medicolegal book contents

8/17/2019 Medicolegal Book Contents

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SECTION I Medical Ethics and Law

1. Te Ethics of Medical Practice 3 VP Singh, Parmod Goyal

Medical Ethics 3; Autonomy 3; Beneficence 4; Nonmaleficence 4

Does Paternalism Really Serve the Purpose? 5

Should Physicians do Whatever Patients Say? 6 ; What Serves the Patient Best? 6 Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations 7

2. Confidentiality and Disclosure in Medical Practice 17 VP Singh, Akashdeep Aggarwal

When Confidentiality may be breached? 17 ; Guidelines on Medical Confidentiality 18

Right to Information Act and Medical Confidentiality 19

Medical Confidentiality and HIV Status 21; Guidelines on HIV esting (March 2007) 22

Judicial Decisions on Medical Confidentiality and HIV Status 23

HIV esting of Patients Prior to Surgery 23

3. Disclosing Medical Errors: Why, When and How? 26 VP Singh, Gautam Biswas

Medical Errors 26 ; Disclosure of Medical Errors 27

Consequences of Disclosing Medical Errors 28

Guidelines on Disclosing Medical Errors 29

4. End of Life Care Decisions: Ethical and Legal Issues 35 Rashmi Datta, Pradeep Sreevastava, Arvind Kumar Singh

Palliative Care at the End of Life 35 ; Magnitude of the Problem 36 Medical Futility 36 ; Withholding or Withdrawal of Life Support 37

Advanced Directives and Do-Not-Resuscitate Orders 38 ; Euthanasia 39

Implications to Human Organ ransplantation Act 39

Legal Aspects of End of Life Issues in India 40

5. Medical Professionalism: Focus on Communication Skills 43 Shalini Ratan

Physician and the Patient: A Changing Relationship 43; Te patient’s Perception 44

Engaging Patients Trough Effective Communication 45

Miscommunication to Litigation 46 ; Physician-patient Communication in Practice 46


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Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practicexviii

SECTION II Documentation of Patient Care: The Legal Aspects

6. Medicolegal Aspects of Informed Consent 51 VP Singh, Dasari Harish

Evolution 51; Objectives 52 ; Meaning 53

What Makes the Consent Legally Acceptable? 54; Exceptions 57

Obtaining Consent: Te Procedure 57 ; Documentation of Informed Consent 57

Judicial Decision on Informed Consent 58

7. Medicolegal Aspects of Medical Records 61 Joseph Tomas, Arun Mavaji Seetharam

ypes of Medical Records 61

Electronic Health Records: An Emerging rend in India 62 Guidelines on Medical Records 64; MCI Guidelines 64

NABH Guidelines 64; Medicolegal aspects of Medical Records 69

Ownership of Medical Records 69 ; Summoning Medical Records by Courts 70

Judicial Decisions Related to Medical Records 70

SECTION III Litigation Against Medical Practitioners

8. Medical Negligence: Meaning, Scope and Legal Interpretation 75

VP Singh, Vivekanshu Verma What is Medical Negligence? 75 ; Essential Components of Medical Negligence 75

ypes of Medical Negligence 77 ; Burden of Proof of Medical Negligence 78

Yardstick used to determine Medical Negligence: Te Bolam’s Rule 79

Criminal Liability of Medical Professionals 80

Guidelines: Prosecution of Doctors for Criminal Rashness or Criminal Negligence 81

9. How to Defend Medical Negligence Lawsuit? 83 VP Singh, MC Gupta

Pattern of Complaints against Medical Practitioners 83

Complaints under Consumer Protection Act—Step-by-Step Approach 83 Facing the Court: Medicolegal ips and Advice 86

10. Compensation in Medical Negligence: How much is Justified? 89 VP Singh, Mukesh Yadav

Compensation in Medical Negligence 89

Multiplier Method: Can it be Used in Medical Negligence Cases? 89

How Much Compensation is Just and Adequate? 92

Impact of High Quantum of Compensation 92

Medical Liability—A Future Crisis: Learning from the Other Countries 93

Crisis Reform Models 93; Caps on Noneconomic Damages 93 No-fault Compensation 94; Health Courts 94


