Medical Law Cases - For Doctors

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Hospitals empanelled with insurance companies must complete the requisite formalities and, that too, in time. (In this case, post-surgery, the patient's insurance claim was rejected as the query raised by the insurance company and the TPA was not replied by the hospital (OP) in time. The court held that this was negligence).
Admission forms of hospitals and nursing homes must have requisite columns/spaces for the patient to write about his/her insurance cover and the hospital staff must ensure that the same is filled by the patient correctly. Patients having insurance cover must be clearly explained about the charges that may be payable, the extent of insurance cover, time taken to get money, and other terms and conditions at the outset, so as to avoid any confusion or conflict later. (In this case, the hospital's (OP) defense which was not accepted by the court was that the patient had neither disclosed that he was insured nor did he show his insurance card).

In all cases of emergencies, ensure that not only sincere and timely efforts are made to call ambulance or to contact other hospitals for transferring the patient, but also these efforts are properly recorded. In case of non-availability of regular/local ambulance, it is advisable to call national helpline numbers like 102/108 to request for ambulance. Calls made on these numbers are recorded and can be useful in a court if required. (In this case, the hospital (OP) was held negligent not for any medical actions or inactions in managing an emergency patient who had come with an Acute Anterior Wall Myocardial Infarction (AMI), but for its failure to produce evidence in the court that efforts were taken to contact another hospital and call another ambulance as its own ambulance was transporting some other patient at that point in time.)
In case of an emergency patient, every medical action must be done with a sense of urgency. (In this case, one of the allegations was that the doctor (OP) wasted 30 minutes in conducting electrocardiogram (ECG) without maintaining vital parameters like temperature and BP in case of a patient who had come with a heart attack.)

This case carves out an exception when a hospital cannot be held liable for the acts done by doctors in that hospital. The court has very clearly held that the hospital (OP) was not liable for the negligent acts of the ENT surgeon and the anesthetist (OP) as they were neither working with the hospital (OP) nor were on its panel and their services were not called for by the hospital (OP), but the hospital (OP) had merely given them permission to use its OT and, that too, freely as the maternal aunt of the patient was a doctor. The law that prevailed till date was that for every negligent act of doctors, the hospital would also be held liable jointly. ,
Hospitals and nursing homes must have clear policies/SOPs on when should a patient be considered as an IPD patient and these must be followed by the staff. (In this case, the hospital (OP) had not prepared the medical records of the patient and considered him as an OPD patient even though OT facilities were provided to remove ventilation tubes from his ears).
MCI regulations very clearly state that preparing and preserving the medical records of an OPD patient is not mandated. Yet, it is advisable to prepare and preserve some sort of records even in case of OPD patients. (In this case, one of the disputes was whether the hospital ought to have prepared the medical records of the patient or not as the patient was to be merely examined and the ventilation tubes in his ears were to be removed as an OPD procedure).
Hospitals and nursing homes must ensure that their facilities are used by only those doctors who are duly qualified to use that facility and are also registered with the Medical Council. (In this case, the hospital (OP) very specifically took defense that it had provided its OT to be used by the ENT surgeon and the anesthetist (OP) who were not 'attached' with the hospital (OP) in anyway, absolutely free of charge for examining a doctor's relative only after ensuring that they both were duly qualified).
Consent of the patient can be oral or written, but for all types of interventions, consent must be taken in writing. (In this case, the child who was 2.5 years was brought to the hospital (OP) by his maternal aunt who was a doctor and admittedly, no written consent was taken to remove the ventilation tubes from his ears. The court presumed that there was consent as the child was very small and his real maternal aunt who had accompanied him was a doctor who understood the nature of the treatment and the treatment was started in her presence).
In case of a minor, consent of the guardian must be taken. Parents are the natural guardian of the child. There can be guardians appointed by courts and in other cases, even the relative of the patient who brings the patient to the doctor/hospital can be considered as guardian and competent to give consent. (In this case, the patient was a 2.5-year-old American citizen who had come to visit his native place in Punjab, and was brought to the hospital (OP) by his maternal aunt who was a doctor. The court presumed that consent of the maternal aunt was present and it was legal and valid).
Hospitals and nursing homes must be doubly sure that the nurses are qualified and registered with the appropriate authorities. Student or intern nurses are only permitted to perform certain acts and, that too, under proper supervision. (In this case, the nurse (OP) had not passed the nursing exams and was not registered with the Nursing Council and the question was whether she was qualified to give sedative intramuscularly to a child under the supervision of a qualified doctor. The court held that she was incompetent to do so). ,
Medical records of all indoor patients are required to be prepared and preserved irrespective of whether fees was charged from the said patient or not.
Anesthetists must specifically record the drugs given to the patient, as well as the dose. Failure to do so may force the court to draw adverse inference. (In this case, the underlying reason for holding the anesthetist (OP) negligent was his failure to maintain record of both the name and the dose of injection Pentazocine given to the patient).
Anesthetists must be vigilant and careful in deciding the dose of drugs administered to the patient.
Doctors and hospitals are ethically bound to provide free services to wards of other doctors.

