Medical Law Cases - For Doctors: Table of Contents

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In case an extra sheet of paper or a document is annexed with a printed consent form, ensure that the patient's signature is taken on each and every page. (In this case, the court found that the patient signed the consent form and the explanation about the proposed surgery, type of surgery, and future complications were annexed with the consent form. In all such annexures, patient's signature must be obtained on every page, or else there is a probability that the patient may allege that the annexures were not present when the consent form was signed and were added subsequently by the hospital / doctor.)

In a situation, where due to threat, coercion, or any such external factor, a doctor or hospital is forced to perform an act, at the first available opportunity thereafter, such incidents must be reported to the police, in writing, and an acknowledgment must be taken. (In this case, the hospital (OP1) took the defense that following the patient's death, her husband had gathered mob and pressurized the doctors by calling reporters from the electronic media and forced its doctors to issue a letter admitting negligence. The court accepted this defense.)
Doctors and hospitals are nowadays hot favorite of media, both print and electronic. Medical negligence is big news. Proper care must be taken in dealing with media in case of a medical mishap and help from journalist friends or PR professionals must be taken to deal with the situation, so that the loss is minimized. (In this case, the hospital pointed out in the court that presence of electronic media was one of the reasons for accepting medical negligence in writing.)
Referral letter of the doctor referring the patient must be duly preserved with the other medical records of the patient. (In this case, the patient alleged that the patient was referred to the hospital (OP1) only because her condition was serious but was not admitted in the ICU. The hospital (OP1) produced the referral letter where nothing of this sort was written by the referring doctor.) ,
Courts have started taking into account rowdy and illegal acts of the patient /attendants. The court's observations in this case are very apt and point out to the aforesaid: "It is seen that though wife (patient) of appellant was dead by putting aside the dead body, appellant illegally tried to harass the doctors. In our view, this practice needs to be coped, because of the deeds of miscreant general public will have to suffer. No doctor will take cognizance of any serious patient if illegal practice will adopt by the relative of the patient."

Hospitals cannot withdraw the life support of a patient on instructions of any other person, not even the closest relatives. In this case, the court has rightly observed that such an act "amounts to offence." The Supreme Court is presently seized of this issue and clarity will emerge once the judgment is pronounced.
Whenever a patient seeks to get discharged on his/her own or contrary to medical advice, the patient must first be asked to sign a "discharge against medical advice" form.
Assisting the patient in a way that does not strictly come under the purview of the doctor's duty is always viewed favorably by the court. (In this case, the patient was discharged; yet the doctor accompanied her to the other hospital till she was admitted therein and the court did draw favorable inference from this act.)
Consumer courts can levy fine against a frivolous complainant. In case the patient's complaint is frivolous, doctors and hospitals must insist on this fine. It acts as a deterrent against false and frivolous complaints of medical negligence against doctors and hospitals. In this case, the lower court had actually imposed a cost of Rs. 10,000/- on the patient's attendants for filing a frivolous complaint.

In procedures where failure leads to a surgical intervention, two elementary precautions must be taken. First, the consent must clearly spell out the possibility of failure of the procedure and the possibility of the consequent surgery. Second, requsite preparedness must be there in anticipation of a surgery. Delay in performing such a surgery could be held as negligence. (In this case, angioplasty crashed and within a few hours, the patient had to undergo open heart surgery. The patient made a very specific allegation that there was no surgical standby which resulted in inordinate delay in performing surgery.) ,
In doubtful cases, especially when the patient's orientation seems doubtful, it is advisable to take additional consent of an attendant, preferably the closest relative present, alongwith the patient's consent. (In this case, though the patient was conscious, signature of both the patient and his wife were taken on the consent form for angioplasty and the court specifically took cognizance of the aforesaid while holding that the consent was proper.)
In case the patient is unable to give consent, consent of the closest relative must be taken. Efforts must be made to do so even in case of emergencies, though strictly speaking, one is not bound to take consent in emergencies. (In this case, angioplasty crashed and the patient was taken for open heart surgery within a few hours, but even then consent of the patient's wife and sister-in-law was taken. The court viewed this favorably.)
Care and caution is required in taking consent from an illiterate or less literate patient. In case of literate patients, courts presume that the patient understood whatever was written in the consent form, but such a presumption does not exist in case of illiterate patients. (In this case, the allegation that signatures were taken in a routine manner was rejected by the court and one of the reasons specifically stated by the court for doing so was that the patient and his family were highly educated.)
In case of critical patients, it is always advisable to take a second opinion or involve other doctors. This advice becomes rather mandatory when such a request is made on behalf of the patient. Patient's request as well as the fact that other doctor/s were involved must be specifically noted in the patient's medical records. (In this case, the court has specifically taken note of the fact that the patient's brother-in-law had brought two consultants who had approved the line of treatment.)
Record specifically the lifestyle habits of patients such as drinking, smoking, and so on which could adversely affect treatment or surgical procedures. (In this case, the court held that the patient's habit of heavy smoking had caused post-operative complications that led to multi-organ failure and, ultimately, death of the patient.)
Important decisions must always be taken after due deliberations with the patient and the patient's family and not in a hurry. Emergencies, of course, are an exception.

