Some recent cases , Medico legal Implications & Defenses.

1. Dr. Loveleen Sharma
MBBS, MHA,PGDMLS
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2. Application of LAW in healthcare
Laws on various aspects of healthcare have been enacted from time to time to regulate the functioning of the hospitals assuming that their implementation will remove the inadequacies and malpractices.
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3.  CONSUMER
Buys any
goods
Hires/Avails
any service
For
consideration
which has
been or will
be paid
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1986

4. Right to
Healthy
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5. Consumer Redressal Agency
NATIONAL COMMISSION
STATE COMMISSION
DISTRICT FORUM
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6. FINAL APPELLATE AUTHORITY
SUPREME COURT
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7. DISTRICT FORUM
• Person qualified to
be a District Judge
as its President
• 2 other members
one of whom
should be a female
• Every Member
shall hold office for
a term of 5 yrs or
upto 65yrs of age
which ever is
earlier
• Jurisdiction to
entertain –claim
upto 20 Lac
STATE
COMMISSION
• Person who is or
has been a judge of
High Court as its
President
• Jurisdiction to
entertain- claim
>20 Lac but not
exceeding 1 Crore
• Appeals against the
order of any
District Forum
within the state.
NATIONAL
COMMISSION
• Person who is or
has been a judge of
Supreme Court
• Not less than 4
members
• Every Member
shall hold office for
5 yrs or upto 70 yrs
of age which ever is
earlier
• Jurisdiction to
entertain claims
exceeding 1 Crore
• Appeals against
State orders
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8. WILL SEE YOU IN CONSUMER COURT !
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9. DHARAMDAS PRITANI vs.HDFC Ergo General Insurance
Company
 Heart Ailment (2008-09)
 Enhanced External Counter Pulsation(EECP)
 45 Sittings
 INR -118000/-
 No hospitalization
 Claim Rejected-
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11. 62 yr old Mr.Indur Chhugani from Khar ,Mumbai sued the developer
of a filthy construction site
Blamed that the abandoned site had every infection spreading
ingredient: open toilets, puddles with stagnant water, construction
material on which dirt settled & an open water tank
Responsible for his repeated bouts of malaria
Court held the builder negligent, Booked under Section 269 IPC
"negligence likely to spread a life-threatening disease
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12. Tells us that …
 Public awareness of medical negligence in India is
growing.
 Hospital managements too are increasingly facing
complaints regarding the facilities, hygiene related
issues, standards of professional competence, and the
appropriateness of therapeutic and diagnostic
methods used
 Claims for Infections suffered in a hospital &
Negligence are on rise above all
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13. Section- 269 IPC
 Whoever unlawfully or negligently does
any act which is and which he knows or
has reason to believe to be likely to
spread infection of any disease
dangerous to life, shall be punished with
imprisonment of either description for a
term which may extend to six months or
fine or with both.
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14. SECTION- 270 IPC
 Whoever malignantly does any act which
is and which he knows or has reason to
believe to be likely to spread infection
of any disease dangerous to life, shall
be punished with imprisonment of either
description for a term which may
extend to two years or fine or with
both.
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15. Hospitals ??
YES, PEOPLE ARE AWARE HOW YOU MUST / SHOULD SERVE THEM
YES, PEOPLE ARE AWARE WHAT SECTIONS APPLY TO YOU
YES,PEOPLE ARE AWARE HOW BOUND YOU ARE ‘LEGALLY’ TO DO SO
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16. Legal rules establish standards that healthcare providers and others must meet and also deter practices that fall below an accepted standard. Law has an important role to play in promoting patient safety.
Obligation to provide a safe environment to protect patients from harm in the course of receiving care.
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17. An elderly patient died from septic shock in the
intensive care unit. The sepsis happened to have been
due to Methicillin-Resistant Staphylococcus Aureus,
possibly related to a catheter, and possibly
transmitted from a patient in a neighbouring room by
less than adequate compliance with infection control
procedures. The family decided to sue hospital.
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18. ANURADHA SAHA
Kin: Dr. Kunal Saha
Resident : Ohio
Victim : Wife
Child Psychologist
Kolkata - For social work project 1998
Skin Rashes- April 7 (AMRI)
Rash Reappeared- May 7
Inj.Depo Medrol- 80 mg twice daily
Admitted at AMRI – 11th May
Deteriorated
Shifted to Mumbai- Breach Candy Hospital
Toxic Epidermal Necrolysis Syndrome
Died on 28th May
CASE 18

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22. Sections of IPC relating to
Medical profession
http://en.wikipedia.org/wiki/List_of_sections_of_Indian_Penal_Code
 Sec 52-Describes ―Good Faith (due care, competence,
caution)
 Sec 80-Accident in doing lawful act.
 Sec 88-Act not intended to cause death, one by
consent in good faith for person‘s benefit.
 Sec 90-Related to consent.
 Sec 176-Failure to inform police when essential.
 Sec 193- Punishment for false evidence
 269-271-Related to spread of infectious disease and
disobedience of quarantine rules .
 272-273-Related to adulteration of foods and drinks
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23.  Sec274-276-Related to adulteration of drugs
 Sec 304-A-Deals with death caused by a negligent
act
 Sec 269-271- Related to spread of infectious disease
and disobedience of a quarantine rule.
 Sec 306-309-Are related with abetment of suicides.
 Sec 312-314-Related to causing miscarriage, abortion
and hiding such facts.
 Sec 315-316-Deals with act to prevent child being
born alive or to cause it to die after birth
 Sec 319-322-Are related to causing hurt, grievous
hurt, loss of vision, loss of hearing or disfigurement.
 Sec 336-338- Deals with causing hurt by rash or
negligent act.
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24. Key Point to Note
 Thin line of difference between Section
304 and 304-A:
Sec. 304 – culpable homicide not amounting to murder
Sec 304 A- the act is never done with the intention to cause
death. Death by negligence
Under Sec.304 the offence is non-bailable while in case of
Sec.304A the offence is bailable
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25. CONFIDENTIALTY
 Article 21 of Constitution of India
Protection of life and personal liberty.
No person shall be deprived of his life
or personal liberty except according to
procedure established by law
 Sec 126 of Indian Evidence Act
Professional communications
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26. THE DILEMMA HOW DO I MONITOR,REPORT THEN ???
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27. National Commission states
that “No doctor can be held
guilty of Negligence if proper
course of practice is adopted
and reasonable care is taken in
administration of treatment”
In defence, it is well accepted
that controlling the spread of
nosocomial infections is rarely
dependent on any one factor
but rather on a 'package' of
surveillance and preventative
measures.
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28. Defense against Negligence
Denial Defense
Affirmative Defense
Delegation of duty to a subordinate
Contributory Negligence by patient
Assumption of risk by the patient
Emergency Situation
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29. VOLENTI NON FIT INJURIA
"to a willing person
injury is not done !"
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30. BOLAM
 A doctor is not guilty of negligence if
he acted in accordance with a practice
accepted as proper by a responsible
body of medical opinion ….A doctor is
not negligent if he is acting in
accordance with such a practice merely
because there is a body of opinion that
takes a contrary view”
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31. BOLITHO
 Doctor can NOT escape his liability
merely by adopting one of the standard
practice. He SHOULD HAVE applied
mind to compare risks and benefits of
accepted standard and chosen the right
one.
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32. The Dilemma
Bolam ratio protects Doctors and Bolitho favours patient.
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ALL WE CAN DO IS !!

34. REMEMBER 34

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