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Tuesday, December 25, 2007

Monday, December 24, 2007

Sunday, December 23, 2007

INDPALMS is Indo-Pacific Association of Law, Medicine and Science

Indo-Pacific Association of Law, Medicine and Science (INDPALMS), Singapore

Thursday, December 20, 2007

Criteria for Accreditation of CEmONC Centres

Criteria for Accreditation of 24 Hour Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Centres - ie Maternal and Child Health Centres

Casualty services

  • A pregnant woman in labour or distress on entering the hospital at any time during the day or night is directly taken to the obstetric casualty and immediately examined by a professional with midwifery skills and decision taken within fifteen minutes.
  • If there are signs or bleeding, convulsions or shock, she should be immediately attended by the Obstetrician on duty and necessary treatment to be initiated.
  • Send the mother to the labour room, ward or operation theatre, depending on the signs and symptoms.
  • No pregnant woman in labour or distress should be turned away from the hospital for any reason at any time of the day or night.
  • Casualty should be located close to the labour room and theatre.
  • Casualty to receive advance intimation about the arrival of the mother and keep the specialist team ready with blood, if needed.
  • Casualty should have the following round the clock:
  • An obstetrician
  • Life saving drugs and IV fluids
  • Facility for examining the patient (including pv)
  • Emergency protocols
  • Telephone connection in the casualty, labour room and blood bank
  • Patient transport system within the institution

Emergency Obstetric Procedures
Procedures
Vaccum extraction
Forceps delivery
LSCS
Emergency Hysterectomy
Manual removal of placenta
Dilation and Curettage
Laparotomy
Blood transfusion

Facilities
Separate theatre for above obstetric procedures.
The Government shall provide at least 4 obstetricians, 4 paediatricians, 2 general surgeons and 2 anaesthetists to each CEmONC centre.

Emergency Newborn Care
Every delivery to be attended by a staff nurse trained in newborn resuscitation.
Paediatricians to be available in the institution round the clock for emergency interventions
Emergency Protocol should be available

Laboratory Services
24 hours laboratory services including
Blood grouping, typing and cross matching
All routine examinations such as haemoglobin, blood glucose, urine sugar, albumin.

Post Natal Care
All normally delivered mothers should be observed in the labour room for at least two hours after delivery. Before transferring the mothers to the postnatal ward, pulse, BP, firmness of the uterus and amount of vaginal bleeding should be checked.

In the postnatal ward vital signs and height of the uterus should be monitored once in two hours for the first six hours and once in six hours till 24 hours. Twice a day monitoring until discharge should follow this.

Those mothers who had instrumental vaginal delivery should be observed in the labour ward for six hours after delivery before transferring the mother to the postnatal ward pulse, BP, firmness of the uterus, urine output and amount of vaginal bleeding should be checked. Postnatal care in the ward is similar to the care provided for normal vaginal delivery.

Post Operative Care
Staff
For the first two hours after surgery, staff nurse remains at the bedside to monitor patient continuously.
Hourly checkups of vital signs (temperature, pulse, BP, and urine output), for the next six hours.
Forth hourly check up of vital signs by staff nurse for next two days and thereafter twice daily till discharge.
Check up by doctor at least once during the first two hours and every sixth hourly for three days and then twice daily till discharge.

Records and Registers
Parturition Register
Case Records
Reporting Formats
Referral register

Ambulance Services
For referral
Ambulance with driver and fuel available 24 hours.
Linkages with other ambulance providers.
Casualty to have telephone attender who will organise the transportation.

Adherence to standard emergency treatment protocol
Standard emergency treatment protocol should in the casualty, in labour ward and in theatre.
The obstetrician and staff nurse posted in the labour ward and theatre should be thorough with emergency protocol.

Quality of provider- Patient interaction
Patient treated with respect and dignity.
Privacy and confidentiality assured.
Informal payment from patients strictly banned.
Informed consent obtained from the family for major procedure.
Procedures clearly explained to family members.
A female attendant to be permitted in labour room while ensuring asepsis.

From http://mohfw.nic.in/dofw%20website/JSY_features_FAQ_Nov_2006.htm

Wednesday, December 19, 2007

ISHA is Indian Society of Hospital Administration

Indian Society of Hospital Administration (ISHA)

Tuesday, December 18, 2007

Sunday, December 16, 2007

Saturday, December 15, 2007

CFMT is Congress of Forensic Medicine and Toxicology

Congress of Forensic Medicine and Toxicology (CFMT)

Friday, December 14, 2007

Thursday, December 13, 2007

Thursday, December 06, 2007

Medico-Legal, Scientific Approach- Criminal Lawss & Justice

Few Links from http://www.legalserviceindia.com/medicolegal/medico.htm

A Comparative Analysis Of Various Indian Legal Systems Regarding Medical Negligence: Criminal, Consumer Protection & Torts Laws: With the awareness in the society and the people in general gathering consciousness about their rights, measures for damages in tort, civil suits and criminal proceedings are on the augmentLaw

Law And Medicine With Special Reference To Genetic Engineering And Gene Therapy: A gene is a locatable region of genomic sequence, corresponding to a unit of inheritance, which is associated with regulatory regions, transcribed regions and/or other functional sequence regions.....By Sayantani ChatterjeeLaw

Are Phase I Clinical Trials of Foreign Drugs Permitted in India: The Indian Clinical Research Outsourcing (CRO) industry is growing rapidly and brings with it attendant regulatory concerns....By Adv.Arijit ChakrabortyLaw

Medical Jurisprudence: An Indian Law Perspective: Medico-legal is the term, which incorporates the basics of two sister professions i.e. Medicine and Law. Everybody talks about the law but few, aside from lawyers, judges and law teachers, have more.....By Sneha VenkataramaniLaw

Medico-Legal Significance Of Bruise: A bruise is called a "Contusion". This is seen as a bluish coloured area on the surface of the skin to begin with. This is due to the rupture of capillaries....By Prof (Dr) J.P.Saxena (M.B.B.S; M.D, F.A.F.Sc; LL.B.) Medico-legal Expert cum Toxicologist & Advocate

Scientific Defence Of Injuries (Abrasions): It is very common to find abrasions in different types of medicolegal cases say Assaults, Rape, Strangulation etc....By Prof (Dr) J.P.Saxena (M.B.B.S; M.D, F.A.F.Sc; LL.B.) Medico-legal Expert cum Toxicologist & Advocate

X Vs Z on AIDS: On account of disclosure of the fact that the Appellant was H.I.V.(+) by the Hospital authorities without the express consent of the Appellant, the Appellants proposed marriage ...

