I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
I will respect the secrets, which are confided in me, even after the patient
has died;
I will maintain by all the means in my power, the honour of the noble
traditions of the medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or
social standing to intervene between my duty and my patients;
I will maintain the utmost respect for human life from its beginning even
under threat, and I will not use my medical knowledge contrary to the laws
of humanity;
I will make these promises solemnly, freely and upon honour.
Functions of the Medical Council
……….
Exercise and maintain discipline in the
practice of medicine with the assistance of its
Medical Disciplinary Tribunal
Establish a code of practice for the medical
profession on standards of professional
conduct and medical ethics and monitor
compliance with such a code
13.1-PRELIMINARY INVESTGATION BY
COUNCIL
“Subject to section18, the Council may investigate any complaint of -professional misconduct,
-Malpractice,
-Dishonesty or
-Negligence or
-A breach of the code of practice
against a registered person including a public officer in respect of whom
it holds a delegated power.
COMPLAINT RECEIVED AT COUNCIL
Possible fault on the part of M.P
•Medical practitioner not concerned
•No obvious fault of doctor
Preliminary Investigation
(I.C)(Section 13)
Council informed
Notify Doctor of the nature of
the complaint
Summon and hear doctor +/-complainant
Summon and hear witness
Call for documents
Judge in chambers(if refusal by a
person to give evidence or
communicate document on ground of
confidentiality
Set aside
Complainant informed
Evidence of fault of doctor
Section 14(1)
No prima facie evidence of fault of doctor
Section 14(2)
Charges drafted
Set aside
•Breach of code of •Prima facie evidence of
practice
negligence, incompetence
Inform
MDT
or grave misconduct
•Act of fraud,
dishonesty,
•Public interest requires that Report to Council not >14
negligence
the registered person should days after completion of
•Act of professional instantly cease to practice proceedings
medicine
misconduct or
malpractice
•Any other act likely
to bring the medical
profession into
disrepute
doctor & complainant
Suspend for not > 6
mths
Cont/d
Private
Disciplinary Proceedings
•Show cause
•Warning/severe warning
Inform doctor & complainant
Public officer
(+delegation of power)
Report to PSC
for decision on
suspension
D Proceedings cont/d
17(3)
Charges not proven
•Charges proven
•Aggravating/alleviating circumstance
Set Aside
17(4)a
Public Officer
(+delegated power)
17(4) b
Every Other Case
•Warning/severe warning
•Reprimand/severe reprimand
Report to PSC
•Suspension from medical
practice for not>12 months
•Removal of name from register
Inform doctor & complainant
17(5)
Punishment (Dismissal or Retirement) by PSC
COUNCIL
Removal of name from the Register
•Decision under 17(4) or (5): inform doctor within
14 days
Section 18
CONVICTION OF REGISTERED PERSON
Show Cause
Punishment as per 17(4) (b)
Section 19
Summary Proceedings (Minor Fault)
Show Cause
Warning/Severe Warning
Preliminary Investigation – Evidence based -Accepted practice
- Literature
- Expert opinion
- Written explanations/interview of defendant
doctor
- Interview of complainant party
- Documents: patient file, Investigations
Deliberations at Council - Views of full board
- Composition of Council
-Doctors :public/private
:General practitioner/specialist
-Nominated members (non-medical)
-1 Rep. each from PMO,MOH,SLO
-vote ± casting vote of Chairman
Sanction- Show cause
Judicial review – aggrieved parties.
•Presided by
Judge + 2 senior
medical
practitioners
No fault of doctor
Doctor at fault
Set aside
Show cause
Doctor+complainant
informed
MDT
•Evidence based
•Hearing of parties
+ witnesses
Sanction
COUNCIL
•Defence lawyers
Deliberations + determination
Charge not proven
Set aside
Charge proven
Show cause
MOH/PSC
(Public officer)
Sanction
Parties informed
Parties Informed
• Malpractice
Medical Council Act: “includes a failure to
exercise due professional skill or care, which
results in injury to or loss of life of a
person”.
•Medical Negligence
Medical Council Act: “includes failure on the part
of a registered person to exercise the proper and timely
care expected from a registered person”.
Act of Omission
Act of Commission
To succeed in a claim for negligence, a
plaintiff patient must prove, on a balance of
probabilities,
The following:
The defendant doctor owed him a duty of care
The defendant doctor breached that duty by failing to
exercise the necessary level of care
Harm and injury was caused by that breach and
He suffered damages which was not too remote ( i.e. it
was foreseeable by the doctor)
“But for” test for proving causation.
“ A doctor is not negligent if he has conformed
with responsible professional practices”.
A G.P must meet the standards of a
competent G.P
A Consultant Gynaecologist must meet
the standard of a competent consultant in
that speciality

