Pediatrician & MEDICAL
NEGLIGENCE
DR.JAYANT NAVARANGE
M.D.,D.C.H.,LL.B.
HON. PEDIATRICIAN,
DEENANATH HOSPITAL
SAHYADRI HOSPITAL
SHREEVATSA, SASSOON HOSPITAL CAMPUS
B.S.S.K.
HON.SECRETARY, MEDICO-LEGAL CELL, IMA
PUNE’S NEW BUILDING PROJECT & HOSPITAL
WING OF IMA, PUNE
VISITING
FACULTY, ILS
LAW COLLEGE
3/19/2016
7:09 AM
DR JRN
1
Pediatrician is answerable to

1. Medical Council
 2. Civil Court
 3. Consumer Forum
 4. Criminal courts
 5. Human rights, Info. Act, POCSO, BMW,
BNHRA, POCSO etc…
 Janata Darbar!!
3/19/2016 7:09 AM
DR JRN
2
Pediatric cases:

Pediatric age is from birth to 18yrs as per IAP.
(up to 19 yrs-AAP), in fact from fetal life! It’s a
developing creature—newborn Adulthood….
 Special problems 1. Cases through parents or guardian
 2. Consenting age- >18, but bet 7-12, court’s
discretion, 12-18—always take child’s consent
too
 3. Period of limitation counted after 18 yrs,
hence preserve documents for 21 yrs +
3/19/2016 7:09 AM
DR JRN
3
CPA: 1986

Easy procedure—lawyer NOT needed
 Practically, no stamp duty
 3 tier system
 Appeal system is peculiar
 Summary procedure
 Pecuniary jurisdiction
 Complicated cases to go for civil court
adjudication
3/19/2016 7:09 AM
DR JRN
4
MEDICAL NEGLIGENCE
DR MODY’S TEXTBOOK
 NEGLIGENCE=WANT OF REASONABLE
DEGREE OF CARE AND SKILL OR
WILLFULL NEGLIGENCE ON THE PART
OF DOCTOR IN TREATING A PATIENT
WITH WHOM A RELATIONSHIP OF
PROFESSIONAL ATTENDANT IS
ESTABLISHED, SO AS TO LEAD TO
BODILY(+) INJURY OR DEATH.


DAMAGE TO PERSON OR PROPERTY

Emotions,
Psychology,DR Reputation,
Financial etc5
3/19/2016
7:09 AM
JRN
MEDICAL NEGLIGENCE

CPA- S. 2(G)DEFICIENCY MEANS ANY
FAULT, IMPERFECTION, SHORTCOMING
OR INADEQUACY IN QUALITY, NATURE
AND MANNER OF PERFORMANCE
WHICH IS REQUIRED OR UNDERTAKEN
BY A PERSON BY CONTRACT OR
OTHERWISE IN RELATION TO ANY
SERVICE.
 DO NOT CLAIM SERVICES WHICH YOU
CANNOT PROVIDE! (e.g. 24 hours service etc.)
 DEFICIENCY HAS WIDER APPLICATION
THAN NEGLIGENCE
3/19/2016 7:09 AM
DR JRN
6
MEDICAL NEGLIGENCE
MEDICAL NEGLIGENCE: TORT(CIVIL) +
CRIMINAL + CONTRACTUAL
CLASSIFICATION:
1.RES IPSA LOQUITOR-i.e.GROSS-(may
amount to criminal)
2.SUBTLE-ACT OF OMISSION OR
COMMISSION-usually civil
3.CONTRIBUTORY
4. NON-NEGLIGENCE
3/19/2016 7:09 AM
DR JRN
7
MEDICAL NEGLIGENCE

ESSENTIAL COMPONENTS: 1. ESTABLISHED DOCTOR PATIENT
RELATIONSHIP
 2. ACT OF OMISSION/COMMISSSION
OR
RES IPSA LOQUITIR
 3. TEST OF PRUDENCY-Bolam’s
principle/test--HOW ANOTHER DOCTOR WOULD
HAVE ACTED IN SIMILAR SITUATION-COMPARISON
WITH AVERAGE PRUDENT DOCTOR

