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Understanding Medicolegal Complications in Everyday Practice

May 19 | 3:30 PM

Medical professionals are increasingly becoming subject to legal actions arising out of the growing demand to make medical treatment more accountable in India. Patients in the country are becoming increasingly conscious of their rights as consumers. One cannot predict with certainty an outcome of cases many a time. Therefore, it is critical for medical practitioners to keep up to speed on the legalities involved pertaining to patient care. Dr. AL Meenakshi Sundaram, Professor of Anaesthesiology & Dean, Government Medical College, Tamil Nadu, is joining us LIVE on Medflix to educate us about the various medico-legal aspects so that we may all have a better grasp of the situation.

[Music] thank you so much for joining us matter in today's uh scenario so we all know that medical legal complications are increasing at an alarming number and patients want to see doctors accountable patients in the country are becoming increasingly conscious of their rights as consumers and we cannot predict with certainty and outcome of many cases so it's important that we understand the legalities involved and we have the honor for of explaining further on this uh very important topic we have the honor of having with us dr a.l minakshi sindhara dr minakshi is professor of anesthesiology and dean at government medical college param tamil nadu sarah has decided to study in life in medical legal cases better to pay side situations so it's an honor to have you on metrics uh tonight thank you so much for joining us thank you thank you so much i'll just be starting your ppt over to usa yeah uh thank you very much and the netflix netflix uh i'm really happy to be here as a legal person and now i thought how to present the views to the doctors so what i thought the doctors are worried about the increasing number of litigations because they don't want to enter into the legal intricacies and they are worried only about the medical problems now i will tell them what is negligence as decided by the supreme court so it is not my views first we should know what is negligence so that we can defend when a case is filed against us we should know how to defend us so i will give only outline what is a negligence then a few examples and as i am an anesthesiologist mostly it will be from anesthesiology but the principle is the same so i will give a outline and as a it is a medical legal session i want to tell all the doctors see my lecturer is not a substitute for seeking a competent legal advice just like we say self-medication is dangerous self-thinking on the legal side is also dangerous we can only feed the lawyer but there are some technicalities in the court so it is not a substitute for engaging in advocate what i want to say even if a patient comes like this injured very badly injured the doctor is simply treating the patient so even they see the pupillary reflux even in this damaged phase they are seeing a pupillary reflex what i want to convey the doctor is active in others crisis but it when it comes to them by legal notice they want to run away it should not be like that so why people are worried legal notices against the doctors are steadily rising the doctors need to know about the legal issues so what i want to convey instead of running only the continuing medical education program we have to run continuing legal education program and the doctors should not feel shy to expose the number of litigations they are facing because it is better always to learn from other people's experience but basically as far as medical legal session is concerned the principle is prevention is better than cure so the doctors are worried about medical legal cases because they feel talking to the policemen and a lawyer it is below their dignity or somewhat they are not comfortable i have seen my colleagues they are not comfortable with the uniform the people if a police is in the uniform if the lawyer is in his attire the doctors are worried we have to change that mentality and another problem the legal people don't in understand the intricacies of medicine that is a problem and we should know what is negligence at the same time relying on textbooks only it is create more problem because the textbooks the lawyers read only that particular subject on the day and they will come prepared but the doctors it is one among the time so it may be a problem and another thing is there is no definite law for each and every problem that is a take-home message definitely all the doctors have to take because routinely they ask me what that judges given they were picked like this the same thing the judge has given another verdict that is a routine question but there is no definite law it is only interpretation of the judge so in a medical negligence case in day-to-day practice you have to convince the judge this is just like passing the examination by convincing the examiner so the judgment varies from judge to judge so the supreme court leads certain guidelines what is negligence it says the professionals like auditors lawyers doctors architects they are professing some technical skills so the only assurance legally what we can give to the patients it is not the treatment curative aspect there is no guarantee we have to specify that we possesses the requisite skill this is the supreme court order so whenever you are sued you have to profess first that you are skilled in that particular profession and there are three elements of negligence you have to analyze the case by case one one there should be a duty that you are treating a patient so there is a duty first of all you have to check whether the duty is there then whether the duty is breached whether you have not done that properly that is a breach of duty and because of breach of duty there should be some damage for the patient then only medical negligence arises this is the jacob matthew case you have to remember that quoted that citation the three elements whenever you are charging other when you are defending yourself you have to say there is a duty there is a breach of duty and there is a resultant damage so the jacob matthew case the supreme court said negligence is the breach of