Medical Law Cases - For Doctors

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Legally, negligence or allegations of negligence cannot be a ground to withhold payment of fees to doctors/hospitals. A very disturbing tendency is marked among patients nowadays, especially when treatment has failed or resulted in complications. An allegation of negligence is immediately made against the doctor/hospital and then reduction in fees is asked or the patient simply refuses to pay fees. Generally, the doctor/hospital oblige by not insisting on fees. Please remember the remedy for negligence is compensation or damages and the same can be awarded only by courts. Any condonation of fees by doctors/hospitals in such a situation sets wrong precedents and its long-term effects are detrimental to the medical fraternity.
Certain procedures like lumbar puncture require delicate handling of the patient and must be done by experienced doctors only. Extra caution is required.
Copies of medical records must be given to the patient or his/her authorized representative within 72 hours of any such request.
Never start, end, or change a treatment simply because the patient desires so. The time, type, and other modalities of treatment are strictly within the prerogative of the doctor.
The responsibility to take care of the patients is more in tertiary care/super speciality hospitals vis-à-vis ordinary hospitals.
Seniors doctors must keep complete check on juniors working under them. Senior doctors are liable for negligence for the negligence of their juniors even though they may be completely uninvolved in the alleged act of negligence. (Legally known as vicarious liability)

The responsibility to spot any abnormality or complication and prompt action increases manifold in case of patients with chronic ailments or pregnant ladies who come for checkup regularly.
Hospitals and nursing homes are responsible during transfer of an inpatient department (IPD) patient till he/she reaches the other facility. Arranging ambulance, drugs, and doctors required in transit are mandatory.
Hospitals and nursing homes must refrain from admitting complicated or serious cases if appropriate facilities are not available and refer the patient to appropriate facility without any delay.
In case any complication arises during the course of any treatment/surgery/procedure, and if indicated, the patient must be transferred to appropriate facility without any delay.
Do not give any false assurance to the patient.

It is advisable that all doctors/hospitals accused of negligence in a particular case prepare their defenses, after consulting each other, preferably in the presence of their respective advocates/representatives. This exercise must be done at the starting point of legal proceedings, that is, preparing reply to legal notices, and must continue till the proceedings are finally disposed off. Any inconsistency is counterproductive to everyone. (In the instant case, the attending doctor and the hospital had taken inconsistent stand, leading the court to an inference of negligence.)
Before answering any legal notice or court proceedings it is absolutely necessary to refer to medical records of the patient that are available.
Name of the doctor/nurse who administers an injection must always be recorded in the medical records of the patient.
Every entry made in medical records of the patient must bear initials of the person making it.

Presence of a pediatrician during or immediately after delivery is not a legal prerequisite but yet desirable.
In cases where serious complications either at delivery or thereafter are anticipated or where there is a specific request from the patient, calling a pediatrician or keeping him/her present during delivery is necessary.
Hospitals and nursing homes must always keep information about availability of consultants whose presence may be required during a particular surgery/procedure. (In the instant case the gynecologist (OP 1) had stated that she had tried to contact a pediatrician to remain present during the caesarean but he could not be contacted.)
Record all the precautions taken in a given case. At times, it elicits favorable response from the court.
Transfer a serious patient to the requisite facility promptly.

Prescribing medicines without physically examining the patient must be avoided, except in cases of emergencies or reasons beyond control. In such cases, record specifically the reasons for prescribing medicines without physically examining the patient. Also, record that the patient was advised to come for physical examination at the earliest.
Follow-up advice must be clearly written on discharge card and any nonadherence by the patient must also be promptly recorded.
IPD patients must be discharged only when they are fit to be discharged according to medical opinion. Any request for premature discharge must be appropriately recorded in medical records and discharge card of the patient.

Admisssion/Consent form must have suitable columns/spaces for the patient to indicate his/her relatives/freinds whose directions must be followed in case the patient is incapaciated to communicate. All patients must be asked to fill this column/space with full name, address and telephone numbers of such relatives/freinds and they must also indicate the order of preference amongst them.
In case of very old/incompetent/emergency patients - name, address and telephone numbers of the person who has admitted the patient must be specifically recorded. Further direction/consent may be sought from this person.
Though there is no hierarchy among relatives prescribed in law for obtaining consent on behalf of an incompetent patient it must be from the nearest blood relative. Only in case of emergencies consent can be obtained from a distant or a nonrelative but the reasons thereof must be properly recorded.
In case where discharge is sought on the ground of the patient's inability to pay, all the formalities of "Discharge against Medical Advice" must be followed and an acknowledgment of the aforesaid reason for discharge must be taken in the patient's own handwriting.
In case of patients who keep dues pending, it is advisable to take a written acknowledgment about the amount due and payable from them before discharging.
Legal notice is an important aspect of litigation. They must be properly replied and the patient's acknowledgment of the receipt of reply must be duly preserved.
The requisite qualifications as well as the experience of a doctor are taken into consideration by the courts in deciding cases of alleged negligence. (In the instant case the court has observed "It is significant to note that … who examined and treated the patient before and after surgery is a highly qualified neurophysician with long experience." )
Giving inflated bill, even at the request of the patient, is patently illegal and may even invite criminal action against the doctor/hospital.

Hospitals and Nursing Homes must ensure that they have the requisite licenses and the same are valid and renewed from time to time.
Be sure that you are duly qualified before projecting yourself as specialist.
Practicing cross-pathies is negligence per se .

Certificate of registration granted by medical council must be placed at a conspicuous part of clinic/consulting room/hospital/nursing home.
Sterilize instruments and use disposable appliances as far as possible.
A patient can approach all or any of the following forums for alleged medical negligence:
1. Consumer Courts
2. Civil Courts
3. Police/Criminal Courts
4. Medical Council Only against government hospitals and government doctors
5. Writ Court - before High Courts or Supreme Court Only against government hospitals and government doctors
6. Human Rights Commission