4. DAMAGE MUST HAVE RESULTED AS
A DIRECT CONSEQUENCE OF THAT ACT, which
itself must be proximate in time..Nexus
3/19/2016 7:09 AM
DR JRN
8
MEDICAL NEGLIGENCE

WHAT IS NEGLIGENCE? S.C.,1969 in Dr
L.B.Joshi v T.B.Godbole has defined as follows
 A person who holds himself ready to give
medical advice and treatment impliedly
undertakes that he possesses skill and
knowledge for the purpose. Such a person owes
his patients when consulted, certain duties, viz 1.A duty of care in deciding whether to
undertake the case
 2. A duty of care in deciding treatment
3/19/2016 7:09 AM
DR JRN
9
MEDICAL NEGLIGENCE
3. A duty of care in administering that treatment
[ BREACH OF CONFIDENTIALITY may be=>Negli.] [NOT
MAINTAINING RECORDS=>Deficiency/Negli.]

ANY BREACH OF ANY OF THESE DUTIES
BECOMES ACTIONABLE (IF THE BREACH
RESULTS IN DAMAGE– PHYSICAL / MENTAL/
EMOTIONAL / ECONOMICAL)

NEITHER THE VERY HIGHEST NOR VERY LOW DEGREE OF
SKILL/COMPETANCE IS EXPECTED-S.C.-BOLAM v FRIERN
HOSPITAL COMMIITTEE,1957 McNAIR; HEWART
MORE THE EXPERTISE CLAIMED, MORE IS EXPECTED!—
[Charlesworth and Percy](Smt Saroj Chandhoke vs Sir Gangaram
Hospital—NC-OCT 2007)


CARE AND NOT CURE IS EXPECTED BY LAW-J.
3/19/2016 7:09 AM
DR JRN
10
TINDALL
MEDICAL NEGLIGENCE
2. GROSS NEGLIGENCE IN SUCH CASES, THERE IS NO NEED FOR
ELABORATE ARGUMENTS- THE THINGS
SPEAK FOR THEMSELVES, e.g.
AMPUTATING WRONG LIMB; O.T.WITHOUT
FUNCTIONAL SUCTION; O2;CROSSPATHY(NEGLIGENCE PER SE); LEAVING
SWAB IN WOUND; Incubator burns(Saren
hospital v Palwinder Singh, Sept 2007, NC)
ETC.
 RASH, RECKLESS ACTS
 VERY DIFFICULT TO DEFEND
3/19/2016 7:09 AM
DR JRN
11
MEDICAL NEGLIGENCE
– Street (1983) Test of res ipsa:
– Where an unexplained accident occurs from a thing
under control of defendant and medical or other
expert evidence shows that such accident surely
won’t occur if due care is used, it is negligence
– P.M. Ashwin vs Manipal Hospital—
Karnataka,C192/1993, decided 18-11-96: Hot water
bag under feet of 2 mo old infant’s inguinal hernia
surgery->burns of 3rd degree-5 lacs awarded against
Ped Surgeon, Anesthetist and Hospital.
– Nurse etc freed-Vicarious liability
3/19/2016 7:09 AM
DR JRN
12
MEDICAL NEGLIGENCE
2. GROSS NEGLIGENCE-Continued:New dimensions->
Failure to make or keep records Not keeping records amounts to gross negligence (res ipsa
loquitur)-National Commission(Dr Gangavardhan v/s K A
Abdul Salem, Kerala, July ’04 CTJ, p 688)Presumption in
such case is-if records would have been produced, would go
against doctor and hospital!
 Consent-Documents: Not informing details of diagnosisassessment, treatment/procedures, alt. methods, likely
outcome etc.
Dr Shyam Kumar vs Rameshbhai H
Kachhiya, NCDRC-CTJ Jan 2007 (Glaucoma
-operated thrice-lost BE vision)It must be written consent as
observed in Saroj Chandhoke v Sir Ganga Ram, NC
Oct.07—consent
for abd. Hysterctomy—vg
done—liable++
3/19/2016 7:09 AM
DR JRN
13
MEDICAL NEGLIGENCE

