LEGAL ASPECTS IN HOSPITAL

1
LEGAL ASPECTS IN HOSPITAL

• Laws regulations applicable to hospitals .
• Enquiries Disciplinary actions
• Permits n Licences.

2

• Introduction
• Definition
• Objectives
• Gen. Acts/legislation applicable to Hosp.
• Law of torts.
• Bill of Rights
• Ethical legal Responsibilities

3
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

4
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

5
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

6
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

7
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

8
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

9
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

10
Introduction

• Society has laid down the laws of land
  prescribing normative behavior of Indls./Groups
  with provision of deterrent corrective punishment
  for any contravention by the society through
  various methods e.g. imprisonment/fine.
• Law can be divided into i)civil law is concerned
  with relationship among people the protection
  of persons right . Violation may causes harm to
  an indl. or property but no threat to society
  ii) criminal law includes rules forbidding
  conduct that is injurious to public order
  specifies punishment to indl who exhibits
  injurious conduct.

11

• Criminal law is concerned with relationship
  between indls. Govt. acts that threatens the
  society its order.
• Crime is an offense against a society that
  violates a law.
• Ignorance of law offers no protection from
  punishment.
• Public is now becoming aware of its own rights,
  obligation of Drs. also obligation of hospitals
  consequently MLC are on rise.

12

• MLC Any case of injury or ailment where some
  criminality is involved is called as MLC.
  Criminality in a case may be Non
  Cognizable(Police has no auth to arrest without
  warrant) or cognizable (police can arrest without
  warrant).
• Dyeing Declaration It is a statement of a
  person, written or oral, who is dying as a result
  of some unlawful act,relating to the material
  facts of cause of his death or bearing on the
  circumstances.
• Magistrate,Doctor, Public personality/police.

13
Various Medico-legal issues
Personal Injury Medical frauds Defensive medicine
Negligence Professional In-competency Organ Transplants
Malpractice Ethical issues in human experimentation Sex Determination genetic counselling
14
Objectives

• Increasing number of MLC has made it necessary
  for hosp. Administrators to understand Medico
  Legal issues.
• To understand Medico legal issues is necessary so
  as to do the right things and protect themselves
  institutes from frivolous litigations also do
  justice to patients.

15
DEFINITION

• Law means body of rules to guide human action.
• Law is a system of rights obligations which the
  state enforces.
• Law is the body of principles recognised by the
  state the administration of justice.

16
Hospital Administration

• Has an obligation to have clear understanding of
  Ethical legal responsibilities. Mgt is
  responsible for policies, for maintaining a safe
  hosp., physical facilities services, must
  ensure building conforms to local bye laws,
  safety regulations,sanitation arrangements.
• Hosp. Being an integral part of the social system
  is subject to all laws of the land.
• Hosp. Is responsible for safety from explosives
  inflammatory gases,chemicals, machinery, steam
  damages from slippery floors etc.

17
Application of Law

• There are no specific laws relating to
  hosp./staff/Equipment.
• Application of Laws related to hosp working, of
  interest are the ones which are concerned with
  Consent, Professional secrecy, evidence, Medical
  negligence, law of torts, organ transplant.

18
General Acts/Legislation applicable to hosp.

• Industrial dispute act 1948 Where gt50persons.
• Minimum wages Act1948 Categories wise.
• Employees Provident Fund Act where gt20 persons
  is punishable by imprisonment.
• Payment Of Bonus Act Where gt40 persons but not
  applicable to charitable/ Non profit hosp.
• Payment of Gratuity act 1972Where 10 or more
  persons work.
• Payment of wages act 1936 within 7 days.
• ESI act 1948 Hosp contributes 4 of total wage
  bill.

19

• Industrial dispute Act 1948 considers strikes a
  breach of contract in public utility service, if
  without 6 weeks prior notice, or within 14 days
  of notice of a strike, or during reconciliation
  proceedings are on.The notice of strike has to be
  intimated within 5days to Govt.
• Minimum Wages Act States No.of hours of
  work/overtime/working days/holidays.
• Workmans compensation Actloss of both
  hands/feet/one hand one foot right/total
  disfigurement of face constitutes 100 loss.Act
  lays down the age of loss of earning capacity.

