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May 2010
Volume 3 | Issue 5
Page Nos. 53-68
Online since Friday, April 30, 2010
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 Escape of an IPD patient - Protocol to indemnify the hospital/nursing home from legal consequences  |
p. 53 |
- In case an IPD patient leaves or escapes from the hospital/nursing home without being duly discharged -
- Forthwith give a written intimation to the nearest police station about the same and take proper acknowledgment with time and date.
- Next, send a letter to the patient by 'registered post acknowledgment due' at the address written in the admission form clearly recording that the patient has left without being discharged.
- Duly preserve the police and postal acknowledgment with the patient's medical records.
- This protocol must be followed even in case of mentally unstable patient who may have simply escaped and the relatives/attendants/friends may also be searching for the patient.
In case any untoward incident happens with the patient or the patient commits any illegal act after escaping, the aforementioned protocol will help in protecting the hospital and the doctors against the legal consequences arising from the same. |
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Legal necessity of involving an anesthetist during a surgery/procedure |
p. 55 |
- Every doctor must seriously contemplate the necessity of involving an anesthetist while planning an intervention no matter how simple or innocuous the procedure/surgery may seem. In case of dilemma, it is advisable to involve an anesthetist rather than not involving one. Proceeding with a surgery/procedure without an anesthetist where the presence of an anesthetist is indicated, is per se negligence.
- Not giving test dose of anesthesia drugs or sensitivity test where indicated, is negligence.
- In case a medical mishap occurs, the reasons for the mishap as well as the justification for following that particular line of treatment must be specifically and carefully recorded.
- The responsibility of the patient's care in transit during transfers is on the transferring hospital.
- Hospitals and nursing homes, government or otherwise, that charge fees from some patients and provide free services to other patients, are liable for negligence before the consumer courts for both the categories of patients.
- Medical records of a patient who has suffered during a medical mishap must be preserved carefully and for a longer period.
- Inform the patient/relatives/friends/attendants about the occurrence of a medical mishap or accident at the first opportunity.
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Conducting surgery/procedure with abnormal vitals - Precautions |
p. 57 |
- Performing a surgery/procedure on a patient with abnormal vitals requires greater caution and due deliberations. In such cases
- Proceed only if your action is justified in medical science and where such a course is absolutely necessary.
- Taking a second opinion would be advisable.
- The reason/s for proceeding must be prominently recorded in the patient's medical records.
- Take high-risk consent from the patient clearly explaining and recording the necessity to proceed.
- Contemplate the complications that may arise during or after the procedure and make necessary preparations to deal with the same. Duly record the aforesaid.
- Every transfer/ of an IPD patient must be accompanied by a discharge or a transfer certificate/note/summary.
- Every investigation must be justified and solely in the patient's interest.
- In cases where an IPD patient is advised transfer, the time of giving such advice must be prominently recorded. Delay in transferring a patient after giving such advice could be construed as negligence. In case of delay, reasons thereof must be specifically recorded.
- Courts give great weight to medical records of the patients prepared and maintained by the hospital/doctor during the normal course and generally don't dispute their genuineness.
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Wealthier the patient, higher the compensation granted by courts |
p. 59 |
- The court in awarding compensation in cases of medical negligence, takes the financial status and the earning capacity of the patient into consideration. Thus patients who are rich or those who earn higher will be paid higher compensation even though the act of negligence and the consequences arising therefrom could be the same in case of a poorer patient. (In the present case, the court has observed that income tax returns of the patient can be taken into consideration in deciding the amount of compensation.)
- Consumer courts can direct the delinquent doctor/hospital to pay to the patient on two counts
- Reimbursement of the actual medical expenses incurred by the patient in getting himself treated in another hospital as well as in/by the delinquent hospital/doctors.
- Compensation on account of loss of business and mental harassment and agony suffered by the patient.
- Treating a patient with outdated treatment is per se negligence.
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Liability of the principal surgeon - Captain of the surgical team |
p. 61 |
- The principal surgeon / interventionist will be liable in courts for any mistake committed by any member of the surgery team, whether medical, para-medical or nursing, during the course of surgery.
