Describes Functions of IMC, SMC, NMC, Professional Misconduct, Rights and Duties of a Doctor, Professional Secrecy, Privilidged Communication, Professional Medical Negligence, consent and its types, Consumer Protection Act

1. MEDICAL LAW AND
ETHICS
-Dr. Divya Reddy, Assistant Professor, Dept. of
Forensic Medicine and Toxicology, RVMIMS
1

2. DEFINITIONS
 Medical ethics - the moral principles which
should guide the members of the medical
profession in their dealings with each
other, their patients and the state.
2

3. DEFINITIONS
 Medical etiquette - Conventional laws of
courtesy observed between members of
the medical profession
3

4. INDIAN MEDICAL COUNCIL
ACT 1956
 The medical council was constituted by the
act
 The first schedule of the Act – Recognized
Medical qualifications granted by Universities
in India
 The second schedule – those granted
outside India
 The Third schedule –
I. Part I: Contains those granted by medical
institutions not included in the first schedule
4

5. INDIAN MEDICAL COUNCIL
(MCI)
 Medical register
 Medical education
 Recognition of foreign medical qualifications
 Appeal against disciplinary actions (within 30
days)
 Warning notice
5

6. REGISTRATION CERTIFICATE
OF MCI6

7. NATIONAL MEDICAL
COMMISSION
 National Medical Commission Bill proposes
to replace the Medical Council of India
(MCI) with National Medical Commission
which will be a central authority that will
responsible for regulating medical
education in the country.
 Four autonomous boards. Each board will
consists of President and four members of
which two members will be part time and
they are appointed by the central
government on the recommendation of a
7

8. NATIONAL MEDICAL
COMMISSION
 These bodies are:
1. The Under-Graduate Medical Education Board
(UGMEB)
2. The Post-Graduate Medical Education Board
(PGMEB)
3. The Medical Assessment and Rating Board: This
board will be responsible to levy monetary
penalties on institutions which fail to maintain the
minimum standards.
4. The Ethics and Medical Registration Board.
 A person who is aggrieved by any decision made
by autonomous board may appeal to commission
8

9. FUNCTIONS OF NATIONAL
MEDICAL COUNCIL
 To lay down the policies for regulating
medical institutions and medical
professionals.
 To assess the requirements of human
resources and infrastructure in healthcare.
 To ensure compliance by the State
Medical Councils with the regulations
made under the NMC bill.
 To frame guidelines for determination of
fee up to 50% of the seats in the private
medical institutions.
9

10. MEDICAL ADVISORY
COUNCIL
 Primary platform through which the states and
union territories may put forward their
concerns before NMC
 They shall advise the NMC on measures to
maintain minimum standards in medical
education, training and research
10

11. STATE MEDICAL COUNCIL
 Medical register
 Disciplinary Control
 Warning notice
11

12. WARNING NOTICE
 RMP is required to observe certain
prescribed rules of the conduct
 Gives list of examples of offences which
constitute serious professional misconduct
 It has the right to consider any new forms of
alleged misconduct not included in the list
 PERMANENT PENAL ERASURE/
PROFESSIONAL DEATH SENTENCE :
Name of the practitioner is removed from
the register in serious professional
12

13. DISCIPLINARY ACTION BY
SMC13

14. INFAMOUS CONDUCT
 Syn: Professional Misconduct
 Conduct of the doctor which might
reasonably be regarded as disgraceful &
dishonorable which is judged by
professional men of good repute &
competence
 It involves an abuse of professional
position
14

15.  6 ‘A’s
i. Adultery
ii. Advertisement
iii. Abortion (criminal)
iv. Association with unqualified persons in
professional matters
v. Alcohol
vi. Addiction
INFAMOUS CONDUCT
15

16.  Dichotomy
 Touts
 Professional secrets
 Conviction- immoral & criminal acts
 Not notifying notifiable diseases
 Refusing Rx- on basis of caste, religion,
race, sex, nationality, some diseases
(A.I.D.S
 False/misleading certificates
INFAMOUS CONDUCT
16

17.  Refusing to Rx emergency cases
 Abuse of dangerous drugs act/scheduled
drugs act.
 Owning a chemist shop/ surgicals
 Adopting unfair means
 Secret remedies
 Patient snatching
 Association with unqualified people -
Violation of PNDT (prohibition of sex
INFAMOUS CONDUCT
17

18.  Abetting / aiding in torture/human rights
violation
 Publish photos/case reports
 Failure to obtain consent- both spouses in
sterilization / in vitro fertilization
 Violating I.C.M.R. guidelines in clinical
drugs trails or other research
 Euthanasia
INFAMOUS CONDUCT
18

