A survey of road accidents in India last year painted a gory picture. Latest survey states that while 4.5 lakh people succumb to crashes every year, 4.8 lakh people are left injured and untreated. Almost 1.3 lakh people die each year from the lack of medical attention following road accidents. But finally it seems like the scenario is about to change, with the ground breaking ruling of the Pt. Pramanand Katara vs. Union of India & Ors. According to Article 21 of the Constitution of India, every doctor is professionally obligated to extend their services to the protection of life. This also includes the Government Hospitals and medical institutions who are obligated to provide immediate medical care.
What defines a medico legal case?
A graphical representation of medico legal cases as per ESIC Model Hospital, Noida
A medico legal case can be aptly defined as a situation where a person requires immediate medical attention due to injuries which suggests criminal offense. Any kind of burn injuries, vehicular accidents involving motor vehicles, trains and other forms of transport, cases of suspected poisoning, sexual assault, criminal abortion and attempted suicide or homicide fall under the category of criminal offense. If a patient is brought in an unconscious state which has been induced due to unknown reasons or is brought in dead without any proper legal documents to state his cause of death then these instances also fall under the scope of a medico legal case. However instead of waiting for legal enforcements to arrive, the primary duty of a doctor present is to provide primary lifesaving care to the patient and then immediately inform the nearest police station. According to Section 39 of Criminal Procedure Code of India, legal investigations should be started as soon as possible to minimize the tampering of evidence on the patient. A doctor can always seek counsel of a medical app to judge if a situation falls under its purview.
What are the primary duties of a doctor during medico legal emergencies?
In cases of emergency all sorts of legal formalities and monetary considerations take a back seat. The only concern of the doctors at a medical institution should be to provide necessary emergency medical care to the patient. Here are a few points to save doctors from getting tangled in medico legal issues:
- Under Article 21 of Indian Constitution, patients cannot be denied emergency medical care. In case any doctor sites the lack of facilities as the reason, he may be held liable for subsequent deterioration in the patient’s condition. If facilities are truly lacking for the complete care and treatment of the patient, then he or she may be transferred to the nearest facility (this includes government hospitals, nursing homes and private facilities) safely.
- In case the patient is unable to pay for required emergency care, the hospital holds no ground to deny him or her treatment at the facility.
- Any sort of consent is overridden in the case of an emergency.
- In case the patient is a victim of suspected sexual assault, he or she cannot be examined by the doctor without a written consent signed by the victim. In case a woman needs to be inspected by a doctor, another woman needs to be present during the examination procedure. In case the suspected victim is male, another man needs to be present during the ensuing physical examination. Or the doctor may be charged with indecent assault under Section 354 of IPC. This is also true in cases of suspected or attempted criminal abortions.
- In the above mentioned cases the examining doctor is bound by law to keep the name and other identifying details of the victim confidential.
- In case of death resulting from suicide, the doctor is bound by law to report the matter to the police for further investigation.
- However, if the patient is alive after attempted suicide the doctor is not obligated to inform the police.
When doctors report a medico legal case to the police he or she is usually given a receipt stating the acknowledgement details of the case, clearly with name of patient, date, time and other details. In case the doctor informs the police over phone, he or she is given a docket number which is a sound proof of intimation and can be used as a proof of intimation of the legal system in the patient’s formal records. It is the responsibility of the doctor in-charge to provide the correct information to the police to help them proceed with the investigation procedure. In case a doctor in confused at such an overwhelming situation he or she can always turn to a medical app which will guide him or her through the necessary procedures step by step.
Can doctors be booked under medico legal cases?
It is extremely important for doctors to understand that although most accident and assault cases fall under the medico legal category, those are not the only ones. Even seemingly simple cases may get entwined with the law if they involve wrong medication, wrong dosage of prescribed meds, wrong treatments etc. All doctors make mistakes once in a while and this is why it is extremely important for every doctor needs to know where and how medicine and law interact. There are usually five different areas where a doctor can face a medico legal challenge. Taking the help of a medical app to pin point these hazard zones will help the doctors tread more carefully.