Wednesday, December 05, 2007

CRIMINAL NEGLIGENCE BY DOCTORS-A SCENARIO OF AGGRESSIVE PATIENTS, CONFUSED DOCTORS AND DIVIDED JUDICIARY!

From http://www.icfmt.org/vol2no4/criminal.htm


Dr. Mukesh Yadav, Assoc. Professor , Deptt. Of Forensic Medicine
M.M.Institute of Medical Sciences & Research, Mullana, Ambala-133203

Email: drmukeshy14_@rediffmail.com
yadav_drmukesh@yahoo.co.in

ABSTRACT

The word “negligence” is always damaging to the reputation of doctors, related to some damage to the patient and a challenge before the judges. In recent years, sudden spurt in the cases of “Criminal negligence” and decision of the Supreme Court (Dr. Suresh Gupta vs. Govt. of NCT of Delhi) raises a fresh debate.

This paper deals with current scenario of “Criminal Negligence”, applicability of Section 304 & 304-A IPC in cases of death of patient during treatment, remedial measures available to a doctor facing the charge of ‘Criminal Negligence’ and a brief discussion of important cases related to the issue, including recent case.

Key Words: Criminal, Doctor, Judiciary, Negligence, Patient.

INTRODUCTION:

Negligence is a term of art, but has distinct meanings in different jurisdictions. In ‘Tort’, damage is an essential ingredient but that element is not necessary in the law of master and servant. In criminal law, there are series of offences based on negligence in which loss or injury is not material, it is enough if the act is likely to cause injury or endanger life.1 Operation of patient without consent is an example of negligence (Statutory Damage) even without actual apparent damage. Dictionary meaning of term ‘Negligence’ is ‘Lack of Proper Care’. As defined by Baron Alderson negligence means: “Omission to do something which a reasonable man guided by those consideration which regulate conduct of human affairs would do, or doing something which a reasonable man would not do”. Same definition is quoted in many decisions of the court.2 ‘Criminal Negligence’ is an offence against the State while ‘Civil Negligence’ is an offence against the individual act, which leads to injury i.e. physical injury, hurt- Section 319, grievous hurt- Section 320 Indian Penal Code (IPC). Loss of property (financial loss) due to some negligent act is always a civil negligence.4 Recent decision of the Supreme Court 5 delivered on August 4, 2004 raises a fresh debate on the issue of ‘Criminal Negligence by the Doctors’. In this case the Supreme Court relied on various decisions of the House of Lords6,7,8,9, 10.

WHY PUBLIC APPEARS TO BE AGGRESSIVE?

There have been an ever-increasing number of cases of patients suing doctors for alleged ‘Criminal Negligence’. Is it just that more patients report to the courts against innocent doctors, or does it have to do with an actual fall in the standards amongst medical practitioners? In the last decades, technical advances in the medical field have meant a better quality of life, with an increased longevity and falling morality levels. Unfortunately, there has not been a corresponding shift in the standard of medical education or investment in the concept of patient management in most of the healthcare setups. Fast-track commercialization and the adoption of corporate culture values by hospitals and members of the medical fraternity only put more strain on the doctor – patient relationship.

REASONS FOR INCREASING LITIGATIONS.

* Overworked or too busy doctors are not able to give enough time to their patients or win confidence of the patients.
* No proper counseling of relatives or timely information about consequences and prognosis of disease.
* Comments on treatment of a doctor by another doctor due to Professional Jealousy.
* Inadequate maintenance of medical records may even be sufficient to establish a prima facie case of Criminal Negligence.
* Media Related: Increasing publicity of negligent suits & awards.
* Social Causes: Increasing awareness about consumer rights.
* High expectation of the patients and their relatives and tendency to put blame on the doctors for death due to any reasons.
* Natural reaction as a result of lost of loved one.
* Public attitude: Only lawsuits and fear of it will keep the abuse by doctors at bay.

All these factors together are responsible for aggressive attitude of public towards doctors.

DEGREE OF NEGLIGENCE:

High degree of negligence is necessary to prove the charge of criminal negligence u/s 304-A IPC. For fixing criminal liability on a doctor or surgeon, the standard of negligence required to be proved should be as high as can be described as “gross negligence”. It is not merely a lack of necessary care, attention and skill.6

The Supreme Court held that “Thus a doctor can’t be held criminally responsible for patient’s death unless his negligence or incompetence showed such disregard for life and safety of his patient as to amount to a crime against the State”. 5 Court further adds, “Thus, when a patient agrees to go for medical treatment or surgical operation, every careless act of the medical man can’t be termed as ‘Criminal’. It can be termed ‘Criminal’ only when the medical man exhibits as gross lack of competence or inaction and wanton indifference to his patient’s safety and which is found to have arisen from gross ignorance or gross negligence.

“Where a patient’s death results merely from ‘Error of judgment” or “an accident”, no criminal liability should be attached to it. Mere inadvertence or some degree of want of adequate care and caution might create civil liability but wouldn’t suffice to hold him criminally liable.5 The following concluding observations of the learned authors11 as quoted by the Supreme Court are apt on the subject and a useful guide to the courts in dealing with the doctors guilty of negligence leading to death of their patients: “Criminal punishment carries substantial moral overtones. The doctrine of strict liability allows for criminal conviction in the absence of moral blameworthiness only in very limited circumstances. Conviction of any substantial criminal offence requires that the accused person should have acted with a morally blameworthy state of mind. Recklessness and deliberate wrong doing, levels four and five are classification of blame, are normally blameworthy but any conduct falling short of that should not be the subject of criminal liability. Common-law systems have traditionally only made negligence the subject of criminal sanction when the level of negligence has been high – a standard traditionally described as gross negligence……….

