Medical Law Cases - For Doctors: Table of Contents

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Follow standard protocols during intervention, especially the ones that are meant to minimize incidents of leaving foreign body in the patient.
All care and precautions must be taken by the operating surgeon to ensure that there are no instruments, gauzes, or foreign bodies left inside the patient's body before closing.
In case any such unfortunate incident is discovered after closing, inform the patient about the same. If it is possible to remove the foreign body, offer to do so, at the earliest. Remember, leaving a foreign body in the patient is considered grave negligence and there is no defense in law for such doctors. But any prompt remedial measures taken by a doctor in such a situation will certainly persuade the courts to take a lenient view.

"Every practitioner, no matter how skilled, will encounter patients who are unexpectedly difficult to intubate. The induction of anaesthesia should be approached with this possibility in mind so that a clear plan of action (rather than panic) can be pursued". (Text book on Anaesthesia, Fourth Edition, Editor: Ronald D Miller)
Anesthetists must visit the patient a day or at least a few hours before the surgery/procedure and physically examine the patient for any abnormality, rather than merely discussing with the consulting surgeon and/or referring to the case papers (which unfortunately is the prevalent practice). Follow standard routine for pre-anesthetic evaluations. Though there is no direct communication between the patient and the Anesthetist, the responsibility and liability of the Anesthetist in the eye of law is the same as that of a surgeon.
Even in OT, if any abnormality is found in the patient that may need special arrangements, refrain from proceeding with anesthesia until everything is in place.
Anesthetist must distinctly and accurately record pre-, post-, and intra-anesthesia notes.
Anesthetists must duly record the drugs as well as their doses and time of administration to the patients.
All standard monitoring devices, like pulse oxymeter, etc., must be present and in working conditions in OT before the patient is anesthetized.
Proper protocols must be in place for immediate and proper tackling of emergencies at hospitals/nursing homes.
Adequate equipments and medical personnel must be in place to tackle any emergency at hospitals/nursing homes.
In hospitals/nursing homes where emergency announcements are made on a public announcement system to doctors for help - avoid taking names of the patient.
The fact that sudden unforeseeable and unpreventable complications of unknown origin may arise must be explained and conveyed to the patient while taking consent.
Name of the anesthetist/s must be clearly written in consent form for anesthesia.
In case where patient insists for a particular procedure/surgery, it must be specifically recorded.

In case a patient is unable to sign the consent form with right/left hand (in the instant case it was due to IV line), take thumb impression of the other hand on the consent form. Specifically record the reasons for taking thumb impression on the consent form. In all such cases, it is advisable to take suitable endorsement from the patient's relatives/friends/attendants on the consent form.
Discharge summary/ticket must be prepared in duplicate. Acknowledgment of receipt must be taken from the patient or relatives/friends/attendants on duplicate before issuing the original copy to them.
Requisite investigations are mandatory before conducting any surgery/procedure.
Medical records of every IPD patient must be maintained carefully - recording each and every step of treatment.

Discharge summary/ticket must be carefully prepared. Specifically state when the patient has to revisit the hospital for follow-up evaluation. Remember a discharge card/summary is a vital piece of evidence with the patient for all times to come.
The fact that the patient has not heeded to medical advice must be appropriately recorded.
During follow-ups, if anything abnormal is noticed, the same must be promptly recorded.
Non-medical incidents that can have a bearing on the health of the patient (in the instant case, the fact that the patient was made to lie on a hard and filthy mattress at her home) must be promptly recorded.

Necessary experience, physical fitness, and age of doctor are taken into consideration in USA in deciding cases of clinical negligence, In India, till date, there is no authoritative judicial pronouncement on these factors. It is, however, advisable that surgeries and procedures requiring intervention (especially delicate, sensitive or complicated ones) must be done by doctors after taking into consideration these factors. It is common sense that these factors have an important role to play in a doctor's overall performance.
It is advisable to take patient's consent rather than not taking one.

Obtain and preserve permanent addresses and contacts of the doctors and nurses present during a medical mishap. Changing jobs is now the rule. But unfortunately, courts draw an adverse inference if these doctors and nurses are not produced by the hospitals/nursing homes in their defense.
Whenever original investigation reports, X-ray/CT/MRI films, are physically handed over to the patient or their relatives/attendants/friends, an appropriate entry must be made in the medical records and their acknowledgment must be taken.
If report of any investigation is doubtful, advice re-investigation rather than not advising it.

Utmost care must be taken in prescribing dose especially in case of sensitive drugs.
A doctor is free to adopt any one line of treatment over the other, but the same should be a duly recognized and accepted practice among doctors of the same specialty.
On observing reaction of a drug, take appropriate remedial steps immediately. Duly record both the reaction and the steps taken in medical records of the patient.
Whenever an investigation report or a scan/X-ray film is returned to the patient, proper acknowledgment of receipt must be taken beforehand. Before returning, check whether reports of such investigations have been duly recorded in the patient's medical records.

In case of HIV tests, irrespective of the results of enzyme immune assay (EIA) - both positive and negative - advice to corelate the results clinically by western blot technique (WBT). This advice must be written prominently on the same report.
Specifically state if the investigations are preliminary in nature. Advice further requisite confirmatory tests.
It is necessary to give separate reports for both preliminary tests as well as final tests.
In case HIV is detected in an IPD patient and the hospital is not fully equipped to treat HIV-positive patients, immediately refer the patient to another hospital having appropriate facilities to treat such patients.