Whenever a particular act is performed on the request or insistence of the patient/attendants, it is advisable to take a written request from them or at least the fact that the particular act is being done on the request of the patient/attendant must be duly recorded in the patient's medical records. (In this case, the doctor (OP2) had specifically pleaded that he had referred the patient to a higher center on the request of the patient's father, but this plea did not convince the court perhaps as nothing was on record.)
In cases where the investigation report shows any abnormality, the option of repeating the investigation must be seriously contemplated by both the diagnostic center as well as the referring doctor. (In this case, the court had very specifically observed that though the platelet count of the patient showed abnormal value, the patient was not advised to repeat the test.)
In suitable cases, after performing an investigation on a machine, repeating the investigation by manual method or other alternative/s must be seriously considered, especially if the findings are abnormal or there is a cause for suspicion. (In this case, the court drew adverse inference against the diagnostic center because "after conducting the test on machine, it failed to repeat it by manual method, particularly when the report had shown abnormal value of platelet count.")
It is advisable that in suitable cases, the investigation reports must also record the name of the machine on which the investigation is performed. (In this case, the court has very specifically pointed out that the diagnostic center (OP3) did not mention in the report the name of the machine on which the blood count of the patient was taken.)
Diagnosis, provisional or final, or at times even suspicions must be written specifically in the prescription. Failure to do so would be construed as negligence. (In this case, the doctor (OP2) admitted that he had not mentioned that the patient was suffering from vasovagal syncopial attack in the prescription as the patient was being treated as an outpatient. The court held that this was improper.)
In all cases where the requisite facilities/doctors are unavailable to manage the patient properly, the patient must be referred to appropriate facility/consultant at the earliest.

Hospitals and surgeons must refuse to perform a surgery in the absence of an anesthetist. Grave emergency is an exception, but even then, efforts must be made to requisition the services of an anesthetist from a nearby area/hospital. The fact that efforts were made to call an anesthetist and the grave emergency, both, must be duly recorded in the patient's medical records and the operation notes. (In this case, the hospital (OP) did try to put a defense that qualified anesthetists were unavailable and, hence, the pediatrician administered anesthesia. But the court found that an anesthetist was available in the District Civil Hospital and was in fact called after the mishap.)
Simply because a doctor has been practicing as an anesthetist, sonologist, or such other specialist for a pretty long time without any adverse event does not mean that this doctor can continue practicing as such. The requsite qualifications prescribed by the Medical Council of India (MCI) are absolutely necessary. (In this case, the hospital (OP) tried to defend the administration of anesthesia by the pediatrician on the ground that he had been a regular anesthetist for over 2000 surgeries and there was no mishap. This defense was obviously rejected by the court.)
Failure to provide the requsite medically indicated aid and support to a victim of medical mishap is viewed as serious defeciency of service by courts. A sense of urgency must prevail in each and every act in any such eventuality. (In this case, the court drew adverse inference against the hospital (OP) as the patient was shifted to the ward even though she had not gained consciousness, ventilator support was withdrawn early, and the patient was given only oxygen incubation. The court had very aptly observed, "When the patient's life was at stake, much more urgent and serious medical steps were required to be taken.")
Before surgery, the anesthetists must review the patient's medical record, history, prior medications, allergies, time requirements, the best combination of drugs to use, procedure to follow, and so on.
Courts in India are granting compensation for factors such as deprivation of love and pleasure of the other partner in case of a married couple.
In case of an unnatural death or where the cause of death is not known, it is advisable to send the dead body for post-mortem. There is no need to wait for any permission or request from the dead patient's attendants/relatives for the same.

Public perception of lethargy of the Medical Council in acting against doctors is perhaps forcing the courts to take a stern view. In this case, the court referred the case of a pathologist (OP) to the Medical Council of India for taking appropriate action and further directed that the Medical Council of India, New Delhi should send compliance report in this case to the Registrar of this Commission within 90 days; otherwise, it would tantamount to contempt of court.
Doctors must be careful in issuing medical certificates. Issuing a false, misleading, or inaccurate certificate could result in disciplinary action. (This case was not a case of medical negligence. The patient, in order to justify his delay in filing an appeal, had produced a medical certificate issued by the pathologist (OP) stating that he was suffering from cervical spondylitis for a period of 9 months. The court held that the pathologist (OP) had issued a false certificate and directed the Medical Council of India to take disciplinary action against the pathologist (OP).