Medical Law Cases - For Doctors: Table of Contents

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Take separate and specific consent for surgery/ procedure; and for transfusion of blood, if anticipated.
In emergencies and in cases where blood transfusion could not have been anticipated, blood transfusion even without consent is permissible. The exception to this rule is patients who have given advance directives prohibiting blood transfusion.
It is safe and advisable to take consent for transfusion of blood for all surgeries/ procedures along with consent for surgery/ procedure, rather than not taking it.
Hospitals must always procure blood from government-recognized blood banks.
Hospitals must develop and maintain proper protocols to ensure that the necessary checks have been done by the blood bank and that the blood is accordingly certified.
Preserve copies of certificates certifying that the mandatory testing of blood has been done by the blood bank, in medical records of the patient.
Blood banks must strictly check blood and certify accordingly, as prescribed by law.

Specifically record the fact that the patient has refused to comply with your advice or line of treatment.
Specifically record the fact that the patient has not kept appointments or is deliberately delaying treatment.

The fact that the patient had been advised admission but had refused must be prominently recorded.
Nurses and paramedical staff must be duly qualified.

Each and every patient in family planning operations must be counseled and specifically told that the method is not 100% safe.
In Consent Form, record specifically that the patient has been counseled and the probability of failure has been specifically explained. (Recently, the Bombay High Court has directed compulsory counseling of all patients of family planning operations in government hospitals.)

In case of emergency, the consulting doctor/ surgeon must attend the patient as early as possible. This fact, as well as treatment given in emergency, must be promptly recorded.
In indoor patients, record meticulously, preoperative and postoperative treatment, suggested investigations, reports, diagnosis and treatment.
Institutions must ensure that duly qualified, competent and experienced doctors, surgeons and anesthetists are at work.

Diagnosis, as well as treatment given by earlier doctors, must be clearly included in the patient's medical records.
Possible complications, prognosis, as well as the time required for recovery, must be clearly spelt out to the patient and recorded in the Consent Form as well as medical records.

Proper protocols must be devised and followed in preparing and preserving medical records of patients. Remember, law is a slave of evidence, and medical records of the patient are the best evidence in defense of a doctor. Hence medical records of the patients must be prepared and preserved meticulously and produced promptly as and when the need arises.

The printed consent forms that are usually used nowadays must have blank space where name and description of the specific procedure must be handwritten. (In law, handwritten material has more evidentiary value over typewritten material, which again has more evidentiary value over cyclostyled or printed material).
It is advisable that consent of the patient must be taken on a day near the date of surgery/ procedure; though legally, a consent once given for a particular surgery/ procedure is effective till it is withdrawn by the patient or till the surgery/ procedure is performed.
Every treatment given to the patient, even the ones which have been attempted but have failed, and name of the doctor who had suggested the treatment should find a place in medical records.
In case of mistakes in case sheets, avoid overwriting. It is advisable to encircle the mistaken portion and then write correctly.
Write, maintain and preserve medical records carefully. Missing medical records always lead the courts to draw an adverse inference against doctors.
Avoid overworked doctors, paramedical staff, especially in surgeries/ procedures.
In case of complications, appropriate specialists must be summoned at the earliest. This must be appropriately recorded.
In case of complications, the patient must be referred or transferred to a better facility if available. This must be appropriately recorded.
Relatives of the patient must be kept involved with the treatment and appropriately informed. The root cause for maximum number of cases for medical negligence is poor communication of doctors with patient.
Private institutions must ensure that in case services of doctors employed with government hospitals are taken, proper permission from the appropriate authorities are in place.