1. MEDICAL NEGLIGENCE
basics
Dr.T.V.Rao MD

2. Ethical norms may be derived
from:
Law
Institutional policies/practices
Policies of professional organizations
Professional standards of care, fiduciary
obligations

3. Clinical Ethics, Law
Clinical ethics may be
defined as: a discipline or
methodology for considering
the ethical implications of
medical technologies,
policies, and treatments,
with special attention to
determining what ought to
be done (or not done) in the
delivery of health care.

4. Clinical Ethics, Law
Law may be defined
as: established and
enforceable social
rules for conduct or
non-conduct; a
violation of a legal
standard may create
criminal or civil liability.

5. Risk Management
Risk Management
may be defined as:
a method of
reducing risk of
liability through
institutional
policies/practices.

6. Why We Need Ethics
Ethics has been described as
beginning where the law ends.
The moral conscience is a
precursor to the development
of legal rules for social order.
Ethics and law thus share the
goal of creating and
maintaining social good and
have a symbiotic relationship

7. When the Malpractice occurs
Medical malpractice occurs when a health-care
provider deviates from the recognized “standard
of care” in the treatment of a patient. The
“standard of care” is defined as what a
reasonably prudent medical provider would or
would not have done under the same or similar
circumstances. In essence, it boils down to
whether the provider was negligent.

8. India takes on Consumer
Protection Act 1986
After the Consumer Protection Act, 1986, has
come into force some patients have filed legal
cases against doctors, have established that the
doctors were negligent in their medical service,
and have claimed and received compensation.
As a result, a number of legal decisions have
been made on what constitutes negligence and
what is required to prove it.

9. What Negligence Means to
patient
In medical negligence cases it is the duty of the
patient or his/her relatives to establish that:
1. There was a duty which the medical practitioner
owed to the patient;
2. There was a breach of duty;
3. The breach resulted in injury to the patient;
4. The injury resulted in causing damages.

10. Patients too Should support
his/her allegations
A person who alleges negligent medical
malpractice must prove four elements:
(1) a duty of care was owed by the physician;
(2) the physician violated the applicable standard
of care;
(3) the person suffered a compensable injury;
and
(4) the injury was caused in fact and proximately
caused by the substandard conduct. The burden
of proving these elements is on the plaintiff in a
malpractice lawsuit.

11. Why Ethics
Read a Quote by
William Somerset Maugham
[C]onscience is the guardian
in the individual of the rules
which the community has
evolved for its own preservation

12. Common Errors can Lead
to Negligence

13. Potential legal actions against
health care providers
There are two primary types
of potential civil actions
against health care
providers for injuries
resulting from health care:
(1) lack of informed consent,
and
(2) violation of the standard
of care. Medical treatment
and malpractice laws are
specific to each state.

14. . Informed Consent.
Before a health care provider delivers care, ethical
and legal standards require that the patient provide
informed consent. If the patient cannot provide
informed consent, then, for most treatments, a legally
authorized surrogate decision-maker may do so. In
an emergency situation when the patient is not legally
competent to give informed consent and no surrogate
decision-maker is readily available, the law implies
consent on behalf of the patient, assuming that the
patient would consent to treatment if he or she were
capable of doing so.

15. Information must be Conveyed in
Understandable format and form
Information that must be conveyed to and consented
to by the patient includes: the treatment’s nature and
character and anticipated results, alternative
treatments (including non-treatment), and the potential
risks and benefits of treatment and alternatives. The
information must be presented in a form that the
patient can comprehend (i.e., in a language and at a
level which the patient can understand) and that
the consent must be voluntary given

16. When matters Go wrong
Law of the State Takes over
An injured patient may
bring an informed
consent action against a
provider who fails to
obtain the patient’s
informed consent in
accordance with state
law.
Never forget Every
Patient has his own
Choice

17. Simple Signature do not End the
matters when thing go wrong
From a clinical ethics
perspective, informed
consent is a
communication
process, and should
not simply be treated
as a required form for
the patient’s signature
or Thumb Impression.

18. Informed choice linked with State
of Mind of the Patient
Similarly, the legal
concept of informed
consent refers to a
state of mind, i.e.,
understanding the
information provided
to make an informed
choice

19. Failure to follow Standards of
Medical care.
A patient who is injured
during medical treatment
may also be able to bring
a successful claim
against a health care
provider if the patient can
prove that the injury
resulted from the
provider’s failure to
follow the accepted
standard of care

20. Updating knowledge and facilities is a
Concern for Self protection
The duty of care
generally requires that
the provider use
reasonably expected
knowledge and judgment
in the treatment of the
patient, and typically
would also require the
adept use of the facilities
at hand and options for
treatment.