- Once a mistake is discovered, all efforts must be directed toward remedial steps rather than in covering up the wrong. Law takes a harsh view of such cover-up attempts.
- Standard protocol in counting swabs and instruments must be strictly followed.
- Appropriate steps must be taken to avoid mixing up of patients lined up for surgery, especially in case of anesthized or unconscious patients. It has proved to be a potential source of error in surgery, worldwide.
- Standard protocols must be followed and appropriate precautions taken to ensure that the wrong side or the wrong digit of the hand / foot or wrong organ of the body is not operated on.
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How much importance must be given to the advice, suggestion or diagnosis of the referring doctor? |
p. 63 |
- In cases where the referring doctor has expressed certain doubts or has made differential diagnosis, the consulting doctor may take the same into consideration but it is not mandatory to first rule out those possibilities and then proceed with exploring other options. If the consulting doctor has reasons to believe that the said suspicions are not at all worth considering, he or she may simply choose to ignore the same and pursue an entirely different line. But in such cases, the reasons to differ with the possibilities expressed by the referring doctor must be briefly but specifically recorded by the consulting doctor in the medical records of the patient.
- Consultants are bound to answer the question/s, if any, framed by the referring doctor.
- Ensure that post-surgery/procedure instructions regarding the time after which water and food can be given to the patient and the type of food that can be given to the patient are strictly followed. These instructions must also be recorded in the patient's medical records.
- Conduct appropriate investigations to arrive at a definite diagnosis and to rule out other possibilities at the earliest.
- In case of complications or if the patient is not responding to the treatment, involving or conferring with senior consultants is advisable and the said fact must be duly recorded.
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Dates in hospital bills - Relevance in courts and precautions |
p. 65 |
- It is advisable that bills of IPD, patients' are either drawn datewise or there should be some indication of the date on which a particular investigation was performed or a consumable was indented. (In the present case, the patient's allegation that too many investigations were performed only on the day of the patient's death was sought to be substantiated by producing bills of the hospital [OP]. The hospital's [OP] defense was that although the investigations were carried out on different dates, the bills for the same were raised on the last day. This defense is believable as hospitals normally raise bills at intervals of 3-5 days or on the day of discharge/death. But, probably this explanation was rejected by the court.)
- Giving inflated bills is both negligence and cheating, a criminal offence.
- Conducting investigations without any justification is negligence. Every investigation that is advised must be relevant and for proper reasons. This precaution is all the more necessary when any test has to be repeated.
- Advice/repeat appropriate investigations at appropriate time, neither too early nor too late.
- Premature discharge of a patient is negligence.
- Make efforts to reach a proper diagnosis at the earliest.
- Every medical act must be duly recorded with date and time.
- IPD patients are legally entitled to receive copies of the medical records. The original medical records are the properties of the hospital.
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Marking the presence of the doctor/s involved with the patient - A legal requisite |
p. 67 |
- Every consultant who visits an IPD patient must put his or her signature along with appropriate remarks, date and time on the medical records of the patient.
- In any procedure/surgery, all the doctors who are involved, including physicians, other specialists, junior assistants and anesthetist/s must record their presence by signing at appropriate places in the patient's medical records. ,
- The principal surgeon/interventionist must seriously contemplate on involving appropriate specialists for a particular surgery/procedure. In case of a dilemma, it is advisable to include a particular specialist in the surgical team rather than not including one.
- Performing a procedure/surgery to correct an earlier medical mistake should ideally be done absolutely free of cost or at the most actual expenses must only be taken. There are reported cases where the courts have expressly taken a lenient view in such cases.
- If the patient refuses to follow some medical advice, inform the patient/relatives/attendants/friends of the consequences and take their written endorsement of having received the advice. In cases where consequences could be serious, withdrawing from the treatment or discharging an IPD patient against medical advice are the other options that must be seriously considered.
- All the physical abnormalities and deformities of the patient that have been observed must be specifically recorded in the patient's medical records.
- A properly drafted and elaborate "discharge against medical advice" must be taken from the patients who seek such discharge.
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