19. 19

20. 20

21. 21

22. RED CROSS EMBLEM
 The emblems of the International Red
Cross and Red Crescent Movement, under the
Geneva Conventions, are to be placed on
humanitarian and medical vehicles and
buildings.
 Wrong belief that doctors are entitled to use it
 Section 12 – Geneva convention act 1960
prohibits its use.
 Section 13 – punishment – fine upto Rs.500 and
forfeiture of goods present in the vehicle
22

23. RED CROSS EMBLEM
23

24. RIGHTS OF A REGISTERED
MEDICAL PRACTITIONER
 To practice medicine
 To choose a patient
 To dispense medicine
 To posses & supply dangerous drugs
 To add title, descriptions etc to the name
 To recover fees
24

25. RIGHTS OF A REGISTERED
MEDICAL PRACTITIONER
 Appointment to
government & public
hospitals
 To issue medical
certificates
 To give evidence as
expert witness
 Entitled to carry out
medico-legal autopsies
 Can remove
25

26. DUTIES OF A REGISTERED
MEDICAL PRACTITIONER
1. To exercise reasonable degree of skill, care&
knowledge during treatment
2. Attendance & examination
3. To furnish proper & suitable medicines
4. To give instructions
5. To execute humanitarian duty in emergencies.
6. To control & warn - Regarding notifiable diseases
7. To inform & warn third parties - Children & adults
who are incapable
8. To inform about risks - regard to poisons and
26

27. DUTIES OF A REGISTERED
MEDICAL PRACTITIONER – MLC
CASES
1. Inform police in all Medicolegal cases
2. Arrange for taking dying declaration
3. Should keep medical records for a period of 10
years
4. Should maintain professional secrecy
5. Should issue medical records within 72 hours
6. Should maintain a registry for MLC cases
27

28. PROFESSIONAL SECRECY
 Implied term of contract between doctor
and the patient.
 If the disclosure did some harm to the
patient, he can sue the doctor for damages
 Should not be discussed even with spouse
if it is not a communicable disease
 Examination of insurance is voluntary and
can be revealed to company
 Information found during autopsy should
not be revealed to public without consent
28

29. PRIVILEGED
COMMUNICATION
 It’s a statement made bonafide upon any
subject matter by a doctor to the concerned
authority, due to his duty to protect the interests
of the community or of the state.
 It should be unbiased, bonafide & without any
malice
29

30.  Infectious diseases
 Venereal diseases
 Notifiable diseases
 Suspected crime
 Self interest
 Patients own interest
 Negligence suits
 Courts of law
 Insurance reports
EXAMPLES FOR PRIVILEGED
COMMUNICATION30

31. PROFESSIONAL
NEGLIGENCE
 Absence of reasonable care & skill
 Willful negligence of a medical practitioner in the
treatment of a patient; which may cause bodily
injury or death of the patient
 4 ESSENTIAL INGREDIENTS:
1. Duty
2. Dereliction of Duty
3. Direct Causation
4. Damage
 Burden of proof lies on the patient
31

32. TYPES OF PROFESSIONAL
NEGLIGENCE
 Civil negligence
 Criminal negligence
 Contributory Negligence
 Corporate Negligence
 Composite Negligence
32

33. CIVIL NEGLIGENCE
 Simple absence of care
& skill This question
arises when:
a. Patient/relative brings
a civil suit against
doctor
b. When a doctor brings
a civil suit for
realization of fees
against the patient
33

34. CIVIL NEGLIGENCE
 Damage may be in the form of:
i. Physical & mental suffering
ii. Prolongation of hospital stay
i. - Increased expenses
ii. - Loss of daily earnings
iii. Reduction in enjoyment
iv. Reduction in life expectancy
v. Death
34

35. EXAMPLES
 Failure to obtain consent
 Wrong diagnosis due to absence of care & skill
 Failure to attend / make alternative
arrangements
 No proper instructions/post-op care
 Failure to immunize/perform sensitivity tests
 If the act of the doctor causes others to catch a
disease from his patients
 Discharging patient prematurely
 Not advising X-ray/F.N.A.C/biopsy or other
necessary investigations
35

36. CRIMINAL NEGLIGENCE
 Gross lack of competence
 Gross inattention
 Gross recklessness
 Gross negligence in the selection & application
of remedies
 Willful/wanted
 Extreme departure from the ordinary standard
of care
 Utter disregard about the safety of the patient
36

