A brief presentation on the Medicolegal aspects of healthcare initially intended for the students - Post Graduate Diploma in Hosp. Management (Medvarsity)

1. MEDICOLEGAL ASPECTS
A Kaleidoscopic view
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2. Moral Principles Guiding
Medical Practice
Beneficence & Non-Maleficence
Autonomy
Justice
Value and Sanctity of Human Life
Truth and integrity
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3. Application of LAW
in healthcare
Laws on various aspects of healthcare have
been enacted from time to time to regulate
the functioning of the hospitals assuming
that their implementation will remove the
inadequacies and malpractices.
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4. INDIAN JUDICIARY &
MEDICAL PRACTICE
Civil Jurisdiction
 Civil Courts
 Consumer Protection Forum
Criminal Jurisdiction
Human Rights Commission
Medical Council of India
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5. You as an
ADMINISTRATOR
Duty of each and every hospital administrator to
know his lawful rights and responsibilities w.r.t the
hospital staff, employees, patients and visitors.
It is necessary that one should have sufficient
background and legal knowledge of hospital care in
order to know when to seek Professional Legal Advice.
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6. VICARIOUS LIABILITY
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Latin Phrase, "Respondent - Superior".
This means let the Superior be responsible.
In other words a person may become liable to
pay damages for amount of negligence
committed by his employees or agents in the
course of carrying out his duties as such
employee or agent.

7. Must have basic knowledge on
 Injury (Accidents)
 Negligence–Civil, Criminal
 Malpractice
 Professional incompetency
 Ethical issues in human experimentation
 Organ transplants.
 Sex determination & Genetic Counselling.
 Euthanasia.
 Ethical Issues in sexually transmittable diseases.
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8.  Medical Termination of Pregnancy Act (MTP act 1971)
 PCPNDT Act
 Registration of Birth & Death
 Medical Council of India Act
 Organ transplantation act
 Bombay Nursing Home Registration Act
 Clinical establishment act
 Labour Laws and the Medical Establishment
 Shop & establishment act
 Bio medical waste management act
 Consumer Protection Act
 Indian Penal Code
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9. CONSUMER PROTECTION ACT
On 24 December 1986 Govt. of India enacted the
Consumer Protection Act 1986 to:
Ensure Rights of Consumers
Provide Remedies for deceived Consumers
Check Unfair Business Practices & Restrictive Trade
Practices.
Quick Redressal
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10. CPA
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Revolutionary act
Applied to medical practitioners since 1991
Made it comparatively easy for the patients to
approach the courts against the doctors
Now more than 10,000 cases are pending in front of
various fora.

11. 1. Right to SAFETY against hazardous goods
and services.
2. Right to be INFORMED about quality,
quantity, purity, standard, price.
3. Right to CHOOSE from a variety at
competitive prices.
4. Right to BE HEARD.
5. Right to seek REDRESSAL.
6. Right to CONSUMER EDUCATION
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12. Consumer Disputes Redressal Forum
Consumer Disputes Redressal Forums
(District Forum)
 Claims less than or equal Rs.5 lacs.
Consumer Disputes Redressal Commissions
(State Commission)
 Claim more than Rs.5 lacs & less or equal to than Rs.20 lacs &
appeals.
National Consumer Disputes Redressal Commission
(National Commission)
 Claim above to Rs.20 lacs & appeals
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13. CPA – “ A cakewalk’’
File WITHIN 2 YEARS of cause of action in the
District Forum where the seller has his business or
lives or where the cause of action arose.
Submit 3 COPIES OF COMPLAINT ON PLAIN PAPER
WITH SUPPORTING DOCUMENTS (receipt, bill etc.)
NO LAWYER IS NEEDED. PRESENT YOUR CASE IN
PERSON.
MINIMAL FEE PAYABLE
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Some
Landmark
Cases

