Medico Legal Tips
Medico Legal tips
These Medico -Legal Tips come to you by courtesy of
Prof ( Dr ) R K Sharma
MBBS (AIIMS) , MD ( AIIMS), FIAMLE , FICFMT ,
Medico-Legal Consultant
President, Indian Association of Medico-Legal Experts , New Delhi
Former Head, Department of Forensic Medicine, All-India Institute of Medical Sciences, New Delhi.
Director, Supreme Medico-legal Protection Services Pvt. Ltd
e mail medicolegalhelpline@gmail.com
website www.smlps.in
Tel no 0091-9891098542
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Medico-Legal Tip of the day- 4
Medico-Legal Tip of the day- 1st Oct 2015
Question- I have read that the Medical Council of India is going to be strict about the
degrees which are to be displayed on the name board and consultation sheet of a
doctor. In your advice, I have read that you can include all the fellowships and such
things in the name board.
I would like to know, if doctors are allowed to include degrees like FCGP (fellow of
college of general practitioners); MRCS (member of royal college of surgeons), MNAMS
(member national academy of medical sciences), M Ch Ortho (Seychelles); which are
not legally recognized by MCI; in the name board for display.
Also, what about the short term fellowships in India and abroad; e.g., fellowship in
Arthroscopy and sports medicine, fellowship in Arthroplasty; which are like 6 month
programmes done by many centers, which are not affiliated to any University and which
are not MCI recognized?
And, what is the status of various distance education programmes, like post graduate
certificate course in Rheumatology, which are conducted by IMA initiative?
Is it that all these can be included in the name board or is there a possibility that if
somebody gives a complaint to the MCI, they can take some legal action against the
doctor, who includes these in his/her name board or consultation sheet?
Kindly give your valuable advice to clarify the situation.
Thanking you,
Dr Shiby John
Pathanamthitta
Answer- Please note that as per MCI directive as of now, you can use degrees,
fellowships, membership on your consultation sheet provided they are recognized.
Many doctors are also writing un-recognized degrees. Till date, MCI has not taken
violation seriously and issues only warning notices.
What will happen in future, we do not know. We will come to know only when
notification is issued.
In case of negligence, when such doctors who are using un-recognized degrees are
brought to notice, the conduct of such doctors may be declared as negligent. Court may
also award compensation.
Medico-Legal Tip of the day- 3rd Oct 2015
Query- Sir, Is the visiting Surgeon covered in his professional Indemnity Insurance for
operating outside his hospital?
I was told that the premium of Insurance is more if the surgeon operates outside his
setup.
Some people say that the hospital where the surgeon visits has to get the Insurance
done for visiting Docs also.
Kindly enlighten us!
With best wishes,
Dr. Sudhir.P Sabharwal,
M.S. (ortho)
Answer- Yes, the visiting Surgeon is covered in his professional Indemnity Insurance
for operating outside his hospital. There is no additional payment for the same. Hospital
will not get surgeon to get insured before surgery, usually hospital asks doctor to take
indemnity himself. Most of the surgeon has taken indemnity own their own.
Medico-Legal Tip of the day- 5th Oct 2015
Query- kindly let me know what is the reasonable good coverage amount for indemnity
for an orthopedic surgeon practicing in his own set up of 10 bedded private hospital practicing
mainly trauma? I am asking particularly in view of last few judgment of honorable Supreme
Court against doctors for negligence in Crore . What would you suggest, private
insurance company indemnity policy or the IMA state branch run PPS scheme?
Thanking you and obligatory to you for your constant medico legal tips which has made
my work more tedious but with much more perfection.
Dr Neeraj Joshi. M.S. (Ortho.) Bhavnagar, Gujarat.
Answer- I will suggest you that you take at least 1 Crore indemnity insurance for
yourself and 2 Crore indemnity insurance for your hospital. I am not in favor of PPS
scheme although it is cheaper.
Take insurance from Govt companies as their experience is better as compared to
private one.
Medico-Legal Tip of the day- 7th Oct 2015
Query- patient died in the hospital who was admitted for fever which after 5days patient
developed TENS. Prognosis explained to the patient’s attendants, rather referral
summary made for higher centre, but attendants did not shift the patient due to non
availability of bed (due to dengue rush).patient died of septicemia after 10 days of giving
the referral letter. During hospital stay initially patient was treated by MD medicine. After
she developed tens she was treated by skin specialist surgeon, nephrologists and
plastic surgeon, along with medical specialist,
Post-mortem conducted in Gov .hospital by the post mortem board who commented on
treatment protocol during hospital stay and give the interim opinion
“Life of the patient can be saved if meticulous treatment given after proper history
.final opinion will be given after viscera and chemical report. Chemical report no poison
detected.” Viscera report say viscera is not preserved properly.
Postmortem board consists of three doctors two forensic expert +one medical specialist.
Now post mortem board is not giving final opinion they make one or the other excuse.
They say we were never three available to give the final opinion.
Now judge ask hospital to constitute new board to give the final opinion. whether judge
can ask to constitute new post mortem board when previous board doctors are already
available .Is it not binding on the previous post-mortem board to give final opinion after
the viscera and chemical report.
Please give your expert opinion in this situation
Dr. Ashok Kumar
Answer- I can only say that there is apathy and attitude of non-working in doctors who
have conducted initial post-mortem. They are offering lame excuse that three of them
cannot meet. If police want, they can take opinion in one day from this board. Simply
they have to summon them in police station on any day with fixed time. The summon
can be served through Medical Superintendent office. If they do not comply, they face
legal action from police and administrative action from govt. Problem is that most of the
time, police is not interested in doing this.
Please remember that court has power to make new board or direct this board to give
opinion urgently. This is inherent power of court.