21. Continuing Medical Education reduces
the Complex problems in clinical Care
The standard of care
emerges from a variety
of sources, including
professional publications,
interactions of
professional leaders,
presentations and
exchanges at
professional meetings,
and among networks of
colleagues.

22. What is Expected From
Doctors
Health care provider
must “exercise that
degree of care, skill, and
learning expected of a
reasonably prudent
health care provider at
that time in the
profession or class to
which he belongs,

23. Law is dynamic
it is constantly evolving
and changing, and this is
particularly true in health
law. Courts and
legislatures respond to
new issues and
technologies by creating
new laws or applying and
interpreting existing laws.
Move with TIME

24. Civil law and Negligence
Negligence is the breach
of a legal duty to care. It
means carelessness in a
matter in which the law
mandates carefulness. A
breach of this duty gives
a patient the right to
initiate action against
negligence.

25. Are you Competent to
Deliver the Care
Persons who offer
medical advice and
treatment implicitly state
that they have the skill
and knowledge to do so,
that they have the skill to
decide whether to take a
case, to decide the
treatment, and to
administer that treatment.

26. What it means a Private
Complaint
A private complaint of rashness or negligence
against a doctor may not be entertained without
prima facie evidence in the form of a credible
opinion of another competent doctor supporting
the charge. In addition, the investigating officer
should give an independent opinion, preferably of
a government doctor. Finally, a doctor may be
arrested only if the investigating officer believes
that she/ he would not be available for prosecution
unless arrested.

27. Internet brings on Lots of
Information even to the patients
The internet offers
many helpful
resources to orient
non-lawyers to
locating relevant law,
several of which are
described below.

28. Burden of proof and chances
of Error
The burden of proof of
negligence, carelessness, or
insufficiency generally lies
with the complainant. The law
requires a higher standard of
evidence than otherwise, to
support an allegation of
negligence against a doctor.
In cases of medical
negligence the patient must
establish her/ his claim
against the doctor.

29. Indian Penal Code and Medical
Negligence
Indian Penal Code,
1860 sections 52,
80, 81, 83, 88, 90,
91, 92 304-A, 337
and 338 contain the
law of medical
malpraxis in India

30. Indian legal system acts in
cases as …
A physician can be charged with criminal
negligence when a patient dies from the effects
of anesthesia during, an operation or other kind
of treatment, if it can be proved that the death
was the result if malicious intention, or gross
negligence. Before the administration of
anaesthesia or performance of an operation, the
medical man is expected to follow the accepted
precautions.

31. May be Lacking precise
Definition
It has long been recognized
that criminal liability of a
physician may result from a
high degree of negligent
conduct. What the law calls
criminal negligence is largely
a matter of degree; it is
incapable of a precise
definition. To prove whether or
not it exists is like chasing a
mirage.

32. Indian Courts are Careful in
Judgements
The Indian Courts have been very careful
not to hold qualified physicians criminally
(instances of quacks for criminal negligence
are there) liable for patients’ deaths that are
the result of a mere mistake of judgment in
the selection and application of remedies
and when the death resulted merely from an
error of judgment or an inadvertent death.

33. Things Can Go Wrong when you
do not Follow Ethics

34. Too many Doctors Increases
Confusion and Litigations

35. Opinions Differ
Mahatma Gandhi
....I am & have been for years
a confirmed anti
vaccinationist. Anti-
vaccination has no backing
from the orthodox medical
opinion. A medical man who
expresses himself against
vaccination loses caste.
Tremendous pecuniary
interests too have grown
around vaccination.”

36. Quotes on Prolonging Life
and Conflicts
In quixotically trying to
conquer death doctors all
too frequently do no
good for their patients’
“ease” but at the same
time they do harm
instead by prolonging
and even magnifying
patients’ dis-ease
Jack Kevorkian,
Prescription: Medicide:

37. Our Lives Dependent on Ethics of Others
Bill Moyers
Our very lives
depend on the
ethics of
strangers, and
most of us are
always strangers
to other people.

38. We cannot Hide our
Negligence for long

39. Never Forget
Tender, Loving care
Reduces Many Conflicts

40. ReferencesClinical Ethics and Law This information reflects the
opinions of its author, Lisa V. Brock, J.D., M.A. (Bioethics),
Medical negligence and the law K K S R Murthy Indian
Journal of Medical Ethics
Consumer Protection Act and Medical Profession - Indian
Penal Code and Medical Negligence Med India
Google Images
*Contain no Conflict of Interest on Legal Matters

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42. The Program Created by Dr.T.V.Rao MD for
many Young Medical Professionals for
Universal Practice in Preventing the Legal
litigations associated with Medical
Negligence
Email
doctortvrao@gmail.com