medical practice- management strategy & consumer protection ii

7/31/2019 Medical Practice- Management Strategy & Consumer Protection II

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In nothing do men more nearly approach

the gods than in giving health to men.

~Cicero


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OVERVIEW

1. How to avoid litigations ; and

2. Defenses for Civil and Criminal Suits.


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The Doctor patient relationship in our country has undergone a sea

change in the last decade and a half.

We witness today a fast pace of commercialization and

globalization on all spheres of life and the medical profession is noexception to these phenomena. As a result, the doctor-patients

relationship has deteriorated considerably. Earlier too, doctors

were covered by various laws, i.e. the Law of Torts, IPC etc., but

since the passing of the Consumer Protection Act in 1986,

litigation against doctors is on the increase.


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1. Signboards and Advertisements should mention actual

facilities available;

2. Prescription head of the doctors should contain the

qualification of the doctor

3. Refrain from claims of guarantee of results;

3. Answer all queries of patient/relatives without getting

irritated;


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4. Training should be imparted to staff about dealing

with patients/relatives under stress;

5. Always update yourself and staff with academic

sessions; workshops; and CMEs.

6. Always ask patients/relatives for feed back on your

services, staff ,charges as well as hospital set up.


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1. Always exercise reasonable skill and care with

equivalent qualification and experience in similar

circumstances;

2. Exhibit reasonable skill and care to patients,

attendants, relatives through expression, body

language, action and discussion;

3. Make good clinical notes of findings on examination

and treatment given;


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4. Where failure to follow instruction, refusal for anyinvestigation and failure to come for reviews on

specific dates should always be recorded;

5. Make sure handwriting is legible.


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1. Professional indemnity is a tool which not only meets the

claim of compensation awarded against the doctor/ hospital

but also gives security if negligence is proved in a Court of

law;

2. Insurance companies not only compensate the third party

claims, but also provide legal aid to hospitals/ doctors;

3. Money paid as compensation is very important, but also the

reputation of the doctor, hospital is at stake.


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1. Forming societies to fight fraudulent claims nor only provide

security , but regular fellowship prohibit doctors from

speaking foul about their colleagues;

2. These forums discuss various provisions of the Acts, cases

fought and lessons to be learned;

3. These to a certain extent can also act as a pressure group on

dissatisfied patients


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PRECAUTIONARY MEASURE


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DOCTORS RESPONSIBILITY

1. Mention qualification, training, experience and designation

on prescription;

2. Date and time of consultation;

3. Mention age, sex and weight of patient;

4. Listen attentively, look carefully and ask questions;

5. Always ask for patient/attendant to repeat history of patient;


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7. Ask patient to come for review next day if you are not sure

about the diagnosis;

8. Mention Diagnosis Under Review until diagnosis is final;

9. In complicated cases mention history of illness and

substantial physical findings on prescription;

10. If patient is erring on any count, make a note of it;


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PATIENTS HISTORY

1. Mention condition of patient;

2. Record history of drug allergy;

3. Describe the name of drug and dosage;

4. If drug is poisonous warning should be written;

5. Give instructions in comprehensive terms;

6. Mention side-effects if any and action to be taken if theyoccur;


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7.Remember to advise in writing pathological, radiological

tests at specific intervals for certain drugs which require

monitoring;

8. Always advice the patient not to stop taking the

medication suddenly;

9. Adjust dosage in case of child, elderly patient, in renal or

hepatic disorder


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DIAGNOSTIC MEASURE

1. Incase of chronic ailment mention treatment to be taken

immediately in case of emergency;

2. Mention prognosis explained, if necessary take signature of patient/

attendant;

3. If you are not sure what disease a patient has always get a

consultation;

4. Provide referring note when ever referring patient;

5. Update knowledge and skill from time to time;


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7. Employ qualified assistants;

8. Always take a legally valid consent before

undertaking surgical/diagnostic procedure;

9. Ask for routine x-ray and other check ups for proper

diagnosis.


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SURGICAL MEASURE

1. In all instances ofswabcases and instrument cases the

surgeon in charge has been directly or vicariously held liable

for negligence. So, always ensure post operative care to

patients;

2. Always seek proper legal and medical advice before filing a

reply to the complaint referred to you from a consumer court


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KNOW YOUR INJECTION

1. Name of the injection;

2. Expiry date;

3. Re-confirm route of administration;

4. Rate of administration;

5. Site of injection;

6. Always use disposable syringes and needles;

7. Incase patient is agitated or non cooperating restrain

him or wait till he calms down;


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HOW TO TACKLE MEDICAL CLAIMS


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NOTICE

a. Do not panic, read the legal notice and understand theclaims alleged;

b. Verify the services your hospital provided with respectto the allegations alleged by the complainant;

c. Notify your hospital as well as your insurance companyabout the legal notice issued;

d. Carry all relevant documents when you approach alawyer to seek legal advise.

e. Explain the entire facts of the case so that the lawyer canguide you on how to reply to the legal notice.

f. Reply to the legal notice issued after seeking guidancefrom a lawyer as soon as possible;


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GENERAL DEFENCES

1. The court does not have pecuniary/territorial jurisdiction.

2. Complaint is time-barred.

3. Complicate issues involved, required recording of evidence of

experts, hence case should relegated to a civil court.

4. Burden of proof of:

(i) Duty of care; (ii) Breach of that duty; (iii) Causation; (iv)

Damage, etc. is on the complainant.

5. The complaints frivolous and vexations and liable to be dismissedunder section 26 of the Act.


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ALLEGATIONS

1. Civil Allegations

2. Criminal Allegation

[Medical Negligence is both a Civil as well as CriminalAllegation]


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CIVIL DEFENCES

1. Mention hospitals infrastructure facilities, special

facilities, back-up support, it with documents.

2. Complainant has not come to the court with clean handsi.e. he has suppressed material facts, e.g. previousillness, treatment etc.

3. Inconsistence between notices sent directly or throughconsumer groups and the complaint made in the court.


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CRIMINAL DEFENCES

1. Mention your qualifications, training, experience, expertise etc.

Support with relevant documents.

2. Written evidence of consent of the patient/relative/attendant to

assumption of inherent and special risks in the treatment.

3. Circumstances of the case; viz. There was emergency, lack of facilities

(e.g. rural area) no one to give history ofpatients illness etc.

4. Reasonable knowledge, skill and care exercised (Rely/quote standard

text books with attested photocopies).

5. Consolation/treatment by patient from other doctor/other systems of

medicine simultaneously.

6. Contributory negligence.


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Justice is conscience, not a personal consciencebut the conscience of the whole of humanity.

Those who clearly recognize the voice of their

own conscience usually recognize also the voice

of justice.

Alexander Solzhenitsyn


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medical practice- management strategy & consumer protection ii

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