Medico-Legal Tip of the day- 9th Oct 2015
Sub: Apathy of post mortem board
In one of such cases, the post mortem board has contacted the hospital concerned and
demanded Rs25 Lakhs to give a favorable report , warning that otherwise they will give
an implicating report.
So corruption can be one of the reasons for apathy and delaying of submission of
report.
Requesting Dr R K Sharma to suggest what to do when a board demands money.
Regards
Dr Manjunath R
Answer- Corruption is a big problem in Govt setup. Doctors demand money from fellow
doctors/ hospitals for writing a favorable report. Even sometimes money is asked even
in cases where there is no negligence.
The only way to deal is to get them arrested by contacting CBI/ central or state vigilance
authorities. It would be correct to inform that a lot of doctors have been arrested and
even sentenced for jail terms. NHRM scam, kidney scam of Noida and Amritsar are
living examples.
Medico-Legal Tip of the day- 10th Oct 2015
Query- I have added a note in the discharge summary of the patient at the time of
giving witness in the court.
The note is at the end of the progress sheet and is assessment of disability as I thought
that it would be easy for me to refer and also that it will be in the case record. The
lawyer had questioned this and told that nothing can be added in the case sheet. I have
only noted the disability assessment and not tampered with it. I have also added the
date it was put. Am I wrong on my part? What is the legal implication?
(Asked by Dr Ajay Rao)
Answer- Please note that no addition or subtraction can be done in documents which
have been submitted in court. The lawyer was right in objecting when you made
addition in discharge summary at the time of giving evidence. You should seek
permission of judge if you intend to do it. You can be prosecuted for destruction of
evidence if you do it without permission of court.
Medico-Legal Tip of the day- 12th Oct 2015
Query- I have seen a patient who had laminectomy and discectomy done 7 years ago
by a senior surgeon. Post operatively patient developed cauda equina syndrome for
which no investigation (MRI) or treatment was given. Patient did not have relief from
sciatica. He recovered his bladder function subsequently. He had relief from sciatica
after 1 yr. But still has bowel dysfunction. Now he has developed recurrent sciatica.
Fresh MRI shows previous surgery at wrong level. I have seen similar cases which have
been covered up because of the name, fame and money power of this doctor. It is a
clear case of criminal negligence. What should I do? What is my responsibility for this
senior man, patient and society?
With regards
Dr. Mahesh. K
Answer- As a doctor, our first duty is toward patient. Please do whatever you can for
patient. If you think, it is a case of criminal negligence, tell the patient and let him decide
what to do with it. He can go to police, civil /consumer court or to medical council. He
may also decide not to do anything. Let the conduct of senior man be judged by peer
review in medical council.
If you have done this, you have fulfilled your duty toward society. If you wish, you can
talk to senior man and listen to his views also on alleged negligence. He may tell
exactly what happened and how, seven years ago.
Medico-Legal Tip of the day- 13th Oct 2015
Query - a patient (15 Yrs) of RTA was admitted in very serious condition in
ICU and put on ventilator immediately with consent of the attendants and
his father also. A multi disciplinary team of doctors supervise them and after
30 days he was normal and shifted in Semi ICU for off and on requirement
of oxygen. In between some other people and his complained to district
authority that he hospital retain the pt for their bill and put out the pt. from
ICU to ward, and some officer came in hospital on Sunday and grave the
patient with help of police from semi ICU and shifted in government hospital.
FIR was lodged against the hospital stating that the hospital demanded Rs. 5
lakhs while the total bill was nearly Rs. 2.5 lakhs out of that Rs. 1.92 lakhs
was dues on patient. FIR lodged on hospital authority under section 343 of
IPC. And same was covered by media also.
Please give me advice
1. How we can lodge the FIR or any suit/case on district authority.
2. How we can get balance payment.
So, advice me for same.
(Name of Hospital withheld)
Answer- This is nothing else but extortion by patient and his attendants. Be brave, you
have to fight it professionally. If you wish, you can also file counter FIR. File a case for
recovery of dues in civil court too. It is better if you hire some medico-legal consultant
too.
Media is always looks for cheap sensational news just to show that they are custodian
of poor public. Just ignore media.
Medico-Legal Tip of the day- 14th Oct 2015
Query- Patient admitted for pain abdomen under investigation but stable and at the
same time his court summon for any other independent case. What a doctor should do
in such situation?
What are the legal complications a doctor or hospital can face?
Dr Mohit Gupta
Answer- If patient is stable and can go to attend court , let him go and attend the court.
If patient needs admission, do admit and you can issue medical certificate so that he
can produce it in court of law. Remember, never give false certificate as court may order
re-examination of patient at Govt hospital and if it is found that you have favored the
patient, action can be taken against you. Court may also order MCI to take action
against you. I have seen many doctors apologizing in court over false certificate.
If you are in Govt service, employer can also take action against you. Only one remedy
is there, no false certificates to be issued at any cost. Hospitals also face similar action
and even license can be cancelled.
Subject: Medico-Legal Tip of the day 15th October 2015
From: Dr R K Sharma <rksharma1@gmail.com> Thu, 15 Oct '15 4:24p
To: Medico-Legal Tip of the day <medico-legal-tip-of-the-day@googlegroups.com>
Show full Headers
Medico-Legal Tip of the day- 15th Oct 2015
Professional Jousting
Contributed by Dr Ajit Jain
Provocation by colleagues- professional jousting-frequent cause of malpractice litigation.
A Surgeon had to convert a Lap Cholecystectomy into open surgery because of difficulties.
Post-surgery, after a couple of months, recurrence of abdominal pain led to further investigations
including CT scan abdomen and a retained abdominal mop was diagnosed.
Patient was unwilling to continue treatment with the same surgeon and went to another surgeon.
Laparotomy was performed by this surgeon and the mop retrieved.
The surgery was videotaped by the surgeon.