duty it may be omission or by commission and negligence becomes actionable on account of injury resulting from the act of omission so these three should be there then the for criminal cases the supreme court said when there is a gross negligence of duty then only doctor can be booked under 304 a ipc it is a ration negligent act mostly when the mob creates some problem the police sometimes just to escape from the mark they may file a case because convincing the doctor is easy they will book them under three not for a pc ipc but it is not possible because only if there is a gross negligence but unfortunately the grass is decided by the judge in the court and the police just like that they follow that is the reason why we have lost even an obstetrician because even she was charged under attempt to murder it is not a profession negligent actor people used to ask me when they are doing like that what we have to do see whenever whenever some people are not following the rules and regulations we have to tackle them only in their way so there is not a ready-made answer if a police officer is not doing it properly what we can do that is the reason why we have to have associations professional associations like ima so to prosecute a medical professional for negligence and a criminal law so just like that they cannot do that so they say the professional will be held the liable for negligence either two findings should be there one he is not possessing the requisite skill or in the he has not exercised that reason of skill which he possessed so that is the two points one there should be a there is no skill or if the skill is not applied and again the supreme court has given clear guidelines see the mostly when a death occurs immediately the angry mob they want to find some reason so they charge the doctors so the supreme court said the human body is a complex machine it is a complex machine and if we cannot understand the instances of medicine these are all the words we have to use while we are defending our case there is a market tendency to for a human actor to blame that is the supreme court statement so a case of occupational negligence is different from professional negligence so a simple lack of care or error of judgment or an accident is not a proof of negligence that we have to know just to be a simple lack of error so if a doctor practices medicine as per the guidelines existing on that day he cannot be held as negligent so what we have to do we have to practice as per the norms available on the day and again the supreme court has given uh guidelines for us it is not the expert how he behaves if i am an anesthesiologist i have to exercise the average skill not the the supreme superman in anesthesiology is practicing i need not do that if the average person in that field what skill he exercises that average skill if it is exercised it is enough so it is not the top most person we cannot say that man will catch even hemoglobin while doing surgery this surgeon has not done that it is not like that so that is an advantage for us so again the supreme court after saying so many things it has mentioned whatever we have said it doesn't mean that the doctors can never be prosecuted yes they can be prosecuted but it is not just like that they should not be prosecuted that's what supreme court has established so in the dr harish kumar purana case this is also a reportable case justice suryagan then the doctor bocanna division bench has given the ruling and the author is justice and they have mentioned who is it is a clear that in every case where treatment is not successful or a patient dies during surgery it cannot be automatically labeled so if a patient dies during surgery and if if we are held for medical negligence you have to quote these points the supreme court has said like this so to indicate negligence there should be a material available on record that is a must and the negligence should be glaring so these are all the words of the supreme court and i want to say some few examples for a medical negligence on consent because people are asking how to take a consent the supreme court and the state consumer disputes retrospect forum they have given the guidelines in this quotable case see the doctor has obtained a concern on a blank paper that should not be like that because now we have to take informed consent so the blank paper consent it is a problem so even the indian medical council says you have to take a informed consent so the state consumer dispute redressal forum ruled the doctor cannot escape his liability because it is taken in a blank paper and in the consent i want to sell for specific thing even in informed consent most of the doctors are getting the consent signed with the patient it is a must it is a must we cannot say for my wife i give consent it is not like that for any major person aged above 18 years they should sign in the presence of witness but what the doctors are omitting consent is to be signed by both the parties so it should be signed by the doctor as well as the patient which is grassly omitted i have seen only the patients are signing the concern form the concern it should not be in a printed paper it should be a informal concept so for example these are all the previous british cases the anesthesiologist has has introduced a dichlorophonic suppository without the concept of the patient so that has become a problem as it is a suppository the lady charged the doctor and the doctor was held in negligent same way a patient wanted to have a general anesthesia but the doctor has given spinal that is absolute negligence when she demanded in writing that it should be given and it was evident because the spinal has produced paraplegia so it is obvious the patient wanted ga so we cannot go against the wish of the patient so even in the constant case one doctor has not taken a written concern this is tamilnadu consumer dispute result forum so the doctor has not taken a written consent but the judge has mentioned that it is a case of thyroidectomy see the patient was all along conscious till the anesthesia is induced she knows the pre-medication her relatives also aware of that so there was an overall consent so just because there is no return concern that the doctor cannot be held a liability