………..

Blame is a powerful weapon. When used appropriately and according to morally defensible criteria, it has an indispensable role in human affairs. Its inappropriate use however, distorts tolerant and constructive relations between people. Some of life’s misfortunes are accidents for which nobody is morally responsible. Others are wrongs for which responsibility is diffuse. Yet others are instance of culpable conduct, and constitute grounds for compensation and at times, for punishment. Distinguishing between these various categories requires careful, morally sensitive and scientifically informed analysis”.

ROLE OF MEDICAL EXPERT'S OPINION:

No case of criminal negligence should be registered without a medical opinion from Expert Committee of doctors and it should be given within a reasonable time. Indian Medical Association (IMA) Punjab claimed “they had secured a directive from Director General of Police (DGP) Punjab that no case of criminal negligence can be registered against a doctor without a report from an Expert Committee.12 Similar situations exist in the case of State of Delhi where Lieutenant Governor issued directions to the Delhi police regarding how to arrest a doctor in medical negligence case, the Delhi High Court also decided to form guidelines for lower judiciary as well as the police to deal with such cases.13

Hon’ble Supreme Court endorsed the same view, as “criminal prosecution of doctors without adequate medical opinion would be great disservice to the community – as it would shake the very fabric of doctor- patient relationship with respect to mutual confidence and faith the doctors would be more worried about their own safety instead of giving best treatment to their patients”5.

APPLICABILITY OF SECTION 304 & 304-A OF IPC:

“The legal position is almost firmly established that where a patient dies due to the negligent medical treatment of the doctor, the doctor can be made liable in civil law for paying compensation and damages in ‘Tort’ and at the same time, if the degree of negligence is so gross and his act was reckless as to endanger the life of the patient, he would also be made criminally liable for offence under section 304-A of IPC”. 5

Incidences are reported in which cases are registered against the doctor’ u/s 304 IPC as doctors are murderer and even not granted bail14, 15.

WHY DOCTORS ARE CONFUSED OVER THE ISSUE OF ‘CRIMINAL NEGLIGENCE’?

Doctors are victims of ‘Trial by media or post mortem of Court’s judgment done by the media’ or misinformation spread through the media and technicality of legal words used in the matters of ‘Criminal Negligence’. As reported by various leading national news papers after the recent decision of Supreme Court 5 “ Doc not Criminally Liable if Patient Dies”16, “Saving the Doctors” 17, “SC Judgment Qualifies Medical Negligence” 18, SC Insures Docs Against Patient Death” 19, SC Ruling a Deliverance for Medical Fraternity”20, “SC Comes to the Rescue of Doctors” 21 etc. “This would mean that the relief the doctors had got due to the Judgment, 5 would not be available to them till the larger Bench give its opinion”.22

Doctors relying on these media reports without verifying the facts from original judgment or through discussion with the legal experts on the issue may fall prey of this misinformation perceived through the eyes of media and may propagate same feeling and knowledge to other colleagues and junior doctors and always remain confused on the issue of criminal negligence. While SC judgments5 mention nothing new except verifying the previous established fact that ‘error of judgment is not negligence”.

ROLE OF MEDIA:

The freedom of information is implicitly covered by, Article 19 and Article 21 under the Indian Constitution.23 Disposing off a case of contempt of Court against the editors of two newspapers recently, the Supreme Court remarked: “It is the duty of a true and responsible Journalist to inform the people with accurate and impartial presentation of news and his views after dispassionate evaluation of the facts and information received by him to be published as a news item”. 24

Since the 1970,s Indian media has played an extremely important role in sensitizing people with information about governance, development, science and technology, foreign relations and so on. However, lately it has also come in for criticism, as highlighted by the above the Supreme Court decision. There is a decline in journalistic credibility, as noted by the Chairman of the Press Council of India as well as the President K.R. Narayanan.

Recently, due to the media preoccupation with the trivia, personality cult, one-sidedness, and instant in-depth investigation, 51 senior journalists feel that the media sides away from important people’s issues that it is losing social content and becoming a consumer product with a manager overshadowing the editor. The media has a tendency to launch “trial by the media”; even sentencing by the media, while a Court proceeding is underway.

DIVIDED JUDICIARY:

Referral of judgment of SC5 to the larger bench further confirms the divided opinion of judiciary and complexity of legal words used in cases of negligence. The much-debated judgment of the SC is now referred to a larger Bench for reconsideration on September 9, 2004. A Bench of Mr. Arijit Pasayat and Mr. C.K. Thakkar observed that the words “gross negligence” or “reckless act” did not fall within the definition of Section 304-A IPC, defining death due to an act of negligence or the culpable homicide not amounting to murder. 22, 25, 26

Between Civil and Criminal liability of a doctor causing death of his patient the court has a difficult task of weighing the degree of carelessness and negligence alleged on the part of the doctor. For conviction of a doctor for alleged criminal offence, the standard should be proof of recklessness and deliberate wrong doing with a higher degree of morally blameworthy conduct.5

SUMMARY & CONCLUSION:

Thus, where a patient’s death, results merely from error of judgment or an accident, no criminal liability should be attached to it. Mere inadvertence or some degree of want of adequate care and caution might create civil liability but would not suffice to hold doctor criminally liable.