37. CRIMINAL NEGLIGENCE
37

38.  Imprisonment with or without fine
 If the patient dies the doctor will be prosecuted
u/s 304(A) I.P.C
 “ Whoever causes death of any person by any
rash & negligent act not amounting to culpable
homicide shall be punished with imprisonment
up to 2 years with or without fine”
 Sec 336 IPC: If no injury has occurred but the
doctor endangered the life of the patient
 Sec 337 IPC: If hurt was caused
 Sec 338 IPC: If grievous hurt was caused
CRIMINAL NEGLIGENCE
38

39. EXAMPLES
 Amputation of wrong part or wrong patient
 Leaving behind instruments, sponges/swabs
etc
 Gross mismanagement of a delivery case
 Administration of wrong substance to eye
 Performing criminal abortion
39

40. PROFESSIONAL NEGLIGENCE
VS PROFESSIONAL
MISCONDUCT40

41. CIVIL VS CRIMINAL
NEGLIGENCE41

42. RES IPSA LOQUITUR
 The thing speaks for itself
 Doctrine of Common Knowledge
 Patient need not prove that negligence has
occurred.
 Pre-requisites:
i. In the absence of negligence the
injury/damage would not have occurred
ordinarily
ii. The doctor had exclusive control over injury
producing instrument or treatment
42

43. RES IPSA LOQUITUR
43

44. DEFENCES AGAINST MEDICAL
NEGLIGENCE
1. Calculated risk doctrine
2. Contributory negligence
3. Vicarious Liability
4. Novus Actus Interveniens
5. Corporate Negligence
6. Products Liability
7. Medical Mal occurrence
8. Therapeutic Misadventure
9. Error in Judgment
10. Res Indicata
11. Res Judicata
12. Composite Negligence
44

45. CALCULATED RISK
DOCTRINE
 In certain management
maneuvers there may be
certain amount of
inevitable risk
 Amniocentesis- 1% risk
of abortion
 C-Section – 0.1% risk of
maternal mortality
 Doctor must give:
1. Justification for risk taken
2. Preventive measures
taken
45

46. CONTRIBUTORY
NEGLIGENCE
 Concurrent negligence/unreasonable conduct on
the part of the patient/attendant which coupled
with doctor’s negligence caused the damage; with
out which the injury would not have occurred.
 Failure to give accurate history
 Failure to co-operate with the doctor in carrying
out all reasonable & proper instructions
 Failure to take suggested treatment
 Discharge Against Medical Advice
 Neglecting follow-up
46

47.  Good defence in
civil cases
 Only a partial
defence
 Limitations :
1. The last clear
chance doctrine
2. The avoidable
consequences
rule
CONTRIBUTORY
NEGLIGENCE47

48. VICARIOUS LIABILITY
 “An employer is responsible not only for his own
negligence but also for the negligence of his
employees”.
 Principle: Respondent superior (let the master
answer)
 Pre-requisites:
i. Employer-Employee relationship must be
established
ii. Employees conduct must occur within the
scope of employment
48

49.  Borrowed servant doctrine
– New employer
responsible
 An employee may serve
more than one employer
a. Junior doctor/intern
b. Nursing staff
c. Pharmacist
 Usually surgeon not
responsible for negligence
VICARIOUS LIABILITY
49

50. NOVUS ACTUS
INTERVENIENS50
 “An unrelated action intervening”
 A person is not only responsible for his actions,
but also for the logical consequences of those
actions
 An element of negligence is essential

51. 51

52. CORPORATE NEGLIGENCE
 Failure of the
administrators of the
hospital to provide
adequate facilities
 Hospital
administrators
should provide
standard
equipments and
component
52

53. PRODUCTS LIABILITY
 Physical agent which caused
the injury or death of the
patient during treatment
 Faulty, defective, negligently
designed instruments or
inadequate operating
instructions- fault of
manufacturer
 If it functioned satisfactorily
for many years, later due to
wear & tear or if not handled
properly – doctor is at fault
53

54. MEDICAL MALOCCURANCE
 Bio-physiological actions & reactions to
different drugs are different & extremely
variable.
Tolerance
Idiosyncrasy
 Must be aware of unexpected,
unexplained &even rare effects
 Not a blank cheque
54

55. MISADVENTURE
1. Therapeutic
misadventure
 Penicillin
 Anti snake venom
 Anti cancer drugs
2. Diagnostic
 Barium enema -
poisoning / rupture
3. Experimental
55