Subsequently; the relatives of the patient confronted the first hospital very aggressively and
demanded compensation.
One of the relatives flashed a CD and said they had a video recording of the mop removal
surgery and threatened to splash it in the media.
Left with no choice, the hospital and the surgeon made a financial settlement.
A Gynecologist performed a hysterectomy for multiple uterine fibroids.
A few months later the patient consulted another gynecologist for vaginal discharge and
abdominal symptoms.
The patient was re-operated and a retained abdominal sponge was removed.
After displaying it to the not inconsiderable number of relatives present, the mop was put in a
fancy glass bottle (much in the fashion of a hunting trophy!) and handed over to the husband of
the patient.
Almost soon after, a large mob, which included activists of a political party, stormed into the
office of the first gynecologist and brutally assaulted him.
An accompanying TV channel crew filmed the entire proceedings which were duly telecast the
next day and the day after.
A Gastroenterologist admitted a patient to hospital for acute pain in the epigastrium.
On the basis of history and clinical examination a diagnosis of ? Acute cholecystitis? Acute
pancreatitis was made.
Treatment was started accordingly and relevant investigations were ordered.
WBC count of 20,400 and presence of fever supported the diagnosis.
Some abnormality in the ECG was attributed to previous IHD 14 years ago.
Liver enzyme levels were abnormal though USG did not reveal any abnormality.
CPK enzyme was found to be raised.
The patient responded to standard line of treatment and was discharged after 8 days, being
asymptomatic now.
After about two and a half months, the patient consulted a cardiologist in another hospital for
chest pain.
This time the ECG revealed fresh ischemia for which he was treated appropriately.
However, the cardiologist allegedly remarked that he was “….shocked at the treatment given at
the previous hospital “and in his opinion, the patient had in fact suffered a myocardial infarct at
the time of the previous admission and the doctors had misdiagnosed it as cholecystitis.
Subsequently, the patient filed a complaint before the National Commission claiming Rs. 55.90
lakhs as damages for gross negligence in diagnosis leading to severe damage to his heart and
thus necessitating a heart operation.
The cardiologist, whose remarks had provoked the litigation, gave his comments in writing and
even filed an affidavit in favor of the complainant.
An Orthopedic surgeon gave a local steroid injection to a lady suffering from severe Tendo
Achilles tendinitis.
A month later, the patient developed rupture of Tendo Achilles for which she was advised repair.
On taking a second opinion from another orthopedic surgeon, she was told unequivocally that
this had occurred because of wrong treatment.
Local injection is never, never to be given and hence she had a good case to claim damages from
the doctor.
He said he was willing to say so in writing. The inevitable happened and the orthopedic surgeon
had to face a lot of unpleasant music .
A Neurophysician, quite recently, diagnosed Hansen’s disease in a patient with foot drop and
other neurological symptoms after due investigations including EMG, etc.
He prescribed Dapsone to the patient after testing the patient for G6PD deficiency.
Shortly thereafter, she developed Stevens- Johnson syndrome.
A Dermatologist whom the patient consulted wrote on his letter-head ‘No evidence of Hansen’s’
and said there was no need to have administered the drug.
Soon after , a crowd of 20-25 persons trooped into the doctors ‘consulting room , intimidated
him and informed him that they were admitting the patient to a high-profile Corporate hospital
and since the complication had occurred because of his mistake , he ought to bear the cost of the
entire medical treatment hereafter.
The relatives of the patient browbeat him into giving a cheque of Rs. 1 lakh in favor of the
hospital where they proposed to admit him.
And they promised to return for more money on an SOS basis!
Orthopedic implant failures, incomplete MTPs, limb amputations ----- the entire gamut of cases
where the common feature was the unintended, or sometimes intended (!), off-the cuff remarks
which instigated patients to make a beeline to an Advocate, marking the beginning of tortuous
litigation and mental and physical harassment of the concerned doctor.
Undoubtedly, a fair percentage of medico-legal problems have their genesis in critical comments
by doctors against the previous treating doctor.
In the USA, such provocation of patients has been given a name.
They call it “Professional Jousting”
Definition: Jousting has been defined as the unfortunate practice of one health care professional
making critical / derogatory comment about another provider’s care, either to the patient or
relatives, without having reviewed all the pertinent records and without discussing his or her
concerns with the previous physician.
Jousting is not always oral.
Criticism recorded in a patient’s case paper can be just as damaging, in fact more, since it forms
part of the documentary record and will become evidence in case of litigation.
Please avoid jousting, as all r human, and can make judgment/ treatment error.
Help your colleagues and don't get into jousting, as it can be u next time.
………………………………………………………………………………………………………
Medico-Legal Tip of the day- 11th Sept 2015
Query- I am pathologist. I have registration of Maharashtra medical council for
both MBBS and MD.
Now I am working in Bhopal (Madhya Pradesh) and want to start my own lab. Is it
necessary to change registration and take new registration of Madhya Pradesh
Medical council?
(Asked by Dr.Sarika)
Answer- As per IMC act, one registration in any state empowers doctor to
practice in any part of India but it has been commonly seen that all state medical
councils are forcing doctors to re-register at place they are working. This is
illegal. Up to now I have not heard that any action has been taken against those
who have not registered with local SMC. It needs to be challenged in court. But if
you have settled permanently in a different place, it is better to switch registration
to local SMC.
Medico-Legal Tip of the day- 12th Sept 2015
Query- This is the case where Lawyer was absent, but if Doctor is Absent for
next two hearing as same as Lawyer, court issue summon to the Doctors. Dear
Sir we are living in India, why Service Tax is not directly paid by Lawyer as same
as other professional.
If lawyer put up the false allegation on behalf of his client, than lawyer should
also responsible and punish as per code of conduct, if CA certify the wrong
document there is a provision for cancellation of certificate than why not the
same on Lawyer.
