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2010| March | Volume 3 | Issue 3
March 31, 2010
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Referring only to authoritative medical texts in difficult times
March 2010, 3(3):25-26
In case of any dilemma, references must be made only to authoritative texts and commentaries. Additionally, seniors and peers of the same specialty can be consulted. (In the instant case, the court has rejected the doctor's defense which was based on a report clearly stating that "It is only a report and not an authorized medical text.").
Patient's habits like drug addiction, alcoholism, etc. must be specifically recorded.
Difference between accident and negligence
March 2010, 3(3):30-30
Ensure that all the equipments required for the surgery/procedure as well as to deal with commonly occurring post-surgery/procedure complications are in working condition before starting an elective surgery/procedure.
Failure of an equipment midway through a surgery/procedure could be negligence. Regular maintenance protocol and keeping spare machines especially for critical or sensitive surgeries/procedures is advisable to minimize chances of such failures.
Post-surgery/procedure complications must be addressed with a sense of urgency. Any delay on this count could be construed as negligence. In case of non-availability of doctors or equipments, the patient may be transferred to another appropriate facility.
Discharge card/summary/ticket must record all medical mishaps, accidents and complications that may have occurred during hospitalization and the steps taken to deal with the same.
Not maintaining or improperly maintaining the bed head ticket by the hospital/nursing home is per se negligence.
Obligation to disclose future risks and complications in discharge card/ticket/summary
March 2010, 3(3):32-33
Complications and risks that may occur post-discharge and their alarm signs/symptoms must be specifically explained to the patient at the time of discharge and duly recorded in the discharge card/ticket/summary. Also record appropriate instructions about post-discharge care, precautions to be taken and further consultation and investigations that must be done.
Give specific instructions and not general ones in the discharge ticket/summary.
Not performing a mandatory investigation/diagnostic procedure is negligence.
Keep the patient informed about risks.
Physically examining the patient, noting and recording the symptoms are mandatory exercises.
Hospitals and nursing homes must ensure that doctors who visit their hospitals keep their private consultations separate, especially with the patients who have consulted them in the hospital.
Consent in multi-stage treatment
March 2010, 3(3):27-29
It is advisable to take specific and separate consent for every stage of treatment in cases of multi-stage treatment and where each stage is independent and distinct. Keep the patients / attendants / relatives involved and informed at every stage of the treatment.
On receiving information that any medical record has been lost / stolen, immediately intimate the said fact to the police in writing and take their acknowledgment on a copy thereof. Duly preserve this copy.
It is advisable that doctors / institutions which provide rare / new / complicated treatment / procedures must prepare and provide the patients with an elaborate and exhaustive brochure describing the therapy, risks, prognosis, and advantages. Take acknowledgment of receipt of this brochure from the patient and keep it with the patient's consent.
Hospitals and nursing homes must ensure that entry of persons into rooms of high-risk patients is controlled and restricted. Permitting relatives / friends to remain with such patients has always been a tricky question. Try to balance between these two competing interests with compassion. If the relatives / friends have to be kept away, they must be taken into confidence and it must be explained to them that the said restriction is only in the patient's interest.
In case of a clinical trial or when trying new medicines for research purposes, strictly follow the guidelines laid down by the Indian Council of Medical Research (ICMR).
It is all the more necessary that specialized units such as the Intensive Care Unit (ICU), Bone-marrow Transplant (BMT) Unit, and so on, must have all the requisite equipments and they must be functioning properly.
Hospitals and nursing homes must ensure that duly qualified doctors are available, and that too on time, to manage post procedure / surgery complications.
Appropriate protocols must be developed and followed to keep the Operation Theater infection-free.
Can consumer courts direct payment of ex-gratia (sympathetic) compensation in the absence of medical negligence?
March 2010, 3(3):35-36
It is obligatory to contemplate and make preparations for emergencies that may occur during a procedure/surgery, especially the frequently occurring ones, before opening on the patient.
It is advisable to disclose unfavourable results to the patient at the first opportunity.
Giving false assurances is negligence per se. The only exception is for therapeutic benefit.
Meticulously record intraoperative notes, especially in case of any complication or emergency.
Once a patient is accepted for treatment, the duty to provide care starts irrespective of whether the patient has actually paid money or not.
Hospitals/nursing homes are liable for medical negligence of staff, including nurses, doctors, surgeons and anesthetists.
Services provided by government hospitals to retired government servants and their dependants are covered under the Consumer Protection Act.
Indian courts have started giving importance to the experience of a doctor. An inference is generally drawn in favor of doctors having more experience.
Is a forensic expert a competent medical expert in all cases?
March 2010, 3(3):37-38
In courts, medical experts are examined by both the parties to support their respective stand. A common but wrong perception prevails in both patients and doctors that a forensic expert is a competent medical expert in all cases. This is patently wrong. A doctor from the specialty that is in dispute is a competent medical expert and not a forensic expert. (In the present case the court has given a categorical finding that a doctor from the field of surgery, gynecology or gastroenterology would have been a competent medical expert and not the forensic expert who was produced by the patient.)
Stopping a procedure/surgery midway on safety considerations is not negligence. But the reasons for doing so must be duly and specifically recorded. The patient must also be duly informed about the same.
In case the surgery/procedure is not performed as advised/planned, the said fact along with reasons thereof must be specifically recorded in the operation notes.
Discharge certificate/ticket/summary must briefly record all the abnormalities found during a procedure/surgery.
Choosing a legally competent substitute/locum
March 2010, 3(3):34-34
The patient must be left in the care of a substitute/locum only if there is another emergency which can justify the absence of the attending doctor.
The attending doctor must take the qualification and experience of the substitute/locum into account before handing over the patient's care.
A patient cannot be denied specialized treatment because of inability to pay.
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