dutyof doctors medico legal aspect

Duty of Doctors- Duty of Doctors- Medicolegal AspectMedicolegal Aspect

Prof. S. BatabyalHead, Dept of FSM

Medical College, Kolkata

Duty of Doctors- Medicolegal Duty of Doctors- Medicolegal AspectAspect

• IntroductionIntroduction• Obtaining consentObtaining consent• Different consenting ageDifferent consenting age• Duty of M.O. in case of suspected Duty of M.O. in case of suspected

poisoningpoisoning• Duty of M.O. in case of criminal abortionDuty of M.O. in case of criminal abortion• Civil and Criminal negligenceCivil and Criminal negligence• Cases for medicolegal postmortemCases for medicolegal postmortem

Duty of Doctors- Medicolegal Duty of Doctors- Medicolegal Aspect contd.Aspect contd.• Legal problems faced by M.O.Laws related to Legal problems faced by M.O.Laws related to

medical practicesmedical practices• Civil law: Law of contract, Law of Tort, Civil law: Law of contract, Law of Tort,

Consumer Protection ActConsumer Protection Act• Medical CouncilMedical Council• Other laws Other laws • ConclusionConclusion• Protocol for police cases & Rape/Sexual assault: Protocol for police cases & Rape/Sexual assault:

Introduction to Rape/Sexual assaultIntroduction to Rape/Sexual assault• Interviewing the patientInterviewing the patient

Duty of Doctors- Medicolegal Duty of Doctors- Medicolegal Aspect contd.Aspect contd.

• Intervention: Preparing the patient for Intervention: Preparing the patient for examinationexamination

• Physical examinationPhysical examination• Providing follow up servicesProviding follow up services• Obtaining laboratory SpecimenObtaining laboratory Specimen• Examination of the VictimExamination of the Victim• Proforma for examination of the accused in a Proforma for examination of the accused in a

rape case: Medicolegal Certificate for Malerape case: Medicolegal Certificate for Male• Medicolegal Certificate for FemaleMedicolegal Certificate for Female

IntroductionIntroduction

• Every registered medical practitioner has to Every registered medical practitioner has to perform some medicolegal duty during discharge perform some medicolegal duty during discharge of his/her dutyof his/her duty

• In the emergency room, they have to make In the emergency room, they have to make injury report in all unnatural casesinjury report in all unnatural cases

• But if the patient is moribund, arrangement of But if the patient is moribund, arrangement of treatment is to be made first. In case the patient treatment is to be made first. In case the patient is not admitted, only PC (police case) is done. But is not admitted, only PC (police case) is done. But if the police case is admitted, IPC (indoor police if the police case is admitted, IPC (indoor police case) is to be done. case) is to be done.

• In both the cases government prescribed form is In both the cases government prescribed form is there. If the form is not available, it may be done there. If the form is not available, it may be done in plain paper under seal and signature of the in plain paper under seal and signature of the medical officer. medical officer.


• Here brief history of the case is necessary. The Here brief history of the case is necessary. The injuries are to be mentioned one by one with their injuries are to be mentioned one by one with their position,position, approximate measurement and type of approximate measurement and type of the injuries ie, abrasion, bruise, laceration the injuries ie, abrasion, bruise, laceration injuries etc injuries etc

• Lastly, the provisional diagnosis of the case and Lastly, the provisional diagnosis of the case and the prognosis of the case are to be mentioned. It the prognosis of the case are to be mentioned. It is a very important duty for EMO (emergency is a very important duty for EMO (emergency medical officer). medical officer).

• If he fails to discharge this duty he may be If he fails to discharge this duty he may be charged under Sec.201 IPCcharged under Sec.201 IPC and the punishment and the punishment may be 3 months of imprisonment or fine upto may be 3 months of imprisonment or fine upto Rs.500.00 or both Rs.500.00 or both


• In addition, during examination of the case a In addition, during examination of the case a male/female attendant should be present for a male/female attendant should be present for a male patient and a female for a female patient. male patient and a female for a female patient. Otherwise the doctor may be charged with Otherwise the doctor may be charged with indecent assaultindecent assault under Sec.354 IPC and the under Sec.354 IPC and the punishment may be imprisonment upto 2 years punishment may be imprisonment upto 2 years with and/or finewith and/or fine

• Next Next in the wardin the ward, the doctor is to examine the , the doctor is to examine the case very carefully and treat the patient with a case very carefully and treat the patient with a reasonable degree of skill, care and knowledge to reasonable degree of skill, care and knowledge to avoid charge of negligence. avoid charge of negligence.

• BHT (bed head ticket)BHT (bed head ticket) is to be maintained is to be maintained properly with care and skill. The doctor should properly with care and skill. The doctor should give proper and suitable prescription. He should give proper and suitable prescription. He should mention the exact quantities and precise timing mention the exact quantities and precise timing for taking medicines for taking medicines


• Here, may have to make Here, may have to make “dying Declaration“dying Declaration”. It ”. It is a statement of a person, written or oral, who is a statement of a person, written or oral, who is dying as a result of some unlawful act. is dying as a result of some unlawful act.

• The doctor is to assess that the patient is in The doctor is to assess that the patient is in good mental condition before the declaration is good mental condition before the declaration is recorded. The declaration is made in question recorded. The declaration is made in question and answer form. and answer form.