With Regards
Davesh Narain and Dr PH Mishra
Answer- I would like to comment as follows
1.
Please remember lawyer is nothing but a representative of accused/defendant/ complainant,
he has no personal interest in case.
2.
If lawyer is absent repeatedly, court proceeds with matter.
3.
If lawyer is putting false allegation, read above again as it is not him but
accused/defendant/ complainant who is saying so.
4.
Lawyer is only assisting accused/defendant/ complainant on his request.
5.
Lawyers are also bound by their ethics and Bar council of India has right to cancellation of
their license. In Nirbhya case (Delhi Gang rape case), defense lawyers have been issued
notices by Bar Council of India to explain their conduct.
6.
Lawyers services are covered under service tax and service tax is payable by client and
lawyer should deposit it.
7.
You should remember that defense/ prosecution lawyers are officers of court as per
provision of law
8.
The courts are not strict to lawyers’ absence as if they proceed without them,
accused/defendant/ complainant can suffer legally and court would not like that.
9.
But nowadays, courts are getting strict with lawyers.
Medico-Legal Tip of the day- 14th Sept 2015
Query- A surgery done in pvt .hospital for hip replacement, patient became
comatose after surgery (no definite cause established, probably embolic
phenomenon). Patient attendant did not deposit any money in prior and now
refused to do so. Can pvt. hospital shift Pt to a district hospital on its own with
attendant consent. What are legal implications in treatment or in this scenario?
Suggest, my friend in up town is faced with this problem.
Answer- I find problem lies with hospital administration. How can elective surgery
was planned and done without deposition of at least 50 percent of charges in
advance. Now patient is refusing to do payment.
Option before you
1. Operate free of cost and problem is solved
2. Document patient attendants are not paying, discharge the patient and ask
attendants to shift to some other hospital
3. If they are not shifting, document everything and shift patient to Govt hospital as
no private hospital will take a non-paying patient.
4. This is potential litigation situation caused by poor management skill.
5. If attendants create problem, call police.
-Medico-Legal Tip of the day- 14th Sept 2015
Query- A surgery done in pvt .hospital for hip replacement, patient became
comatose after surgery (no definite cause established, probably embolic
phenomenon). Patient attendant did not deposit any money in prior and now
refused to do so. Can pvt. Hospital shift Pt to a district hospital on its own with
attendant consent. What are legal implications in treatment or in this scenario?
Suggest, my friend in up town is faced with this problem.
Answer- I find problem lies with hospital administration. How cans elective
surgery was planned and done without deposition of at least 50 percent of
charges in advance. Now patient is refusing to do payment.
Option before you
1. Operate free of cost and problem is solved
2. Document patient attendants are not paying, discharge the patient and ask
attendants to shift to some other hospital
3. If they are not shifting, document everything and shift patient to Govt hospital as
no private hospital will take a non-paying patient.
4. This is potential litigation situation caused by poor management skill.
5. If attendants create problem, call police.
Medico-Legal Tip of the day- 15th Sept 2015
Query- I have seen some doctors keeping the name of the medical college from
which they have done post graduation in their name boards and their
consultation sheets. Some doctors add things like gold medalist and all ...is it
legal to keep the same in the name boards and consultation sheets?
Thanking you,
Dr Shiby John, Pathanamthitta, Kerala
Answer- It is permissible to add all the above mentioned. You are also allowed to
add fellowships, memberships, awards and orations too.
Medico-Legal Tip of the day- 16th Sept 2015
Query- I am an Orthopedician with degrees MBBS and MS Ortho and registered
with Karnataka Medical Council. I also have a Post graduate degree in Information
Technology - MSc (IT) obtained by Distance education in Sikkim Manipal
University. In fact I am a software developer and IT consultant to some medical
institutions apart from actively practicing orthopedics. Can I add MSc IT to by
name boards and consultation sheets? Presently I have added the degree, only to
my visiting cards.
(Asked by Dr Ramachandra HM)
Answer- I am very happy to learn that you are equally qualified in information
technology. You can definitely add MSc (IT) in your card and letter head. I have
observed that some doctors put degrees with college name in such a way that it
may appear as additional degree just like MAMC ( Maulana Azad Medical College)
is not kept in bracket but with degree . Such practices may invite ethical violation.
Medico-Legal Tip of the day- 17th Sept 2015
Query- Recently I came to know about a case for which I seek your expert
opinionA 3-4 years old girl child was brought by parents to a doctor(pediatrician) with
the complaints of some redness, itching, frequent touching by the child in the
perineal area(noticed by mother soon after the child returned from her school and
not sure whether the problem existed before hand or not).The child was examined
by the doctor, who noticed some features of inflammation/irritation/redness etc.
and nothing else(in form of injuries/fluid, discharge/any other abnormality).The
Doctor diagnosed this case as non-specific vulvitis(not an uncommon condition)
and advised for local Hygiene( by washing with soap and water, keeping area dry,
using cotton underpants etc.) and some local medications ;deworming etc. and
the parents left the clinic satisfactorily.
After few hours (6-8 hrs or so in the evening), the doctor received a call from the
local area Police station. The police officer threateningly talked to the doctor and
told him that the parents have complained to the police about the possibility of
sexual abuse of the child by the School van driver/ male attendant when the child
was brought by them after the school got over. The police officer scolded the
doctor For "Destruction of Evidence by asking parents to clean the local
area(perineum) by washing and also failing to collect any swabs etc."
I want your opinion on the following issues1. Was the doctor truly negligent in collecting the evidence when neither the
clinical examination nor the circumstantial evidence9in form of history provided)
pointed towards that?
2. How to safeguard oneself from such mishaps to avoid subsequent
harassment? Should we always keep a possibility of sexual abuse in case of any
girl child (or even boy for that matter) who have any perineal symptoms in form of
irritation/itching etc,?
