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2010| January | Volume 3 | Issue 1
February 27, 2010
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Astrology, doctors and law
January 2010, 3(1):1-2
Postponing a procedure/surgery for astrological reasons by a doctor cannot be a doctor's defense in a court of law, especially if it is an emergency. You can consider requests made by patients to start a procedure/surgery at a particular "muharat" or to avoid "rahu kalam." In India, such requests are common. But, in emergencies, you must brush aside all such requests and proceed with the appropriate course of treatment. In case the patient refuses or hesitates in giving consent, you must withdraw from the treatment immediately and duly record the reasons in medical records. (j1, left para 1)
It is imperative to provide copies of medical records of a patient within 72 hours of any request. Such a request can be made by the patient either orally or by fax, e-mail, letters, etc. (j1, right para 2)
Differential diagnosis and medical negligence
January 2010, 3(1):11-12
In case of differential diagnosis, the reasons, symptoms and clinical findings supporting the same must be meticulously recorded. Efforts must be made, to arrive at a definite diagnosis, if possible and the same must also be recorded. (j27, left para 4)
Every medical act must be in accordance with the prevailing practice, acceptable to doctors of that specialty and in accordance with medical science, at that point of time. It is therefore necessary to keep oneself updated regularly. (j27, left para 3)
Record meticulously the changing clinical profile of the patient and steps taken to diagnose and manage the same. (j27, right para 5)
Issuing death certificates for a "probable" cause of death
January 2010, 3(1):7-8
Death certificate must be given only when the cause of death is known to you with certainty and must be recorded accordingly. (In the present case, the doctor [OP] was clearly wrong in recording the cause for death as "probably Bronchial Obstruction.") (j15, left para 1)
In case of any unnatural death or where you are not absolutely sure about the cause of death,
Inform the police about the death in writing with a request to conduct post-mortem.
Take acknowledgment on a duplicate copy from the police and duly preserve the same.
Do not issue death certificate under any circumstances. (j18, left para 1)
Death certificate must have the registration number, full name and address of the doctor. (j15, left para 1)
Do not be complacent in treating friends or neighbors, even if they have paid no fees. Law expects the same standard of care from a doctor whether he/she is treating neighbors, friends or others. (j15, left para 1)
All prescriptions must properly record the name, age, clinical history, symptoms, vitals, complain, diagnosis (if any) and then drugs, investigations advised, etc. Important instructions and precautions must always find a place in the prescription. (j15 and j18, left para 1)
In case of any rowdy behavior of the patients/attendants/relatives, inform the police in writing, at the first opportunity. Take acknowledgment on a duplicate copy from the police and duly preserve the same. (j15, right para 1)
In case of an emergency, refer the patient to the appropriate facility at the earliest. (j14, left para 1)
Caring patients having suicidal tendencies
January 2010, 3(1):9-10
In case of patients who have a suicidal tendency, are mentally infirm, old-aged, children, alcoholics, psychotics, or drug addicts, hospitals and nursing homes must:
Refuse admission, if not, be absolutely sure that special care can be provided to such patients.
Take a high-risk consent from the attendants/relatives/friends of the patient, on admission.
Take special care. Nurses and other paramedical staff must be specifically and strictly directed to keep a constant vigil on such patients.
Attendants of such patients must be given written advice to always remain with the patient, and a written acknowledgment of their having received this advice must also be taken. In appropriate cases, encourage them to bring their own private nurse.
Contemplate potential areas where such patients can create problems and take efforts to plug them. Duly record the steps taken.
Remove sharp objects and other dangerous items, which can physically harm the patient or others, from the patient's vicinity. (j23, right para 4)
Give elaborate written instructions about the patient's care to their attendants/relatives/friends and always take their written endorsement below such instructions. (j20, right para 3)
De-addiction and rehabilitation centers are legally bound to take special and greater care of their patients. (j21, left para 4)
Avoid, if possible, changing ink or pen midway when writing any medical record as the difference can be projected as manipulation by the patients in court. (j21, right para 2)
Precautions in renting space in a hospital to medical stores, diagnostic centers, blood banks, etc.
January 2010, 3(1):3-4
Hospitals and nursing homes must be careful in giving spaces in their premises to medical stores or diagnostic centers as the usual inference drawn by the patients and courts is that they are an integral part of the hospital/nursing home. In such cases, the hospital/nursing home must:
Have a carefully drafted, appropriately stamped and duly registered agreement with these centers, clearly recording that the relationship inter-se between them is strictly on a 'principal-to-principal' basis
Disclose the inter-se relationship to the patient in the admission form itself
Ensure that bills/receipts issued by such centers clearly record that they are independent entities and 'not' a part of the hospital/nursing home
Ensure that these centers do not carry out any illegal or unethical activity and are supplying standard medicines and services. (j6, left para 2)
Inability or refusal of the patient to buy any drug or undergo any treatment, for monetary reasons or otherwise, must be duly recorded. If possible, such a refusal must be taken in the patients own writing. (j6, left para 1)
Patient's request not to use life-supporting equipment must be taken from the patient in writing and a high-risk consent form must be signed with at least two independent witnesses. (j7, left para 1)
In case a patient does not follow medical advice, duly record the same. In case of IPD patients, inform the said fact to the patient's relatives/attendants in writing and take their endorsement on a copy. (j7, left para 1)
Whenever advice for transferring a patient to another hospital is given, suggest name/s of more than one hospital, if possible and leave the choice on the patient. Duly record the names suggested in the medical records. (j5, right para 1)
Always dispense medicines of standard companies and within the expiry period. Ensure that the packaging is not damaged. (j5, right para 2)
Drugs and equipment required in emergencies must always be kept available. (j5, right para 1)
All precautions must be taken and all the necessary arrangements must be made to deal with side effects before starting any treatment/drug. This protocol is all the more necessary in case of frequently occurring side effects and the ones that have serious consequences. (j8, right para 3)
Hospitals must be equipped with the necessary facilities, doctors and medicines for managing common complications. (j8, right para 3)
All the doctors and hospitals involved in a court case must preferably have a joint meeting before finalizing their defense to the allegations of the patient. (j8, left para 3)
Responding to part-consent and part-refusal of the patient
January 2010, 3(1):5-6
In case the patient gives part consent and refuses to give consent for some part of the treatment/surgery/procedure -
Contemplate whether that part of the treatment/surgery/procedure, which has been consented to, can be disconnected from the part that has been refused.
Weigh the consequences of not performing the part that has been refused. If you foresee even a slightest problem, it is advisable not to proceed rather than proceeding. You must withdraw yourself from the treatment if the consequences of part refusal are harmful and risky.
In case you decide to proceed, take elaborate consent attested by two independent witnesses clearly recording that only part consent has been given and part has been clearly refused.
Specifically record the aforesaid in the medical records. (j12, left para 1)
In case of patients who may have a personal grudge or enmity against you, you must consider the option of refusing to treat at the outset. Instances of such patients resorting to allegations of medical negligence only to take revenge have been reported. (j11, right para 4)
Removing the wrong appendage/tooth or performing a procedure on the wrong side is negligence per se. (j11, left para 2)
Do not tolerate any misbehavior of the patient. Strictly warn the patient to stop it forthwith and not to repeat it. However, if the misconduct persists inform the police or other relevant authorities in writing about the same, at the first opportunity. (j11, right para 4)
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