It is a notice issued by the medical council drawing the attention of medical practitioners to some practices which will be considered unethical and punishable.
1. Association with unqualified Persons
2. Advertising
3. Adultery in a professional relationship
4. Abortion unlawful
5. Addiction
6. Alcohol
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Ethics on the Human experimentation:�
Basic Principle- No patient should be worse off as a result of the experiment than he might have been otherwise in the hands of a reasonable and competent medical man.
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Privileged communications:
A privileged communication is one which would have been defamatory and actionable, but is prevented from being so by reason of circumstances rebutting existence of malice.
When the physician has legal, moral, social duty to perform to make communication to another, such having a corresponding interest or duty in protecting of his interest or in performance of his duty.
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Physician responsibility in criminal matters�
Under section 176 & 202 IPC a physician is ordinarily supposed to inform police about any criminal act coming to his knowledge in his professional work.
But he is not legally bound.
When a suicide case is treated
Commission or intention to commit criminal abortion by his/her patient
But in case of death of such patients police must be informed
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Malpraxis (Professional Negligence)�
Failure to exercise reasonable degree of care and skill or wilful negligence of a medical practitioner in the treatment of a patient so as to lead to his bodily injury or death.
Negligence is omission to do something, which a reasonable man would do, or doing something, which a prudent and reasonable man would not do.
Doctor is not liable for honest mistakes or mere error of judgement in making diagnosis or prescribing a treatment.
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Black’s Medical Dictionary
Negligence:-
Conduct, whether of action or omission, which may�be declared and treated as negligence without any argument or proof as to the particular surrounding circumstances, either because it is in violation of a statute or valid municipal ordinance, or because it is�so palpably opposed to the dictates of common prudence that it can be said without hesitation or doubt that no careful person would have been guilty of it
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Professional Negligence
Onus of proving negligence lies with plaintiff
The injury must be directly traceable to the alleged want of due care and skill
Negligence unproductive of damage gives no right for action.
Bolan Test of Negligence
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Civil Negligence
Patient brings an action for damages in civil court against the physician.
Suit must be filed within 2 years from the date of alleged negligence
and once a decision is taken, the case cannot be reopened in any court.
Standard of care required varies according to the qualification of the physician, House surgeon, GP, Specialist.
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Criminal negligence
Is that conduct of the medical practitioner, which results in prosecution by the state in order to protect the community and punish the wrong doer
Sec.304A IPC who ever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide shall be punished with imprisonment up to 2 years or with fine or with both.
Some times charged with Sec.304 (Culpable homicide)
the act by which the death is caused is done with the intention of causing death, or causing such bodily injury as is likely to cause death - Imprisonment for life
the act is done with the knowledge that it is likely to cause death, but without any intention to cause death, or to cause such bodily injury as is likely to cause death – For 10 years
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Criminal negligence
Examples
Gross mismanagement of delivery especially under influence of alcohol or other narcotics.
Grossly incompetent administration of general anaesthetic
Administration of wrong substance in to eye causing loss of vision
Amputation of wrong limb or finger or operation on wrong patient or part
Leaving instruments or swabs in the body cavity during operation
Performing criminal abortion
Performing operation while drunk or drugged resulting in to death
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The doctrine of Res Ipsa Loquitur
The thing speaks for itself.
1) The nature of injury suggests by common knowledge or expert evidence that without negligence it does not occur.
2) The Plaintiff cannot contribute to his own injury.
3) The physician was in exclusive control of instrumentations.
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The doctrine of Res Ipsa Loquitur
Some Examples
Prescribing an overdose of medicine producing ill effect.
Giving poisonous medicine carelessly
Leaving cotton swab or instruments etc. in body cavities during operations
Prolonged splinting causing loss of use of limb.
Failure to give A.T.S. / Toxoid in cases injury
Burn from hot water bottles, X-ray etc.
Mismatched blood transfusion
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To Avoid Charge of Negligence
Keep pace with progress in science
Do not write non-academic degrees
Don't wrongly claim foreign training or specialist status
Restrict your practice to the field of training and level received
Not to promise cure
Advise hospitalisation in serious cases
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To Avoid Charge of Negligence
Do not prescribe treatment without Clinical examination
Confirm your diagnosis by investigation
Consult other colleagues in complicated cases.
Provide text book management
Condition of patient to be regularly recorded
Take informed consent from proper person before operation or special procedure
Prescribe cheap drugs unless indicated otherwise
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To Avoid Charge of Negligence
Anaesthesia- An accepted agent used after examining patient, his urine etc.
Personally verify record with the Patient before surgical procedure.
Advise immunisation against tetanus where ever indicated
Post operative care is his legal responsibility
Give timely warning in serious cases
Take medical liability insurance
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Contributory Negligence
It is the conduct on the part of the patient, which has helped to produce the harm of which complaint is made.
Physicians take this plea when they are charged for civil malpraxis.
This is no ground in criminal cases.
Burden of proof lies on the physician
Contributory negligence is taken into consideration by courts in awarding damage to the Plaintiff.
Contributory negligence must be concurrent with that of doctor’s negligent act to be a good defence.