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Contents xix

11. Professional Indemnity Insurance: Better Safe than Sorry 97 Rajendra S Bangal

Professional Indemnity Insurance 97 ; What does it Cover? 98

What it Does not Cover? 98 ; AOO: AOY Ratio 100

Premium Rates (Individuals) 100 ; Premium Rates (Individuals) 100

Premium Rates (Clinical Establishments) 100 ; Retroactive Date 101

An Ideal Indemnity Insurance Policy: Proposed Components 101

SECTION IV Medical Laws and Judgments Governing the Medical Professionals

12. Landmark Judgments Related to Medical Professionals 105 VP Singh, Krishnadutt Chavali

Dr Suresh Gupta’s Case 105 ; Jacob Mathew’s Case 107

Supreme Court’s Observation on Negligence 108

Martin D’Souza’s Case 109 ; V Kishan Rao’s Case 111

Supreme Court’s Observation on Expert Medical Opinion 111

Supreme Court’s Observation on Martin D’Souza’s Case 112

13. Medicolegal Outlook on ransplantation of Human Organs Act 113 Sunil Shroff, Sumana Navin, Hemal Kanvinde, Sujatha Niranjan, Christopher Barry

ransplantation of Human Organs and issues Rules 2014 113

Medicolegal Aspects of Living Donation and ransplantation 115 Medicolegal Aspects of Deceased Organ Donation and ransplantation 116

Future Challenges 117

14. Medicolegal Outlook on Biomedical Waste Management Act 120 VP Singh, Pardeep Singh

Biomedical Waste 120 ; Biomedical Waste (Management and Handlings)

Rules, 1998 121; Penalties under the Environment Protection Act 130

15. Medicolegal Outlook on PC-PND Act 132

Chandrashekhar A Sohoni Preconception and Prenatal Diagnostic echniques Act in a Nutshell 132

PC-PND Act–Controversies and Practical Difficulties: Safety Measures to be

taken by the Doctors 135

SECTION V Medicolegal Issues in Various Specialties

16. Medicolegal Issues in Obstetrics and Gynecology 143 Charu Mittal, Prabuddh Sheel Mittal

Medicolegal Issues in Obstetrics 144; Medicolegal Issues in Gynecology 148 Medicolegal Issues in Perioperative Patient Care 148

Surgical Complications: Medical and Legal Implications 150


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Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practicexx

Specialist as an Expert Witness in a Court of Law 151

General Precautions during day to day Practice:

Avoiding Malpractice Lawsuits 152

17. Medicolegal Issues in Surgery 154 Manu Shankar

Preoperative Period in Surgery 154; Peroperative Period 156

Postoperative Period 156 ; Consent in Surgery 157

Role of Anesthesia 157 ; Surgical Complications 158

‘Never Events’ in Surgery 159 ; ake Home Message for the Surgeons 160

18. Medicolegal Issues in Orthopedics 162 Sarvdeep S Dhatt, Siva Swaminathan S

Why Orthopedicians are Vulnerable to Malpractice Lawsuits? 162

Consent in Orthopedics 163; Complications in Orthopedics 164

Wrong-Site Surgery 164; Avoiding Malpractice Lawsuits 164

19. Medicolegal Issues in Ophthalmology 167 Dinesh Verma, Amandeep Singh

Medicolegal Issues in Ophthalmology 167

Vulnerable Domains in Ophthalmic Practice 168

Managing the Risk of Lawsuits 171

20. Medicolegal Issues in Pediatrics 174 Yogesh Dave

Why Study Medicolegal Issues in Pediatrics? 175

Informed Consent in Pediatrics 175

Error in Diagnosis during Emergencies 176

Patient Safety in Pediatrics 177

Neonatal Intensive Care: Vulnerable to Malpractice Lawsuits 177

Communication Skills—Key Role in Pediatrics 178

21. Medicolegal Issues in Radiology 181 Chandrashekhar A Sohoni

Errors in Radiology 181; Judicial Decisions on Radiological Errors 184

Why Radiology is Vulnerable to Medicolegal Conflicts? 182

Avoiding Litigation in Radiology 186

22. Medicolegal Issues in Blood ransfusion Practice 189 Ranabir Pal, Gautam Sarker, Debashis Sinha

Where we Stand as of Now in India? 189 ; National Blood Policy 189

Medicolegal Aspects in Blood ransfusion Services 191

Challenges of Blood Screening 192 ; Who will Bell the Cat? 193 ake Home Message 194


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Contents xxi

23. Medicolegal Issues in Dentistry 197 Shilpa Pharande

Medicolegal Aspects of Dental Practice 197; Medical Emergencies in Dentistry 198

Protection Against Litigation 201; How to Avoid Litigation? 201

24. Medicolegal Issues in Anesthesiology 205 Manpreet Singh, Ajay Kumar, Lakesh Anand

Standard of Care 205 ; Duty of Care and Liability 206

Medicolegal Issues in Anesthesiology 206 ; Error of Judgement 209

Mistake 210 ; Burden of Proof 210 ; Res ipsa loquitur 210

How to Decrease the Likelihood of a Lawsuit? 211

Accepted Practices and Procedures 212

Accidents, Misadventures, and Mishaps 212 Inherent Risks 213; Choice of reatment 213

Keeping the Professional Knowledge and Skill up-to-date 213

Cases to Observe 213

Index 217

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