“To convict, therefore, a doctor, the prosecution has to come out with a case of high degree of negligence on the part of the doctor. The courts have, therefore, always insisted on the case of alleged criminal offence against doctor, causing death of his patient during treatment, that the act complained against the doctor must show negligence or rashness of such a higher degree as to indicate a mental state, which can be described as totally apathetic towards the patient. Such gross negligence alone is punishable”. 5

Court further adds, “Criminal responsibility carries substantial moral overtones. Some of life’s misfortunes are accidents for which no body is morally responsible, others are wrong for which responsibility is diffuse, yet others are instances of culpable conduct & constitutes grounds for compensation & at times for punishment. To distinguish between these categories requires careful, morally sensitive & scientifically informed analysis”. 5

This approach of the courts in the matter of fixing criminal liability on the doctors, in the course of medical treatment given by them to their patients, is necessary so that the hazards of medical men and medical profession being exposed to civil liability, may not unreasonably extend to criminal liability and expose them to risk of landing themselves in prison for alleged criminal negligence.

Medical Council of India and State Medical Councils should come forward to strictly implement its regulations over medical profession because the failure of these regulatory bodies to keep check on the erring doctors or to effectively enforce ethical guidelines framed in 2002 27, are the reasons for falling standard of health care in India.

The editor of a newspaper or a Journal, the Supreme Court said, has a greater responsibility to guard against untruthful news and its publication. “If the newspaper publishes what is improper, mischievously false or illegal and abuses its liberty, it must be punished by a court of law”. While a free and healthy press is indispensable to the functioning of a true democracy, the Court said the freedom of the Press is subjected to reasonable restraints. 24

What everybody can hope that new decision would come up not only with clear definition of the ‘criminal negligence but also with exact meaning of the legal words used in defining the case of criminal negligence by the highest law protector and giver of India.

References:

1. Kedar Nath vs. State, AIR 1965, Allahabad 233.
2. M/S Krishna Roadways, Nathdwara vs. Madanlal, 1984 R.L.W. 25.
3. (R3Bhajan Lal Gupta vs. Mool Chand Khairati Ram Hospital, reported in 2001 (1) CPR 70-N.C.
4. Smt. Beti Bai Saxena vs. S.L. Mukherjee (Dr.) 2001 (2) CPR 405- Punjab & Haryana State Commission, para 13)
5. Dr. Suresh Gupta vs. Govt. of NGT of Delhi & another (Criminal Appeal No. 778 of 2004, SLP (Cri) No. 2931 of 2003.
6. R. vs. Ademako [1994 (3) All E.R. 79].
7. Suleman Rehman Mulani Vs. state of Maharashtra [19689(2) SCR 515]
8. Laxman Balkrishana Joshi Joshi vs. Trimbak Baper Godhbole [1969 (1) SCR 206]
9. Municipal Corporation of Delhi vs. Ram Kishan Rohtogi AIR 1983 SC 67.
10. Drugs Inspector vs. B.K. Krishnaiah AIR 1981 SC 1164.
11. Alan Merry and Alexainder McCall Smith; “Errors, Medicine and the Law”: 247-248.
12. Sunday Times, August 08, 2004: 2.
13. “Fresh Rules in Negligence Arrests”, The Times of India, August 23, 2003: 3.
14. “H C Rejects Doctor’s Bail Application”, Sunday Times of India, August 15, 2004: 8.
15. “Quack Botches up Tongue Operation, Kills Teenage Girl’ Hindustan Times, June 8, 04:10.
16. “Doc not Criminally Liable if Patient Dies”, Hindustan Times, August 6, 04: 1.
17. “Saving the Doctor” Hindustan Times August 9, 04: 6.
18. “SC Judgment Qualifies Medical Negligence”, The Times of India August 11, 04: 14.
19. “S C Insures Doctors Against Patient’s Death”, The Times of India August 6, 04: 6.
20. “SC Ruling a Deliverance for Medical Fraternity”, Sunday Times, August 8, 2004: 2.
21. “SC Comes to the Rescue of Doctors”, The Tribune, August 12, 2004: 10.
22. “SC Judgment on Doctor’s Criminal Liability for Larger Bench”, The Tribune, September 10, 2004: 1.
23. Narendar Kumar, “Constitutional Law of India”, Edition-1997: 146
24. State of Human Rights in India, (3.3): 94-95.
25. “Negligence by Doctors: Bench to Review Verdict”, The Times of India. September 11, 2004: 10.
26. “Apex Court to Review its Order on Docs Culpability’ Hindustan Times, September 10, 04: 9.
27. The Indian Medical Council (Professional conduct, Ethics and Etiquettes) Regulations – 2002.

Monday, December 03, 2007

AIIMS faculty members strike

Peush Sahnidiscusses the ethical issues raised by the first strike of faculty members of the All India Institute of Medical Sciences at http://www.ijme.in/o74re131.html

The Government of India set up the Fifth Pay Commission to revise the salaries of its employees. The Commission submitted its report and in 1997, the government implemented most of its recommendations for Central Government employees. The All India Institute of Medical Sciences, New Delhi, was created by legislation enacted by Parliament as an autonomous institution with certain specified objectives as an institution of national importance. Hence, the pay structure of the faculty members of this institution was approved by Parliament. Subsequently, with each pay commission’s recommendations a procedure was followed for the pay revision. Essentially, a committee was formed under the chairmanship of the health secretary, which would recommend the revisions keeping in mind the recommendations of the pay commission. In all such situations previously, this committee’s recommendations were accepted and implemented by the government.

The methods
As in the previous instances, the government set up a committee under the chairmanship of the then health secretary to consider the revision of pay scales of the faculty members of AIIMS in the light of the Fifth Pay Commission’s recommendations. This committee submitted its recommendations to the government. The government did not accept these recommendations, instead issued an order implementing essentially a direct conversion of the previous pay scales to the new pay scales recommended by the Fifth Pay Commission. As this was in contravention of past precedence, the faculty members of AIIMS did not accept the revised pay scales.

