Medical Law Cases - For Doctors

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Law accepts that different doctors will act differently in similar situations. Law takes into consideration the doctor's personal choice in choosing an alternative amongst the various that may exist. (In this case, the patient had alleged negligence by comparing treatment given to him with that of another patient having similar ailments. But the first reasoning given by the court to reject this allegation was that both the patients were under different consultants. Though this is not a binding precedent, it is a clear indicator that law recognizes personal preferences of each and every doctor subject to the condition that every medical action is within the parameters of "accepted medical practice".)
Law accepts that different patients may require different treatments for the same ailment.
Duly record in the medical records as well as discharge card/ticket/summary the reasons if any for selecting one line of treatment over another, especially if there is another school of opinion supporting the other alternative.
In situations where a procedure has failed and another procedure/surgery has to be attempted, the patient/attendants/relatives must be informed about the aforesaid at the earliest and their acknowledgment of having received the information must be taken in writing. This protocol is all the more necessary where the results of any delay could be disastrous.
Loose talk by nursing or paramedical staff is one of the major causes resulting in patients' grouse. Proper instructions must be given to the staff to avoid commenting on treatment and to have minimal interaction with the patient.
Hospitals and nursing homes must ensure that critical patients are attended by appropriate specialists expeditiously.
Information about the patient's condition must be given to the relatives/friends/attendants regularly.
Medical actions performed during emergencies or critical patients are looked upon leniently by the courts.

Write proper qualifications and degrees on your stationery; otherwise, it can be held as false and misleading representation and unfair trade practice.
Giving false assurance to the patient is negligence.

While handing over X-ray/sonography/MRI plates or investigation reports to the patient, the following are advised:
1. Prescription in case of OPD patient must record the fact of handing over.
2. In case of IPD patients, record the fact of handing over in the discharge card. Additionally, take a written acknowledgment from the patient of having received the same. Preserve this acknowledgment with the patient's medical records. (In this case, the court disbelieved the doctors' (OPs) defense that the X-ray plates were handed over to the patient as this fact was not recorded in the discharge slip. The court clearly observed that the defense would have been complete if the doctors (OPs) could have produced the postoperative X-rays. It is common knowledge that in India, X-ray reports/plates are routinely handed over to the patient without taking any acknowledgment, but in a given case the courts may not take cognizance of this fact and insist on a written proof of delivery.)
Private hospitals/nursing homes and doctors must think twice before taking any professional help from doctors employed in the government hospitals. (In this case, the court has drawn adverse inference against both the private hospital that had taken professional services from the doctor employed in a government hospital as well as the doctor employed in the government hospital who had given his professional services.)
Hospitals and nursing homes must not admit a patient until and unless appropriate consultants are available to manage the patients.

Care must be taken in using appropriate medical terms in writing medical records. (In this case, the patient pointed that the nurse had recorded that CPR was started at 4.00 p.m. though cardio-respiratory failure had set in at 3.45 pm. The hospital and doctors (OPs) had to take pains to explain and clarify in the court that the nurse's writings in medical record only meant that cardiac monitoring was started at 4.00 p.m., whereas they had started CPR at 3.45 p.m. when endotracheal intubation was done and intracardial adrenaline, Efcorline and Atropine were administered. The doctors and hospital (OPs) would have been more comfortable if the nurse had clearly recorded cardiac monitoring instead of CPR at 4.00 p.m.)
Though intra surgery /procedure notes may be written by junior doctors or nurses, after completion of the procedure/surgery, the principal surgeon must personally check the same and then put his/her signature.
Delay of even a few minutes in performing procedures like CPR is negligence. In this case, the court has observed, "in such emergency, time is the essence and success will be measured in minutes and seconds… No delay is allowed".
Leaving a patient at a critical stage is not only unethical but is viewed unfavorably by the courts.
Wrong choice of anesthesia is negligence per se.

Transferring patient to an ill-equipped hospital is per se negligence. Be doubly sure that the requisite infrastructure, equipments and consultants are present in the other hospital before advising the name of any hospital to the patient. In case there is more than one such hospital/nursing home, suggest the names of all and leave the final choice to the patient. Duly record the names of the hospitals suggested to the patients as well as the patient's choice.
In India, one of the primary reasons for friction between patient and doctor is improper or at times even complete absence of communication. Complete and regular information on all aspects of treatment is a well-recognized right of the patient and it must be duly respected. (In this case, the medical team had decided to take the patient who had suffered cerebro-vascular accident to one Bombay Hospital only for the purpose of performing CT scan and thereafter transfer the patient to another nursing home. But during transit the patient developed respiratory problems and was straightaway driven and admitted in the nursing home. The patient's wife alleged negligence on the ground that the patient was to be admitted in the said Bombay Hospital and not the nursing home. Perhaps proper communication and explanation to the patient's relatives before, during and after transferring the patient could have made the difference.)
In case of transferring critical patients, ensure that the ambulance is well equipped and that the patient is well attended by trained doctors in transit.

Leaving a patient under the care of another substitute/locum in appropriate cases is not wrong, but the patient must be duly informed about the same and the substitute/locum must be a competent and experienced doctor. (In this case, the court outrightly rejected the patient's allegation that the gynecologist (OP) was negligent as he had gone to attend a workshop when the patient was having post-procedure complaints. The court drew inference in favor of the gynecologist (OP) as he had kept another gynecologist as locum to manage patients during his absence.)
Keeping oneself updated with latest knowledge by regularly attending CMEs, workshops, seminars, conferences, etc. is both a legal and medical requirement. In this case, the court has observed, "Attending of conference is sometime sine qua non for the professionals like appellant (gynecologist (OP) herein) who has to keep himself appraised of latest technology and latest knowledge imparted in such conferences". This observation is a clear indication to the judicial thinking which recognizes the necessity of doctors getting regularly updated.
Law clearly recognizes that mere failure of a surgery/procedure/treatment is not negligence. In this case, the court has aptly summarized this legal proposition thus: "Every second operation on the patient does not mean that first operation was a failure one".

All efforts must be taken to collect samples for investigations in the hospital/laboratory as it reduces the chances of any mistake by the patient in collecting or bringing the sample. But in cases where the sample bought from outside is accepted, the said fact must be duly and promptly recorded in the investigation reports. [In this case, the court had rejected the laboratory's (OP) defense that the sample was bought by the patient from outside and had termed it as an afterthought. The laboratory's (OP) defense could have substantiated if the fact of the patient bringing sample from outside would have been duly recorded in the investigation report.]

Inability or delay in diagnosing a rare disease/occurrence is not negligence. (In this case, the court held that the failure of a doctor to detect a sponge left in the patients' abdomen during a previous surgery done by another doctor, which is a "rare occurrence", was at the most "a reflection on his professional competence" but not negligence.)
Elucidating and recording correct and complete medical history of the patient is very important. It not only has a direct bearing on the treatment but at times even protects from medico legal problems. (In this case, the patient had undergone hysterectomy at one Geeta hospital and was hospitalized for post-surgery complications in Get Well hospital (OP). Later, at another hospital, viz. Life Line hospital, it was diagnosed that the patient had complications due to a sponge left in her abdomen during hysterectomy and the same was surgically removed. The patient alleged that hysterectomy was negligently performed at Get Well hospital. Discharge slip of Get Well Hospital and medical records of Life Line Hospital, wherein the fact that the patient was operated at Geeta Hospital was meticulously recorded, saved Get Well hospital (OP) in the court.)