A common practice might be declared not to be
rightly accepted: (common professional
practices might be wrong)

The judiciary find it acceptable to challenge
medical opinion, but only when the latter has no
rational basis.

There may be circumstances where the
provision of information will be “ so obviously
necessary to an informed choice that no prudent
medical men would fail to make it”.
“the
facts speak for themselves”
can help a patient in situations where
he cannot specify what exactly caused
the injury.

the doctor has to establish his
innocence, rather than the patient having
to prove the doctor’s guilt.


“take your victim as you find him”
the doctor is liable for all damages even if the damages
are more serious because of the patient’s pre-existing
illness or condition.




Failure in regard to the contractual obligations by
a doctor when he agreed to treat a person.
Burden of proving negligence and damage on a
balance of probabilities lies with the patient
plaintiff.
A medical accident can be compensated but not the
natural development of an illness.
Claims for compensation may be based on:
- the tort of negligence
- tresspass to the person and battery; or
- breach of contract

Arises in case of death or serious injury to a
patient.

The degree of negligence must be so grave as
to go beyond a matter of compensation.

The doctor may be prosecuted by police or
charged in a criminal court for culpable
homicide.

Concurrent negligence by the patient and
the doctor, resulting in delayed recovery or
harm to the patient.

Defence for the doctor in civil cases.

Burden of proof on doctor.

Liability of the master (employer) inspite of absence of blame
worthy conduct on his part.

Negligence

Employer responsible for negligent acts of his servants.

Within the scope of his employment/range of services.

Tort of occupier’s liability (e.g. visitor injured on hospital grounds).