The dispute
Attempts were made by the faculty to have direct discussions with governmental representatives to resolve this dispute without recourse to an agitation. In the face of little progress, the faculty members resolved to take mass casual leave for one day to press for resolution of the dispute. An appeal was made by the Prime Minister to the faculty members to withdraw their applications for casual leave. However, the faculty decided not to withdraw their casual leave applications but in deference to the appeal of the Prime Minister continued to perform their duties to avoid any hardship to the end users of their service - the patients. Repeated attempts to resolve the dispute did not result in any meaningful action and therefore the faculty proceeded on an indefinite strike unprecedented in the history of AIIMS. A public interest litigation was filed in the Delhi High Court by a concerned citizen pleading for banning the AIIMS strike as well as strikes by doctors all over the country. The faculty members of AIIMS withdrew their strike on the intervention of the Delhi High Court. The High Court passed interim orders for implementation of the recommendations of the committee chaired by the health secretary and directed the government to resolve the dispute by 30 June 1999. However, the matter is still sub- judice and awaiting a final resolution.

The key players
The three key players in this dispute are the government, the faculty of AIIMS and the patient. The impact of the actions of one led to consequences suffered by the other two. The other minor players in this conflict are the students, nurses and other health care staff of the AIIMS. The impact on them would be of an indirect nature except in the case of the students who would suffer in case of a prolonged strike which may have resulted in rescheduling of teaching programmes, examinations and even extension of the duration of their tenures. However, this did not happen. The teaching programmes were rescheduled but the examinations were not postponed.

The patients
They were affected maximally for no fault of theirs as innocent bystanders between two warring groups. Could they have done something to resolve the dispute and thus avoid the hardship? Possibly not. Even today we lack aware and conscious citizens in our country. Few people are willing to come forward to help resolve a dispute which does not affect them directly. As the number of people affected by the strike at AIIMS would be a minuscule proportion of the total population of our country it is unlikely that they could have made any impact to the resolution of the dispute. However, the public interest litigation filed by ‘a concerned citizen’ in the Delhi High Court did give an impetus to resolution of the immediate crisis.

The faculty
The dispute arose when the government, without assigning any reasonable explanation, decided to do away with the previous precedents. It also possibly arose from an increasing perception of ‘neglect’ of the AIIMS by the government. Could they have adopted a different course of action and still hoped to achieve a just resolution of the dispute? Having failed to elicit a response from various government functionaries, members of Parliament and ministers, whom they approached to explain their predicament, they had few other choices. Also, the government had acceded to pay- related demands of two other sections of health care workers (nurses and paramedical personnel) in the recent past only after they had gone on strike.

The government
As the prime decision maker it had the maximum ability to resolve the dispute. Having accepted the previous precedents as correct and setting up a committee to decide the pay scales of the faculty, it should have continued to follow the precedent and accepted the committee’s recommendations. However, if it felt that it had made a mistake it should have corrected it prior to setting up the committee or before the committee gave its recommendations.

Resolving disputes in the health sector
With the dispute clearly defined it should have been possible to put into place a mechanism to arrive at a just, well argued, amicable solution. Unfortunately, neither does such a mechanism exist nor was any attempt made to create it to solve this dispute. While disputes are bound to occur, the need to resolve them without recourse to an agitation is of paramount importance. The lack of a process to resolve disputes is the prime reason for the increasing number of agitations in the health sector. Necessarily, this process would need to be such that the ‘agitated’ and the ‘agitator’ would both have confidence in obtaining a just solution.


Peush Sahni, Associate Editor, The National Medical Journal of India, All India Institute of Medical Sciences, New Delhi 110 029

Friday, November 30, 2007

Do's & Dont's for Doctors

Having trained ONLY to heal, Doctors are not very mediquettes savvy and inspite of having done justice to the problem at hand may leave the patient with a feeling that enough time/ attention was not given. Doctors always wonder what they should do and what they should not do. Following are some of the guidelines.

Do's for Doctors
* Mention age & sex of the patient. In a pediatric prescription, weight of the patient must also be mentioned.
* Always put your hand on the part that the patient / attendant says is painful. Apply your stethoscope on him, even if for cosmetic reasons.
* Listen attentively. Look carefully. Ask questions intelligently.
* If, after completing the examination, the patient / attendant feels that something has been left out or wants something to be re-examined, oblige him.
* Always face the patient. Maintain eye contact that is comfortable to the patient. Some patients tolerate very little eye contact. Learn to observe out of the corner of your eyes.
* In case you have been distracted / inattentive during the history taking, ask the patient / attendant to start all over again. He will never mind it. As far as possible, consultations should not be interrupted for non-urgent calls.
* Ask the patient to come back for review the next day, in case you have examined him hurriedly or if you are not sure about the diagnosis / treatment.
* Mention "diagnosis under review" or "quot;under evaluation" until the diagnosis is finally settled.
* If the patient / attendants are erring on any count make a note of it or seek written refusal.
* Record history of drug-allergy.
* Write names of drugs clearly. Use correct dosages and mention clearly method & interval of administration and mention side effects.
* In a particular drug / equipment is not available, make a note.
* Prescribe with caution during pregnancy / lactation.
* Adjust doses in case of a child / elderly patient and in renal or hepatic disorders.
* Mention where the patient should contact in case of your non-availability / emergency.
* If you are not sure what disease a patient has after a thorough work-up, get a consultation with a referring note and show your concern.
* Update your knowledge and skill from time to time. Many doctors tend to deteriorate in their knowledge, skills & attitude, over a period of time. Not only do they make any attempt to update themselves, but also they slip downwards.
* Preferably employ qualified assistants.
* Always obtain a legally valid consent before undertaking a surgical / diagnostic procedure.
* It is mandatory to screen every patient for Hepatitis B/ HIV infection before every surgery, blood transfusion so that false claims are not made at a later date.
* In case of MTP/ Sterilization, always follow the guidelines issued by the Government of India.
* Routinely advise X-rays in injury to bones & joints and related diseases of bones / joints.
* Always rule out pregnancy before subjecting the uterus to X-ray.
* Always read reports carefully & interpret the results of tests / X-rays properly and make a note of it. In case of any doubt, recheck with the lab / diagnostic centre.
* In all instances of swab cases & "instrument cases", the surgeon incharge is generally held directly or vicariously liable for negligence. The surgeon incharge must therefore personally ensure that such mishaps do not occur.
* The period for the responsibility of the surgeon extends to and includes the post-operative care. He must, therefore, ensure proper post-operative care to the patient.
* In case of death of a patient occurring while undergoing surgery / diagnostic procedure, the higher hospital authorities / police authorities must be informed without loss of time. In such cases, autopsy/post-mortem is mandatory.
* In case the hospital / clinic claim to provide 24-hour emergency service, availability of necessary equipment in working order and competent staff within reasonable time is mandatory.
* Always seek proper legal and medical advice before sending reply to the notice sent by the patient or his representative or to the complaint referred to you from a consumer court.