• The declaration should be noted down in The declaration should be noted down in verbatim or the patient in presence of two verbatim or the patient in presence of two reasponsible witnesses. It should be signed by reasponsible witnesses. It should be signed by the doctor, the patient and the witnesses.the doctor, the patient and the witnesses.


• Another important medicolegal duty of the Another important medicolegal duty of the doctors in the ward, is to help in the preparation doctors in the ward, is to help in the preparation of of “Dying Deposition“Dying Deposition”.”.

• It is the statement of a dying man, before a It is the statement of a dying man, before a Magistrate and the accused or his Counsel, on Magistrate and the accused or his Counsel, on Oath. In a ward, it is a bed side court. Oath. In a ward, it is a bed side court.

• Here, the doctor has to certify the mental and Here, the doctor has to certify the mental and physical fitness of the patient to make such a physical fitness of the patient to make such a statement.statement.


• Now, in the operation theatre, Now, in the operation theatre, the doctor in the doctor in charge of the operation should be very careful charge of the operation should be very careful before going to operation properbefore going to operation proper..

• He should note that all the formalities have He should note that all the formalities have been completed. The been completed. The written consentwritten consent of the of the patient and the guardian should be taken before patient and the guardian should be taken before going for operation. going for operation.

• Before closing the operation, the Before closing the operation, the swab countswab count and the instrument count should be made so and the instrument count should be made so that none of them remains in the operation that none of them remains in the operation field. field.


• If any one of them remains in side the operation If any one of them remains in side the operation area, the doctor may be charged with criminal area, the doctor may be charged with criminal negligence under negligence under “Res Ipsa Loquitur“Res Ipsa Loquitur” which ” which means “The thing speaks of itself”.means “The thing speaks of itself”.

• The doctor may be charged with criminal The doctor may be charged with criminal negligence under negligence under Sec.304A IPCSec.304A IPC causing the death causing the death of any person by doing rash and negligent act not of any person by doing rash and negligent act not amounting to culpable homicide and the amounting to culpable homicide and the punishment is imprisonment upto 2 years or with punishment is imprisonment upto 2 years or with fine or with both. fine or with both.

• In addition, administrative proceedings will start In addition, administrative proceedings will start against the doctor and he may be dismissed from against the doctor and he may be dismissed from the service and his name may be erased from the the service and his name may be erased from the State Medical Council.State Medical Council.

Duty to take consent in Duty to take consent in medical practice: -medical practice: -• Consent means Consent means voluntary agreementvoluntary agreement, compliance , compliance

or permission when a patient is coming to a or permission when a patient is coming to a doctor for treatment, the consent is implied. doctor for treatment, the consent is implied. There is no need of taking written consent. There is no need of taking written consent.

• But in some But in some special cases written consentspecial cases written consent is is required. In criminal cases, the victim and the required. In criminal cases, the victim and the accused can not be examined without his/her accused can not be examined without his/her written consent. The court also can not compel a written consent. The court also can not compel a person to get medically examined against his/her person to get medically examined against his/her will.will.

• A) A) In case of rapeIn case of rape, the victim should not be , the victim should not be examined without her written consent.examined without her written consent.

• B) In medicolegal cases of B) In medicolegal cases of pregnancy, delivery pregnancy, delivery and abortionand abortion, the woman should not be examined , the woman should not be examined without her written consent.without her written consent.

ConsentConsent

• But the But the convicted person can be examined convicted person can be examined without his/her consent by applying without his/her consent by applying reasonable forcereasonable force. Because the convicted . Because the convicted person has no civil right.person has no civil right.

• Different consenting age: -Different consenting age: -• For medicolegal examination For medicolegal examination 1212 years and years and

above.above.• For sexual intercourse For sexual intercourse 16 16 years and above.years and above.• For operation to suffer any bodily harm For operation to suffer any bodily harm 1818

years and above.years and above.• A child A child under 12 yearsunder 12 years of age and an of age and an insaneinsane

person can not give valid consent.person can not give valid consent.

Requirement of consentRequirement of consent :- :-

• In various field of medical practice written In various field of medical practice written consent is required. Only some example are consent is required. Only some example are given here :-given here :-

• For For contraceptive sterilizationcontraceptive sterilization written consent of written consent of both the husband and wife should be obtained.both the husband and wife should be obtained.

• For For artificial inseminationartificial insemination written consent of both written consent of both the donor and the recipient side should be the donor and the recipient side should be obtained.obtained.

• For For medical termination of pregnancymedical termination of pregnancy the written the written consent should be obtained from the woman as consent should be obtained from the woman as well as from the guardian.well as from the guardian.

• For For organ transplantationorgan transplantation, the organ of the dead , the organ of the dead person should not be removed without the person should not be removed without the consent of the person having lawful possession consent of the person having lawful possession of the body.of the body.

• Pathological autopsyPathological autopsy should not be conducted should not be conducted without the consent of the guardian or legal without the consent of the guardian or legal heirs of the deceased. But for medicolegal heirs of the deceased. But for medicolegal autopsy no consent is required. Only inquest is autopsy no consent is required. Only inquest is sufficient to hold this autopsy.sufficient to hold this autopsy.

• In case of In case of emergencyemergency, no consent is required to , no consent is required to save the life of the patient in good faith.save the life of the patient in good faith.