but these are all the judgments delivered in 1992 now the era is changing so there may be dog judges like pleasant like this on the left hand side of mine and the judges may be some judges may be like this so we have to be very careful in consent so for this concerned i want to give some thing the supreme court said the concern should be procedure specific if you are doing explorative laboratory if you keep only expiration you cannot go further beyond that when you want to go beyond the consent for which the consent was given for the procedure it should be only life-saving it should be only life-saving because in is needed for blood transfusion then name of the anesthesiologist and name of the surgeon is to be mentioned in the consent form these are the cases on uh consent the same way lord makula in a western country under justice laputi they have given so many judgments favorable for the doctors so we have to read those judgments here a patient was given consent for ga but for pain relief they have given caudal anesthesia so the patient complained that i have not given my consent for cardinal analgesia but the justice ruled justice said then step by step the equation cannot take a consent and the doctor cannot take a consent from the patient because if the patient is consenting to undergo hernia refe it means it is amniography there should not be any there should not be any stepo is concerned like incision of the skin incision of the subcutaneous tissue it should not be like that but judgment differs the both sides look same but if you observe carefully there is some difference same way the judgment also differs so we have to be very careful and here in the consent cases the one husband has given consent for the wife the wife developed a problem and the wife petitioned the court and lost the case they said the husband has given the consent but she has appealed in the higher court i don't know what is the problem within the wife announcement she appeared in the higher court my husband cannot give consent for me yes the court has clearly mentioned see that i have given the exact words of the ruling there was no consent that the patient's spouse was authorized to consent on our behalf it is a legal terminology that is applicable for us also we cannot take a consent for a surgery on the wife from the husband the husband and wife relationship does not itself make one spouse the agent of the other these are all the legalities so what are the lessons what is you have to get a informed consent and in unconscious patient you can proceed as a life-saving procedure but once the patient has regained the consciousness subsequent surgeries you have to take a consent the implied consent means if a patient is entering into your consultation room you need not take a consent to examine him because just because the patient is walking inside your consulting room it means the patient is consenting himself or herself to be examined by the doctor so that is a implied concern it is a hidden consent same way in a but once the emergency is over the subsequent surgeries you have to take consent so as i said in the samira goli case this is the supreme court case it summarizes the principles of a consent a doctor has to seek and secure the consent of the patient before commencing a treatment the patient should have the capacity and the competence to concern here the supreme court says see you have to give only adequate information in australia in european countries the consenting is very strict even 0.1 death may be possible you have to explain that but in indian country supreme court has ruled you have to give adequate information but you should not frighten the patient because the supreme court thought if a doctor is saying so many complications then the patient may refuse the particular treatment and he may go for a treatment under a quack so to avoid that only the supreme court said you give adequate information so the nature and procedure of the treatment an outline of the substantial risk so we cannot say any anesthesia the patient may die but it cannot be put into a informed consent format because the patient may refuse the particular treatment so even the remote test complications need not be mentioned and a balance should be achieved so whether you have achieved the balance or not it will be decided by the court only so in the consenting it is always better to error on the higher side but the patient should the patient can get a treatment from another doctor but the patient should not resort another treatment option that is the therapeutic procedure if a consent is given for a specific treatment you have to apply only that specific treatment the unauthorized additional surgery the actually the samira pulley case is the patient has given consent verb but the patient claimed she is 40 years unmarried so she says i have lost my uterus without my permission they have lost the uterus they said only explorative diagnostic laparoscopy but they have removed my uterus but the supreme court ruled she has aged 40 but even then you cannot remove the uterus because the consenting is only for diagnostic laparoscopy but just because considering the age 40 she may not enter into a reproductive age group the supreme court has ruled you return the money which has been charged by by the hospital so they have given the guidelines only in that so the samira colleague is you please read all the doctors who are attending this so but some point of time the consent is not required in some cases one medical emergency because as per legal parlance the medical consideration takes over legal consideration and life-saving measures same way in notifiable diseases like cholera dengue corona the patient cannot see you why you have informed others we are informing the public health authorities that a poverty patient has been admitted because here legal consideration takes over a medical considerations same way armed forces patient of the patients working in a hotel and a psychiatric examination ordered by the court at the time and all there is no concern then the implied consent as i said if the patient is injured like this we cannot go and take a concern so we can operate without a concern but once the patient's condition stabilizes you have to take a