for doctor

1. Medicolegal issues in Obstetrics and Gynecological
practice
Dr. Putul Mahanta MD, FIAMLE, FICFMT
Associate Professor, Tezpur Medical College, Tezpur
Editor: Modern Text Book of Forensic Medicine &Toxicology
Editor: Medical Writing: A Guide for Medicos, Educators & Researchers
Editor-in-Chief: International Journal of Health Research & Medico Legal practice
E-mail ID: drpmahanta@gmail.com; Website: http://www.ijhrmlp.org
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2. HRH Status & Challenges
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Number of surgeons, anesthetists &
obstetricians /lakh people in India is 6.4
compared to 59.2 in Brazil.
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India has 250 health workers/lakh population.
Target by 2022 is 500/lakh population…

3. Where we stand??
Facility of health care is still a
distant dream for the common & poor people
in India. Common causes of complains1:
Intraoperative problems (32%), Failure of
diagnosis or delay in diagnosis (17%), Failure to
recognize complications (7%), Failed sterilization (6%),
Failure to warn or inadequate consent (5%) &
Performance of operation without indication (3%)
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4. Mistake is Mistake
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5. BEFORE THE AGE OF 40 MORE THEN HALF OF
GYNECOLOGISTS HAVE ALREADY BEEN SUED
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6. Potential areas of litigation in Obstetrics
That involve extensive legal & clinical knowledge in regards to examination
of the obstetrical patient
• Antepartum care:History,diagnosis,investigations(…HIVtest) highriskpt.
• Subsequent visit: Screening for congenital abnormalities, IUGR,
IUFD, multiple pregnancy, Sex selection & PCPNDT Act.
• Intrapartum care: Injudicious administration of oxytocics*
• Open and endoscopic surgery
• Mode of delivery (CS/difficult vaginal delivery)
• Drugs during pregnancy & lactation
• Surrogacy
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7. Potential areas of litigation in gynecology
That involve extensive legal & clinical knowledge in
regards to exam of the patient & taking informed consent:
• MTP
• Female sterilization
• Open & endoscopic surgery
• Urogynecology
• Assisted reproduction.
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9. Examination of
patient
Gynecologists are at high risk
of false accusation
•Consent prior to examination
•Maintain privacy during exam
•Mandatory presence of female
attendant (3rd party)
Professional
& personal
conduct
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10. Informed consent
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Liable if a pt. does not give "informed consent" to a medical procedure that
results in a harm to the patient, even if the procedure is performed properly.
FOLLOW THE GOLDEN RULES:
• Engaging with the patient
• Empathizing with her needs
• Educating her as to the available options
• Enlisting her approval for the appropriate choice
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11. Forensic Gynecology
Gynecologists have little contact with Forensic
Problems. Examination of the alleged victim of
• Sexual assaults as per the protocols [Section 164 (A)
CrPC].
• Domestic violence
• Sexual violence, etc.
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12. Exam of
alleged victim
of rape
survivor:
DGP, Assam, & the health dept. of the Govt. of
Assam & all other concerned to ensure that:
• A female victim of sexual offence is
examined only by lady Govt. Doctor
• If there is no lady doctor available, a
private female practitioner at state
expense can be employed or
• Vaginal smear be collected by a trained
female nurse & examined subsequently by
a lady doctor.
Gauhati High
Court in a PIL filed
in the year’09
issued directions
in its order dated
19.08.2010:22
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13. Diagnosis of
Gynecological
Diseases
Omission of routine steps
misguides to run in a wrong path
• No step should be omitted in history
taking & clinical examination.
• Suggest investigative procedures as
needed.
• Opinion of other specialty in doubtful
diagnosis.
• Menstrual history
Wrong
diagnosis is a
strong ground
for
malpractice
claim
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14. MTP
MTP is legal <20 wks under MTP Act, 1971. Litigation may follow while:
• Continuation of pregnancy after the procedure
• Excessive or continued bleeding due to incomplete evacuation
• Injuries/perforation (Uterus, UB, Gut, etc.)
• Failure to diagnose ectopic pregnancy while performing MTP
• Death following procedures
• Done by quack or unqualified persons
• Done at unrecognized place
• Done without consent
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15. Consent for MTP of woman alone is sufficient,
provided she is:
• Not of unsound mind & >18 years of age.
• Understands the nature, purpose & consequences of
what she is consenting to.
• Consent of spouse is not necessary.
• Enough if she says that “she is >18 years of age, no
documentary proof is needed”.
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16. SC DIRECTIONS
MTP Act legalizes MTP only <20 wks. an exception being Sec.
5 of the Act, which allows abortion >20 wks. in case it is
“immediatelynecessaryto save the lifeofthepregnantwoman.”
The Draft Bill of 2017 also allows abortion from 20 wks. to 24
wks. in case the fetus suffers from substantial abnormalities
& pregnancy involves a substantial risk to the mother.
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SC
allows 13 yrs
old Mumbai rape
survivor, 31 wks
pregnant, to
abort foetus
According to the petitioner in the
case, the apex court observed that
the mental trauma of carrying the
pregnancy forward was too much for
the girl & she must terminate the
baby as per her wish.