• If the doctor fails to follow these rules of If the doctor fails to follow these rules of consent, he may be charged with professional consent, he may be charged with professional negligence (malpractice) both civil and criminal negligence (malpractice) both civil and criminal negligence. The punishment may be issuing of negligence. The punishment may be issuing of warning noticewarning notice for infamous conduct, erasure of for infamous conduct, erasure of names civil negligence and criminal negligence names civil negligence and criminal negligence where the patient dies after operation and the where the patient dies after operation and the consent has not been taken.consent has not been taken.

Suspected PoisoningSuspected Poisoning

• In case of In case of homicidal poisoninghomicidal poisoning, the doctor is duty , the doctor is duty bound to inform the police officer or the bound to inform the police officer or the Magistrate. But the doctor should confirm his Magistrate. But the doctor should confirm his suspicion before expressing an opinion. For this suspicion before expressing an opinion. For this he must : he must :

• (a) (a) Collect Collect urine, vomit and faeces and submit for urine, vomit and faeces and submit for analysis.analysis.

• (b) Carefully observe and record the (b) Carefully observe and record the symptomssymptoms in in relation to food.relation to food.

• (c) Consult in strict confidence with (c) Consult in strict confidence with senior senior practitioner. practitioner.

• (d) Either remove the patient to hospital or (d) Either remove the patient to hospital or engage nurses of his confidence.engage nurses of his confidence.

• (e) Any (e) Any suspected articlessuspected articles of good, excreta and of good, excreta and stomach wash samples should be preserved. stomach wash samples should be preserved.


• Non-compliance is punishable under Sec.201 IPC Non-compliance is punishable under Sec.201 IPC if it is proved that the doctor did it with the if it is proved that the doctor did it with the intention of protecting the accusedintention of protecting the accused. If the doctor . If the doctor is sure that the patient is suffering from suicidal is sure that the patient is suffering from suicidal poisoning, he is not bound to inform the police.poisoning, he is not bound to inform the police.

• If the doctor is summoned by the investigating If the doctor is summoned by the investigating police officer, he is bound to give all information police officer, he is bound to give all information regarding the case that has come to his notice. regarding the case that has come to his notice.

• If he If he conceals the information, he is liable to be conceals the information, he is liable to be prosecuted under Sec.202 IPCprosecuted under Sec.202 IPC if he gives false if he gives false information, he is liable to be charged with the information, he is liable to be charged with the offence of giving false information under Sec.193 offence of giving false information under Sec.193 IPC. IPC.


• A government medical officer is required to A government medical officer is required to report to police all the cases of suspected report to police all the cases of suspected poisoning, whether accidental suicidal or poisoning, whether accidental suicidal or homicidal in nature. homicidal in nature.

• If a case of suspected poisoning dies, death If a case of suspected poisoning dies, death certificate should not be issued but death certificate should not be issued but death declaration should be made and it should be declaration should be made and it should be communicated to the nearest police station.communicated to the nearest police station.

Duty of a doctor in a case of Duty of a doctor in a case of criminal abortion :-criminal abortion :-• A criminal abortion is the induced destruction and A criminal abortion is the induced destruction and

expulsion of the foetus from the womb of the expulsion of the foetus from the womb of the mother unlawfully when there is mother unlawfully when there is no therapeutic no therapeutic indication for the operation. indication for the operation.

• The doctor’s duty in this case is to guard all the The doctor’s duty in this case is to guard all the informations obtained by him as a informations obtained by him as a professional professional secrecysecrecy. He must urge the patient to make a . He must urge the patient to make a statement about the induction of criminal statement about the induction of criminal miscarriage. miscarriage.

• If she refuses to make a statement, he should If she refuses to make a statement, he should not pursue the matter. He must treat her to the not pursue the matter. He must treat her to the best of his ability. He must consult a professional best of his ability. He must consult a professional colleague. colleague.

Duty of a doctor in a case of Duty of a doctor in a case of criminal abortion :-criminal abortion :-• If the If the woman dieswoman dies, , he should not issue a death he should not issue a death

certificatecertificate, but should inform the police for , but should inform the police for making arrangement for postmortem making arrangement for postmortem examination.examination.

• Under sec. 312 IPC whoeverUnder sec. 312 IPC whoever voluntarily causes voluntarily causes criminal miscarriagecriminal miscarriage is liable for imprisonment is liable for imprisonment upto 3 years and or fine and if the woman is upto 3 years and or fine and if the woman is quick with the child the imprisonment may quick with the child the imprisonment may extended upto 7 years.extended upto 7 years.

• In this case, In this case, bothboth the person procuring the the person procuring the miscarriage and the woman are miscarriage and the woman are liableliable for for punishment. If this case, both the person punishment. If this case, both the person procuring the miscarriage and the woman are procuring the miscarriage and the woman are liable for punishment. liable for punishment.

Duty of a doctor in a case of Duty of a doctor in a case of criminal abortion :-criminal abortion :-• If the miscarriage is caused If the miscarriage is caused without the without the

consentconsent of the woman, the imprisonment of the woman, the imprisonment may be upto 10 years under Sec.313 IPC. may be upto 10 years under Sec.313 IPC.

• If the woman diesIf the woman dies from the act of criminal from the act of criminal abortions, the punishment is upto 10 years abortions, the punishment is upto 10 years under sec.314 IPC, under sec.316 IPC under sec.314 IPC, under sec.316 IPC causing death of quick unborn child by causing death of quick unborn child by any act amounts to culpable homicide, and any act amounts to culpable homicide, and the punishment may extend upto 10 years the punishment may extend upto 10 years of imprisonment.of imprisonment.