3.ACT OF OMISSION:
e.g. NOT DOING
BASIC INVESTIGATIONS FOR F.U.O., not
performing LSCS FOR PRIMI WITH BREECH
 Dr.Louie v K.PathummaLady in labour with
PROM and on Syntocinon was left
unattendedrupture uterus –death, held
negligent.
A LOT OF DELIBERATIONS AND PRODUCTION
OF EVIDENCE NEEDED---JUDICIAL
DISCRETION HAS A BIG ROLE
3/19/2016 7:09 AM
DR JRN
14
MEDICAL NEGLIGENCE

4.ACT OF COMMISSION:
e.g. Giving ß-blocker to an asthmatic; Radical
mastectomy without histo-pathological evidence;
Steroids in AGN etc.
Leaving foreign body inside,as in RBKabdi v Dr RT
Kulkarni; Nihal Kaul v PGI Chandigarh etc.(here, it was
discovered in ashes after cremation-held negligent)
Act of omission & commission are 2 sides of same coin---
Here too, detailed evidence is needed to be presented
by either side to prove allegations or innocence.
Judicial
has DRa JRN
big role
3/19/2016 7:09 discretion
AM
15
MEDICAL NEGLIGENCE
5. NEXUS IN THE ACT AND DAMAGE:
 THE ALLEGED DAMAGE MUST HAVE
RESULTED AS A DIRECT CONSEQUENCE
OF NEGLLIGENT ACT- AFTER THE
PATIENT WAS DISCHARGED FOLLOWING
SURGERY, SOME UNFORESEEN
COMPLICATIONDEATH- HELD, NO
NEGLIGENCE (VENKATAPPA v Dr Shallikeri,
1995, KARNATAKA)

IF NEGLIGENCE, BUT NO DAMAGE,IT IS
CONSTRUED AS NON-NEGLIGENCE
3/19/2016 7:09 AM
DR JRN
16
MEDICAL NEGLIGENCE
 CONTRIBUTORY
NEGLIGENCE:
PATIENT DOES NOT COMPLY WITH
INSTRUCTIONS-HE IS PARTLY OR
WHOLLY RESPONSIBLE FOR
DAMAGE-e.g.MD.ASLAM v IDEAL HOSPITAL,


ORISSA,1994—PATIENT ATE HEAVY FOOD AND HAD
LOT OF VISITORS->WOUND INF. & BURST ABDOMEN.>DEATH-NON-COMPLIANCE:HENCE NO NEGLIGENCE
AN ADVOCATE COMPLAINED ABOUT WRONG
DISPENSING BY CHEMIST AND INJ.BY THE DOCTOR—
ADVOCAE SHOULD HAVE READ IT!-HARI MOHAN CO.v
K.PANDEY,BIHAR,1994
Nathuram Dhaka vs Jaipur Hospital—Ortho—nail—no follow
up
by patient—SC,Rajasthan—Sept.2007CTJ
3/19/2016 7:09 AM
DR JRN
17
Criminal v Civil Negligence
SR.
No.
CRIMINAL
*Do NOT fear arrest*
CI VIL-incl. Consumer
*Do not worry about practice,
adverse publicity*
1
Police (govt.) is a necessary party– of
course private criminal is possible
It is between private party and may be
Govt. is a party
2
Insurance, vicarious liability principles
are NOT applicable
Insurance, vicarious liability
principles are applicable
3
No period of limitation
Period of limitation, 2 or 3 yrs
4
Aim: Deterrent, Punitive
Aim: Compensation
5
Establishes wrong doer
Establishes rights
6.
S.304 A2 of IPC saves doctors to a great
extent
Strictest proof beyond doubt needed
No such need for civil, but needed for
consumer
Proof of probability is enough
7
Saturday, March 19,
REMEMBER S. 304A HELPS DOCTORS—HAVE THE JUDGMENTS ON COMPUTER…
2016
MEDICAL NEGLIGENCE