consent again in the record keeping is another problem then medical negligence day to day practice we are seeing the record keeping is very poor by the doctors in most of the areas because in one case sheet the doctor has mentioned that the death is due to postpartum memories but unfortunately for the doctor they have read every book and they said the standard book shah obstetric and gynecology and by dr ratnam they say if it is a postpartum hemorrhage you should have given oxytocin uterotonic drug and you should have gone for a balloon template or internally battery ligation see just by labeling the lawyer reads what are the treatment options available as per the standard textbooks and they check whether the standard treatments are followed so if suppose your patient is having postpartum hemorrhage for example i am saying if you if the gynecologic obstetrician is given oxytocin then your prostaglandins are your tamponade manners or the blood transfusion or whatever manners if you are doing that standard practice then you cannot be held negligent so the record keeping should be very correct as i said duty breach resultant damage so this should not be this should be established by the person who is charging the doctor as negligent then in day-to-day medical practice if there is a negligence then the court as well as [Music] the doctor they can ask for a expert witness so the expert testimony is the best way to convince the people but what the expert should do it is given in the supreme court guidelines the expert should help the court and it the court should understand the intricacies of medicine so the expert should explain it in a clear language which could be understood by the court but the catch is the expert witness need not be accepted by the court it is only a guiding principle so we have to note that because in one case that is this national consumer disputed result forum in this the expert opinion said there is no negligence but the andhra pradesh state consumer reversal forum has awarded 10 likes as compensation because ethios noted the doctor should watch for changes in blood pressure it is not been done and the patient the doctor has to document the process which is also omitted and in in some hospitals the anesthesiologists are allowed to read books these are all the consumer dispute redressal forum statements so there is no reading between 3 30 and 3 50 pm see that judge looks for even 20 minutes gap so this judgment varies from judge to judge so you cannot ask me so what is the reasonable interval in which we have to record the findings with the automated apparatus what i feel if you take a print out of that or with that print out if you write every five minutes there will not be any problem because no judge can claim uh why the cash it has not been written below five minutes interval so the record keeping should be perfect what i want to convey the communication with the patient is to be there documentation is to be there that that you have communicated and again the communication of the documentation then documentation of the communication pressure and preservation of the documentation these five are important whenever you are practicing to avoid medical legal problems communication documentation communication of the documentation documentation of the communication and the preservation of the documentation so when you are treating a patient without a proper infrastructure it is a negligence it is a negligence so in one most of the time the defibrillator will not be there and in the case sheet they will write the patient has developed a ventricular vibration but they could not defibrillate the patient so in those areas definitely it is a case of negligence so you have to have adequate infrastructure because when the defibrillator is not available in one case the port has mentioned if the day deformator is not available the anastasia should have procured the same as a precaution r should have brought these facts to the notice of the patient so what i feel it is always better to avoid medical legal complications in day-to-day practice you please have an open mind don't concede any fact don't hide any information just to have the patient even if the patient goes from your hands don't bother because you can have a peace of mind these legal problems will not be there so you tell them these equipment is not available it may be remotely needed but i should tell you then you have to record that then because the code says without a machine you should have refused the treatment part in a remote areas it may not be a possibility but in the remote even if a patient is undergoing epilepsectomy under spinal anesthesia if the patient is aged 24 years there is no need for a defibrillator as a doctor i can say but if the patient develops ventricular vibrillation and if the default is not available legally it is a negligence so even in this case i used to jovially remark the court has awarded 4 lakh 15 000 for non-availability of defibrillator and the court is given a chair sixty percent is to be given by anesthesiologist thirty percent by the orthopedician and a ten percent by the cardiologist if the surgery was successful sixty-five will be taken by the anesthesiologist this is only for uh same way blood should be available in adequate quantity then people will ask copy of the case it is to be given or not there are contradictory judgments uh the maharashtra medical council said it has to be given yes but the puna medical foundation ruby hall clinic case it says no but what i want to say case sheet need not be given to the patient it should be given only to the police or the court but the patient is eligible for a discharge summary so you have to give a summary that there is no way of escapism when the patient is going out of the hospital under your advice or against medical advice you have to give a research summary some people are not giving if the patient is going against medical advice but you have to give a research summary and another problem i want to say if a patient refuses particular treatment then definitely it should be in a written format if a patient refuses because you have to it is the duty of the doctor to prove that the patient has refused the treatment it is mainly in jehovah's witnesses