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WARNING NOTICE

  • 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/-
  • Sec 179:Refusing to answer question - 6 months + Rs 1000/-
  • Sec 180:Refusing to sign statement - 3 months + Rs 500/-
  • Sec 181:False statement on oath- 3 yrs + fine
  • Sec 191-195:False evidence and fabrication of false evidence upto 7 yrs. + fine
  • Sec 197:Issuing or signing of false certificate - 7 yrs. + fine

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I.P.C. (Cont.)

  • Sec 202:Intentional omission to give information of offence by person bound to inform- 6 months with fine
  • Sec 212:Harbouring an offender- 3 to 5 years+ fine
  • Sec 218:Framing incorrect record to save from punishment-3 yrs+ fine
  • Sec 284: Negligent conduct with respect to poisonous substances- 6 months+Rs. 1000/
  • Sec 285:Fire or combustible matters - as above
  • Sec 306:Abetment of suicide - 10 yrs + fine

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10/08/2022