Dont's for Doctors

* Don't prescribe without examining the patient.
* Never examine a female patient without the presence of female nurse / attendant, especially during genital & breast examination.
* Don't insist on the patient to tell the history of illness or be examined in presence of others. He has a right to privacy and confidentiality.
* Don't prescribe a drug or indulge in a procedure if you cannot justify its indication.
* Don't prescribe or administer a drug which is banned, e.g. Analgin, Oxyphenbutazone etc.
* Don't over-prescribe - too much of the drug, too large a dose, for too long.
* Don't under-prescribe - not prescribing the needed drug, dose is too small, length of treatment is too short. Calculate proper dose, esp in children.
* Don't prescribe multiple drugs. Such prescription may be due to inability to form a correct diagnosis or other causes. Possibilities of drug interactions increase with polypharmacy.
* Don't write instructions on a separate slip. Don't allow substitutions.
* Don't do anything beyond your level of competence. Competence of doctors, nursing staff is defined by their qualification, training, experience and competence of a hospital/nursing home is defined, in addition to the competence of its doctors and nursing staff by the availability of various equipments in working order and back-up support, e.g. handling of cases of accident/emergency, severe reaction to drugs, anesthesia, etc. and availability of resuscitative equipment., etc.
* Don't refuse if the patient/attendant wants to leave against medical advice. It is their right. Document this properly.
* Never avoid a call for help from a nurse on duty at night. In all probability, a genuine emergency may be there.
* Don't refuse the patient's right to know about diagnosis & treatment of his illness.
* Don't withhold information, however harsh & difficult, in seriously/ terminally ill patients. It must be conveyed with compassion & gradually, if time permits.
* Don't leave at the time of death. There is a tendency, especially on the part of the senior doctors, to go away at this time when their presence and experience are most needed.
* Don't hesitate to extend your condolences and sympathies to the bereaved persons.
* Don't forget to provide genetic counselling to couples and parents with known family history/children having genetic abnormalities, e.g. Thalassemia, Hemophilia, etc.
* Don't issue death certificates unless you have yourself verify death.
* Don't refuse the patient's right to examine and receive an explanation about your bill regardless of the source of payment; whether it is reimbursed by the government or by his employer/insurance company.
* Don't refuse the patient's right to know about the hospital rules & regulations.
* Don't dump hospital garbage including used disposables in the open. It should be properly incinerated / destroyed to prevent spread of disease or reuse by unscrupulous persons.
* Don't refuse first-aid/medical care to accidents & emergency cases even if it is a medico-legal case. It is a primary duty of every doctor/hospital to provide treatment upto his/its true level of competence in such cases before referring them to a higher centre, if required.
* Never talk loose of your colleagues, despite intense professional rivalry. It is bound to come back to you and patients also do not appreciate it.


From http://www.indiandoctorsguide.com/non-clinical/legal/dos-donts/

Thursday, November 29, 2007

Medico Legal Problem

It is always better not to find faults amongst our colleagues in such situations. Both the pediatrician and obstetrician were qualified, they did not waste time in treating or referring the case. In a case of CPD with Fetal distress, LSCS is the right treatment and the child may be asphyxiated at birth, so pediatrician intervened and finding it a difficult case to be handled referred it to the higher center. There is no evidence that any medical person has accelerated the death of the baby hence it can’t be said that there was obvious negligence in this case(1). In a case Smt. P. Venkatalakshmi vs Dr. Y Savitha Devi, III (2001) CPJ 402, the patient was a third gravida with one previous normal delivery and second being a miscarriage. This patient was on hormonal injections and her ultrasound examinations during this pregnancy revealed normal growth of the fetus. At term there was prolonged second stage with fetal distress and the liqor was meconium stained. The large sized baby (3.8 Kg) was delivered by forceps application. The pediatrician was not present at the time of delivery and reached after about 45 minutes of the birth of the baby. The baby had severe birth asphyxia and hence was shifted to NICU. The baby had many neonatal complications but ultimately discharged after about 15 days of hospitalization. The complainant alleged that there was unnecessary delay in delivering the baby, the method of pulling the baby by forceps is a crude method and absence of pediatrician in such a complicated case, all these amounts to negligence. In this case the Andhra Pradesh State Consumer Dispute Redressal Commission, Hyderabad held that it is wrong to assume negligence on part of doctors merely because something went wrong with the patient. It is most unfortunate that the baby had birth asphyxia and would have strong feeling to compensate it. But asphyxia by itself in the absence of proof of negligence on the part of doctor may not make out a case for damages. There must be direct connection between injury suffered and the treatment given. In another case, Premnath Hospital vs Smt Poonam II (1998) CPJ 205, where a premature child born to toxemic mother had died, The Haryana State Consumer Redressal Commission Chandigarh held that it is unfortunate that despite all the medical attention, care and treatment given by qualified doctors the baby expired. But for this misfortune, the doctors cannot be held liable and no compensation at all can be awarded to the complainant.

Under no circumstances the relatives can forcefully take the case paper and get it xeroxed. This amounts to creating nuisance under the influence of alcohol as per the provisions of Sec. 85 of Bombay Prohibition Act. The various sections of Indian Penal Code that may be applicable in such a situation includes, Unlawful assembly (Sec.141-145), Assault (Sec. 351), Criminal trespass (Sec. 441, 447), Criminal intimidation (Sec. 506,507) etc. depending upon the number of individuals present and the type of unlawful acts committed by them. The xerox copies of documents have not much legal validity unless they are certified by the hospital authorities. The facts that the relatives created nuisance, forcefully took away the case paper and got it xeroxed may go against the complainant during the legal proceedings. The records or the documents are the property of the hospital. The hospital has to provide a copy of documents to the relatives whenever they ask for it. The recent MCI regulations / guidelines say that the record must be provided within 72 hours to the relatives/friends if they ask for it(2).