they will refuse blood transfusion and what is battery if a patient is not willing to undergo one particular treatment and if you do it on your own it is called the battery violation of the patient consent so the battery case there are so many cases are there always don't go against the wishes of the patient and another problem in day-to-day practice they will ask whether the cases can be given to the juniors the coach says the doctor need not lie by the side of the patient it is mentioned clearly the doctor cannot be expected to lie by the side of the patient they can delegate they can delegate they can come on call but the delegation is to be to the competent person you cannot give it to a non-medical person or anyone it should be given to a competent person so in a medical college of hospitals when the pg is doing post graduate is anesthetizing or adapting some treatment to the patient the concern the consultant is responsible for this because they have to supervise the post graduate same way whether the post mortem has to be done or not there are two findings the gujarat state consumer dispute the return cell forum it said the only avenue to prove the cause of that is post-mortem so you have to do but the national commission said in our country some patients mostly most of the public they are not willing for postmodern so if the cause is certain you need not do post mata but in the postmodern case i want to tell you whenever there is a problem it is always better to go for a postmodern because postmodern is the final diagnosis if you are so sure if you can certify death you can certify but when there is a dispute it is always better if the third party certifies so then people will ask me who has to inform whether the patient has to inform or a doctor has to inform for postmodern answer is both can inform patients attender can ask for postmodern because patient cannot ask for postmodern she is already no more so patience attender can ask for postmortem the police people can ask for postmortem if the attenders are not willing it should be recorded in the presence of a police so to avoid litigation [Music] day-to-day practice never be angry with the patient don't charge too much don't insist on fees if you expect a problem don't leave them free of cost also if you leave them free of cost they may think that there is some problem have occurred and explain everything without any bias and in case if you are attending the court never irritate the judge if you receive a legal notice never go for out of court settlement deal it legally because in my opinion i feel if a doctor has not received any legal notice he may not be a practicing doctor or he may be a phd doctor so the observations just for example i am saying so before parting with the judgment the court said we are inclined to mention that the number of medical negligence cases against doctors are increasing the court also feels for that but at the same time the court cannot do anything so as a tip for choosing the lawyer in case if you are receiving a medical notice legal notice it is good to have a lawyer who knows law it is better to have a lawyer who knows medicine or who can understand your questions but always the best liar is who knows the practical management it is not legality or medical subject the practical management counts so you have to know that so what we have learned from so many judgments the supreme court has mentioned these are the favorable points i am quoting a surgeon with shaky hands under fear of legal action cannot perform a successful operation and a struggling physician cannot administer the end dose of medicine so court feels a doctor should not be taken to court just like that and another point i want to say there are two options available in the treatment if you are selecting any one method it is enough no one can ask why you have not done that if there are two acceptable guidelines because most of the time one is a conservative management another is a surgical management if there are two managements if you practice one you are not [Music] liable for medical negligence so in this case in the top top means it is a usual law that it is not a penal code law so in law of thought that is in the court's own opinion if a doctor has to defend the doctor has to show that the standard of care is employed these are the standard words you have to say you take some stored in your laptop so that you can immediately give it to the lawyer so the standard of care and the skill attained was that of ordinary competent medical professional as i said it is not a superman in your field ordinary skill if it is exercised it is enough because the quota also feels everybody cannot score 100 out of 100 so the defendant acted in accordance with the general and approved practice is enough so if there is a professional association forming guidelines you please follow the guidelines i think there are so many questions so we can run through the discussion so that we can i can answer the questions so in the bolum test golem test is a good test you have to know what is golem this bolum was given electro convulsive therapy ect without anesthesia at that time there was a fracture so they say the fracture occurred in his negligence but the court ruled see at that time at that time 1957 people were doing it without anesthesia so it said that the golem test is what the average man average doctor does if the same thing is done it is not a negligence so the problem test is practiced in india also then this martin diesuza case you have to know because the court has mentioned to file a criminal complaint against a doctor a medical opinion is to be obtained from a medical board that is prima facie there is a negligence then only they can file a criminal case so as a carry home message i want to tell you the doctors and the snakes are respected by the public out of fear but whenever public get a chance both would be beaten we have to be remember that so the lawyers and the public are dancing our shoulders and they may harass doctors even for flimsy reasons so the best way is to be friendly with the public as well as the lawyer so avoid litigation and enjoy life so once again i thank netflix and all participants thank you so much dr minakshi we thoroughly enjoyed the