Medical Law Cases - For Doctors

Export selected to

Endnote

Reference Manager

Procite

Medlars Format

RefWorks Format

BibTex Format

Give guarded prognosis to the patient. Courts draw inference in favor of the doctor.
Overwriting or erasing gives a wrong impression and must be avoided. In case of any corrections, encircle the wrong entry and write the correct entry besides it. (In this case, the lower court had doubted the defense of the ophthalmologist (OP1) as there were 'corrections and overwriting with different inks' in the medical records produced in the court).

In case any last minute change is contemplated either in a treatment or an intervention after taking consent, a fresh consent must be taken, clearly recording both the initial agreed course and the subsequent changes. The requisite entries must also be made in the patient's medical records. (In this case, the defense that at the last minute, after examining the patient, the doctors had decided to operate on the left side first, although initially it was decided that the right side would be first operated was rejected by the court, as there was no consent for the same. The defense that the patient's mother was orally informed and had consented for the same was rejected by the court).
In case of minor patients, consent of their guardians should be taken.

Try to avoid any abnormal reaction or overreaction after a medical mishap, although it is a normal human tendency. Correcting medical records or writing something in the medical records that is not written normally are a few such instances. (In this case, one of the allegations made by the patient's husband was that after the patient's death the surgeon (OP) directed the hospital (OP) to issue a receipt showing that the surgeon (OP) had rendered his services without any charge. Such reactions persuade the courts to draw adverse inference against the doctor/hospital).
In case of medical mishaps it is all the more necessary to involve and consult the requisite specialists and that too at the earliest. (In this case, the anesthetist was unable to intubate the patient. The patient alleged that the surgeon (OP) performed tracheostomy, although an ENT Surgeon ought to have performed the same. The patient also alleged that even though the hospital (OP) had stated that cardiac arrest was the cause of death, yet no heart specialist was summoned or consulted).
Specifically record the time and duration of a medical mishap or complication. (In this case, the medical board appointed by the court observed that, "The time and duration of cardiac arrest is not mentioned in the medical case sheet, which has an impact on the hypoxic injury to the vital organs").
Every doctor is competent to decide on the course of treatment and can disregard the opinion or advice of other doctors. However, rejection requires contemplation, caution and proper justification. (In this case, one of the allegations was that the surgeon (OP) had willfully disregarded the advice of the patient's doctor).
It is important that certain relevant observations like the patient 'feeling nervous' and so on must be duly recorded in the patient's medical records. (In this case, it was alleged that the patient while walking into the OT fell down, but the same was denied by the doctors (OP) in the court. However, they admitted that the patient was 'feeling nervous'. Recording this observation could have certainly helped the doctors (OP) in the legal proceedings).
Medical records have to be written contemporaneously, as and when an act is performed. Emergencies of course would be an exception. (In this case, the court observed, "It appears that all the papers were prepared in one go").
Contemplation is required when fixing a date for performing an elective planned surgery. Depending on the patient's condition, the ailment, and the availability of requisite resources, the date must be fixed, neither too early nor too late. (In this case, the court has questioned fixing the date for surgery after two weeks for a patient suffering from appendicitis).
It is always advisable to insist on fresh investigation reports on a day near the date of the scheduled surgery. (In this case, the court drew adverse inference from the fact that the doctors (OPs) had relied upon investigation reports that were three days old and observed that fresh investigations ought to have been done in the given case).
Perform standard pre-anesthesia protocol including investigations/assessment and duly record the same in the anesthesia notes.
The patient must be moved to the OT in a trolley.
Record respiration rate and oxygen level in the blood (pulse oximetry) in the
surgery/anesthesia notes.

In cases where the probable result of delayed action could be serious or where sensitive organs are involved, law expects quicker action from doctors and hospitals. Delay in such cases could be termed as negligence. (In this case, the patient after undergoing cataract surgery complained of irritation in the eyes, but was referred to another center after three days. The National Consumer Commission held the hospital (OP) negligent after observing that the patient ought to have been referred to a higher center immediately after detecting the complications rather than waiting for three days "as the organ affected is the most sensitive one". The delay of three days, which otherwise would not have been of much importance was held inappropriate as the patient's eye was involved).
Strict aseptic conditions must be maintained in the Operation Theater (OT). The requisite protocol must be religiously followed. The OT must be fumigated at regular intervals. The records of all such activities must be duly preserved and in appropriate cases it must be produced in the court in defense. (In this case, the hospital (OP) had produced a sterility test culture report of the OT and equipment that were examined at a microbiology center, which were found to be sterile in the relevant period. The hospital (OP) would have been better placed if it had placed before the court records showing that the requisite protocol to keep the OT sterile was duly followed).
In case the required facilities or doctors are unavailable to manage any complication of a hospitalized patient that may have arisen, the patient must be referred to an appropriate facility at the earliest.