The assailant is responsible for all the consequences of
his assault – the immediate and remote – which link the
injury to death.
! Breach in continuity of events by entirely new and
unexpected happening (not reasonably foreseeable).
Doctor
Patient
Non- medical staff
Institution
(Employer)
Doctor
:
:Time factor, workload (no. of patients)
Fatigue – lack of concentration
Experience / competence
Referral to specialists (specialized centres)
Financial
Medical certificate
Easy money – illegal abortions
Monitoring &Follow up
Other Doctors
Reports-Histopath,X-ray
Withholding information
Patient
Institution (Employer)
CONTRIBUTORY NEGLIGENCE
Not following doctors’instruction
Vicarious Responsibility
Understaffing
Equipment
Nursing
X-Monitoring
Others
X-Execution of
doctor’s orders
Unavailability/Faulty
Essential/Emergency drugs
Non Medical Staff
Laboratory technician-lab. Errors, delays
Professional relationship between colleagues
Making disparaging comments about colleagues( in front of other
colleagues, staff, patient party).
Taking over a patient under care of another colleague without prior
information to the latter.
Proper referral of patients to other colleagues.
Sharing of medical knowledge/new technologies + assistance to
colleagues.
“Overcharging” of patients.
During surgery/anesthesia, e.g. monitoring
Esp. after surgery/intervention
Instructions/orders not executed properly
Availability of treating doctor
Postoperative complications
Anaphylactic shock
Handing over to other colleagues in case of unavailability
Deficiencies in nursing care-monitoring of head injured patient
-delay in executing instructions
Patient smelling alcohol:
injured patient
May mask certain signs in head-
Wrongly tagging as alcoholic without excluding other diagnosis
Follow up, monitoring + management of critically ill-patient
especially in ICU
Too many patients in casualty
Rationale for request
Not seeing results of URGENT INVESTIGATIONS
Unnecessary delay in requesting special
investigations, e.g. CT scan
Use of decorative letter head
Over description of doctor’s
qualities /competence (publicity)
Handwriting – wrong dispensing
Explaining to patient
Perception of indiscriminate prescription /
over prescription of certain drugs (e.g.
steroids) in chikungunya
Gastric perforation (in patient of chikungunya)
Death certificate issue
Without examining corpse
Cause of death (true?)
Use of abbreviations
Time of death
Requirements of Medical Council Act
Date of examination
Full name and address of the patient
Registered name and address of the RMP
Signature of the RMP
Cases: Backdating and postdating
diagnosis (?confidentiality)
Not confirming identity of patient (patient in police custody)
e.g.. Blood transfusion form –Identity of patient
- Degree of urgency/when needed
- X-match/type & screening
- type of products and quantity
Doctor-Doctor
Patient
Non Medical Staff
Scanty/ no clinical notes
Name of doctor
Date and time of examination, diagnosis/D.D
Pre operative status
Treatment/Operation notes
Progress
Investigations/Monitoring
Handwriting-wrong dispensing
Use of Abbreviations (CST,ISQ, ADS)
“If it isn’t written, it wasn’t done”
Four most frequent themes in case
of a bad outcome:
1. Believe your monitors!
2. Record keeping
3. Surgical team agreeing as to what occured
(Avoid rushing to condemn)
4. Communicate with patient before and
after
Flow Chest ( common surgical accidents leading to Medical
malpractice Suits
Blood Transfusion Mistakes
Wrong Patient
Wrong Side of the Body
Paralysis from Splints
Medical
Surgery on wrong Digits
Practitioner
Failure to X-ray Fractures
Tight Plaster Casts
Anaesthetic Mishaps
Surgical Errors
(e.g. ligation of ducts)
Retained Objects
Removal of Wrong
Organ
Good-Proper-Adequate……?
Questioning-Listening-Responding-Explaining
Precautions to comply with:
Disclose information only to the proper person
or authority
Preserve confidences as far as possible (avoid
idle conversation about patients, use “aliases”)
Do not disclose beyond what is required by the
law and the situation
Document in patient’s record the reasons for
and circumstances of the disclosure.
Situations where it is ethically and
legally required to reveal information:
When the patient consents
To medical colleagues
As a statutory duty (Re: Infectious diseases)
As information to relatives
In the interest of research projects
In disclosure to court
In the discovery of documents in court
proceedings
In the public’s interest
INFORMED CONSENT1 (BRAND)
Benefits of treatment
Risks of treatment
Alternatives (other treatment options)
No treatment (risks of)
Documentation + signature(patient, doctor,
independent witness)
 Material Risk
 The “Prudent Patient” Test
 Therapeutic Priviledge
Battery/Tresspass
INFORMED CONSENT2 based on information about:
The name of the operation
The nature of the proposed treatment
What the operation involves
The potential complications
The special precautions required postoperatively
The limitations of treatment
The success rate of the operation
How the patient will feel after treatment
What happens on admission

Respect for patient’s autonomy (self
determination)

Non-maleficence (the duty to do no harm)

Beneficence (contribute to patient’s welfare).

Justice (equitable distribution of benefits and
burden).

Fidelity (truthfulness and medical confidentiality).

Veracity (honesty).
Concerned with the conventional laws and
customs of courtesy which are generally
followed between members of the same
profession.
A doctor should behave with his colleagues
as he would like to have them behave with
him.
Concerned with moral principles for members of
the medical profession in their dealings with each
other, their patients, and the state.
AIM: to honour and maintain the noble
traditions of the medical profession