presentation especially the last couple of slides and images thank you so the insights you have shared are of tremendous value to us which is giving a moment to our doctors to put in their questions in the comment box their doctors are there yes sir we'll take them uh dear doctors please put in your question in the comment box also if you want to directly direct your question to dr minakshi you can touch on the ray's hand feature and then you will receive an audio video prompt and then you can come on stage and ask the question so yeah we can wonderful presentation says dr putnam thank you yes so we have a raise hand request uh shall we take that dr raghvendra dr raghuwan so i've accepted your request could you please turn on your audio video and come my question is regarding hiv diagnostic tests some facilities they use only register under that one column will be there for a hiv test and they take signature is it enough either or else they have to take a written consent again in a format which is right it is always better to have it in the patient's own handwriting so if you are doing a pre-op investigation you can include hiv in that pre-operative investigation so there the consent is not needed but if you are testing for hiv a separate consent that is always if it is in a written format it is better but just because it is not possible we are having it in a printed format but at least in the printed format we can show it in the code that we have obtained this but without a consent we should not go for hiv testing because the patients are arguing that their morality is lost by asking for hiv so they can take signatures in a register is it enough yes yes enough enough enough because there should be but the thing is that you can get it anywhere signature in the register is always a better thing it is not in a printed format but in the register it should be mentioned i am ready to undergo hiv testing whatever it is in your local parlance it should be there okay thank you sir thank you so much thank you thank you sir so we have another raise hand request by dr venkata i'm just accepting your request sir could you please turn on your audio and video dr venkat giri could you please turn on your audio video hello good lecture as usual my question is [Applause] foreign but on the day of surgery i'm not that my junior gives anastasia has been operated with the consent of both surgeons but patients shoot them and he was divested office all positions that surgeon is it so in india also or any whatever the legal reason i mentioned in my lecture legally the name of the anesthesiologist used to be written in the consent form so it is compulsory see now when you are doing a preoperative assessment if you have mentioned in the consent form that you are going to anesthetize the patient then if you are changing the anesthesiologist your junior or senior it should be informed to the patient because as per the consent form the patient has consented to be anesthetized by you not by your substitute so if you are not going on the day of anesthesia the patient should be informed that is the thing but he can do what he can do clutter he should be informed no no what i have two things in the government hospitals or where the uh it may be rotation nobody knows who is giving an essay one thing is that if you say government hospital then i will say government is a department it is not a person it is not a person so anybody can assess anybody can anesthetize because it is a department so when you are suing in a government setup you can sue the anesthesia department then it is the department's hod he has to decide who has to be answerable but the thing is it is taken care of by the government it is a setup so it cannot be mixed private and government it is not like that government it is the government whoever anesthetizes whoever assesses it is not a problem so don't mix government and a private sector okay in case of private in the corporate hospital then many ph.d may be done by somebody and i i don't know whether they write the name of a particular person that is the reason pse whether the patient knows that he won this anesthetizing me or not that thing second thing is in a group practice and there are many people okay today you may be seeing that in the group somebody else may be doing now it is more and more we are seeing the group practice or people doing that in that whether there will be any problem patient is thinking that you may not say that i thought so it is very clear no sir sir it is very very clear because in a group practice the patient is giving a consent to be anesthetized by that particular group not by a particular doctor it is where in a corporate hospital the patient is going to the hospital and not to the doctor concerned so in a medical legal cases the corporate hospital takes over the burden a same way in a group practice the group takes over the burden but in a private setup it is only that private anesthesiologist takes up the burden so it is only the at the time of consenting with whom the patient is consenting that is the issue if he is coming to you in a private practice you under the patient will sign but if he is going to your group just like x group the anastasia will sign for x group so it is not that man it is for the x group so it is absolutely they are different thank you thank you thank you so much sir yeah uh so we have a couple of more requests uh dr samba i'm accepting your request please do come on stage by turning your audio and video on dr sambar i have accepted your request i saw his doctors also put his questions in the comment box so um regarding the fees in case of trouble uh so you said there is no need to charge more so dr sambhat wanted a bit more clarity on that aspect so it is very simple i said don't insist on fees because in the legal lecture i want to be very careful my slide said don't insist on fees if you expect a problem at the same time don't leave them also free of cost i have mentioned that because if the patient is treated free people are not taking in the right sense they think the doctor has committed some mistake same way ah doctor the lawyer loses the case even then he's paid for the case both side liars are paid only one liar wins but they are getting the fee so