The civil and criminal The civil and criminal negligencenegligence • Professional negligenceProfessional negligence is absence of reasonable is absence of reasonable

degree of care and skill or willful negligence of a degree of care and skill or willful negligence of a medical practitioner, in the statement of a patient medical practitioner, in the statement of a patient so as to lead bodily injury of death of the patient.so as to lead bodily injury of death of the patient.

• The question of The question of civil negligencecivil negligence will come, will come, when a patient in case of death, any relative bring when a patient in case of death, any relative bring suit in a civil court for realization of compensation suit in a civil court for realization of compensation from his doctor, if he has suffered injury due to from his doctor, if he has suffered injury due to negligence.negligence.

• Similarly the doctor can bring a civil suit for Similarly the doctor can bring a civil suit for realization of his fees from the patient or his realization of his fees from the patient or his relatives who refused to pay the same on the relatives who refused to pay the same on the ground of professional negligence. ground of professional negligence.

Examples of civil negligenceExamples of civil negligence

• Loss of earning of the patient due to negligent act of the Loss of earning of the patient due to negligent act of the attending doctor.attending doctor.

• Expenses incurred eg. Hospital expenses, special Expenses incurred eg. Hospital expenses, special investigation, special diet, etc.investigation, special diet, etc.

• Reduction of expectation of life of the patient due to Reduction of expectation of life of the patient due to wrong treatment.wrong treatment.

• Reduced enjoyment of life of the patient.Reduced enjoyment of life of the patient.• Pain and suffering, either physical or mental.Pain and suffering, either physical or mental.• Loss of potencyLoss of potency• Death of the patient.Death of the patient.

• A doctor is not liable for an error of A doctor is not liable for an error of judgement or of diagnosis, if he has judgement or of diagnosis, if he has secured all necessary data in which to secured all necessary data in which to base a base a sound judgementsound judgement. .

• Contributory negligenceContributory negligence on the part of a on the part of a patient is very good defence for patient is very good defence for negligence.negligence.

Criminal negligenceCriminal negligence

• Criminal negligence occurs when the physician Criminal negligence occurs when the physician exhibits gross lack of competency, gross exhibits gross lack of competency, gross inattention, criminal indifference to the patient’s inattention, criminal indifference to the patient’s safety or gross negligence in the secretion and safety or gross negligence in the secretion and application of remedies. application of remedies.

The followings are some examples of the criminal The followings are some examples of the criminal negligence :-negligence :-

• Gross mismanagement of the delivery of a Gross mismanagement of the delivery of a woman.woman.

• Gross incompetent Gross incompetent administration of a general administration of a general anaesthesiaanaesthesia

Criminal negligenceCriminal negligence

• Administration of a wrong medicine in to Administration of a wrong medicine in to the eye causing loss of vision.the eye causing loss of vision.

• Amputation of wrong finger or operation Amputation of wrong finger or operation on a wrong limb.on a wrong limb.

• Leaving instruments, tubes, sponges or Leaving instruments, tubes, sponges or swab in abdomen.swab in abdomen.

• Performing criminal abortion Performing criminal abortion

• A single professional act by a physician may A single professional act by a physician may subject him to subject him to both civil and criminal liabilityboth civil and criminal liability, eg, , eg, if a physician performs an unauthorized if a physician performs an unauthorized operation on a patient, he may be sued civilly for operation on a patient, he may be sued civilly for damages and prosecuted criminally for assault.damages and prosecuted criminally for assault.

• The doctor may have to pay damages in terms The doctor may have to pay damages in terms of monetary fine as well as convicted for of monetary fine as well as convicted for criminal negligence under criminal negligence under Sec.304A IPCSec.304A IPC with with imprisonment upto 2 years or with fine or with imprisonment upto 2 years or with fine or with both.both.

• Lastly, another very important medicolegal duty Lastly, another very important medicolegal duty of the doctors is to hold medicolegal of the doctors is to hold medicolegal postmortem examination and to examine the postmortem examination and to examine the victim girl and the accusedvictim girl and the accused person. person.

• Every doctor who has permanent registration Every doctor who has permanent registration number of State Medical Council is entitled to do number of State Medical Council is entitled to do this job. this job.

• Although, it is the job of service doctor, the Although, it is the job of service doctor, the private practitioner may be asked to do this job private practitioner may be asked to do this job during National Emergencyduring National Emergency. Hence, here is some . Hence, here is some idea about it.idea about it.

Cases for medico legal Cases for medico legal postmortem examinationpostmortem examination

• All unnatural death cases.All unnatural death cases.• Sudden death, where cause of death is Sudden death, where cause of death is

not known.not known.• All cases of death due to poisoning.All cases of death due to poisoning.• Traffic accidents death cases.Traffic accidents death cases.• Traffic accidents death cases.Traffic accidents death cases.• Death occurring during operation or Death occurring during operation or

under anaesthesia.under anaesthesia.

Cases for medico legal Cases for medico legal postmortem examinationpostmortem examination• Death occurring in Death occurring in prisonprison, police custody, jail , police custody, jail

custody, asylum, Borstal school, etc. Here, custody, asylum, Borstal school, etc. Here, postmortem examination is to be done under postmortem examination is to be done under Video Photography as per directive of Human Video Photography as per directive of Human Rights Commission.Rights Commission.