The patient must be advised appropriate facility for transfer, if necessary by name, keeping in view all the relevant factors. (In this case the gynecologist (OP) pointed to the court that he had advised that the patient should be transferred to the district government hospital which was good and also nearby, but the patient's relatives took the patient to a far off city).
Doctors are not bound to heed to each and every request for transfer made by the patient or attendants. However refusing or delaying a transfer even after request for the same has been made, has consequences, and hence, one should be cautious in such situations. (In this case, the gynecologist (OP) did accept in the court that although a very specific request was made to transfer the patient to another hospital by the relatives it was initially refused and only later the patient was permitted to be shifted).
Recording the steps taken in managing the patient properly acts as a complete defense. (In this case the court while holding that the gynecologist (OP) was not negligent observed that "The case history filed in evidence also indicates other steps taken by the Respondent gynecologist [OP] right from the time of her admission till her discharge and from this there does not appear to be any lapse or negligence in the treatment and care").
Perform the requisite pre-surgery/procedure assessment of the patient.

Freak accidents are not completely avoidable, but due care and caution must be taken by everyone in every act. The concerned hospital and doctor would be liable to pay compensation in all such cases. (In this case, post surgery when the patient was on the trolley waiting to be shifted to the ward, another trolley suddenly dashed against the patient's trolley and the patient had to be re-operated. The court directed the hospital (OP) to pay seven lakhs to the patient as compensation).

Law permits deviation from a standard protocol, but utmost care and caution is required in deviating from an essential feature of the standard protocol. It could be construed as negligence, especially in case of a highly specialized or sensitive protocol. Deviation, if any, must be medically justified and the reason/s thereof must be specifically recorded in the patient's medical records. (In this case, the patient was treated according to the 'DeAngelis protocol,' which required assessing the pH urine level of the patient, but the same was not done by the doctor (OP). The court rejected the doctor's (OP) explanation that he did not advise the same, as the patient was hydrated and her urine output was normal. The court held that the assessing the pH level "forms an essential feature of the DeAngelis protocol").
Clinical judgment does have an important role to play even in cases where certain standard protocols are followed. How much can a doctor deviate from a standard protocol will depend on the situation and will change from case to case. However, deviating from the 'essential features' of a protocol requires lots of caution and contemplation and should be attempted only in extraordinary circumstances. (In this case, the doctor (OP) had justified his deviation from the standard protocol in the court by stating that "The dosages, drugs, and schedules are changed/modified according to the clinical situation in the patient's best interest. Whatever is mentioned in a protocol is a guideline/schedule to be applied keeping in view the condition of the patient ― and depends upon the patient's response to the treatment." But this defense was rejected by the court).
One wrong entry in the medical records could mean trouble. Before making entries in medical records like a discharge card or transfer note, other relevant records of the patient must be duly checked and verified. (In this case, according to the doctors (OPs), the patients' relatives were trying to take advantage of a single wrong entry made by the nurse, which was falsified by other medical records of the patient) .
If something fundamental is amiss ― doctors, infrastructure or any other facility, specifically inform the patient in writing, and that too before accepting the patient for admission or starting the treatment. (In this case the court held the doctors and the hospital (OPs) negligent as they had failed to inform the patient about the non-availability of the MTX measuring equipment in the hospital before admitting the patient for chemotherapy).
Human error is unavoidable. However, proper precautions must be taken to minimize the same. (In this case, one of the allegations was that the nurse had used a wrong measuring glass as a result of which the patient was given additional fluids contrary to the doctor's advice).
Greater experience of the doctor is always advisable, especially in high-risk, new or highly technical procedures / treatments. (In this case, one of the allegations was that the doctor (OP) did not have the requisite experience in dealing with complications arising out of a high dose of HDMTX. The court did not comment on the same.)
Improper communication with patients is often the root cause of legal problems. (In this case, the patient's son had specifically alleged that when his father spoke with the doctor (OP) regarding his mother's fever, the doctor (OP) felt inconvenienced at being disturbed for a small fever and spoke rudely).
Perform the requisite investigations at the requisite intervals.
Failure to advise hospitalization when indicated is negligence.

Law expects that everyone should speak the 'truth, nothing but the truth, and the whole truth'. Failure to do so in court is 'perjury', a crime for which the delinquent can even be imprisoned. In recent years a tendency is noted by the courts that doctors deposing as medical experts try to shield the doctor accused of medical negligence. At times the testimony of the medical expert is clearly unscientific, senseless, and false. Courts are repeatedly making harsh observations against doctors who try to shield other doctors in their testimony. If this trend continues, the day is not far when a doctor could even be imprisoned for giving false testimony. (In this case, the court not only rejected the medical expert's testimony, but has gone to the extent of observing that, "it is apparent that a doctor will refrain from criticizing the other doctor, when both of them reside in the same city").