**BURDEN OR ONUS OF PROOF:
 IT RESTS ON THE COMPLAINANT AND
HAS TO PROVE WITH FACTS,
SUPPORTING DOCUMENTS AND
EXPERT EVIDENCE

**THE POSITION REVERTS IN
SITUATIONS LIKE O.T./ICCU WHERE
PATIENT HAS NO ACCESS-i.e. DOCTOR
HAS TO PROVE HIS INNOCENCE ; & SO IS
THE CASE WITH RES IPSA –Savita Garg v
National Heart Institute, SC 2004
 TEXT BOOKS; JOURNALS; AFFIDAVITS…
3/19/2016 7:09 AM
DR JRN
19
MEDICAL NEGLIGENCE

NON-NEGLIGENCE-

A> DIFFERENCE OF OPINION
B> WRONG RESULT DESPITE DUE
CARE, SKILL AND DILIGENCE
C>ONE OF THE 2 OR MORE STANDARD
METHODS OF TREATMENT WAS
FOLLOWED(Subramanyam v Dr
Krishna-Sangstaken tube/sclerotherapy,1993)
D> NEW MEDICINE/THERAPY GIVEN
AFTER FULL FORMALITIES
E>FEES( Dr Bhattacharya’s appeal)




3/19/2016 7:09 AM
DR JRN
20
Pediatric cases:

1.Total free hospital: B.C. Joshi v Dr. Sandeep Kumarc-16 0f 02, N. Delhi, 2002— Only such facilities are
exempt. Beware charity/trust hospitals. Govt.
Hospitals NOT exempt in majority of situations
 2. Check jurisdiction: Deepak Behl v Dr Narendra
Rege-Maharashtra, 1999. Case treated in Mumbai and
defendant doctor in Mumbai—district forum, Nashik
wrongly entertained the case-Ped Orthopedic case
 3. Check limitation period: Lalluram Mena v Dr S.
Mathur, Rajasthan, c-69/1999, decided 16-11-2000Neoneatal jaundice-kernicterus. Frivolous complaint +
time-barred. Contributory negligence. Patient fined!
 Time limit is 2 yrs in CPA and 3 yrs in Civil.
3/19/2016 7:09 AM
DR JRN
21
Pediatric cases:

4.Substitute medicine by hospital pharmacy + Not
checked by resident—Deepak Gokarna v Mahant
Gurumukh Charitable hospital-c-191/1994,
decided 2002. Instead of Monocef, Omnatex was
given, 1 gm iv stat for a 4 yr old boy having
tonsillitis; IV fluids showed reactions: taken as
gross negligence. Rs 10,000 awarded

5. Appeal sos: Maharashtra, appeal 949/1999
 Dr Mrs Bhatambre v baby Kolpe: Septicemia and
Malaria. (Jaundice) Distirct forum went against
doctor-reversed by State forum. Now , you have to
deposit amount and appeal within 1 mo.
3/19/2016 7:09 AM
DR JRN
22
Pediatric cases:

6. Dr. Rakesh Jain v Rakesh Kumar Khare-MP2001,decided 20-8-2002
Neonatal hyperbilirubinema-13mg at 1 day to 40 mg
on D5->Kernicterus. 4.75 lacs compensation.
Ref.:Meherban Singh: up to 1mg/100 gms wt is
normal!
7. Jayendra Pandya v Dr. Lalit Trivedi C-84/1993
decided 1996-Gujrat:Measles diagnosed instead of
SJS—1 day delay in diagnosis-Pediatrician finedGP, hospital, eye specialist etc acquitted. Not
suspecting a serious ailment by specialist not
pardoned!
3/19/2016 7:09 AM
DR JRN
23
Pediatric cases:

8. Pravinbhai Khubchandani v Dr Rajendra Sah,
Gujrat-C-231/1993, decided in Nov 1997:
Bronchiloitis baby left for monitoring to
incapable and unqualified doctor—Rs
1,00,000/- awarded
 So friends, cases are many! Be prepared!
Forewarned is better prepared!
 In Pune,case of 1.5 crores against Pediatrician. 6.5
crores against Neuro-surgeon and in Kolkata,
77.77crores against skin specialist Dr. Mukharji.
These all are leading doctors!
3/19/2016 7:09 AM
DR JRN
24
Pediatric cases;

9.Antenatal diagnosis—In a case against Dr . I.C.
Verma from AIIMS, the fetal diagnosis of a 2nd
gestation was +ve for Thal. Major in AIIMS and –ve
in UK. Hence the fetus was allowed to go to term—at
4 mo proved to be Thal. Major-National commission
awarded full medical support all thro’ life, though No
negligence was proved!Similar 2 more decisions (on
compassionate ground)
 GOVT HOSPITALS NOT EXEMPT FROM CPA
 10. Newborn given Nalidixic acid for diarrhoea on
day4—alleged cause of seizures—prescribed by
gynecologist—Cross-speciality
3/19/2016 7:09 AM
DR JRN
25
M. Mathew v. Director, Karuna Hospital
1998 (1) CPJ 476:1998 (1) CPR 39 Kerla
SCDRC
8½ years old son had fever and tonsillitis. On
advise of pediatrician, staff nurse gave injection
paracetamol on left buttock. Boy developed foot
drop. Neurologist diagnosed sciatic nerve palsy.
Dr. Lucy Jacob, pediatrician said this was
accepted complication. Staff nurse was
unqualified. So not qualified to administer injection.
.
Actionable negligence. Hospital liable. Awarded 1.06
3/19/2016 7:09 AM
DR JRN
26
lakh





TAKE CARE OF I V LINES:
IV CANULA CAUSING DEVELOPMENT Of
GANGRENE & AMPUTATION
Shivaji Gendeo Chavan v. Chief Director,
Wanless Hosp
1995 (3) CPJ 43 Maharashtra SCDRC
18 yr old son admitted for CRF. Advised kidney
replacement.-till then, Venous catheter in right
thigh for regular dialysis. Lack of care caused
infection in A V fistula-> Gangrene-> Leg
amputated. Died 20 days later. Expert doctor’s
witness submitted by patient. Awarded 2 lakhs
3/19/2016 7:09 AM
DR JRN
27
Pediatric cases: Lessons

Known complications:
 Dipti Sarkar v Sam-1993-Orissa Neuroparalytic reaction to ARV—proper
ICU Rx given-patient died—Held NonNegligent,
 Non-anticipation of a common complication
and failure to treat => Negligence
 Dr Shah v Dr.Mukharji-SJS case—claim of
77,77,77,550/-SC has directed to fix
compensation for negligence.Case pending
for finalising the amount
3/19/2016 7:09 AM
DR JRN
28
Pediatric cases: Lessons

KG Sangavi v Chatrabhuj Hospital—Guj-1998:
 Fever with Jaundice—Rx for Falciparum
also given, though not proved—patient
died. Text book reference shown that
antimalarials in jaundice do not kill pateint.
Hence, no negligence.
 TapanKr Nayak v Orissa State-Fever with
seizures followed DPT. Later MR, CP.
Alleged, all due to DPT. Proved that MR
must have been pre-existent. Nonnegligence.
3/19/2016 7:09 AM
DR JRN
29
Pediatric cases: Lessons

M.Parimana v Dr. CP Jagannath-TN-1998 Complainant’s son diagnosed as “rabies” on
clinical grounds—no path. Confirmatory
test. OK-No Negligence
 Law permits logical diagnosis and diagnosis
by exclusions of diseases based on history
and clinical examination. However,
whenever possible, have proofs too!
3/19/2016 7:09 AM
DR JRN
30
POCSO--Health Professionals

1. Recognise signs of sexual violence in a child
victim.
 2. Report cases of sexual violence against
children.
 3. Know the legal procedures in cases of sexual
 violence against children.
 4. Know and respect the rights of children.
 5. Keep in mind the best interests of the child
while conducting a medical examination.
 S.19-21 Doctor faces jail (6-12 months)/fine for
3/19/2016 7:09 AM
DR JRN
31
failure
to inform police…
MEDICAL NEGLIGENCE