20

• Motor vehicle Act1988 Breath analyzer test/blood
  test. Police can detain a person for alcohol test
  for not more than 2 hrs.
• Drug Act 1940Regulates import,manufacture,distrib
  ution sale of drugs in India.Insecticide,disinfe
  ctant contraceptives cosmetics are included
  in this Act. It lays down the drugs which can be
  sold over the counter those e.g. schedule H L
  normally would not be sold without prescription.

21
Medical / professional Acts

• Indian Medical Council Act 1933.
• Indian Nursing Council Act 1947.
• The Pharmacy Act1948 Hosp has to acquire drug
  licence if it sells drug otc.
• Births Deaths Marriages registration Act.Hosp
  is bound to inform all births/deaths taking place
  in a hosp.

22
Miscellaneous Acts Applicable to Hospitals

• Societies registration Act,1860 It governs
  working Mgt of institutions est. or owned by
  charitable trusts.
• State Public charitable Trust Acts.
• Acts in relation Establishment of Nursing homes.

23
Law of Torts

• Tort is defined as Any wrong,injury or damage is
  done to the person for which a civil suit can be
  brought e.g. wrong operation, operating without
  consent, leaving instrument inside the
  body,invading the right of privacy, breach of
  professional secrecy, defamation,malicious
  prosecution, misrepresentation.

24
COPRA 1986

• This Act came into force w.e.f.1 Sep,1987.
• Advantage Minimal cost is involved matter is
  decided within 3 to 4 months.
• Provides redressal for defective goods,deficient
  service, unfair trade practices.
• Consumer A person who hires any services for any
  considerations, any beneficiary of such
  services other than who hires, when such services
  are availed of with the approval of the first
  mentioned person.

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• Deficiency Any fault,imperfection shortcoming or
  inadequacy in the qlty,nature manner of
  performance of a contract,or otherwise in
  relation to the service.
• Service means service of any description except
  free service personal service.
• A claim for compensation under COPRA must be
  filed within 3Yrs.
• National Forum deals cases gt10 lacs, state forum
  gt5lacs district forum upto 5lacs.

26
BILL OF RIGHTS

• Respectful care
• Complete information regarding diagnosis,tmt,prog
  nosis.
• Pt. Has right to information from Dr before he
  gives consent.
• Right to refuse tmt,to the extent permitted by
  law to be informed of med. Consequences.
• Right to privacy, all communication records be
  treated as confidential.
• Hosp must provide evaluation,service,/or
  referral as indicated by the urgency of case.

27

• Relationship of hosp to other hosp where one is
  being referred to.
• Right to refuse to participate in research.
• Right to know appointments/availability of DR,
  continuity of hlth care requirements after
  discharge.
• Right to examine receive explaination of bill.
• Right to Hospital rules.

28
Offences Professional Misconducts

• Adultery/improper conduct/association with
  patient.
• Issuing false certificates.
• Conviction by court of law for offences involving
  moral factors.
• Selling of schedule poisons
• Performing an abortion or illegal operation/op
  without consent.Disclosing patients secrets.
• Issuing certificates to unqualified persons.
• Advertisement of services or the institutions run
  by the physicians. Use of agents.

29
Organ Transplant

• There is no specific central legislation which
  permits sale/purchase of organs. Indian law is
  silent on trade in human organs.
• Transplant of Human organs Bill1992 is under
  consideration deals with various aspects of organ
  transplantation.It deals with measure to curb
  malpractice,punishment for donors,doctors even
  advertisement seeking donation of organs.

30
MTP ACT 1972

• Specifies conditions under which pregnancy can be
  terminated., the persons who can perform
  termination places where such procedures can be
  performed. It can be performed either in Govt.
  hosp or other places approved by the Govt.

31
Current Ethical Issues

• Aids
• Abortions
• Euthanasia
• Sterilization
• Adoption of children
• Ethical issues poor patients
• Ethical Issue of Examination of females.
• Use of new drugs on trial on patients.

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ETHICAL ISSUES

• We will have to treat every case on its merits,
  if we do our best in all honesty, we will make
  the decision right. Respect for a patient is
  fundamental to the Dr. pt relation ship respect
  we show reflects what we think of the patients
  worth.