Medico-Legal Issues
1. Consent
2. Handling ‘medico-legal cases’ (Medical jurisprudence)
3. Record-keeping – duly catalogued and indexed
4 Court – attendance
5. Adequate care – Medical-negligence
Do Not Record (on Files) / Must to avoid
1. Allegations, disputes and anger
2. Agitated counter-opinions
3. What else can be done?
4. What else could have been done?
5. Justifications
6. Later Alterations / Deletions of information
Record-Keeping : Importance
1. Treatment of patient – day to day progress – to guide self, others (e.g.
those called for consultation)
2. Follow-up management
3. Medico-legal purposes
4. Insurance / Payment disputes
5. Medical Research – data analysis (ICD Index Codes)
6. ‘Right to Information’ (RTI) ACT
7. Consumer-Court requirements under CPA-Medical Negligence
What to Record?
1. Completion of Page 1 (Admn. Records) on the file
Legible Name, Age, Sex, Address details
Accurate dates of Adm / Dis / Death
Comprehensive Diagnosis
Signatures
2. Detailed case history and examination
3. Daily progress (Medical) notes, opinions, consultation, Decision-making
4. Investigations – Make a note of important tests in the file
Consent
Express willingness / Agree / Give permission
Voluntary agreement
1. Informed- Doctor’s responsibility to disclose the necessary
information to secure consent
2. Real consent- Doctor must warn his patient of the (Bolam’s Law)
inherent risks of the recommended treatment; In accordance with the
accepted practice considered proper (by a responsible Medical Body)
Real Consent
i. Voluntary
ii. Capacity and competency of patient
iii. Adequate level of information (Remote risk of harm, 1-2% risk, need
not be disclosed)
Supreme Court of India
Samira Kohli case (2008)
Medical Negligence
Incompetent Patient
1. Children
2. Mentally disadvantaged (Down Syndrome)
3. Unconscious / Altered sensorium
4. Prisoners
5. Mental disorders / Schizophrenia (Proper certification)
6. Unable to hear / understood – language barrier
Seeking Consent
1. From the patient (competent)
2. Attendants (close relative) if incompetent patient
Proper identification and recording of name, address,
relationship
Better if attested by others
3. Consent for Surgery/Risky management/ Resuscitation/Postmortem
Summons
1. To be accepted, always
2. To be returned with request to the Court in case of incomplete and
untraceable information (Polite language)
3. Extreme care for summons from the Sessions Court / High Court – Must
attend.
4. Request for postponement if notice is ‘too short’ or ‘very urgent work’
5. Must attend, if summoned second time.
Medico-legal Cases
Type of cases
i. Grievous injuries – Drowning, hanging, rape, attempted suicide
ii. Poisoning, even if accidental
iii. Grievous traffic injury (due to patient’s mistake)
iv. Extensive (> 40%) burns, even if accidental
v. Grievous injuries – even if accidental
Fall from a height
Under earth mound burial, Electric shock, Lightening
vi. Attempted abortion (unauthorized)
Procedure
1. Information to the local Police Post
2. Put a note about this in the file. Mark “M.L.C.” on the file.
3. MLC Proforma to be prepared
4. ‘Not fit to make statement’ – recording and reporting
5. Patient statement and dying declaration, preferably in the presence of a
Magistrate / others available (Duly signed)
6. Inform police before discharge (and on death)
Consent - Issues
1. Consent vs Medical Advice
2. Free and voluntary
3. Competent (vs incompetent) patient
4. Proxy consent
5. Withdrawl of consent
WHO Declaration on Promotion of patients’
rights
“Patients have the right to be fully informed about their health status,
including the medical facts about their conditions; about the proposed
medical procedures together with the potential risks and benefits of each
procedure; about alternatives to the proposed procedures, including the
effect of non-treatment and about the diagnosis, prognosis and progress of
treatment”.
Withholding / Withdrawing life-supportive
treatments
Assisted ventilation
Other life-supports
Resuscitation
“Do Not Resuscitate”
When not to resuscitate
Ethical (Moral) Issues
Legal overlap / contradictions
Resuscitation
Withholding / withdrawal of life supportive treatments
Medical Research (Theses)
Publications - Copyrights