• In case of In case of dowry deathsdowry deaths. Here, postmortem . Here, postmortem examination is preferably to be conducted at examination is preferably to be conducted at least by two doctors.least by two doctors.

• Death certified as due to Death certified as due to postoperativepostoperative shock or shock or haemorrhage.haemorrhage.

• In In exhumationexhumation cases. cases.• Before holding medicolegal autopsy inquest is Before holding medicolegal autopsy inquest is

required from the police authority or Magistrate required from the police authority or Magistrate

LEGAL PROBLEMS FACED BY LEGAL PROBLEMS FACED BY THE DOCTORS .THE DOCTORS .• In the past, litigations were less in India, In the past, litigations were less in India,

because people were not aware of their rights. because people were not aware of their rights. In developed countries like U.S.A. , U.K., Canada In developed countries like U.S.A. , U.K., Canada etc., there is Medical Law specially for medical etc., there is Medical Law specially for medical profession. profession.

• Unfortunately, there is nothing like Medical Law Unfortunately, there is nothing like Medical Law in India; so litigations are based on criminal Law, in India; so litigations are based on criminal Law, Law of Torts, Law of Contracts, Consumers’ Law of Torts, Law of Contracts, Consumers’ Protection act, etc.Protection act, etc.

• Medical Law does not mean doctor’s Medical Law does not mean doctor’s negligence. It includes doctor-patient negligence. It includes doctor-patient relationship, their duties and rights, M.T.P. Act. relationship, their duties and rights, M.T.P. Act. Family Planning etc. etc. Family Planning etc. etc.

LEGAL PROBLEMS FACED BY LEGAL PROBLEMS FACED BY THE DOCTORS THE DOCTORS • When a doctor is showing absence of When a doctor is showing absence of

reasonable degree of care and skill in reasonable degree of care and skill in treating his patient, he may be charged treating his patient, he may be charged with Civil negligence. with Civil negligence.

• When a doctor is showing gross lack of When a doctor is showing gross lack of competency and gross in attention, he competency and gross in attention, he may be charged with Criminal negligence. may be charged with Criminal negligence. So the doctors should possess some legal So the doctors should possess some legal knowledge to protect themselves from knowledge to protect themselves from negligence.negligence.

SOME LAWS IN RELATION TO SOME LAWS IN RELATION TO MEDICAL PRACTICEMEDICAL PRACTICE

• Criminal Law.Criminal Law.• Civil Law.Civil Law.• Consumer Protection Act.Consumer Protection Act.• Medical CouncilsMedical Councils• Other Laws.Other Laws.

CRIMINAL LAWCRIMINAL LAW SECTIONSECTION OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS193 IPC193 IPC PerjuryPerjury Imprisonment upto 7 Imprisonment upto 7

yrs.+/- Fine.yrs.+/- Fine.

197 IPC197 IPC Issuing False Issuing False certificatecertificate

-do--do-

191 IPC191 IPC Hostile WitnessHostile Witness -do--do-

354 IPC354 IPC Indecent assaultIndecent assault Imprisonment upto 2 Imprisonment upto 2 Yrs. +/- Fine.Yrs. +/- Fine.

SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment from Imprisonment from

3 Yrs. To 10 yrs.3 Yrs. To 10 yrs.+/- Fine.+/- Fine.

TOTO316 IPC316 IPC376 IPC376 IPC RapeRape Imprisonment upto 7 Imprisonment upto 7

yrs. May be 10 yrs. May be 10 yrs, may be life yrs, may be life imprisonment +/- imprisonment +/- fine.fine.

SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS

312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment from Imprisonment from 3 Yrs. To 10 yrs.3 Yrs. To 10 yrs.+/- Fine.+/- Fine.TOTO

316 IPC316 IPC376 IPC376 IPC RapeRape Imprisonment upto 7 Imprisonment upto 7

yrs. May be 10 yrs. May be 10 yrs, may be life yrs, may be life imprisonment +/- imprisonment +/- fine.fine.

497 IPC497 IPC AdulteryAdultery Imprisonment upto 5 Imprisonment upto 5 Yrs. +/- FineYrs. +/- Fine

The legal protection for DoctorsThe legal protection for Doctors

• Sec.88 to 93 IPCSec.88 to 93 IPC• To follow the rules of consent.To follow the rules of consent.

CIVIL LAWCIVIL LAW :- :-• This can be divided into TWO groups:-This can be divided into TWO groups:-• Law of ContractLaw of Contract• Law of Tort.Law of Tort.

(A) (A) LAW OF CONTRACTLAW OF CONTRACT

• Here, there is a specific contract between a Here, there is a specific contract between a patient and a doctor, which may be ORAL, patient and a doctor, which may be ORAL, WRITTEN or IMPLIED one, under which the WRITTEN or IMPLIED one, under which the doctor is supposed to treat the patient and the doctor is supposed to treat the patient and the patient is liable to pay the specific or reasonable patient is liable to pay the specific or reasonable fees to the doctor.fees to the doctor.

• In operative cases, usually the contract is In operative cases, usually the contract is between surgeon and patient ONLY; and between surgeon and patient ONLY; and anaesthesists, cardiologists, paediatricians, and anaesthesists, cardiologists, paediatricians, and other doctors may NOT be a party. other doctors may NOT be a party.

• They have an implied contract with the surgeon They have an implied contract with the surgeon only. Hence the surgeon may be vicariously liable only. Hence the surgeon may be vicariously liable for his negligence for his negligence

LAW OF TORTLAW OF TORT..