A doctor should obtain written consent from the patient himself for his treatment. A patient reserves all right to refuse any treatment even if the treatment has the power to save his life. Consent may be required for diagnosis, treatment, organ transplant, disclosure of medical records and research work. In case the patient is deceased, consent of relatives in required after death in case consent was not obtained from patient when he was alive.
b. While prescribing medication:
The name of the patient should be written clearly with other relevant details including age, sex and appointment date. The drug name, dosage, frequency and duration of the medication are to be signed by the doctor himself. Doctors are to ask patients about any prevalent or known drug allergies before prescribing medication. Verbal prescriptions are accepted only in cases of emergencies. In case the patient is admitted to the facility, proper care is to be taken that the BHT or Bed Head Ticket is maintained and updated regularly.
c. Doctor patient confidentiality:
A relationship of a doctor with his or her patient falls under the category of “fiduciary” which means that the doctors are bound by ethics to keep all patient information confidential. Doctors should remember that even revealing a patient’s name is breaching confidentiality. So before disclosing any kind of personal details, including the patient’s name a doctor should obtain proof of consent. In fact, competent children have the same rights of confidentiality as adults. A doctor is required to divulge personal information of patients only when his social responsibilities outweigh their responsibilities to their individual patients. They are in fact required to report to concerned authorities in cases of communicable diseases, births, illegal abortions and people who may be suspected of having terrorist associations.
d. Keeping records of patient details:
Doctors should remember to assign dates to their notes. In case of handwritten notes, doctors should end them with their own signature. Notes should not be scratched up, in case of changes; amendments can be added with proper dates and signature. All decisions made, actions taken, information harvested, clinical history and progress, results, consents and referrals should be clearly documented in the journals. It is advisable not to include comments which may otherwise be interpreted as racist, sexist, communal or ageist.
This simply means keeping the records clean and transparent. Keeping all the above mentioned points in view, all doctors should proceed keeping in mind that the patients reserve the right to see their own records. In cases discrepancy, a medico legal investigation can be initiated which will call for the disclosure of doctor’s reports. So it is imperative to include all details in forms, reports and other formal documents. Any kind of inconsistency in patient or case details can call for an investigation against the doctor. No relevant information should be left out of the records on purpose. Very often, in our country, doctors encounter families who want certain information to be omitted out of documents, but it is the doctor’s legal responsibility to maintain impeccable records and complete any form of certificates truthfully.
The main problems faced by doctors in India
In most of the first world countries like U.S.A, Canada and U.K people are aware of their rights. There are Medical Laws which have been formulated for enforcement of proper medical practice. However, in India there are so section of law that cater specifically to the medical community so all the subsequent litigations are based on civil and criminal laws. In addition to that many cases are also based on Consumer Protection Acts, Law of Contracts and Law of Torts.
In cases of gross lack of competency and attention a doctor can be charged with Criminal negligence. In cases of absence of reasonable degree of care and skill, patients and their family members can charge the doctor with Civil negligence.
The patient may directly file a complaint against the doctors on the ground of negligence. The council has complete power to punish doctors in case negligence is proven. Punishment can range from a warning notice to permanent erasure of name from Medical Registrar.
Consumer Protection Act came into action in 1986 and acted as a part of an international agreement to provide protection to the interest of the consumers. The main goal of this act was to maintain a decent standard and quality of services that people buy for money. At the moment medical services also fall under COPRA, 1986. The patients can file at case at the District level with the District Consumer Dispute Redressal Forum with or without a lawyer. a case can also be filed at the State level or at the National level. the dispute redressal commissions at all these levels have the complete power to order compensation for the patient and/or his family.
Medico legal duties of a doctor
A medical app is fully capable of updating a doctor of all his medico legal duties too. All clauses and sub-clauses of these duties are noted in detail. The app also includes multiple case reports from across the country and relevant advice to help them.
a. Dying Declaration
It falls under the medico legal duties of the doctor to take the “Dying Declaration” of a patient. This is the statement of a person recorded in writing or orally who is dying as a result of criminal activity. The declaration is to be recorded in simple question and answer format without any indication of intent to influence the patient’s declaration. The declaration is to be noted verbatim. Prior to the commencement of the recording the doctor should assess the patient’s mental condition.
b. Dying Deposition
This is the statement of a dying man under oath which is presented before a Magistrate and the accused or his Counsel. It is the medico legal duty of the doctor to help in the preparation of a Dying Deposition. It is also the doctor’s duty to certify if the patient is mentally competent to make a sound statement.
Having a medical app can save a doctor from any confusion regarding his or her medico legal duties. He can simply refer to the detailed index, run live searches and look for the latest updates regarding all his duties including both dying declarations and depositions.
Medico legal laws need to be exercised for the complete definition of doctor patient relationships, duties and rights of doctors. Since medico legal knowledge is not avid in India and its medical community medical apps are now gaining popularity. A single medical app has the power to pool in all kinds of legal information that may be pertinent for a particular situation. The medical app is updated on a regular basis to keep the medical community up to date with the changing laws and regulations. This app has the potential to stop the exploitation that doctors are currently facing in many situations across the country.