3. What should be the doctor stand now? How should he prove his innocence?
4. Any other relevant point that has been missed to make this discussion more
educative.
Unfortunately this is a true incident that has happened with one of my friends. He
had a harrowing time to defend himself and ultimately ended up in paying bribe to
the police.
Seeking a detailed reply from your kind self so as to educate all of us regarding
such tricky situations
(Asked by Dr Sanjeev Aggrawal)
Answer- This incident is unfortunate but can happen again. The doctor was not at
fault. He treated the patient as per history given by parents. Since he did no
wrong, he should have guts to tell police man that he did according to history
given by parents and he is not detective .He should have never paid any bribe.
Now answers to your questions
1. Doctor did no wrong as he acted according to history given by parents.
2. We are not detectives but we should be vigilant. Nowadays, it is better to discuss
possibility about sexual assault with parents.
3. He need not prove his innocence. Just say that he acted as per history given.
4. It is always better to record history given by parents in such cases on
consultation sheet to show later to police if such need arises.
5. 3-4 year child can talk easily, so do not rely on parents history alone, ask nurse to
discuss with small child possibility assault.
6. You have to use own judgment, in cases of assault, you can see contusion/
abrasion or bloody discharge and would be very painful to touch. Injuries may be
present in inner aspects of thigh and other body area. Vulvitis would not be so
painful and discharge is not bloody. Child would cry in cases of assault while
touching but pain is less in vulvitis.
Medico-Legal Tip of the day- 19th Sept 2015
Query- Please clarify what are the legalities involved in case a minor girl
approaches the hospital for MTP for pregnancy below 12 weeks
regards
Dr. Sanjeev Gupta
Answer- Just turn her back and ask to come with parent/ guardian.
Reason
1. She is minor and cannot give consent for an operative procedure
2. She is pregnant; case is of rape as age for sexual intercourse consent is 18 years.
3. If she does not go, inform police
Medico-legal Tip of the day – 21st Sept 2015
Question – Is consent required for blood transfusion?
Case - National Consumer Commission - M. Chinnaiyan v/s Sri Gokulam Hospital &
Anr.
The patient underwent hysterectomy and was transfused 2 units of blood, perhaps infected
with HIV. No consent for transfusion of blood was taken. In defense, it was stated that
blood transfusion was not anticipated and hence consent was not taken. But the surgeon’s
noting in the medical records and the nurse’s notes clearly had directions to keep 2 units of
blood ready before the surgery. Both the surgeon and the hospital were held negligent for
not taking separate and specific consent for blood transfusion.
Medico-Legal Tip of the day- 22nd Sept 2015
Query- What are the legal/medico-legal guidelines governing a surgeon in the following
situations:
a) HbSAg positive status of surgeon
b) HIV positive status of surgeon
Is a surgeon allowed to operate on a HbSAg/HIV negative patient if he takes universal
precautions? Does he have to inform the patient of his positive status?
Regards
Dr. Bhavesh Kumar
Answer- If surgeon is ready to take precautions , then there is no bar to operate on
HbSAg/HIV negative patient but it is better if he informs the patient before operation as
if patient is infected while operation , he can take surgeon to the court for infecting him.
It is always better to inform hospital administrators too as he may be charged of
withholding vital information.
Medico-Legal Tip of the day- 23rd Sept 2015
Query- I am in govt job and getting NPA. Can I do charitable work with some charitable
hospital with or without any honorarium after taking permission? Is such permission
usually allowed?
(Name withheld)
Answer- As such there is no bar to charitable work but since you in govt career,
restrictions apply.
1. Govt always views charitable work done by govt doctors as suspect as a lot of doctors
work in charitable hospitals and take money cash.
2. If you receive some honorarium, you have to convey the same to govt.
3. Charitable work can be commenced only after taking permission.
4. Most of time , permission is denied as govt assumes that you are on 24 hour duty all
year as you can be called anytime.
5. Permission for charitable work can be easily given in govt run programmes, emergency/
disaster management etc.
Medico-Legal Tip of the day- 25th Sept 2015
Query-Once a senior and influential lawyer in courtroom while I was for the
evidence in that case used me as a subject to demonstrate how a sickle can
cause two injuries. I was embarrassed but keeping my calm I also grabbed him
and showed him how two injuries are possible with a sickle. Can a lawyer or
anyone use a doctor to demonstrate on his or her body the mechanism of injury?
Judge ignored this all in my case.
Dr Subhash Kashyap, MD Derma, IGMC Shimla HP
Answer- Anybody can use anyone for demonstration in court, of course with
consent. You could have objected if lawyer wanted to use you for demonstration.
Infect, you also participated in it. You felt bad as he tried to encroach on your
domain. Please remember lawyers are known to do any antics to help their client.
Since, lawyer was defending his client, judge patiently listened to him but ignored
you as you are an expert and hold independent opinion to be delivered when
asked. Do not feel bad about it. It is in power of judge how to conduct his court
and he is free to choose modalities.
Medico-Legal Tip of the day- 26th Sept 2015
Sir, there are many surgeons and physicians in India who after
receiving MBBS or MD/MS from recognized institutions of India went
abroad and received foreign qualification, after working or gaining
experience in some or other super specialty. Their foreign
qualification may not be subject specific as it used to be say up to
1990. (For example FRCS in England was not specific for plastic
surgery till later part of last century). Such people started their
super specialty practice in India since decades and continue to do so
at many prestigious positions. My questions are:-1. does the article 7.20 of MCI code of conduct which was added
only in 2002 (i.e. A Physician shall not claim to be specialist unless
he has a special qualification in that branch.) disallows them to
practice their super specialty what they have been doing for decades
or they can still continue as they still satisfies provisions of article
(1.4.2 i.e. Physicians shall display as suffix to their names only
recognized medical degrees or such certificates/diplomas and
memberships/honors which confer professional knowledge or
recognizes any exemplary qualification/achievements.