• Certain duties are imposed on every person Certain duties are imposed on every person in the society irrespective of monetary in the society irrespective of monetary consideration. Thus a doctor is also having consideration. Thus a doctor is also having certain specific duties towards his patient, certain specific duties towards his patient, paying or complimentary. paying or complimentary.

• “ “ If a doctor commits an act, which other If a doctor commits an act, which other reasonable doctor of his standard would not reasonable doctor of his standard would not commit; or a doctor OMITS to do something commit; or a doctor OMITS to do something which other doctor would certainly do is a which other doctor would certainly do is a NEGLIGENT ACT” . The doctor is liable for that NEGLIGENT ACT” . The doctor is liable for that under Law of Tort. under Law of Tort.

CONSUMER PROTECTION ACTCONSUMER PROTECTION ACT : :

• This act is most hot subject in the medical This act is most hot subject in the medical world today. This act is enacted in 1986 as a part world today. This act is enacted in 1986 as a part of an international agreement seeking to provide of an international agreement seeking to provide for better protection to the interest of consumer for better protection to the interest of consumer and to provide speedy and simple redressal to and to provide speedy and simple redressal to consumer’s disputes.consumer’s disputes.

• The purpose of the act :-The purpose of the act :-• To protect the interest of the consumers of To protect the interest of the consumers of

different commodities for which they pay but do different commodities for which they pay but do not get standard quality of service.not get standard quality of service.

• Example – daily commodities of use, Banking, Example – daily commodities of use, Banking, Food Transport, Electricity supply et etc.Food Transport, Electricity supply et etc.

• Procedure of lodging complaintsProcedure of lodging complaints :- :-

• At any centre mention below with/without At any centre mention below with/without engaging a Lawyer and paying a nominal fees.engaging a Lawyer and paying a nominal fees.

• At At District levelDistrict level – District Consumer Dispute – District Consumer Dispute Redressal Forum - to be chaired by a District Redressal Forum - to be chaired by a District Judge and two other members. Compensation Judge and two other members. Compensation towards damages towards damages upto Rs.20 lakhsupto Rs.20 lakhs

• At At State levelState level – State Consumer Dispute – State Consumer Dispute Redressal Commission – chaired by a High court Redressal Commission – chaired by a High court Judge and two other members. Compensation Judge and two other members. Compensation above above Rs.20 lakhs to 1 CroreRs.20 lakhs to 1 Crore..

• At At National LevelNational Level – National consumer Dispute – National consumer Dispute Redressal Commission – chaired by a Judge of Redressal Commission – chaired by a Judge of Supreme Court and four other members. Supreme Court and four other members. Compensation Compensation more than Rs.1 Croremore than Rs.1 Crore..

Apprehensions :-Apprehensions :-

• Bad doctor-patient relationship.Bad doctor-patient relationship.• Tendency for extensive laboratory investigation.Tendency for extensive laboratory investigation.• Tendency to make different Tendency to make different

Indemnity/Insurance policy for paying Indemnity/Insurance policy for paying compensation.compensation.

• The treating Physician will charge more from the The treating Physician will charge more from the general patients.general patients.

MEDICAL COUNCILMEDICAL COUNCIL..

• A patient can file a complaint with the A patient can file a complaint with the respective council for doctor’s negligence. respective council for doctor’s negligence. Unfortunately the council has power to punish Unfortunately the council has power to punish the doctor but does not have the power to order the doctor but does not have the power to order compensation even if the negligence is proved.compensation even if the negligence is proved.

• The punishment which can be given to the The punishment which can be given to the doctor by the Medical Council/state Medical doctor by the Medical Council/state Medical Council –Council –

• Issuing a warning notice.Issuing a warning notice.• Temporary erasure of name from Medical Temporary erasure of name from Medical

Registrar.Registrar.• Permanent erasure of name from Medical Permanent erasure of name from Medical

Registrar.Registrar.

OTHER LAWS :OTHER LAWS :

• Under M.T.P. Act, Drug Act, Bombay Under M.T.P. Act, Drug Act, Bombay Nursing Home act etc. patient can file a Nursing Home act etc. patient can file a complaint to the respective authority. Here complaint to the respective authority. Here also they do not have power to order also they do not have power to order compensation compensation

CONCLUSION CONCLUSION :-:-

• TO AVOID ALL THE MEDICOLEGAL TO AVOID ALL THE MEDICOLEGAL PROBLEMS CERTAIN PRECAUTIONS TO BE PROBLEMS CERTAIN PRECAUTIONS TO BE TAKENTAKEN :- :-

• Keep full and accurate Medical Records.Keep full and accurate Medical Records.• Employ standard care and skillEmploy standard care and skill• Do not fail to get written informed consent.Do not fail to get written informed consent.• Diagnosis to be confirmed by laboratory tests.Diagnosis to be confirmed by laboratory tests.• Proper investigation to be advised.Proper investigation to be advised.• Proper immunization schedule to be followed.Proper immunization schedule to be followed.

• Sensitivity tests to be done where applicable.Sensitivity tests to be done where applicable.• When diagnosis is obscure consult another When diagnosis is obscure consult another

senior/specialists.senior/specialists.• Do not criticize another practitioner.Do not criticize another practitioner.• To check the condition of the equipment To check the condition of the equipment

frequently.frequently.• The drug to be identified with expiry date The drug to be identified with expiry date

before introduction.before introduction.• The patient must not be abandoned.The patient must not be abandoned.• No female patient should be examined No female patient should be examined

without any female attendant.without any female attendant.• Anaesthesia should be given by a qualified Anaesthesia should be given by a qualified

person.person.• NEVER GUARANTEE A CURE.NEVER GUARANTEE A CURE.