15. Dr. Laxman Balkrishna Joshi vs. Dr.Trimbak Bapu
Godbole and another (1969)
A patient had suffered from fracture of the femur.
The accused doctor while putting the leg in plaster
used manual traction
Used excessive force for this purpose, with the help
of three men
Such traction is never done under morphine alone but
done under proper general anaesthesia.
This gave a tremendous shock causing the death of
the boy.
On these facts the Supreme Court held that the
doctor was liable to pay damages to the parents of
the boy.
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16. Indian Medical Association vs. V.P.Shanta
(1995)
This landmark judgment decided that service
rendered by medical professional comes under section
2(1)(0) of the act & hence the consumer protection
act was applied to the medical practitioners
It defined conditions such as
 Who is a consumer ?
 What is medical negligence ?
 What is deficiency in service ?
 What are the patent conditions under which medical
practitioners can be held responsible ?
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17. Poonam Verma vs. Ashwin Patel & Ors. (1996)
The professional may be held liable for negligence on
the ground that he was not possessed of the requisite
skill which he professes to have.
Thus a doctor who has a qualification in Ayurvedic or
Homeopathic medicine will be liable if he prescribes
Allopathic treatment which causes any harm.
Negligence “ per se”
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18. 18
MEDICAL NEGLIGENCE
Legal term to achieve compensation for
injuries caused.
Derived from a latin word „Negligere‟
meaning „not to pick up‟
Failing to do what a reasonably prudent
person would have done in similar
circumstances
Foreseeable risk/harm
Breach of Legal duty to care
4 Ds : Duty, Deficiency, Direct Cause,
Damages