A doctor must be careful in sending samples to a pathology laboratory not having the requisite facilities to perform that particular investigation. This could be termed as negligence. (In this case, the court held the gynecologist (OP) negligent for not sending the biopsy sample to the best available institution and taking help of a private laboratory of the pathologist (OP) which did not have the equipment to process the biopsy sample and send the sample further to another laboratory). ,
Writing any medical records on the patient's insistence should be done with utmost caution. The reason/s thereof must be duly recorded in such writings and a copy must always be kept in the records. (In this case, the allegation was that the gynecologist (OP) "made unsigned and undated writing on the paper to deliver it to the doctor of PGI." The gynecologist (OP) had to clarify in the court that one of the patient's attendants came and asked for the patient's records as the doctors of PGI where the patient was referred required the same. It was a Sunday and the attendant was asked to come on the next day, but he insisted and, therefore, the gynecologist (OP) "wrote on the plain paper a description of all the diagnosis"). ,
Hospitals/doctors sending samples for investigations must ensure that the packing and handling of the same is done carefully. ,
It is advisable that samples for investigations are not handed over to the patients/attendants/relatives, as this reduces the chances of the sample getting spoilt. But if the samples have to be handed over, a proper endorsement of the patients/attendants/relatives in this regard must be taken.
Delay/failure to deliver investigation reports by pathology laboratories/imaging centers is per se negligence.
Doctors, especially gynecologists who perform sonography, must be doubly sure that they have the requisite qualifications/permission in accordance with the MCI regulations to do so. Law in this regard is still not very clear. (In this case, the doctor (OP) who performed sonography was not a sonologist, but a postgraduate who had practiced for a year under a sonologist, and he referred to certain regulations which permitted him to do so. The court held that he was not qualified and competent to do sonography). , , ,
Pathology laboratories must clearly communicate to the referring doctor/hospital in case the sample is spoilt.
The fact that the sample for investigation has been spoilt should be clearly and immediately intimated to the patients/attendants/relatives by the referring doctor/hospital. Efforts must be made to collect fresh samples. (In this case, the sample sent for biopsy after performing hysterectomy was autolyzed. The court held the gynecologist (OP) and the pathologist (OP) negligent for their failure to intimate the same to the patient and to perform other investigations to rule out other possibilities).
Presurgery investigations and, that too, the appropriate ones must always precede any surgery/procedure. (In this case, the court held the gynecologist (OP) negligent for not insisting on CT scan before the surgery to check the possibility of ovarian cancer, a common disease in ladies and merely relied on sonography. The court referred to the expert opinion given by a radiologist stating that "as compared to ultrasonography, CT scan is a better imaging modality").
Stating untruths in the court hardly helps and should be avoided at all costs. Once the falsehood is discovered, the hospital/doctor loses all the sympathies of the court.

It is advisable to let the patient purchase implants from a distributor/outlet/shop of his/her choice and this fact of the patient purchasing the implant from outside on his own must be clearly recorded in the medical records. (In this case, the court has viewed the fact of the PF nail being purchased by the patient's attendants from outside in favour of the hospital (OP).
Implants must be purchased of standard companies and from authorised distributors/outlets/shops.
Failure of patient to follow medical advice or to come for follow-up when advised must be specifically recorded. (In this case, the court drew adverse inference against the patient, as he did not heed to the medical advice of post-surgery rest and indulged in election campaigning and did not turn up for follow-up as per medical advice).
Refusal of the patient to give consent must be specifically recorded in the medical records and if possible, an endorsement to this effect must also be taken from such patients/attendants/relatives.
In case of elective surgeries/procedures in high-risk patients, take high-risk consent.

Law accepts certain complications as unavoidable part of medicine. In this case, the court has clearly observed that stricture or narrowing of the CBD is an acceptable complication of cholecystectomy and not negligence.
The patient must be clearly explained and counseled about the procedure/intervention and also about the changes or alternative/s that may have to be adopted midway. Consent must clearly record the name of the procedure as well as the route and the other alternative/s that may have to be attempted. (In this case, one of the allegations was that the surgeon (OP) had originally agreed to perform cholecystectomy by laser/laparoscopy, but at the time of surgery, he opted for open surgery).

In case, an investigation report is preliminary, ought to be repeated after a few days as per the accepted practice, is grossly abnormal or doubtful for any reason and a repeat investigation has to be advised to the patient; the said advice must be given to the patient in writing and, that too, in the first/preliminary report. (In this case, the defense of the hospital (OP) was that test for serum prolactin is always repeated after a gap of 3-4 days, and accordingly, the patient was "orally" advised to come again for the repeat test, but she got the repeat test done from PGI. The court disbelieved this defense simply because it was not in writing).