professional fees is just too for your effort in treating the patient you are not guaranteeing any result but i what i want to say when the when the mob is there don't insist on which when they are taking a dead body at the time if you say there is a balance of two lakhs you pay suddenly they will turn violent it is only practical management it is not a legal management legally you are eligible for collection of your fees you can sue the patient's attendant and you can get your fees that are legal but again always the practical person succeeds so practically don't pick up a quarrel god we have a couple of more requests dr satya i'm accepting your request please come on stage by turning on your audio and video [Music] hello yeah yes sir hello sir what's up evening sir how are you thank you fine thank you well i am sas pg actually yeah sir when we are individually practicing in hospital early morning 230 or three o'clock patient brought with severe culminating one you are explaining the risk to the patient attenders they are refused to sign the concern they are refused to accept the patient is risky [Music] how to get escape from the situation it is not a escapism you are not going to treat the patient you are at liberty not to treat the patient even my medical council also says the doctor cannot be forced to give a treatment it is only here in consideration they are forcing this is just like if they are forcing you to give your all the money in your pocket what you will do we have all but here the patients have come for treatment if they are not accepting the risk you cannot treat you just like that you walk then if they are manhandling a doctor for doing that it is almost a different story i cannot answer that here it is only a personal thing legally if the patient is not accepting the risk you are not bound to treat the patient in case if the patient has been admitted and if you are going there and if he refuses then as i said you have to prove that the patient has refused so you please write the patient has refused to concerned get the relative sign if they are refusing to sign get your nursing staff to sign the patient has refused or go on a video recording so if the patient refuses the burden of proof lies on your shoulders okay thank you sir see you thank you thank you thank you uh so yeah taking the questions in the comment box so um we have a question from dr rajesh kumar mlc implications in cases of expenses related llama case i'm not sure so could you please rephrase the question in case of expenses related llama case how could you please rephrase the question doctor meanwhile sir we have uh one more raise hand request just checking this out dr srimulu i'm excited i have accepted your request sir could you please come and state somebody has asked about that the patient leaving without without pain yes dr sanjay has asked what is that so we have a question uh why giving discharge summary is a must in llama case so dr rajesh ah that's right see even if the patient is going against medical advice you have given some treatment they have paid for that they have every right in the discharge summary you have to say at the end you have given treatment treatment treatment at the end the patient is discharged against medical advice so disassembly is a must you cannot escape from that whatever treatment you have given you have to give the summary yeah yeah sorry for not getting that question right so why giving a discharge somebody's must in these cases that has been taken so dr pal says in a significant decision the kerala high court has recently ruled that medical services fall within the purview of the term service defined under section sorry defined under section 2 of the consumer protection act so your thoughts on the matters yeah it is it is a definitely see that is the reason why we say sometimes public are blaming and the doctors are behaving like industrialists they are behaving like industry see the court has mentioned the court is mentioned is just like a trade we are coming at our consumer protection act so it is definitely we are falling in the ambit of that now the doctors are trying associations are trying to remove it from the consumer code but even now we are under the consumer protection act only we cannot escape from that then what i feel as if if i were not a doctor then i feel consumer protection act is mandatory against the doctor so we have to accept as a law abiding citizen just because we are doctors we cannot say we should not be sued we are not guards we are within the ambit we have to live within the system yes well perfectly well said uh so we have a question from dr venus when the patient is unconscious and surgery is advised consent can be given by the available relative or another person who brought her him to the hospital can that be done anyone anyone even consent is not needed here the legal terminology says the medical consideration takes over legal considerations that is the point you have to write even the doctor without anybody is concerned he can operate he has to write it in the case sheet the patient has been brought by this man this man condition is a poor the patient is going to lose his life we try to catch up the relatives not possible just to write a story because the court never finds caught in the good summary concept it is called a good summary the answer somebody is risking just because somebody is transporting an injured patient if the patient dies on the way that man is not held responsible so even without a consent you can operate correctly on the same lines we had a question can the photocopy of the case sheet be given no no no it need not be given if you are giving it is out of your interest legally k sheet need not be given to the patient or the attender case sheath can be produced only with the police or with the court or with the any that judicial authorities means if the doctors are conducting an inquiry collector conducting inquiry in maternal death there the original case it has to go even photocopies see if you are giving it is out of your purview if you are so happy but what i am saying legally it is not mandated okay so uh we have a question from dr harish is death on table dot consent valid in court of law for emergency cases no that's what i