56. ERROR IN JUDGEMENT
 Only because of error in judgment, a
doctor cannot be held negligent if he has
executed proper skill and care
56

57.  Damage has occurred to the patient due
to negligence of two or more persons and
not from the part of the patient
 Compensation should be split between the
defendant
COMPOSITE NEGLIGENCE
57

58. RES INDICATA
 A case should be filed within 2 years
from the date of alleged negligence.
58

59.  Things have been decided
 Once a case is completed between two
parties, it cannot be tried again
RES JUDICATA
59

60. PRECAUTIONS TO AVOID
NEGLIGENCE
I. Communication:
 Be polite, establish
good rapport
 NEVER guarantee cure
but care
 Prognosis: no
exaggeration
 Give proper & clear
instructions -
prescriptions - diet - pre-
op instructions - use of
60

61. PRECAUTIONS TO AVOID
NEGLIGENCE
II. Case records
 Up-to-date,
accurate &
complete
 Patient refusing
any particular
treatment,
investigation
 Discharge against
medical advice
 Consent: own
61

62. PRECAUTIONS TO AVOID
NEGLIGENCE
III. Update knowledge
 M.C.I stipulates 30 hrs of C.M.E. in five
years
 Must keep abreast with the latest
developments
 Always practice standard procedure of
Rx -never experiment.
62

63. IV. Do not neglect the
patient
 Reasonable
degree of care &
skill
 Attend regularly
 All necessary
investigations
 Consultation if
required
 Arrange for a good
PRECAUTIONS TO AVOID
NEGLIGENCE63

64. V. Do not criticize another doctor
VI. Associate with good & qualified staff
VII. Cordial working atmosphere
VIII. Guard against hazards-Adverse drug
reactions
IX. Instruments, equipments etc should be
well maintained – serviced regularly,
repaired or replaced
PRECAUTIONS TO AVOID
NEGLIGENCE64

65. MEDICAL INDEMNITY
INSURANCE
 Contract between insurance
company and the doctor to
compensate in professional
negligence
 Objectives:
1. To protect Professional interest of
doctors
2. To pay for the conduct of defence of
doctor in medical negligence
3. To compensate the amount the
court declares to the opposite party
65

66. CONSENT
66
 Means voluntary agreement, compliance or
permission.
 Types:
1. Expressed
1. Verbal
2. Written
2. Implied

67. INFORMED WRITTEN
CONSENT67
 Consent given after
understanding the result, nature
and quality of all possible risks
involved as well as having
alternate choice.
 Doctor Should explain:
a. Diagnosis
b. Proposed line of Rx
c. Alternatives available
d. Pros & cons
e. Relative chances of success

68. 68

69. EXCEPTIONS FOR INFORMED
CONSENT69
1. Therapeutic Privilege
2. Emergency Doctrine
3. Therapeutic Wavier
4. Loco Parentis

70. THERAPEUTIC PRIVILEGE
70
 Privilege to withhold from patient, if
disclosure would cause serious psychological
threat to the patient
 Eg: Malignancy
 Should be informed to relatives and written
consent should be obtained from them.

71. EMERGENCY DOCTRINE
71
 In an emergency doctor can perform surgery on
an unconscious patient, when no guardian or
parent is available.
 Necessary to save life
 92 IPC – Any harm caused to a person in good
faith, even without consent is not an offence if
the situation is such that it is impossible for that
person to give consent & has no guardian or
other person in lawful charge of him

72. THERAPEUTIC WAVIER
72
 In emergency situation, competent person may
give up his right by waving it.

73. LOCO PARENTIS
73
 In place of a parent
 In emergencies involving children, when their
parents or guardian are not available, consent
can be taken from person who is in charge of
the child.
 Eg: teacher or principal of residential school

74. RULES OF CONSENT
74
 Needed for every medical examination
 If implied no need of formal consent
 Oral consent-presence of III party
 beyond routine physical examination – written
consent
 No prescribed Proforma –should be in a proper
form & suitable for the situation
 Not to be taken at the time of admission but before
the procedure/examination
 To be valid- no blanket consent

75. 75
Questionable legal validity

76. SECTIONS
76
 53(a) CrPC: accused examination even without
consent by the request of SI
 53 (b) CrPC – when the accused happens to be a
women
 54 CrPC – arrested person requesting to be
examined to collect evidence in his favor
 87 IPC - > 18yrs –valid consent to suffer any harm
which may result from an act not intended or not
known to death or grievous hurt
 88 IPC – done in good faith and for his benefit -
Children < 12yrs & an insane person cannot give
valid consent