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20. Dr.Louie vs. Smt. Kannolil Pathumma
The National Consumer Commission held that Dr. Louie
showed herself as an M.D. although she was only M.D.
Freiburg, a German Degree which is equivalent to an
M.B.B.S. degree in India.
She was guilty of negligence in treating a woman and her
baby who died.
There was vacuum slip, and the baby was delivered in an
asphyxiated condition
(Misrepresentation of skills)
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21. Spring Medows Hospital vs. Harjol Ahluwalia
A child was admitted for typhoid fever. Nurse asked
the father of the patient to get an injection Lariago
which was administered by the nurse to the patient
who immediately collapsed. Child suffered a cardiac
arrest on account of the medicine having being
injected which led to brain damage.
The National Commission held that the cause of
cardiac arrest was intravenous injection of Lariago of
such a high dose.
Both the doctor and nurse and the hospital were
found liable and Rs.12.5 lakhs was awarded as
compensation to the parents.
(Liability of hospital & the employees)
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22. Pt. Parmanand Katara vs. Union of India & Others 1989
The petitioner referred to a report published in the newspaper
“The Hindustan Times” in which it was mentioned that a
scooterist was knocked down by a speeding car.
Seeing the profusely bleeding scooterist, a person who was on
the road, picked up the injured and took him to the nearest
hospital.
The doctors refused to attend and told the man that he should
take the patient to another hospital located 20 kms away
authorized to handle medico-legal cases.
The injured was then taken to that hospital but by the time he
could reach, the victim succumbed to his injuries.
(Emergency medical care, a must ! )
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23. A medico-legal case is a case of injury/illness
where some investigation by law enforcement
agencies is essential to establish and fix
responsibility for the case in accordance with
the law of the land.
Simply put, it is a medical case with legal
implications or a legal case requiring medical
expertise
Medico-Legal Case
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24. Who can label a case as MLC
Casualty doctor (emergency physician) attending the
case. The doctor who has -First contact with patient
should prepare an ML case report. In rape victims the
examination and preparation of MLC is done by A
female doctor.
Indoor treating doctors can also make the case MLC
if they think it should have been made but it wasn‟t
made
Patient or their relatives request to label a case MLC
or not, shall have no effect on doctor‟s decision
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25. Cases to be treated as MLC
All cases of Trauma and Burns – The circumstances of which
suggest commission of an offence by somebody.
(Irrespective of suspicion of foul play).
All vehicular, Industrial accidents or other unnatural accident
cases specially when there is a likelihood of patient‟s death or
grievous hurt.
Electrocution.
Suspected or evident sexual assault, criminal abortion.
Unconsciousness where its cause is not natural or not clear.
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26. Suspected or evident poisoning or intoxication.
Referred from court or otherwise for age
estimation medical examination.
Brought dead with improper suspicion of an
offence.
Coma where cause could not be ascertained.
Suspected self-infliction of injuries or
attempted suicide.
Starvation including “Hunger Strike”.
Unclaimed newly born.
Medical malpractice
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27. Receiving a MLC
Case brought by the police for examination &
reporting.
Person in question was already attended to by a
doctor and a medico-legal case was registered in
the previous hospital, and the person is now
referred for expert management/ advice.
If the doctor feels that the circumstances/
findings of the case are such that registration
of the case as an MLC is warranted, he should
immediately and inform the patient before
converting the case into MLC.
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28. 1985
„‟Decision Of The Committee‟‟
The committee under the chairmanship of the Director-
General of Health Services had taken the following
decisions
Whenever any MLC arrives the hospital, the medical
officer on duty should inform the duty constable,
name, age, sex of the patient and place and time of
occurrence of the incident, and should start the
required treatment of the patient.
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29. Zonalisation for the hospitals to deal with
medico-legal case will only apply to those
cases that are brought by the police.
All government hospitals, medical institutes
should be asked to provide the immediate
medical aid to all the cases irrespective of
the fact whether they are medico legal cases
or otherwise.
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30. Casualty Service
Some of the cases may need immediate
surgery and resuscitation measures.
Essential to have in Casualty area :-
1.Sufficient numbers (in working condition) trolleys
stretcher, wheel chairs, etc.
2. Sufficient number of observation beds.
3. Life saving drugs, IV fluids, monitors, etc.
4. Laboratory facilities, Radiological facilities.
5. MLC Registers -- properly maintained.
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31. Important Precautions
Consent
Section 13, of the Indian Contract Act, 1872.
Types of Consent:
 Implied
 Express
 Informed
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32. Exceptions
 Medical emergencies (section 92 IPC)
 Notifiable diseases
 Immigrants
 New admissions to prisons
 Court Orders for examination
and treatment
 Under Section 53(1) of the CrPC
 Members of Armed Forces –
(Ministry of Home Affairs, Government of India, Letter
No.8/179/71-GPA, dated 25th November, 1972. )
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33. Examination & Documentation
By the doctor who examined (first contact)
Complete HISTORY : Precise and to the point
LEGIBALY/CLEARLY WRITTEN DOCUMENTS
with assigned MLC number on all reports
DETAILED DESCRIPTION of injuries
AVOID ABBREVIATIONS
WHEN IN DOUBT obtain consultation from
seniors
NO BACK DATED MLC
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34. Collection & Preservation of
Samples
All relevant specimens /
evidence should be collected,
identified, labeled, sealed and
preserved.
 Section 201, IPC
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35. Confidentiality & Privacy of
Medical Records
Policy & Procedure:
 As an impersonal document
 As a personal document
Indian Evidence Act, 1872
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36. Custody of MLC records
 Preservation
 Safety and security
 Issue of records
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37. Certifying Fitness
 As a part of documentation of ML Case report or
whenever the I.O requests the doctor for
certifying fitness of the patient to make a
statement the examining doctor will certify the
same on the original MLC sheet. He/she will
mention date and time clearly with signature,
name in full with designation below the
certification.
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38. Information is given only to I.O or any
person designated by I.O
If the I.O. gives requisition for any
clarification regarding certain points
mentioned in the report given, answers are
to be given in writing.
MAINTAIN CONFIDENTIALITY
If the I.O. demands an original document/
photocopy of the same , X-ray etc, of a
MLC, it is given and a receipt obtained.
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39. Register as early as possible
Not informing the police of such cases may
invite trouble to the doctor
u/s 39 CrPC (cases wherein public is duty-
bound to inform the police)
Liable to be prosecuted u/s 177 & 201, IPC
(giving false information & causing
disappearance of evidence)
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40. Other MLC related issues
Dying Declaration (section 32 Indian Evidence Act)
Admission & Discharge of MLC
In case of death of MLC patient
Brought Dead
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41. CONCLUSION
When we look at this fascinating spectrum of
development of Indian Medical Law scenario one
must say that in last 20 years it has now
substantially matured.
The judiciary is trying its best to produce a
balance between the patients & doctors interests.
Now is the time when medical organizations should
also come forward to take this initiative further.
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