Medical-legal issues

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Medico-Legal Issues
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Medico-Legal Issues

• Consent
• Handling medico-legal cases (Medical
  jurisprudence)
• Record-keeping duly catalogued and indexed
• 4 Court attendance
• 5. Adequate care Medical-negligence

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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

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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

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What to Record?

• Completion of Page 1 (Admn. Records) on the file
• Legible Name, Age, Sex, Address details
• Accurate dates of Adm / Dis / Death
• Comprehensive Diagnosis
• Signatures
• Detailed case history and examination
• Daily progress (Medical) notes, opinions,
  consultation, Decision-making
• Investigations Make a note of important tests
  in the file

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Consent

• Express willingness / Agree / Give permission
• Voluntary agreement
• Informed- Doctors responsibility to disclose the
  necessary information to secure consent
• Real consent- Doctor must warn his patient of the
  (Bolams Law) inherent risks of the recommended
  treatment In accordance with the accepted
  practice considered proper (by a responsible
  Medical Body)

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Real Consent

• Voluntary
• Capacity and competency of patient
• Adequate level of information (Remote risk of
  harm, 1-2 risk, need not be disclosed)
• Supreme Court of India
• Samira Kohli case (2008)

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Medical Negligence
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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

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Seeking Consent

• From the patient (competent)
• 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

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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.

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Medico-legal Cases

• Type of cases
• Grievous injuries Drowning, hanging, rape,
  attempted suicide
• Poisoning, even if accidental
• Grievous traffic injury (due to patients
  mistake)
• Extensive (gt 40) burns, even if accidental
• Grievous injuries even if accidental
• Fall from a height
• Under earth mound burial, Electric shock,
  Lightening
• vi. Attempted abortion (unauthorized)

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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)

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Consent - Issues

1. Consent vs Medical Advice
2. Free and voluntary
3. Competent (vs incompetent) patient
4. Proxy consent
5. Withdrawl of consent

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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.

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Withholding / Withdrawing life-supportive
treatments

• Assisted ventilation
• Other life-supports
• Resuscitation
• Do Not Resuscitate
• When not to resuscitate

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Ethical (Moral) Issues

• Legal overlap / contradictions
• Resuscitation
• Withholding / withdrawal of life supportive
  treatments
• Medical Research (Theses)
• Publications - Copyrights

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