77. SECTIONS
77
 90 IPC– consent given under fear of injury or
due to misunderstanding consent by an
insane/intoxicated who is unable to
understand the nature & consequences of the
act
 92 IPC – Any harm caused to a person in good
faith, even without consent is not an offence if
the situation is such that it is impossible for
that person to give consent & has no guardian
or other person in lawful charge of him from
whom it is possible to obtain consent in time to

78. CONSENT
78
 Open consent- in case where diagnosis is not
known.
 Consent of hostel inmates
 Vaccination- Law gives consent
 A person can be treated with out consent for the
benefit of the society
 Consent given for committing a crime like
criminal abortion – invalid
 For contraceptive sterilization, consent of both
Husband & Wife

79. CONSENT
79
 In other types of operation the consent of
other spouse is not needed - But it is
advisable: - danger to life - may destroy /
limit sexual function - may cause death of
unborn child
 Unlawful to detain any patient
 Donating organs
 Clinical autopsy
 Defence in civil negligence

80. CONSUMER PROTECTION ACT
198680
 Purpose To protect the interest of consumers
Includes services like, household articles, banking,
food, transport, entertainment, electricity etc.
 Medical profession - included in 1995 Aims to provide
cheap & speedy remedy
 Criticism:
1. Defensive medicine
2. Indemnity insurance
3. Frivolous complaints
 District forum < 20 lakhs; State commission >20
lakhs; < 1crore; National commission > 1crore
 Doctors are excluded in the latest CP Bill 2019.

81. CONSUMER PROTECTION BILL
201981

82. WORKMEN’S COMPENSATION
ACT 192382
 For providing compensation to workmen for
injuries sustained in workplace or diseases
contracted by them
 Schedule I – gives list of disabilities due to
injuries and their percentage
 Schedule III – Occupational diseases and
industrial poisons
 Not liable for compensation if at the time of
sustaining injury he was under the influence of
alcohol.
 RMP issues injury certificate in such cases

83. TRANSPLANTATION OF HUMAN
ORGANS ACT 1994; UPDATED
201283
 The Transplantation of Human Organs Act provides
for the regulation of the removal, storage, and
transplantation of human organs for therapeutic
purpose and for prevention of Commercial dealings
of human organs.
 Organs that can be transplanted are – the heart,
kidneys, eyes, liver, lungs, pancreas, intestine, and
thymus.
 Tissues include bones, tendons cornea, skin, heart
valves, and veins.
 Worldwide, the kidneys are the most commonly

84. 84
 Section 3 – Any donor may prescribe,
authorize the removal, before his death, of any
human organ of his body for therapeutic
purposes
 Where no such authority was made by any
person before his death but no objection was
also expressed by such person for therapeutic
purposes
 where brain- stem death of any person, less
than eighteen years of age, occurs and is
certified, any of the parents may give authority
TRANSPLANTATION OF HUMAN
ORGANS ACT 1994; UPDATED
2012

85. 85
 Section 4: Removal of human organs not to be
authorized in certain cases.
 Section 5: Authority for removal of human
organs in case of unclaimed bodies in hospital
or prison.
 Section 6: Authority for removal of human
organs from bodies sent for PME.
 Section 7: Preservation of human organs
 Section 8: Restrictions on removal and
transplantation of human organs
TRANSPLANTATION OF HUMAN
ORGANS ACT 1994; UPDATED
2012

86. 86
 Section 10: Regulation of hospitals conducting
the removal, storage or transplantation of human
organs.-
 Section 11: Prohibition of removal or
transplantation of human organs for any purpose
other than therapeutic purposes
 Section 12: Explaining effects, etc., to donor
and recipient.
 Section 13: Appropriate Authority
 Section 14: Registration of hospital engaged in
removal, storage or transplantation of human
organs
TRANSPLANTATION OF HUMAN
ORGANS ACT 1994; UPDATED
2012

87. 87
 SECTION 18: PUNISHMENT FOR REMOVAL OF
HUMAN ORGAN WITHOUT AUTHORITY-
 Any person helps in any manner in the removal of
any human organ without authority – shall be
punishable with imprisonment may extend to five
years and with fine
 Where any person convicted is a registered medical
practitioner, – his name shall be reported by the
Appropriate Authority to the respective State
Medical Council for taking necessary action
including the removal of his name from the register
of the Council for a period of two years for the first
TRANSPLANTATION OF HUMAN
ORGANS ACT 1994; UPDATED
2012

88. 88

89. 89

90. 90