Quackery:
 Unqualified person knowingly transgressing the
limits—it is a crime under IPC—it is never taken
as acts in “good faith”.
 Crosspathy-Dr. Ashwin Patel vs Poonam Verma
(SC1994), cross-speciality or unqualified persons
giving treatment
 LSCS done by a qualified surgeon and not
gynecologist taken as quack—G Sukumar v Dr
Bodiga—3 lacs awarded—Aug. 2007—SCDRC,
Andhra
Now, Bombay HC-2007- DMLTs not allowed to run
labs of their own.
3/19/2016 7:09 AM
DR JRN
32

MEDICAL NEGLIGENCE
LIABILITY IN DIAGNOSIS, TO
WARN OF INHERENT RISKS(of
course, not each and every one and the
remote one) & IN RESPECT OF
TREATMENT—inform about ROP for
preterm needing O2—1.8 crores/April
2015 for not informing for fundoscopy on
discharge…
A CONSULTANT IS NEGLIGENT WHEN
HE DELEGATES RESPONSIBILITY TO HIS
JUNIIOR WITH THE KNOWLEDGE
DR JRN
THAT HE IS INCAPABLE.
3/19/2016 7:09 AM
33
MEDICAL NEGLIGENCE










DEFENCES FOR DOCTOR:
1. MISTAKE OR MISADVENTURE
2. INHERENT RISK IN
MANAGEMENT
3. VOLUNTIA NON-FIT INJURIA (consent)
4. ACTS DONE IN GOOD FAITH
5. ACCIDENT
6. TAKEN ALL PRECAUTIONS
7. PERIOD OF LIMITATON—usually from
date of discharge(Oct 2007-NC-Saroj
Chandoke vs Sir Gangaram)
8. CONTRIBUTORY NEGLIGENCE
9. ERROR OF JUDGEMENT-NOT GROSS

10. ACTED
3/19/2016 7:09 AM
ADEQUATELY
AND ON SCIENTIFIC
DR JRN
FOOTING—Should be explainable logically
34
MEDICAL NEGLIGENCE

LORD DENNINGROE V MINISTRY OF
HEALTH: WE SHOULD BE DOING DISSERVICE TO SOCIETY IF WE WERE TO
IMPOSE LIABILITY FOR EVERY THING
THAT HAPPENS TO GO WRONG..
 WE SHOULD NOT JUDGE 1949 ACT WITH
1954 SPECTACLE!-The case of Xylocaine
ampoule crack .RETROSPECTIVE WISDOM!
 J.BERRRIE in Moore v Lewishan Group-if
there are 2 schools of treatment, adhering to 1
is not negligence.
3/19/2016 7:09 AM
DR JRN
35
MEDICAL NEGLIGENCE

VICARIOUS LIABILITY:

WHAT EVER IS DONE BY AGENTS,
SUBORDINATES, CONTRACTORS, EMPLYEES,
WHICH RESULTS IN INJURY TO PATIENT,
BECOMES LIABILITY OF DOCTOR+/HOSPITAL—RESPONDENT SUPERIOR IS THE
PRINCIPLE—HARJOT AHLUWALIA VS SPRING MEADOWS
HOSPITAL-2000(SC) Rs. 1,700,000/- awarded
LIABILITY EXISTS DESPITE ABSENCE OF
BLAMEWORTHY CONDUCT OF MASTER
Legal3/19/2016
principle:
RespondentDRSuperior
7:09 AM
JRN
36
MEDICAL NEGLIGENCE
VICARIOUS LIABILITY EXAMPLES:
 HARJYOT AHALUWALIA v SPRING
MEADOWS HOSPITAL, N. DELHI
CHILD GIVEN I.V.LARIAGO-BRAIN DEATHRs.17 LACS AWARDED
 K.K.RADHA v SEKHAR EVEN IF DR. IS
ONLY A PANEL DR., HOSPITAL IS
VIAIOUSLY LIABLE AS BILL AND
DISCHARGE CARD ISSUED BY HOSPITALNATIONAL COMMISSION,1997
3/19/2016 7:09 AM
DR JRN
37
MEDICAL NEGLIGENCE