PROTOCOL FOR POLICE CASES & PROTOCOL FOR POLICE CASES & RAPE/SEXUAL ASSAULT.RAPE/SEXUAL ASSAULT.• A patient when comes to ER/OPD of Govt. A patient when comes to ER/OPD of Govt.

Hospital C/O any injury/Accidental/Self-Hospital C/O any injury/Accidental/Self-Infected/Homicidal/Poisoning/Sex assault/Burn Infected/Homicidal/Poisoning/Sex assault/Burn injury etc. proper reporting in papers supplied injury etc. proper reporting in papers supplied from Police Dept. – the named as indoor Police from Police Dept. – the named as indoor Police cases/outdoor police cases where history taken cases/outdoor police cases where history taken and other points are written. and other points are written.

• The form should be properly filled up with The form should be properly filled up with signature of patient/patient party and witness signature of patient/patient party and witness should be taken marks of identification of patient should be taken marks of identification of patient should be noted. should be noted.

• The size of injury in which part of the body the The size of injury in which part of the body the injury is present. Age of injury, type of weapon injury is present. Age of injury, type of weapon used should be noted.used should be noted.

• If there are minor injury patient should be If there are minor injury patient should be treated properly at ER with advice to attend treated properly at ER with advice to attend SOPD/OPD next morning and or to attend ER in SOPD/OPD next morning and or to attend ER in necessary.necessary.

If patient is unconscious and If patient is unconscious and unknown thenunknown then

• Name of persons brought the patient Name of persons brought the patient should be noted with full address and their should be noted with full address and their signature should be taken.signature should be taken.

• The valuable materials with the patient The valuable materials with the patient should be seized. These should be should be seized. These should be properly packed labeled and handed over properly packed labeled and handed over to Ward Master with records kept in the to Ward Master with records kept in the ward.ward.

Other special points which should Other special points which should be done in the ward.be done in the ward.

• After receiving the patient in the ward the doctor After receiving the patient in the ward the doctor and Nurse should note for – and Nurse should note for – – Airway – if obstruction, proper managementAirway – if obstruction, proper management– Bleeding – if present, proper managementBleeding – if present, proper management– Cardiac – condition of the heart should be noted with Cardiac – condition of the heart should be noted with

B.P./Pulse.B.P./Pulse.• The weapon should be seized. It should be The weapon should be seized. It should be

noted that whether the patient come alone or noted that whether the patient come alone or with some persons.with some persons.

• If police personnel brought the patient then his If police personnel brought the patient then his name should be written in the form.name should be written in the form.

RAPE/SEXUAL ASSAULTRAPE/SEXUAL ASSAULT

• The victims and accused should be examined as per The victims and accused should be examined as per written prayer or/and order from Honorable Magistrate written prayer or/and order from Honorable Magistrate (S.D.J.M.).(S.D.J.M.).

• The written consent of victim and accused must be The written consent of victim and accused must be taken in form.taken in form.

According to the Bureau of Police research and According to the Bureau of Police research and Development the number of rape cases per lakh Development the number of rape cases per lakh population has risen continuously in India over the year, population has risen continuously in India over the year,

• the highest volume of rape cases was registered in Sikkim the highest volume of rape cases was registered in Sikkim followed by Jammu and Kashmir, Madhya Pradesh, Assam followed by Jammu and Kashmir, Madhya Pradesh, Assam and West Bengal. and West Bengal.

• Among the major cities in India Delhi has shown the Among the major cities in India Delhi has shown the highest number of rape cases in one year followed by highest number of rape cases in one year followed by Bombay compared to other metropolitan cities in the Bombay compared to other metropolitan cities in the world.world.

What is Rape?What is Rape?

• Rape is defined as an unlawful carnal knowledge Rape is defined as an unlawful carnal knowledge of a female for and against her will. of a female for and against her will.

• Carnal knowledge is defined as penetration of Carnal knowledge is defined as penetration of genitalia no matter how slight by the penis genitalia no matter how slight by the penis occurs while the female is sleeping unconscious occurs while the female is sleeping unconscious or under the influence of alcohol or drugs. or under the influence of alcohol or drugs.

• A male who is sexually assaulted is sodomized.A male who is sexually assaulted is sodomized.• Sodomy is oral or anal penetration.Sodomy is oral or anal penetration.

Nursing AlertNursing Alert :- :-• The management of the sexual assault is The management of the sexual assault is

important but immediate physical health should important but immediate physical health should be ensured first.be ensured first.

• A complete primary and focused assessment A complete primary and focused assessment should take place being alert for signs of internal should take place being alert for signs of internal haemorrhage, shock or respiratory distress but haemorrhage, shock or respiratory distress but victim is suffering from trauma in the form of victim is suffering from trauma in the form of physical assault the trauma should be managed physical assault the trauma should be managed in the order of established priorities.in the order of established priorities.

• Most emergency department have commercially Most emergency department have commercially prepared rape evidence collection kits as well as prepared rape evidence collection kits as well as written protocols for the treatment of injuries, written protocols for the treatment of injuries, legal documentation and sexually transmitted legal documentation and sexually transmitted disease and pregnancy prevention.disease and pregnancy prevention.