2. Can an amend mend done in 2002 i.e. section 7.20 may be used
with retrospective effect to affect those who practiced some
specialty for decades or section 1.4.2 which existed earlier to 2002
and exists even today protects them.
Dr. Kamal K. Parwa, New Delhi
Answer- Please note that all notifications from MCI are in
prospective in nature and apply from date of notification. Legislation
is prospective. Although govt has power to do retrospective
legislation (Just in Videophone Tax Case) but it does in only in
exceptional circumstance.
Unless mentioned specifically, all notifications are prospective in
nature. This is law of natural justice.
Medico-Legal Tip of the day- 28th Sept 2015
Question- When a patient is billed in a corporate/ private hospital, how much is the doctor responsible in the
process of billing if any dispute arises over the billing? Also, some hospitals do not or are reluctant to issue the
patient bills (i.e. pharmacy expenses and other charges they made to the patient) to the responsible doctor (in
some cases the only amount he is aware is his part of the treatment). What rights do the doctor/ surgeon have
in accessing these bills? In cases of dispute, Will the doctor/ surgeon be excused if he has not been shown the
bills or is not involved in the billing of the patient?
How do the rights alter, if any, in cases of 1. cash payment by patients brought by the doctor (I presume he
would be responsible and has rights in these cases), 2. cash payment cases referred by the hospital to the
doctor for treatment, 3. Cases covered by Insurance policies, 4. Cases covered by government schemes like
Employees Health Scheme, Aarogyasri etc.
Also please outline rights for doctors employed by the hospital and those who are not employed by the hospital
but involved in a case by case basis.
Best Wishes,
Dr Srinivas Kambhampati MS(Ortho), PG Dip (Applied Biomechanics), FRCS(Glasg), FRCS(Trauma & Orth)
Consultant Orthopaedic Surgeon
Vijayawada,Andhra Pradesh, India
Answer- Your query is too long but I will answer some basic issues
1. Doctor along with hospital is fully responsible for billing. If you are a visiting consultant, remember patient has
come to the hospital because of you. Doctor is fully responsible. All payments have to be acknowledged and
proper bills to be issued.
2. In case of dispute, you are fully responsible along with hospital.
3. Rights of patient /doctor are not dependent on mode of payment either by cash/ cheque/ insurance companies/
govt.
4. Rights are also not affected if you are consultant or employee of hospital.
5. Hospital carry vicarious responsibility in disputes .
6. All bills to patient carry your clearance , it is presumed.
7. Hospital bills to patient as per your direction.
Medico-Legal Tip of the day- 29th Sept 2015
Query- If a surgeon is invited to operate on patients to a city other than his usual
place of work. He operates and goes back, and the doctor inviting him looks after
the patient in post op period. This fact, that post op care will be done by the local
team, is duly informed to the patient, and a due informed consent taken on this
arrangement. In such a situation if a complication happens in the post op period,
can the operating visiting surgeon be held responsible for it, and can the
argument that the surgeon operated and left be held against the visiting surgeon.
Dr. J. Maheshwari
Answer- In above situation, operating surgeon is primary doctor and is
responsible for all events that may happen. He has made a bonafied arrangement
to look after patient in his absence. He cannot be accused of leaving patient
unattended. But he is responsible for negligence done by post-operative team as
they are doing duty on behalf of him.
Medico-Legal Tip of the day- 30th Sept 2015
Query- As I understand, the primary doctor is one under whom the patient is admitted. If
the patient is admitted under the doctor who has invited the surgeon from outside, in
that case what is the liability of operating surgeon?
Dr Rajiv Jain
Sr. Consultant Orthopedic Surgeon
Max Super-speciality Hospital
IP Extension, Delhi 110092
Answer- In above case, liability of operating surgeon would be confined to surgery and
its complications. Primary doctor under whom patient is admitted is fully liable for all
treatment done to patient including surgery. Hospital would be vicariously responsible
for all treatment.
--
Medico-Legal Tip of the day- 3rd Sept 2015
Query- In private nursing homes, lot of BAMS doctors work as Medical Officers.
How safe it is to continue this in court of law? If untoward incident happens, can
a BAMS doctor share the responsibility via a vis MBBS doctor?
Dr. Atul Mittal. MS Mch. , Consultant Urologist. , LAJWANTI Hospital
Jalandhar
Answer- It is sad reality that a lot of BAMS doctors work as resident in many
private nursing homes or hospital. It is grossly illegal as they are not trained in
modern practice.
In case of negligence, doctor would be charged of taking help from unqualified
staff and entire blame would go on primary physician. BAMS doctors are
appointed instead of MBBS doctors as they charge one third salaries. Later they
practice full time our system of medicine.
Medico-Legal Tip of the day- 4th Sept 2015
Query- few doctors ,practicing in Delhi for years ,without registering in
DMC,IS IT ILLEGAL,CAN ANY PUNISHMENT IS POSSIBLE FOR IT.
doctors having registration in other states, using registration no in Delhi
without mentioning state can confuse patients of same no in
Delhi(which no belong to other doctor registered in DMC)
(Asked by Dr Deo Rishi Tripathi)
Answer- As per IMC act, one registration in any state empowers doctor
to practice in any part of India but it has been commonly seen that all state
medical councils including DMC are forcing doctors to re-register at place
they are working. This is illegal. Upto now I have not heard that any action
has been taken against those who have not registered with local SMC. It
needs to be challenged in court.
Medico-Legal Tip of the day- 7th Sept 2015
Query- I have been at AFMC faculty sometime back. While MUHS used to come
for annual inspection they used to insist that we should have registration in
Maharashtra medical council also but when we showed them the ruling that once
registered with MCI or any of its branch another registration is illegal and not
required, they agreed and never insisted. I strongly feel that the country should
have only one central registration i.e. MCI. The branches should be to facilitate
that if required and work as its subsidiary and not an independent body making
their own rules. In other countries it is like this.
