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 Table of Contents    
 
Year : 2017  |  Volume : 10  |  Issue : 9  |  Page : 133
Law recognizes "Open Nursing Home" - Absence of a contract between admitting doctor and hospital remains a potential area of conflict

 
   Suggested precautions 
  1. A distinct category of hospitals and nursing homes exists today, commonly known as "Open Nursing Homes," where qualified doctors not empanelled with that hospital also admit their patients and the hospital merely provides infrastructure and services. The admitting doctor continues as the doctor incharge/primary physician of the hospitalized patient and accordingly advices investigations, diagnoses, and treats the patient. In this case, the court has recognized this category, without specifically naming it, taking into account the hospital's (OP) contention that it was "a multi-specialist hospital, wherein different specialised doctors admit their patients under their own care and treatment" and it 'provides infrastructural facility of nursing staff, equipments' facility to the concerned doctors and also allied facilities and in return ... gets room rent and nursing charges." A written contract is advisable between doctors and hospitals in such cases. (In this case, the doctor (OP) had referred the patient to the hospital (OP) and the referral letter also advised investigations and the treatment to be given during hospitalization. The doctor (OP) visited the patient twice immediately after admission, tried resuscitating when the patient was critical, and ultimately signed the death certificate also. But when allegations of negligence were made in the court, the doctor (OP) simply refused to accept that he was the primary physician of the patient stating that he was in "no way related" or was an "official consultant doctor" of the said hospital (OP) and only the hospital (OP) was liable for deficiency in patient care. The hospital (OP) clarified that the patient was completely in control of the doctor (OP) who had also received a part of the charges paid by the patient's attendants to the hospital (OP). The court held that the doctor (OP) was the primary physician of the patient during hospitalization and was solely liable for negligence in providing care).
  2. Content of a medical record and not its name (such as prescription/referral letter) is relevant in deciding the real nature of the document in court. (In this case, the doctor (OP) stated in defense that the letter addressed by him for admission to the hospital (OP) was a "simple letter of reference" and therefore he was not liable for the patient during hospitalization. This letter recorded brief history, and diagnosis, as well as the investigations to be performed and the medicines/treatment to be started at the hospital (OP) after hospitalization. The court held that the doctor (OP) had given orders as the primary physician of the patient during hospitalization and this letter was not a simple letter of reference).
  3. Any failure to attend an emergency patient or when a hospitalized patient is critical should have a valid reason that can be shown/proved in courts. Courts are very harsh when there is a failure to discharge this mandatory duty. (In this case, the doctor (OP) was called when the patient was critical. The doctor (OP) stated that he could not come as he was busy in another operation. The court rejected this defense as relevant documents were not produced and details of the purported operation in which he was busy was not provided. The court termed this defense as an "after thought" and "false explanation.")
  4. The fact that a doctor has attended the patient before death should not be the only reason to issue Death Certificate. (In this case, the court held that the doctor (OP) continued to remain as the primary consultant of the patient even after hospitalization although the doctor (OP) vehemently denied the same. One of the reasons for the aforesaid was that the doctor (OP) had issued the Death Certificate to the patient. The court rejected the doctor's (OP) defense that he had issued Death Certificate "because he was the last medical attendant of deceased.")
  5. Patients have the right to get admitted/referred/transferred in a hospital of their choice. Two precautions need to be taken by the referring doctor. First, to confirm whether the hospital of the patient's choice has the requisite facilities to handle that patient. Second, to record specifically in the prescription/referral note that the hospital was the patient's choice and not that of the referring doctor/hospital.
  6. Attending an emergency/critical patient without permission of the primary physician is permissible and is viewed favorably by courts. (In this case, on the request of the patients relatives, the other doctor (OP) attended the patient who was critical but admitted under the doctor (OP). The court appreciated the efforts made by the other doctor (OP)).



   Facts of the case Top


The patient was brought to the doctor (OP1) at 11:30 am who advised admission at the hospital(OP2) and gave a letter to the patient's attendants. The doctor (OP1) visited the patient at 12:00 pm and again at 2:15 pm. The patient's condition deteriorated at around 6:00pm. The relatives requested another doctor (OP3) taking rounds to see the patient till the doctor (OP1) arrived. The other doctor (OP3) examined the patient. The relatives contacted the doctor (OP1) at around 7.40 pm who said that he was busy in an emergency. The doctor (OP1) came at 9:00 pm. The patient who was critical by then died. The doctor (OP1) issued a Death Certificate.


   Patent's allegation/s of medical negligence Top


It was alleged that the doctor (OP1) did not render services when the patient became critical and was therefore responsible for the patient's death.


   Doctor's defense Top


  • It was stated by the doctor (OP1) that he advised admission at the hospital (OP2) and visited the patient at 12.00 pm and 2.25 pm only at the insistence of the relatives, had not taken any fees from the patient/relatives, and hence was in no way concerned with what happened with the patient at the hospital (OP2).
  • It was stated by the doctor (OP1) that he was busy with another operation when contacted by the patient's relatives at 7:40 pm and hence could not attend the patient.
  • It was stated by the doctor (OP1) that he issued the Death Certificate because he was the last medical attendant to attend the patient.
  • It was stated by the hospital (OP2) that it provided only infrastructure and services to doctors to admit and treat their patients and was in no way concerned with the treatment of patients. It was further stated by the hospital (OP2) that it had paid charges to the doctor (OP1) from the fees collected from the patient/relative.
  • It was stated by the doctor (OP3) that he was not the patient's doctor and treated the patient on humanitarian grounds at the insistence of the relatives due to their inability to contact their doctor (OP1).



   Findings of the court Top


  • The court found that the letter given to the patient by the doctor (OP1) requesting admission also gave directions for investigations and treatment at the hospital (OP2), and the records of the hospital (OP2) also recorded that the admission was under the care of the doctor (OP1). The court therefore observed that the various investigations performed on the patient and treatment given was done on the advice of the doctor (OP1),the patient was under the care of the doctor (OP1), and hence liable for negligence.
  • The court rejected the defense of the doctor (OP1) that he was busy in another operation when the patient's relatives called him at 7.40 pm as he was unable to produce documents to prove the same.
  • The court appreciated the doctor (OP3) who had treated the patient on the request of the relatives as the patient was critical and the doctor (OP1) was not available.
  • Hence, the doctor (OP1) was held negligent whereas the hospital and the other doctor (OPs) were not held negligent.



 

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