18. Spouse consent for sterilization on therapeutic grounds is not
necessary in law.
Patient not living with her spouse, the consent of the patient is all
that is necessary.
Consent of both the spouses is necessary for ‘tubectomy’ & of her
husband in case of Abortion in case of contraception failure/rape..
Discuss with husband if married, the proposed operation if time &
circumstances permit. Every endeavour should be made to obtain his
consent to MTP unless the patient expressly forbids it.
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Consent to other procedures

19. If single, no consent is required from the putative father. Prudence dictates,
however, that the doctor should endeavour to obtain the consent of the parents
of such a girl, if she is living with them.
Obtain the girl’s authority before you seeks the consent of her parents as her
wishes must always be respected.
If the girl is under 18, take written consent from her parents even she don't
want.
A termination should never be carried out in opposition to the girl’s wishes even
if the parents demand it.
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Consent to other procedures

20. Infertility
Possible legal problems
•Artificial insemination donor (AID)
•Surrogacy
•Ovum donation
•Cryopreservation of embryo
•Embryo research
ICMR GUIDELINES 2017
Assisted
reproductive
technology
(ART)
Assisted
conception
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21. in vitro fertilization
No act of in vitro
fertilization or artificial
insemination shall be
undertaken without the
informed consent of the
female patient & her
spouse as well as the
donor.
VIOLATIONSOFTHECODEOFETHICS
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PROFESSIONAL
MISCONDUCT
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22. PROFESSIONAL
MISCONDUCT
IS THE VIOLATION OF THE REGULATIONS 2002
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◦ Pre-Conception & Pre-Natal
Diagnostic Techniques
(PCPNDT) Act
◦ Violation of MTPAct, 1971
Violation of sex
determination tests:
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23. Professional Misconduct
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Two
Nanded doctors
were sentenced to six
months' imprisonment &
fined Rs 10,000 each for
violating the PCPNDT Act
in a March 2010
case

24. Medical
Records
If he/she does not maintain
the medical record of
his/her indoor patients for a
period of 3 yrs & refuses to
provide the same within 72
hrs
Violations Of The Code Of Ethics
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Professional Misconduct
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25. Medical Records in Litigation
MR is the Basic Legal Document in medical malpractice litigation. A
well-organized, well-written record is the best defense.
Poorly-written, disorganized record is strong evidence of an
incompetent health care provider.
Poorly-kept record is not, in itself, proof of negligence on the part
of the health care provider, but it is proof of substandard care.
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26. CHAPTER 2
Engagement for an obstetric case:
• When a physician who has been engaged
to attend an obstetric case is absent &
another is sent for & delivery
accomplished, the acting physician is
entitled to his professional fees, but
should secure the patient’s consent to
resign on the arrival of the physician
engaged.
DUTIES OF
PHYSICIANS
TO THEIR
PATIENTS
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Think Twice
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Media is waiting
To suck like that of chocolate !
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31. What to do? Where to go??
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33. Principles of ethics
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Conduct of
biomedical
research
involving
the HP
implicates
a variety
of ethical
concerns:
Dignity: Respect the persons
Beneficence (Non maleficence): First do no harm
Autonomy: Respect the right of the individual
Privacy
Justice: Treat pt fairly without discrimination

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EthicalPrinciples
Legal
Updates
Updates
subject
Knowledge
Gynecologists
have a duty to
Acquaint
themselves
With the law
CONCLUSION
Doctor-patient relationship is
of the utmost faith
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35. Sometimes the
chains that
prevent us from
being free are
more mental
than physical
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