Informing the police is always a better option in such situations because:

(i) If the patients or relatives lodge FIR then we have to take defensive approach that too when we are not at fault.

(ii) In this case the relatives were probably under the influence of alcohol

(iii) They had forcibly seized the documents

It is a well accepted fact that proper communication, humanly approach and balanced behavior with the patient or their relatives is the best way to avoid medico-legal complications in most of the cases(3). Consensus is now developing that communi-cation skills training should form a part of undergraduate medical curriculum.

The role of hospital administration is always vital in such cases. The administration should always provide proper instruments and minimum basic facilities for the functioning of the hospital. This issue has already been raised by the relatives. The facilities available should be informed without any exaggeration to the community. Excessive publicity may be dangerous sometimes. A social worker with good communication skill, who can manage unruly, abusive relatives will always be an asset to the institution in such situations.

Satish Tiwari,
Associate Professor in Pediatrics,
Medical College, Amravati,
Maharashtra, India.
E-mail: drtiwarisk@hotmail.com

References

1. Tiwari SK, Baldwa M. Medical negligence. Indian Pediatr 2001; 38: 488-495.

2. Indian Medical Council regulations. An excerpt from Indian medical Council (Professional conduct, Etiquette & Ethics) regulation 2002, in Part III, Sec. 4, Gazette of India April 2002; pp. 1-17.

3. Tiwari SK. Legal aspects in medical practice. Indian Pediatr 2000; 37: 961-966.


From http://www.indianpediatrics.net/oct2003/oct-1011-1013.htm

Wednesday, November 28, 2007

Doctors and Criminal Law

Satish Kamtaprasad Tiwari

Mahesh Baldwa*

From Dr. Panjabrao Deshmukh M. Medical College, Shivajinagar, Amravati 444 603, Maharashtra, India and *University Department of Law, Mumbai University, Mumbai 400 032, Maharashtra, India.

Correspondence to: Dr. Satish Tiwari, Yashodanagar No. 2, Amravati 444 606, Maharashtra, India.

E-mail: satishtiwari@vsnl.net

The dawn of third millennium has seen many ups and downs in human relations. There have been many turbulent changes in the society. This has not spared even doctor-patient relationship. The rapid changes in the medical field have strained the age-old good relations between the patient and the treating physician or surgeon.

Criminal law is applicable to all individuals and doctors are no exception to it. As far as medical practice is concerned patients or relatives usually don’t approach the police. But now-a-days this scenario is also changing. In last few decades as doctor patient relationship has deteriorated, the complaints against doctors have increased(1). According to the provisions of Indian Penal Code 1860 (IPC) any act of commission or omission is not a crime unless it is accompanied by a guilty mind (MENS REA). The acts are not punishable only because it led to some mischievous results unless associated with intention or mental attitude of the person. Most of the times doctors treatment is in good faith, with the consent of the patient and hence most of the provisions of IPC are not applicable to the doctors unless or until there is rashness or gross negligence. The following Sections of IPC are related to medical profession(2):

Sec. 29 Deals with documents

Sec. 52 Describes "good faith"

Sec. 90 Related to consent

Sec. 176 Failure to inform police whenever essential

Sec. 269-271 Related to spread of infectious disease and disobedience of a quarantine rule.

Sec. 272-273 Related to adulteration of food and drinks.

Sec. 274-276 Related to adulteration of drugs.

Sec. 304-A Deals with death caused by an negligent act.

Sec. 306-309 Related with abetement of suicide.

Sec. 312-314 Related to causing mis-carriage, abortion and hiding such facts.

Sec. 315-316 Deals with act to prevent child being born alive or to cause it to die after birth.

Sec. 319-322 Related to causing hurt, grievous hurt, loss of vision, loss of hearing or disfigure-ment.

Sec. 336-338 Deals with causing hurt by rash or negligent act.

Sec. 340-342 Related to wrongful confine-ment.

Sec. 491 Related to breech of contract.

Sec. 499 Related to defamation.

Section 304 and 304-A

There is lot of discrepancy while applying these sections in cases of professional negligence by doctors. Most of the times the police authorities register the cases of professional negligence deaths under Sec. 304 of IPC. According to this Section the offence is non-bailable. This causes lot of hardship, bad reputation and mental agony to the doctors. In fact the police should register the cases of deaths due to medical negligence under Sec. 304-A of IPC, in which the offence is bailable and the doctor can be released on bail. This judgement has been passed by Bombay High Court in Criminal Revision application no. 282 of 1996 (Dr. Mrs. Mrudula S. Deshpande vs State of Maharashtra) dated 28th November 1998(3). The basic difference is that in Sec. 304 there is intentional act of negligence while in 304-A the act is never done with the intention to cause death.

Grievous hurt

Sec. 319-322 of IPC are related to causing grievous hurt for example loss of limbs, loss of vision, loss of hearing or disfigurement etc. Sec. 336-338 deal with causing grievous hurt by rash or negligent act.

Examples: (1) While giving IV fluids suppose there is leakage of fluid in surrounding tissue resulting in spasm of vessels and subsequent necrosis of limbs. (2) A surgical procedure is done on eye, limbs, face etc. without adequate aseptic precautions resulting in local infection. This may lead to loss of eyes, limb or disfigurement of face, (3) An unqualified doctor performing surgical procedure which results in permanent damage to eyes, limbs, hearing etc.

Wrongful confinement (Sec. 340-342 of IPC)

A patient cannot be detained on the grounds of non-payment of hospital charges. This may constitute the offense of wrongful confinement under Sec. 340-342 of IPC. Doctors can take advance or fee from the patient before starting the treatment.