Interviewing the patient :-Interviewing the patient :-

• Consent should be obtained for the examination Consent should be obtained for the examination of collecting of swab/evidence for release of of collecting of swab/evidence for release of information to law enforcement agencies.information to law enforcement agencies.

• Record history of event in the patient’s own Record history of event in the patient’s own words.words.

• Ask the patient has bathed, gargled or brushed Ask the patient has bathed, gargled or brushed teeth changed clothes or urinated defaecated teeth changed clothes or urinated defaecated since attack – may alter interpretation of since attack – may alter interpretation of subsequent findings.subsequent findings.

• Examine rectum for signs of trauma, blood and Examine rectum for signs of trauma, blood and semen stains.semen stains.

Interviewing the patient :-Interviewing the patient :-

• Record time of admission, time of examination, Record time of admission, time of examination, date and time of sexual assault and the date and time of sexual assault and the appearance of the patient.appearance of the patient.

• Document any evidence of trauma – Document any evidence of trauma – dislocation, bruises, laceration, secretion, torn dislocation, bruises, laceration, secretion, torn and bloody clothing.and bloody clothing.

• Record emotional state.Record emotional state.• All collected samples & records to be All collected samples & records to be

enveloped by sealed.enveloped by sealed.

Intervention : Preparing for Intervention : Preparing for physical examinationphysical examination

– Assist the patient to undress over a sheet large piece Assist the patient to undress over a sheet large piece of paper to obtain debris.of paper to obtain debris.

– Protect patient against sexually transmitted diseases Protect patient against sexually transmitted diseases such as gonorrhoea, H.I.V. etc.such as gonorrhoea, H.I.V. etc.

– Immediately obtained (positive swab taken in the Immediately obtained (positive swab taken in the immediate post rate period will only reflect existing immediate post rate period will only reflect existing disease).disease).

– Place each item of clothing in a separate paper bag Place each item of clothing in a separate paper bag (plastic bags promote moisture retention which may (plastic bags promote moisture retention which may lead to formation of mold and mildew which can lead to formation of mold and mildew which can destroy evidence).destroy evidence).

• Label bags appropriately : give to appropriate law Label bags appropriately : give to appropriate law enforcement authorities and has to be sealed enforcement authorities and has to be sealed

Physical ExaminationPhysical Examination..

• Examine the patient ( from head to toe) for injury Examine the patient ( from head to toe) for injury especially to the head, neck, breasts, thigh, back and especially to the head, neck, breasts, thigh, back and buttocks.buttocks.

• Assess for external evidence of trauma (bruises, Assess for external evidence of trauma (bruises, laceration, stab wounds).laceration, stab wounds).

• Inspect fingers for broken nails and tissue and foreign Inspect fingers for broken nails and tissue and foreign materials under nails.materials under nails.

• Document evidence of trauma with body diagrams or Document evidence of trauma with body diagrams or photographs.photographs.

• Assist in conducting oral examination to determine Assist in conducting oral examination to determine secretion status of patient compared with that of secretion status of patient compared with that of assailant.assailant.

• obtain a saliva specimenobtain a saliva specimen• take prescribed cultures of gum and tooth areas.take prescribed cultures of gum and tooth areas.

Providing follow-up services.Providing follow-up services.

• Make an appointment for follow up surveillance Make an appointment for follow up surveillance for pregnancy, sexually transmitted disease and for pregnancy, sexually transmitted disease and HIV counseling.HIV counseling.

• The patient should be accompanied by family The patient should be accompanied by family member or friend when leaving the health care member or friend when leaving the health care facility.facility.

• Inform the patient for counseling services to Inform the patient for counseling services to prevent long term psychological effects. prevent long term psychological effects. Counseling services should be made available to Counseling services should be made available to the family.the family.

Obtaining Laboratory Obtaining Laboratory Specimen Specimen

• Collect vaginal aspiration which is examine for Collect vaginal aspiration which is examine for presence or absence motile/non-motile sperm.presence or absence motile/non-motile sperm.

• Use sterile swab to draw from vaginal pool for Use sterile swab to draw from vaginal pool for acid phosphatase, blood group, antigen of acid phosphatase, blood group, antigen of semen and precipitation test against human semen and precipitation test against human sperm and blood.sperm and blood.

• label all specimens with name of patient, date, label all specimens with name of patient, date, time of collection, body area from which time of collection, body area from which specimen was obtained and names of personnel specimen was obtained and names of personnel collecting specimens to preserve chain of collecting specimens to preserve chain of evidence, give to designated person (crime evidence, give to designated person (crime laboratory) etc. and obtain an itemized receipt. laboratory) etc. and obtain an itemized receipt.

• Examination of the VictimExamination of the Victim : :• It must be remembered that the police or court It must be remembered that the police or court

has no power of compelling a women to show has no power of compelling a women to show the private parts of her person for examination the private parts of her person for examination of medical practitioner, male or female.of medical practitioner, male or female.

• Conclusion :Conclusion :• Rape has been described as :-Rape has been described as :-• “ “ not an act of sex but an act of violence with not an act of sex but an act of violence with

sex as the primary weapon”. It may lead to a sex as the primary weapon”. It may lead to a wide variety of physical and psychological wide variety of physical and psychological reactions.reactions.

dutyof doctors medico legal aspect

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