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MEDICAL PRACTITIONER AND CONSUMER PROTECTION

In nothing do men more nearly approach


the gods than in giving health to men.

~Cicero

OVERVIEW
1. How to avoid litigations ; and 2. Defenses for Civil and Criminal Suits.

INTRODUCTION The Doctor patient relationship in our country has undergone a sea change in the last decade and a half. We witness today a fast pace of commercialization and globalization on all spheres of life and the medical profession is no

exception to these phenomena. As a result, the doctor-patients


relationship has deteriorated considerably. Earlier too, doctors were covered by various laws, i.e. the Law of Torts, IPC etc., but

since the passing of the Consumer Protection Act in 1986,


litigation against doctors is on the increase.

MANAGEMENT- HOW TO AVOID LITIGATION

1. PREVENTION AT PERSONAL LEVEL 2. PREVENTION AT PRACTICE 3. PREVENTION BY PROFESSIONAL INDEMNITY 4. PREVENTION BY PEOPLE SUPPORT GROUPS

PREVENTION AT PERSONAL LEVEL

1. Signboards and Advertisements should mention actual facilities available; 2. Prescription head of the doctors should contain the qualification of the doctor 3. Refrain from claims of guarantee of results;
3. Answer all queries of patient/relatives without getting

irritated;

4. Training should be imparted to staff about dealing


with patients/relatives under stress;

5. Always update yourself and staff with academic sessions; workshops; and CMEs.

6. Always ask patients/relatives for feed back on your services, staff ,charges as well as hospital set up.

MANAGERIAL PRACTICE
1. Always exercise reasonable skill and care with

equivalent qualification and experience in similar


circumstances; 2. Exhibit reasonable skill and care to patients, attendants, relatives through expression, body

language, action and discussion; 3. Make good clinical notes of findings on examination and treatment given;

4.

Where failure to follow instruction, refusal for any investigation and failure to come for reviews on specific dates should always be recorded;

5. Make sure handwriting is legible.

PREVENTION BY PROFESSIONAL INDEMNITY

1. Professional indemnity is a tool which not only meets the claim of compensation awarded against the doctor/ hospital but also gives security if negligence is proved in a Court of law; 2. Insurance companies not only compensate the third party claims, but also provide legal aid to hospitals/ doctors;

3. Money paid as compensation is very important, but also the reputation of the doctor, hospital is at stake.

PREVENTION BY PEOPLE SUPPORT GROUPS

1. Forming societies to fight fraudulent claims nor only provide

security , but regular fellowship prohibit doctors from


speaking foul about their colleagues;

2. These forums discuss various provisions of the Acts, cases fought and lessons to be learned;

3. These to a certain extent can also act as a pressure group on dissatisfied patients

PRECAUTIONARY MEASURE

DOCTORS RESPONSIBILITY
1. Mention qualification, training, experience and designation on prescription;

2. Date and time of consultation;

3. Mention age, sex and weight of patient; 4. Listen attentively, look carefully and ask questions; 5. Always ask for patient/attendant to repeat history of patient;

7. Ask patient to come for review next day if you are not sure about the diagnosis;

8.

Mention Diagnosis Under Review until diagnosis is final;

9. In complicated cases mention history of illness and


substantial physical findings on prescription;

10. If patient is erring on any count, make a note of it;

PATIENTS HISTORY
1.

Mention condition of patient;

2. Record history of drug allergy; 3. Describe the name of drug and dosage; 4. If drug is poisonous warning should be written;

5. Give instructions in comprehensive terms;


6. Mention side-effects if any and action to be taken if they

occur;

7.Remember to advise in writing pathological, radiological

tests at specific intervals for certain drugs which require monitoring;

8. Always advice the patient not to stop taking the


medication suddenly;

9. Adjust dosage in case of child, elderly patient, in renal or hepatic disorder

DIAGNOSTIC MEASURE

1. Incase of chronic ailment mention treatment to be taken


immediately in case of emergency; 2. Mention prognosis explained, if necessary take signature of patient/ attendant; 3. If you are not sure what disease a patient has always get a consultation; 4. Provide referring note when ever referring patient;

5. Update knowledge and skill from time to time;

7.

Employ qualified assistants;

8.

Always take a legally valid consent before undertaking surgical/diagnostic procedure;

9. Ask for routine x-ray and other check ups for proper
diagnosis.

SURGICAL MEASURE

1. In all instances of swab cases and instrument cases the surgeon in charge has been directly or vicariously held liable for negligence. So, always ensure post operative care to patients; 2. Always seek proper legal and medical advice before filing a reply to the complaint referred to you from a consumer court

KNOW YOUR INJECTION


1. Name of the injection; 2. Expiry date; 3. Re-confirm route of administration; 4. Rate of administration; 5. Site of injection; 6. Always use disposable syringes and needles;

7. Incase patient is agitated or non cooperating restrain


him or wait till he calms down;

HOW TO TACKLE MEDICAL CLAIMS

NOTICE
a. Do not panic, read the legal notice and understand the claims alleged; b. Verify the services your hospital provided with respect to the allegations alleged by the complainant; c. Notify your hospital as well as your insurance company about the legal notice issued; d. Carry all relevant documents when you approach a lawyer to seek legal advise. e. Explain the entire facts of the case so that the lawyer can guide you on how to reply to the legal notice. f. Reply to the legal notice issued after seeking guidance from a lawyer as soon as possible;

GENERAL DEFENCES
1. 2. 3. 4. The court does not have pecuniary/territorial jurisdiction. Complaint is time-barred. Complicate issues involved, required recording of evidence of experts, hence case should relegated to a civil court. Burden of proof of: (i) Duty of care; (ii) Breach of that duty; (iii) Causation; (iv) Damage, etc. is on the complainant. The complaints frivolous and vexations and liable to be dismissed under section 26 of the Act.

5.

ALLEGATIONS

1.

Civil Allegations

2. Criminal Allegation
[ Medical Negligence is both a Civil as well as Criminal Allegation]

CIVIL DEFENCES
1. Mention hospitals infrastructure facilities, special facilities, back-up support, it with documents.

2. Complainant has not come to the court with clean hands i.e. he has suppressed material facts, e.g. previous illness, treatment etc.
3. Inconsistence between notices sent directly or through consumer groups and the complaint made in the court.

CRIMINAL DEFENCES
1. Mention your qualifications, training, experience, expertise etc. Support with relevant documents. Written evidence of consent of the patient/relative/attendant to assumption of inherent and special risks in the treatment. Circumstances of the case; viz. There was emergency, lack of facilities (e.g. rural area) no one to give history of patients illness etc. Reasonable knowledge, skill and care exercised (Rely/quote standard text books with attested photocopies). Consolation/treatment by patient from other doctor/other systems of medicine simultaneously. Contributory negligence. 2.

3.

4.

5.

6.

Justice is conscience, not a personal conscience but the conscience of the whole of humanity. Those who clearly recognize the voice of their own conscience usually recognize also the voice of justice.

Alexander Solzhenitsyn

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