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Duty of Patient
To submit to all customary and necessary physical examination and investigations
To exercise ordinary care in matter of co-operation with doctor.
To follow reasonable and necessary treatment
To continue such treatment for such time as may be reasonably required
To inform the doctor if there is any marked change in his condition, which may necessitate a change in treatment.
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Vicarious Responsibility (Liability for the Act of Another)
As a general rule a man is responsible for any wrongful act done by his agent or subordinate provided such act is within the reasonable scope of their employment by the principle of respondent superior (let the master answer)
The physician/Surgeon is charged for negligence even though he was not personally negligent and the damage to patient resulted due to negligence on the part of nurse/junior doctor/ paramedic / or medical student
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Vicarious Responsibility
Managers/ owners of hospital not responsible for negligence of superior medical staff like professors etc. if properly qualified persons were appointed. But responsible for negligence of junior medical personnel & paramedics
No responsibility for criminal acts or in criminal negligence cases to managers or the doctor.
Responsibility is only in civil negligence cases and also
Provided the act was committed in the presence of the doctor or with his consent.
Or though it was performed in his absence , the act was within the reasonable scope of duty of the negligent staff.
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Vicarious Responsibility
Liability of hospital management in regard to negligent acts of honorary visiting specialist is not settled.
Hospital is responsible for injuries self inflicted in mental cases as adequate precautions should have been taken by the hospital to prevent such injuries..
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Fiduciary duties
There is special relationship between the patient and the doctor and the doctor should not abuse any influence that he has over the patient.
Do things which harm the interest of the patient
Pairavi for others to the important patients like ministers.
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Consumer Protection Act (CPA) / (COPRA)�
Cases are filed without paying court fee
Legal procedure is informal
Does not apply to State/ Central Govt. hospitals
It does not apply to a doctor/ hospital providing Completely free service to all patients.
But it will apply if an individual patient was treated free.
Case can be filed against a doctor even if he was not negligent
Case can be filed even though there is no damage to the patient
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COPRA Courts & Their Powers
District Courts
Headed by a person of rank of District Judge
Claims are filed up to 50 Lac
State Court
Headed by a person of the rank of High Court Judge
Claims up to 2 Crore are filed
Court of appeal from decision of district court
National Court
Headed by a person of rank of Supreme Court Judge
Claim of more than 2 Crore
Court of appeal from state court decisions
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Consumer Courts
The remedy under the Consumer Protection Act is an alternative in addition to that already available to the aggrieved persons/consumers by way of civil suit. In the complaint/appeal/petition submitted under the Act, a consumer is not required to pay any court fees but only a nominal fee.
Decisions are to be given in time bound fashion
Proceedings are informal. The petitioner can argue his own case
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Criminal Laws with Medical Applications
Indian Evidence Act:
Sec 45 : Expert witness
Sec 46 : Refresh memory from text book
Code of Criminal Procedure:
Sec 53(1):Application of force in medical examination of accused
Sec 53(2): For females force can be used only by lady medical officer or in her presence
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Cr.P.C.
Sec. 174(1): Poilce Inquest carried out
Suicide, or killed by another or by an animal or by machinery or by an accident, or has died under suspicious circumstances
Sec. 174 (3): Dowry Death
Death within 7 years of marriage
Sec. 174 (4): Magistrate Inquest
By executive magistrates
Sec 291(1):Evidence once recorded accepted in subsequent proceedings
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Indian penal Code ( I.P.C.)
SECTIONS EMPOWERING DOCTORS
Sec 80-Nothing is an offence which is done by accident or misfortune, and without any criminal intention or knowledge, in the doing of a lawful act, in a lawful manner, by lawful means, and with proper care and caution.
Sec 81-Nothing is an offence merely by reason of its being done with the knowledge that it is likely to cause harm, ,if it be dome without any criminal intention to cause harm , and in good faith for the purpose of preventing or avoiding other harm to person or property.
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I.P.C.
Sec 87, 88, 89,92, and 312 empowers a doctor to examine , treat, operate, amputate , castrate or abort a patient; under certain conditions and precautions
Sec 93 protects doctors from any charge if communication of truth to the patient has resulted in to harm if it was done in the interest of the patient
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CHECKS ON MEDICAL PRACTITIONERS
Sec. 52:- Nothing is said to be done or believed in " good faith" which is done or believed without due care and attention.
Sec. 90:- Consent invalid
if given under fear of injury
under misconception of fact
consent of an insane
consent of intoxicated
consent of child under 12 yrs.
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Consent
Consent can be
Implied or expressed
But must be informed
Essential ingredients of informed consent are-
An understanding of nature and consequences of the act for which consent is given.
He must also be told the alternative courses available to him
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I.P.C. (Cont.)
Sec 161:Taking gratification other than legal remuneration in an official act - 3 years + fine
Sec 172:Absconding to avoid service of summon- 6 months+ fine
Sec 174:Non-attendance in obedience of summon - 6 months+Rs 1000/-
Sec 175:Omission to produce document - 6 months + Rs 1000/-
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I.P.C. (Cont.)
Sec 178:Refusing to take oath when duly required - 6 months +Rs 1000/-