must
be proximate & efficient cause of death. It must be
• “ Causa causans & not Causa sine qua non”.
• Case law: Dr.Suresh Gupta Vs Govt.of NCT Delhi & Anr (2004,6 SCC 422)
• Martin F D’souza Vs Mohd. Isfaq (SC 635of2002)

16. DEATH ON OPERATION TABLE
• Unexpected turn of events in OT resulting in sudden death of the patient,
especially in a minor case or a diagnostic procedure case results in a bad scene.
• News is shocking to the waiting relatives
• Results in violence against hospital staff members & damage to the hospital
property.
• U/CrPc Sec.154 FIR lodged by relatives with Police causes apprehension of
imminent arrest resulting in damage to the Surgeon’s reputation & causes mental,
physical & economical strain .

17. VICARIOUS LIABILITY
• Principle of respondent superior is that a man is responsible for any wrongful
act done by his subordinate if the act is within the scope of
employment.”Master servant relationship”. Case Law:
• Harjot Ahluwalia Vs Spring Meadows Hospital (1998,(3) CPR (1) SC)
• An untrained nurse administered Inj. Chloroquine I.V. instead of Inj
Chloromycetine to a child of 4 yrs. with fever, dehydration & toxaemia –
developed cardiac arrest- revived-but has permanent vegetative life- Was
awarded compensation.

18. BROUGHT DEAD TO HOSPITAL
• Serious patient brought by relatives/ friends to Casualty of hospital
• On examination found dead
• So, declared dead by the doctor
• Results in verbal & physical abuse against the Doctor & the staff
members; causing tense situation in the hospital campus &
disturbance to inpatients of the hospital & surrounding area.

19. DOCTRINE OF INFORMED CONSENT
• Aims at giving sufficient information to a patient to enable him to make a knowledgeable
& informed decision about the use of a drug, device or procedure & outcome of
treatment. The duty to warn a patient of any likely harm has also been included in
Doctrine of Informed Consent. The doctor has a moral, ethical & legal duty to provide all
information enabling the patient either to accept or reject treatment. Treatment without
informed consent may invite action for negligence.
• IPC Sec.88, provides exception for an act done in good faith to save life of a patient with
consent.
• IPC Sec.92, provides exception for an act done in good faith to save life of a patient, even
without consent.

20. MEDICAL RECORDS
• OPD papers- At least 2 years- Hospital should have a record of OPD
paper
• IPD Papers- At least 3 years
• It is mandatory to provide for copy of Medical records to patient on
request, but no need to provide to anyone else (Including Police) if
not ordered by court of law or Medical board.
• All records need to be Digitized as per the Electronic Medical
Records Standards In India Released in 2013

21. SC’S 11 POINTS GUIDELINES TO COURTS TO
ADJUDICATE COMPLAINTS AGAINST
DOCTORS.
1) Negligence is a breach of duty
2) Error of judgment is not negligence
3) Application of reasonable degree of skill & knowledge is expected from
doctors
4) Conduct below standard by a doctor would be liable for actionable
negligence
5) Difference of opinion would not be negligence….. contd

22. SC’S 11 POINTS GUIDELINES TO COURTS TO
ADJUDICATE COMPLAINTS AGAINST DOCTORS
6) Higher element of risk taken by a professional in grave situation without
getting the desired result may not amount to negligence.
7) If a doctor has followed one of the standards of practice, he would not be
liable for negligence-Bolam case .
8) A doctor should practice without fear..
contd…

23. SC’S 11 POINTS GUIDELINES TO COURTS TO
ADJUDICATE COMPLAINTS AGAINST DOCTORS
9) Law would not permit unnecessary harassment of doctors
10) Criminal proceedings against doctors to extract uncalled compensation
must be prevented at any cost.
11) Doctors would get protection as long as they perform their duties
judiciously.
• “Uneasy lies in the head that wears invisible crown”.

24. “A HEALING TOUCH TO THE HEALERS”
• The Supreme Court Of India has applied
healing touch so that doctors can work without fear as
long as they work judiciously.

25. MEDICAL SCIENCE HAS CONFERRED GREAT
BENEFITS ON MANKIND BUT THESE BENEFITS
ARE ATTENDED BY UNAVOIDABLE RISKS.
• Every surgical procedure is attended by risks.
• We cannot take benefits without taking risks.“Discipline of
Law” by Lord Justice Denning
• ( Wooley V Ministry of Health & Anaesthetist

26. REMEDIES AVAILABLE TO DOCTORS
• Apprehension of arrest U/Sec.304-A or apprehension of being
victimized on trivial grounds apply for anticipatory bail
• After arrest –apply for a bail U/Sec.436CrPc
• During trial- apply for quashing the F.I R U/CrPc
Sec.482
• (State Of Haryana V Bhajan Lal,(ARI 1992 SC 604)

27. PREVENTIVE STEPS TO AVOID LITIGATION

28. PREVENTIVE STEPS TO AVOID LITIGATION
I) Primary prevention
1. Human element – tactless handling casual remarks etc.
2. Attitude and the behavior of the entire system from receptionists to
cashier
3. Seeking second opinion
4. Progressive breakdown of doctor patient communication.
5. Be compassionate
6. Continuing medical education.

29. PREVENTIVE STEPS TO AVOID LITIGATION
II) Secondary prevention
1. Use or reasonable skill and care keeping in mind
1. Medical aspect
2. Social aspect
3. Legal aspect
2. Proper documentation from time to time and record
keeping including legally valid informed consent.

30. PREVENTIVE STEPS TO AVOID LITIGATION
III) Tertiary prevention:
Professional indemnity insurance cover.

31. NINE RS OF PREVENTIVE STEPS
1. Rapport with patients & relatives.
2. Rationale: discussion on differential diagnosis and prognosis indicating thought
process
3. Records: Maintain from time to time. Essential for defense.
4. Remarks: Avoid casual remarks, harsh words, avoid criticism of other doctors.
5. Rx: Indications and contra indications of the drug be kept in mind while prescribing.
• contd…….

32. NINE RS OF PREVENTIVE STEPS
6. Res ipsa loquitor - the principle that the mere occurrence of some types of accident is
sufficient to imply
7. Respect: lack of respect of the outcome of the treatment or for the welfare of the
patient indicate indifference
8. Result: of the treatment: most important from the patients point of view.
9. Risk: should be explained to the patient while taking the informed consent.

33. •A doctor tries his best in emergency to
save patient’s life. He does not gain
anything by acting with negligence. A
surgeon with shaky hands under fear of
legal action cannot perform a successful
operation. Such timidity forced upon a
Doctor would be a disservice to the
society.

34. TO CONCLUDE IN THE WORDS
OF
EX -CHIEF JUSTICE OF INDIA,
JUSTICE VARMA
“BE YOU EVER SO HIGH…
…THE LAW IS ABOVE YOU”