Medical Law Cases - For Doctors

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"Every doctor should, for his own interest, carefully read the Code of Medical Ethics which is part of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 issued by the Medical Council of India under Section 20A read with Section 3(m) of the Indian Medical Council Act. 1956."
"Life is surely more important than side effects."
"Current practices, infrastructure, paramedical and other staff, hygiene, and sterility should be observed strictly."
"No prescription should ordinarily be given without actual examination."
"The tendency to give prescription over the telephone, except in an acute emergency, should be avoided."
"A doctor should not merely go by the version of the patient regarding his symptoms, but should also make his own analysis including tests and investigations where necessary."
"A doctor should not experiment unless necessary and even then he should ordinarily get a written consent from the patient."
"An expert (proper consultant) should be consulted in case of any doubt."
"Full record of the diagnosis, treatment, etc. should be maintained."
Instances of negligence per se :
1. "Removal of the wrong limb.
2. Performance of an operation on the wrong patient.
3. Giving injection of a drug to which the patient is allergic without looking into the out-patient card containing the warning.
4. Use of wrong gas during the course of an anesthetic, etc."
Criminal liability will be attracted against the erring doctors if he/she:
1. "Leaves a surgical gauze inside the patient after an operation.
2. Operates on the wrong part of the body.
3. Removes an organ for illegitimate trade."

It is advisable to avoid patients who have personal grudge or past enmity with the doctor or hospital, except in emergencies. A doctor is legally competent to refuse to treat a patient at the outset in case of nonemergency patient.
Tape-recording, video-recording, sting-operations are the order of the day. Suitable precautions must be taken, especially when dealing with unfamiliar patients or patients behaving strangely. A loose comment could be a cause for trouble for you or another peer. (In the present case, the patient had alleged that he had video recorded conversation of another consultant who had opined that the surgeon who had operated the patient must be a fraud and cheater).
It is advisable to give a choice of a few standard pathology laboratories and imaging centers to the patient instead of one. But if the patient insists or gets investigations done from a nonstandard facility, record this fact as also the fact that a few standard facilities were suggested to the patient but were ignored.
Duly record in appropriate cases that the procedure/surgery could not be completed as planned.

Merely because a patient gets infected, the hospital/nursing home will not be held negligent. Law accepts this as unavoidable part of modern medicine. But proper protocols to disinfect OTs and ICU's must be in place and they must be followed regularly and strictly and the same must also be properly recorded. These records must be produced in courts, if required, to demonstrate that due care is been taken by the hospital/nursing home on this count.
Appearance of bedsores and steps taken to manage it must both be specifically recorded. The present trend among patients is to cite appearance of bedsores as evidence of negligence.
For a patient on ventilator, all protocols such as usage of disposable sterile breathing circuits and usage of disposable filters and disposable suction catheters must be strictly followed.
Patients who seek discharge against medical advice or discharge on request must be:
1. Explained the prognosis and possible complications that may arise in case of premature discharge; and
2. Made to sign a proper discharge form where suitable endorsement must be made by the patient/attendants, preferably in their own handwriting, that they have been explained the prognosis and possible complications that may arise from premature discharge.

With the number of specialties and super-specialties multiplying every day, be doubly sure that the ailment you are treating is clearly within the domain of your qualifications, knowledge, and experience.
Inform the patient about complications at the earliest, except in cases when nondisclosure is necessary for therapeutic purposes.
Discharge ticket must record all the complications that have occurred during hospitalization, the treatment, and patient's condition at discharge.

Delay in managing critical patients is per se negligence.
In all procedures/surgeries availability of blood must be confirmed beforehand. In case of procedures/surgeries where there is slightest chance of requirement of blood, it is advisable to requisition and keep blood ready rather than not. Duly record the aforesaid.
Specialists must be called at the earliest in case of complications. In case of known or frequently occurring complications, the relevant specialists must be present in the OT or at least sounded beforehand. Duly record the aforesaid.
Requisite preprocedure investigations must be done and recorded.
Amount of blood loss, if any, in procedures/surgeries must be duly recorded in the patient's medical records.
Law takes into consideration the handicaps faced by doctors working in remote or rural areas.

In case of any doubts, refrain from giving a clear finding. Either record your doubts along with your findings or go in for another scan/X-ray, if indicated.
"Correlate clinically" - must find a place in all investigation reports.

In case medical records are not found and you suspect foul play, it is better to inform the police about the incident with a request to investigate. Such a request should be in writing, and in appropriate cases, names of suspects should also be disclosed. Take acknowledgment of receipt from the police and duly preserve it.
If medical records have been destroyed or misplaced due to shifting, fire, floods, white ants, etc. it is advisable to insert a newspaper advertisement announcing the incident and calling upon the patients to provide photocopies so as to reconstruct the medical records. Duly preserve copies of the advertisement. Such an exercise will act as a valid defense in all future litigations.
Patient is only entitled to photocopies of the medical records on payment of necessary charges and not inspection of original medical records though in the course of legal proceedings original documents can be called for and will have to be produced.
Recording the exact condition of the patient on examination/at admission is imperative.