SOME POINTS TO REMEMBER
 1. ALL CAN MAKE A MISTAKE-MOST
SENIOR & LEARNED CAN PROVE
NEGLIGENT
 2. IF YOU DIAGNOSE BRILLIANTLY, IT’S
YOUR DUTY-DON’T TAKE CREDIT-BUT
IF YOU COMMIT PALPABLE MISTAKE,
IT’S LIKELY TO BE NEGLIGENCE.
 IT MAY BE YOUR FIRST NEGLLIGENCE,
IT IS NEVER PARDONED, EVEN IF
INTENTION IS GOOD.
3/19/2016 7:09 AM
DR JRN
38
MEDICAL NEGLIGENCE

IF ONE TREATS HIS PATIENTS AS IF HE IS
TREATING HIS DEAR AND NEAR PERSON,
WITH LOVING CARE AND
SCIENTIFICALLY AND ADEQUATELY, IT IS
UNLIKELY, HE WILL PROVE NEGLIGENT,
PROVIDED DOCUMENTS ARE WELL
MAINTAINED.
 REVISE DIAGNOSIS IF NO RELIEF—
Additional opinions-but their must be collective
decisions and actions—Nandakishor Verma v
Batra Hospital-NC-Sept 2007
3/19/2016
MIND
7:09 AMYOUR BEHAVIOUR!
DR JRN
39






MEDICAL NEGLIGENCE
PREVENTION OF ALLEGATIONS:AATTENTITION; ADDITIONAL OPINION
BBEHAVIOUR; BILLS
CCOMMUNICATION; CONSENT(or denial);
COMPASSION; Consent for vaccines too.
DDOCUMENTS= YOUR FRIENDS/FOES!
EEXPERTISE; EFFICIENCY

I Indemnity Insurance-Adequately and
Continually; Check identity—KYC!
 Be careful of SJS, Dengue & H1N1 infection—
also TB—follow Govt. guidelines

Adverse media publicity cannot be avoided by and large
3/19/2016 7:09 AM
DR JRN
40
INSURANCE--INDEMNITY

Have a continued indemnity coverage of 40 lacs
and continue uninterruptedly at least 3 yrs after
you stop practice!
 Rate is 1.5Rs/1000 covered + ST—very low
premium and is deductible expense for your
income tax
 Keep the insurer informed of any problem
 Futuristic(?):1. Arbitration clause
 2 May be we ask patient to have his disease
pertaining mediclaim for each admission in
3/19/2016 7:09 AM
DR JRN
41
hospital
Crosspathy:

1. Poonam Verma V Dr Ashwin Patel-1996SC- MMC Act 1965- S2(d)Medical
practitioner must restrict to his pathy.
 2. Dr. S. N.Nambudri vs Haneefa—Kerala:
Appeal 533,662/1995, decided 14-5-1997 Hep B jaundice->coma->death. The
Ayurvedic doctor used both Allopathic and
Ayurvedic drugs
 + Under-investigations, that too from nonstandard lab=> Negligence +deficiency
3/19/2016 7:09 AM
DR JRN
42
Quackery:

Quack is a person who does not have
knowledge of a particular system of
medicine but practices in it. They are guilty
of NEGLIGENCE PER SE. It violates A21
of constitution of India-Right to life.
Inform them to Civil Surgeon of local area–
Punjab SC, 2000 in Avtar Sing Bhatora V
Dr Swaran P Garg
 Dr Baleshwar Prasad vs F D MahantJharkhand
 KM Balkrishnan V Padma Ayurveda
Vaidyashala for claiming medicines for
cancer
other cases!
3/19/2016
7:09 AM cure…And many
DR JRN
43
THANK YOU
3/19/2016 7:09 AM
DR JRN
44