Dr PK Agarwal
Ex- Prof Ortho, AFMC Pune
Answer- Prof Agarwal, what you are saying is absolutely correct . But it is not
happening. Most of state medical councils are insisting that doctors practicing in
that area should register with them. Even NABH assessors are doing same.
Private hospitals are also forcing consultants and residents to register with local
SMC.
MCI is all silent as usual. IMA is also not doing anything, what to do?
Only solution is to approach court which majorities of doctors are not in
favor of going.
Medico-Legal Tip of the day- 10th Sept 2015
Query- I am an orthopedic surgeon from Bangalore. I had been asked to give
witness and assess disability of the person in treated in a civil court. I had gone
twice to the court and stood in the witness box, but the opposite party lawyer was
absent. The judge noted that the lawyer is absent and hence cross examination of
the doctor is not required.
Now the lawyer has asked me to come again to be cross examined. I told that I
would have to be paid 10000 rupees as my loss of earnings to attend again.
The lawyer it seems has told that they are ready to pay 1000 rupees, and if I do
not attend will issue summons.
Why should I attend, since I gave gone twice and was ready to be cross examined
but the lawyer himself was not present. Can I put a case against the lawyer for not
being present on those two days, wasting my time and my practice. Is it right to
demand 10000 since it is the amount I would lose in a day if I don't attend my
hospital and also if I lose out on trauma cases.
(Asked by Dr Ajay Rao)
Question- I share your concern as it is genuine. Many times doctors have
suffered like this. Time of doctors is wasted in courts as our law system is faulty.
It requires that all evidence has to be proved beyond doubt and reasonable
opportunity should be given to accused. This is abused by accused and his
lawyers and doctors and other witnesses suffer. The remedy lies in bringing this
to notice of judge who can take action. But my observation is that judges act
rarely.
You cannot demand money as per your choice to give evidence, if you think you
are less paid , bring it to knowledge of judge who can increase it but may not
increase to your satisfaction. There may be a possibility that he may rebuke you
too for asking too much money.
You will not get anything to sue the lawyers as you would lose money and
time both. Just bear with the system. Please remember attending court is our
constitutional duty and if we do not go, we can be arrested too.
Medico-Legal Tip of the day- 1st Sept 2015
Query- What is the status of the MCI / Govt of India recognition of Post graduation
degrees/experience from US/UK Australia etc. in case the basic MBBS is already done from
India.
Dr Pradeep Sharma Insan MD,FAMS, Professor, RP Centre AIIMS New Delhi, India.
Answer- Post graduate degrees from US, UK, Australia, Canada and New Zealand are
recognized by MCI. A gazette notification is available at MCI website. See below.
http://www.mciindia.org/tools/announcement/Recognition%20out%20side%20India.pdf
Medico-Legal Tip of the day- 31th August 2015
Query- Whether any Indian doctor who is having MCI recognized MBBS and DCH
qualification is after giving exam of WHO world health organization recognized MD
pediatrics degree of Texilla American university George town Guyana , can write suffix
of MD PAED .DCH. MBBS in his letter head. as MCI clearly mentioned you can write
only MCI recognized degrees or the certificates/diplomas or qualifications which shows
your knowledge.
(Name withheld)
Answer- As per MCI guidelines, doctor can write on his letter head only those degrees
which are recognized by MCI. Writing un-recognized degree may create an impression
that doctor is specialist while he is not. In cases of negligence, he can be prosecuted for
fraud and very high compensation may be awarded against him. MCI too can suspend
him from basic degree.
Medico-Legal Tip of the day- 28th August 2015
Query- What are the MCI guidelines regarding doctors involved in business?
(a) Owner of a hospital
(b) Partner in running a hospital
(c) Running a related medical equipment firm such as a implant company.
(d) Who are the relatives prohibited from running a related business firm such as an implant
company?
Dr J. Maheshwari, Consultant Orthopedic Surgeon
Answer- Please note there are no guidelines prescribed by MCI which prohibit/ control doctors
for doing business. Infect , so many doctors are now involved in healthcare industry as owners/
partners in hospitals/nursing homes , some are running IT starts up in healthcare, some are in
pharma companies as directors and founders. Founder of Dr Reddy Laboratories was a doctor
only.
As far as Implant Company is concerned, there may be conflict of interest. It should not be seen
that doctor who is heading or controlling Implant Company forcing doctors of his own hospital
to use implants of that company. No restrictions are on relatives either. So many doctors are now
doing MBA and setting up their own ventures.
Medico-legal Tip of the day – 26th august 2015
Question – can a case be made medico-legal even after discharge of patient? What is late MLC?
Answer- yes, any case can be made medico-legal even after discharge of patient. If at any stage
of treatment, doctor feels that in this case investigation by law agencies is required, he can make
this case as medico-legal and inform the police. This is called as late MLC.
Medico-Legal Tip of the day- 24th August 2015
Query- It seems to have become common practice for hospital / clinic employees to share
patient information (prescriptions, reports, demographic details) over Whatsapp groups and other
SMS services. In fact, some times, patients send their details to doctors over such mediums. Is
this legal or can the said employees / institutions be taken to court? If it is illegal, do you have
any suggestions for replacing these technologies since it does speed up work-flows and adds
considerable value.
(Name withheld on request)
Answer- Now a day, there is blatant disregard to privacy of patient information as it is shared
on social media without consent of patients which is a very dangerous trend. Legally speaking,
patient can take doctor to court for divulging of this information. Maharashtra Medical Council
has taken some steps as doctors were uploading operation videos on whatsapp.
