Medical Law Cases - For Doctors: Table of Contents

Export selected to

Endnote

Reference Manager

Procite

Medlars Format

RefWorks Format

BibTex Format

Detail recording of all the accidents involving the patient must be made in the medical records. The details of the accident, the injuries sustained by the patient, post-accident clinical condition, investigations and treatment given must be specifically recorded.
Post-accident, first assess the impact of the accident and if required, perform appropriate investigations. Duly record the same. (In this case, the patient who had fallen in the bathroom was not assessed for the impact by CT scan or other investigations, and the court held that this was serious lapse.)
Falling in the bathroom and sustaining injuries is one area of concern to the hospitals. Using non-slippery tiles, cleaning the bathroom regularly, and ensuring that weak and old patients are always accompanied by an attendant to the bathroom, are some basic precautions that can minimize such incidents.

Hospitals, nursing homes, clinics, etc. must ensure that the infrastructure, furniture, fittings, etc. are of standard quality and are properly and regularly maintained. Any fault or shortcoming whenever and wherever noticed must be immediately set right. Please remember that any accident that may happen due to the aforesaid may result in legal proceedings for negligence in civil and criminal courts and for deficiency in service before the consumer court. (In this case, a loose door at the waiting room of a nursing home fell on a patient's head, causing skull injury. The court directed the doctor (OP) to pay compensation to the patient.)

Every doctor / hospital is free to fix their own fees. Patients cannot allege deficiency in service by comparing fees charged by other doctors/hospitals of the same speciality / locality, though keeping track of the fees charged by others may be a mandatory exercise from a commercial viewpoint. (In this case, the court outrightly rejected the allegation of the patient that the hospital (OP) had charged him excessively on comparing the fees charged by the hospital (OP) with that of another hospital where he had received treatment.)
It is mandatory that all accidents, attempted suicides or suspicious cases are reported to the police. If the patient has failed to report, the doctor must do so, and that too, at the first opportunity. Failure to report such a case to police is neither negligence nor deficiency in service though the consequences of non-reporting can be serious and can result in other problems for the doctor/hospital. (In this case, the State Consumer Commission has reversed the decision of the lower court which had held the hospital (OP) negligent for not reporting a medico legal case to the police.)

Compromising with a patient (or for that matter, in any legal dispute) is always advisable rather than undergoing the tardy process of litigation in India. The following are the important points that must be kept in mind in this regard:
1. It is mandatory that all such compromises are duly recorded in writing.
2. It is advisable that the compromise deed is prepared by or under proper professional legal advice.
3. The patient or their heirs and legal representatives, as the case may be, must expressly relinquish their right to sue the doctor for alleged medical negligence for a mutually agreed amount.
4. The legal document must be properly executed with two independent witnesses and the same must be duly registered / notarized.
5. No part of the compromise amount must be paid in advance. Payment must be made only after the document is properly sealed, signed and registered/notarized.
6. Payment must preferably be made by account payee cheque. Cash should be avoided.
7. Once a patient agrees and accepts money under a compromise, thereafter the patient cannot approach any court for compensation. The exception to the aforesaid would be if the patient is able to make out a case that he had agreed to sign the compromise deed under coercion, fraud, misrepresentation or undue influence. (In this case, the patient had signed a compromise deed, and thereafter approached the consumer court for compensation. The court clearly refused to entertain him and specified that such a course was not available as the patient was "not under any coercion or under undue influence while signing that agreement.")
8. Even after compromise, the patient reserves the right to initiate criminal action, or even police can initiate action even without any complaint from the patient. Crime is a wrong against the society and the state is the prosecutor.
In case where the outcome of any procedure / surgery / treatment is doubtful, correct and clear picture must be given to the patient rather than giving any false assurances. Consent must also record the aforesaid without any ambiguity.
Important precautions must be specifically explained and duly recorded in the prescription / discharge card, and if the same has not been followed by the patient, this fact must also be duly recorded.

Medical records must be written diligently and truthfully. Instances where the outcome of a treatment has been unfavorable or an accident has taken place must be clearly and specifically recorded. Courts draw favorable inference in such cases. (In this case, the court had appreciated the conduct of the cardiologist (OP) in recording both the complaint of abdominal pain made by the patient during angiography and the diagnosis of aortic dissection. The court observed that "The conduct of appellants [cardiologist (OP2) and hospital (OP1)] go to show that they did not try to tamper with the medical record. They came out with clean hands. They had nothing to hide. … Their conduct does not reflect the mind of a negligent medical professional".)
Courts accept that accidents are an unavoidable part of medicine and also that at such times the tendency to blame the doctor / hospital does exist. (In this case, the patient suffered aorta dissection during angiography. The court, while rejecting the allegation of negligence observed that, "We cannot overlook that at a times accident may occur or causes like hypertensive condition of the patient may result in aorta dissection and subsequently the medical practitioner may be blamed by the patient or his / her relatives.")
Try to perform a scheduled procedure / surgery on time. In case of any deviation, duly inform the patient about the said fact as well as the reasons for same.

Any delay in performing a procedure / surgery or starting a treatment could be held as negligence. There can be no hard and fast rule and it would differ from case to case. In an emergency, even a minute's delay could be negligence while in other cases even days would not make any difference. Courts generally avoid drawing adverse inference against medical decisions unless the wrong is gross and patent. (In this case, the gynecologist (OP) took the decision to perform cesarean, but postponed the same for more than 2 hours and in this intervening period, the fetus was dead. The court did not find this delay unreasonable.)
Symptoms must be co-related; and in appropriate cases, immediate action must be taken.
Investigation reports must duly note the date as well as the exact time of performing the same. (In this case, though the date of the scan was recorded, the exact time was not recorded and this shortcoming was specifically noted by the court.)

In case further steps have to be taken to confirm an initial finding, it is mandatory to clearly state the aforesaid in the preliminary investigation report itself.
In case there is more than one standard method of performing an investigation, the particular method adopted must be clearly specified in the report.

It is a well-settled law that following any one method of the many that may be prescribed by medical literature, preached by medical science, or practiced by peers is not negligence. The only precaution that needs to be taken in such cases as a matter of abundant precautions is to once again refer to standard commentaries and consult peers.
Not writing the potency of drugs prescribed or its dose could be construed as negligence.