said see if the if you are getting a consent like the patient is dangerously ill it means the patient is going to die so you need to put it as a separate factor because the code fields you see who will accept if you say the patient may die that is recently we say the patient is dangerously ill that means the patient is about to die both are safe so not be a concern so say the patient is dangerously ill there is a threat to life don't say the patient may die on the table no no one will accept putting it in a palatable way we have a question from uh yeah dr julie grace along the same lines of the case sheet uh mamas some of them request case sheets for their insurance policies what about that sir casey it is not mandated because see they think the doctor just because a clerical person is saying they are demanding so what i am saying it is not mandate that if a insurance company is putting its foot down and saying it has to be given then there is a whatever i am saying is legal it is not mandated see in most of the offices sometimes the club say you have to sign on the left side only not on the right side and people laying on that side they don't ask why it is happening because we have to get things done what i am saying don't hold the k sheet tightly in a practice if a patient demands feet it doesn't mean i'm not saying you don't give the cage what i'm saying if there is a problem you need not give the case sheet legally if there is a problem if there is no problem you give whatever you want to give you give it yes uh so dr narayan asks your uh the current standing on do not resuscitate dnr papers see at all dna valid here it has not come into vogue in indian guidelines do not resuscitate guidelines are applicable only in the western countries because it itself has so many implications see the patient while in a good same condition he has to say the relatives cannot say do not resuscitate my relative just like that if a wife is seriously ill the husband cannot say do not resuscitate her so the do not resuscitate the policy it has to be given by the patient like i have to write it now itself in case if i am living on the support of ventilators but in india it has not come into play so we cannot take do not resuscitate orders as of now then defense will be difficult we have to defend that okay so we have a couple of more questions would be all right if i took them we are a little past ten so yeah we are already we have crossed 10 anyway i will leave my mail id even they can put the questions to my mail i will answer them if they are giving the thing you can take two more questions then you give my mail id it is i will tell d r a l meanwhile gmail.com so if they send their queries i will answer them or else they can take yeah d r a l meenakshi yeah you can refer to the comment box for the mail id uh as of now we'll take two more questions doctor chattertyah should test reports like baby reports e t mri be given i think that was the rest of the question it has to be given what is that the patient has paid for that it has to be given to the patient only you cannot hold that okay yes so according to mci if patient has photocopy of case sheet within 72 hours hospital has to give the photocopy to the patient your thoughts on that now see what i am saying is legally it is not mandated even by that american it is only that see the discharge summary is a summary of the case sheet this summary is the case sheet so you have to mention everything in the discharge summary and you have to give when you anticipate your lengthy summary this are some reason again i say it has to be given only in the law enforcing agencies if the medical council demands the kgt you have to give not to the patient not to the patient when fighting legal airs take a case of a dying patient can the doctor sign as a legal witness i could not get the question fighting when fighting legal air take lti of dying patient doctor science is the worst impression this is a technical question why when the patient is dying when they are having a left hand compression whatever it is taken why you are going and signing who is fixing it i see the left hand thumb impression is to be done by a conscious man when the patient is dying how we can do that why you are going and certifying this is unnecessary why you are going and certifying i'm saying as a colleague say why they are taking a left hand okay the question was can the doctor sign as a legal witness there in that scenario see it is not anybody can sign us a legal witness leave alone doctor but i am saying my brother doctor why you are taking the risk of signing that and anybody can sign the doctor uh yes is there any law against verbal abuse of doctors by patients yeah you can it is already there it is already the nursing home protection act is there so but the thing is see the verbal abuse on the lead is not taken by the police also very seriously you can you can lie is there it is harassing even not as a doctor even if i abuse you or if i abuse any person they can go but it will not be taken this practical management understands that we have a couple of more comments some amazing yeah then it has to be made only you say see i am willing to answer all the queries so tomorrow morning i will answer all their questions i will do everything i will answer everything i will not go without that i might data you thank you sir that is very kind of you uh dear doctors we're putting in the email id in the comments box very quickly please uh put in your questions there and sir has assured that he will take all the questions as of now nasa thank you so much for this wonderful session we hope to see you again on netflix uh there's a lot more to learn on this topic about the terminologies and we would love to have you again here thank you so much sir we have learnt a lot from you today thank you sir good night thank you

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dr. AL Meenakshi Sundaram

Dr. AL Meenakshi Sundaram

Professor of Anaesthesiology & Dean, Government Medical College | Perambulur, Tamil Nadu.

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dr. AL Meenakshi Sundaram

Dr. AL Meenakshi Sundaram

Professor of Anaesthesiology & Dean, Governme...

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