Patients should also avoid sending this information on social media lest they may lose
opportunity to defend in court in case of litigation.
Medico-Legal Tip of the day- 22nd August 2015
Query- I have a patient 1 yr old girl- bilateral clubfoot, very irregularly treated. Her [L] side
seems fully corrected but her [R] needs surgery anyway which being a child of this age needs to
be done under general anesthesia. I told the parents that under general anesthesia I will examine
her [L] side also and if need be surgery may need to be done if the movement isn’t adequate .
This surgery involves no additional expense or blood loss and has a wound which at most will
have 1-2 stitches.
The father is not willing for any procedure to be done on the [L] side.
Now what should be done?
1.
Refuse to treat the child altogether
2. Get an informed consent and do only the [R] side – mention in informed consent by parents
that the father is not willing to do the [L] side and may need to be done at a later date
Requesting your opinion
With kind regards
DR C CHERIYAN KOVOOR, CONSULTANT ORTHOAPEDIC SURGEON,
ERNAKULAM MEDICAL CENTRE, BY PASS, KOCHI
Answer- Remember father is natural guardian who is legally authorized to take decision
regarding his daughter. Consent should be free and complete. It should not be for half or
compromised treatment. Such cases, if done, usually land up in litigation. So, it is better to refuse
to treat child altogether. I know that you have sympathy toward child but it should not over-ride
your own safety and reputation.
Medico-Legal Tip of the day- 20th August 2015
Query- Can I file a suit for defamation when I win a case of compensation filed in a
district consumer court by a notorious patient having malafied intentions.
Regards
Dr Mohd Iqbal, Orthopedic Surgeon
Answer- Please note that in CPA Act there is provision of awarding compensation if
judge finds that the complaint was false, frivolous and unjust. Rs 10000 can be awarded
against petitioner.
Defamation is at present a criminal offence and its status is being challenged in
Supreme Court. (Please see Gadkari vs. Arvind Kejariwal Case). Defamation cases are
tough to prove and last long. But legally speaking, you can file a case. Most important in
these cases is malafied intention to prove. They are governed by Law of Torts.
Medico-Legal Tip of the day- 19th August 2015
Query-if a female of 25 years with 9 month pregnancy, brought dead to peripheral govt
hospital, what are the rules about post-mortem examination?
Who can carry out the PM exam?
When there are no previous complaints of any illness, no specific history available, any need to
refer body to forensic experts at higher centre?
Answer- Female of 25 years with 9 months pregnancy if brought dead to hospital should be
made MLC and police should be informed. A medico-legal post-mortem is must. A Gynecologist
& obstetrician must be co-opted as member of team. It is preferable that post –mortem
examination is done by a board of doctors including forensic expert.
If cause of death is not ascertained by PM examination, it should be referred to higher centre for
higher forensic expertise. In each state, a referral centre is there duly notified by govt.
Medico-Legal Tip of the day- 18th August 2015
Query- A Road-Traffic-Accident case was referred and admitted to my hospital and sent for xray examination of thigh and leg with a note on referral form as "OUT-SIDE-MLC'; case.
1-Should the x-ray examination be done as MLC and thumb impression and mark of
identification of the patient fixed/noted on the radiographs and the report or can it be done as
non-MLC patient/
2- Should the radiographs and report be safely kept in the x-ray dept for court cases in future or
can these be given to the patient/attendant on discharge?
3- If x-ray examination of MLC is done in hospital after my working hours and in my absence,
who will attest thumb impression and note the mark of identification of the patient on the
radiographs and reports? Can the x-ray technician doing the -x-ray take RTI/LTI and mark of
identification on the radiograph and report?
Please clarify the responsibility of the reporting radiologist in such OUT-SIDE MLC and a
regular MLC and what radiological procedure is to be followed for x-ray examination and
reporting in both situations.
Thanks
(Dr.) Ashok K. Wadhwa
Senior Consultant & HOD – Radiology
Answer- Please note that out-side MLC means that MLC has been made at first hospital and
then patient was referred to you. In that case, there is no need to make fresh MLC, on MLC
register write MLC number and reference of hospital. But since this case is MLC in nature, it
has to be treated as MLC while giving treatment. It means that all x-rays should be labeled as
MLC. X-ray requisition form should have signature and thumb impression of patient which can
be taken by x-ray technician but attested by radiologist. All x-rays must be preserved for 10
years. All x-rays must be reported only by radiologist.
Even after duty hours of radiologist, formalities can be completed by x-ray technicians. In case
of RTI, a copy of x-rays can be given to patient on chargeable basis but a copy must be kept in
hospital records. In some hospitals like AIIMS New Delhi, MLC x-rays are handed over to
police when they come to collect original MLC.
Medico-Legal Tip of the day- 17th August 2015
Query - I would be grateful if you could answer my below 2 questions.
1) What are our duties & responsibilities/ implications while issuing a medical
certificate? We get lots of requests to issue certificates to near & dear ones for obliging
them (back pain, ankle sprain etc), so that they may apply for leaves etc in their place of
work. In most instances it is a word of mouth, background checks are impossible to do.
2) In several orthopedic surgeries, persons with a non medical background like implant
company representatives’ scrub up for facilitating surgical procedures. Sometimes we
have noted that non allopathic doctors with BAMS (Ayurvedic) background also scrub
up in surgeries & assist. How legal is all this?
(Name withheld)
Answer1. We should not issue certificates just to oblige our patients, friends and their relatives.
It can land doctor into serious problems as these certificates may be used in courts,
offices and schools where authorities may order re-medical examination. Doctor can be
fined and even sent to jail for giving false certificates. Medical council can erase name
too from medical register.
2. During surgery, if un-authorized or unqualified persons are present then it is against
ethics. In case of alleged negligence, onus will shift on surgeon to explain and it may be
counted as gross negligence