Medical Law Cases - For Doctors

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Correcting medical records is permissible, but fabricating or manipulating is both illegal and unethical. Encircling the wrong entry and writing the correct one besides it is better than erasing or putting white ink over the wrong portion. (In this case the court held the gynecologist (OP) negligent for not attending to the patient who was critical, by relying on an entry in the patient's medical records, wherein time of examination, which was shown as 1:45 a.m. was corrected and subsequently written as 1:40 a.m. Even as the gynecologist (OP) sought to portray this as a genuine correction, the court held it as fabrication).
In case the patient / relatives / attendants take away the medical records of the patient forcefully or otherwise or try to mutilate them, lodging a proper written complaint with the police should be the first mandatory step.
Hospitals and nursing homes must ensure that the vitals are checked at regular intervals and duly recorded. If the same are abnormal, checking must be done at shorter intervals.
In all cases of unnatural death, the dead body must be referred for postmortem.
Hospitals and nursing homes must ensure that suitable specialists are available for consultation as and when indicated. In case of unavailability the patient must be referred to a higher center.

A doctor practicing in a speciality is a "medical expert" of that particular specialty in the court. This aspect should be remembered by all doctors not only for defending one's own self in the court on allegations of medical negligence but also to consult peers in serious or complicated cases or cases where there are doubts about the course of treatment. If a respectable number of doctors of your speciality agree with a certain course of action, you can fearlessly proceed with the same. This is Bolam's law which defines the parameters of the standard of medical practice in many parts of the world, including India. (In this case, the patient had alleged that the pathology laboratory (OP) had given a wrong blood report and had cited a letter written by his family physician pointing out to this negligent conduct. The court observed that the family physician was not a pathologist, and hence his opinion was not an expert opinion to nail the pathology laboratory (OP). Opinion of another pathologist could only have been considered as expert opinion by the court).

It is advisable that the consent form must also be signed by the doctor in charge of a patient though in India, there are no specific statutory guidelines or reported cases making it mandatory for the doctors to put signatures in consent forms. (In this case, the anesthetist and doctors (OPs) had specifically stated in the court that there was no procedure of doctors signing in the consent form, and the court has not expressed any opinion regarding the same.)
Post surgery/procedure complications are acceptable to law, but any failure or neglect or delay in managing the same is construed as negligence.
A patient who has undergone surgery/procedure must be discharged only after confirming whether the patient is suffering from any post surgery/procedure complications, especially the commonly occurring ones. Discharging a patient without diagnosing and treating such complications is a common mistake for which doctors are held negligent.
At times, changing pens while filling the consent form or changing the person who is filling the consent form, or any addition, alteration or erasure gives an impression of manipulation and hence must be avoided.
Before taking consent, explain to the patient the prognosis, complications and risks involved.
In cases where an indicated or scheduled procedure/surgery has to be delayed or abandoned due to some abnormal vitals, duly record in the medical records the reasons for delay or cancellation.
Record date on each and every entry made in medical record. (In this case, the court had taken specific note of the fact that the date of readmission of the patient was not noted in the medical records.)

Maintaining medical records in the prescribed format is compulsory even in emergencies. Appropriate entries regarding investigations, diagnosis, treatment, etc. must be duly made. Even in emergencies, a doctor is required to act prudently though given the constraints law always takes a lenient approach in such cases. Courts do take into consideration the emergency situation that exists.(In this case, the court held the gynecologist (OP) negligent as there were no corresponding entries in the medical records regarding treatment, but reduced the amount of compensation because the gynecologist (OP) had attended the patient who was serious and that too when others had refused to attend.),
Blood group must be clearly recorded in the medical records, especially if blood is requisitioned. It is one of the commonest omissions committed in surgeries/procedures.
Steps taken to requisition blood must be specifically recorded in the medical records. (In this case, the gynecologist (OP) had pleaded that the relatives of the patient were asked to arrange blood, but they had failed to do so. The court rejected this defense as there were no corresponding entries in the medical records about the same.)
Anticipate emergencies that may arise and make appropriate preparations beforehand to deal with the same.

In case a patient refuses or fails to perform the investigations advised, especially the ones that are mandatory, the said fact must be meticulously recorded in the medical records of the patient.
Gynecologists must duly record the gestational age and the expected date of delivery in the patient's medical records.
Requisite investigations must be advised and that too at proper time. Failure to perform the same is negligence per se.
In case the referring doctor has any doubts on the reports of a scan / X-ray / MRI, a second scan / X-ray / MRI must be advised. Duly record your doubts as well as the fact that a repeat scan / X-ray / MRI has been advised to the patient.
Sonologists and radiologists must advise a repeat or second-level scan / MRI / X-ray in case of doubt.
Sonologists must record complete fetal biometry.

Law accepts that unanticipated intraoperative complications are unavoidable for which a surgeon / interventionist cannot be held liable. But at the same time, any delay or failure in identifying the same or taking requisite corrective steps could be termed as negligence. (In this case, the patient had undergone surgery for hernia and it appeared that some injury was caused to the testicular blood supply. When the patient complained of pain, the surgeon (OP) advised hospitalization which the patient refused. The court held that the surgeon (OP) was not negligent and observed that "intraoperative complications are not always avoidable and it is the duty of the doctor when reported to identify and rectify the same, which was attempted by the second opposite party (surgeon), requesting the complainant (patient) to get admitted in the hospital, for which the complainant (patient) was not willing.")
Wrong or incomplete history given by the patient or non-production of old medical records is emerging as one of the prominent areas of concern to the doctors. While giving history, the patient may not give complete history or at times even gives false history, but in court, the patient alleges that inspite of knowing the correct and complete history, the doctor proceeded in a way that was contraindicated. Unfortunately, there is nothing on the doctor's side to produce in the court to point out to what the patient had actually stated to the doctor if history is not completely recorded. Giving the patient a standard questionnaire and asking the patient to fill it is a good option for minimizing this problem.,
Intra-surgery notes must specifically and clearly record any abnormality that is found after opening the patient.
Patient's refusal to get admitted on medical advice must be duly recorded.

Administering certain drugs without performing a sensitivity test could be negligence.
Once a patient has suffered adversely, it becomes imperative to be more cautious in managing the patient further. (In this case, the patient who was treated as an outpatient had drug reaction on the first day yet on the next day, he was administered Tetracycline without performing any sensitivity test.)

Any accident or harm caused to the patient's relatives or attendants by negligent conduct of a doctor/hospital is also covered under the consumer court though such a relative does not have any relationship with the doctor/hospital as a consumer. The duty of a doctor/hospital is not limited to the patient only, but in certain cases it extends to the attendants, relatives, and even the society. (In this case, the father of the patient was electrocuted due to electricity leakage from the hospital's water cooler and the hospital (OP) was directed to pay compensation of Rs. 3,00,000.)
Hospitals and nursing homes must take proper care regarding leakage of electricity. Proper insulation and such other precautionary measures must be in place.
In all cases of unnatural death, the dead body must be sent for postmortem. No permission is required from the relatives/attendants to do so. On the contrary, failure to perform postmortem leads the court to draw an adverse inference against the doctor/hospital.