If a police officer is keeping the doctor in detention, in cases of bailable offenses, he is liable for the offense of wrongful confinement under these Sections of IPC.

Definitions

Crime or offence means any act or ommission which is contrary to any law or statute for the time being in force.

Summons is the process of court asking the opposite party to appear and answer the allegation preferred by the party who has brought action.

Warrant means an order issued by the court, magistrate or a competent judicial authority, directing a police officer to make arrest, seize or search or to do any other work incidental to administration of justice.

A Warrant case is related to an offence punishable with death, life imprisonment or imprisonment for more than two years. Example: If a doctor helps a pregnant woman in getting rid of the child or to cause its death after its birth.

Cases other than warrant cases are Summons cases. If a doctor acts negligently by using infected syringe or instrument resulting in an infection to an uninfected patient exemplifies a Summons case.

Cognizable offences are those in which a police officer may arrest without warrant, according of Schedule I of Criminal Procedure Code (CPC).

Non-cognizable offences are those in which a police officer can’t arrest without a warrant, e.g. a doctor knowingly disobeying a quarantine rule is liable to be punished with imprisonment upto 6 months or fine.

Bailable Offences are those in which bail can be granted by any law for the time being in force. In such cases bail is matter of right. The court can’t refuse bail and the police has no right to keep the doctor in custody. If any police officer puts a doctor in detention in such cases, he is liable for the offense of wrongful confinement under Sec. 340-342 of IPC(4).

Non-Bailable offences are offences other than the bailable or an offence in which bail can’t be granted. These are the serious offences in which a person may be convicted and imprisoned for term extending more than ten years. For example, offences under transplantation of Human Organ Act 1994.

Presumption of innocence: Law presumes that a person is innocent till his guilt is proved. The onus of proof is on prosecution(5).

Mistake of law: "Ignorentia juris non excusat, means ignorance of law or mistake of law (existence or mistaken understanding) is not excusable. Erroneous or wrong conclusion of law is not a valid defense. For example, if a doctor carries out prenatal test intended to abort a female fetus, can’t avoid prosecution by saying that I was unaware of any law which punishes such act.

Mistake of fact is a situation where a person not intending to do unlawful act, does so because of wrong conclusion or understanding of fact. The guilty mind was never there while doing the act. The person may not be held responsible in such cases.

Res Judicata:This doctrine of law means "the things have been decided". According to this principle, once the case is completed between two parties, it cannot be tried again between the same parties. Suppose a patient sues a hospital for any wrong, damages or malpractice and the things are decided, he cannot subsequently sue the doctor again separately for the same negligence.

Res Ipsa Loquitur is a situation of gross negligence or rashness. The things are so obvious that they "speak for themselves". Most of the time there is no need for any proof of negligence in such cases. Common examples include giving blood transfusion to wrong patient, or operating on wrong side of the body or wrong patient.

Consent in Criminal Law (Sec. 90 IPC)

A valid consent must be given voluntarily, by an adult who is not of unsound mind. The consent must be given after reasonable understanding and without any misrepre-sentation or hiding of the facts. Thus the consent should be an informed consent, preferably in writing and in presence of witnesses. All components of valid consent are applicable even for the consent in criminal law. According to criminal law, it is an offence to cause injury to any person even with his consent. No person has right to give consent to suffer death or grievous hurt. This point has to be kept in mind specially during cases of organ transplantation. The donor may have given consent under family, social or financial pressures. In cases of dead donors if there is no expressed will, the body is the property of the heirs and their consent is required.

Criminal Liability

A person who commits a wrongful act, shall be liable for it. The crimes are public wrongs and aim of criminal proceeding is to punish the wrong doer. The law imposes liability on him who fails to perform duty. The wrongful act may be (a) Intentional or wilful wrong this usually doesn’t apply in medical practice as no doctor has intention to cause harm to his patient, (b) negligent act – the doctor fails to take proper care, precaution and is just indifferent to the consequences of his act. Lack of skill proportional to risk undertaken also amounts to negligence; (c) wrongs of strict liability created by some special statutes like transplantation of human organ act (1994)(6).

When to Inform Police

A doctor has to inform the police in following circumstances (personal communication Dr. Jayat Navrange). Failure to inform police in such cases may result in penal consequences. Police must be informed in (i) cases of suspected homicide, (ii) cases of suicidal deaths, (iii) unknown, unconscious patient, (iv) death on operation table, (v) suspected unnatural death, (vi) sudden, unexpected, violent and unexplained death, (vii) instant death after treatment or reaction of medicine, and a (viii) married lady dying within seven years of marriage due to any reason.

It is advisable to inform police in following circumstances (i) undiagnosed death within 24 hrs. of admission or specially if there is any suspicion, (ii) any cases of poisoning, (iii) accidental deaths, and (iv) in cases of hospital deaths if (a) accidents not related to medical management like fall from staircase etc., though there is no legal obligation on doctor, it is advisable to inform the police, (b) unexpected or rare complications may occur sometimes, e.g. a child may vomit, aspirate the content and may die. This is very unpredictable and it is not obligatory on part of the doctor to inform such deaths. But it is better if we inform the police because sometimes patient’s relatives may allege negligence in such cases. In cases of death due to negligence in treatment there are no specific provisions to inform the police but in order to avoid untoward incidences it is better to inform the police.

"Brought dead cases": In such cases, if the cause of death is apparent and there are no reasonable grounds to suspect some medico-legal complications then it is not necessary to inform the police. If the cause of death can’t be ascertained in any case then it is desirable to send the body for postmortem examination preferably with the help of the police. It is advisable to suggest postmortem in the following circumstances: (i) whenever death is sudden, unexpected or unexplained, (ii) accidental deaths which may be roadside, domestic or industrial, (iii) when precise cause of death is needed for insurance claim purposes etc., and (iv) as a help to arrive at final diagnosis.

Information to police shall preferably be in writing and the written acknowledgement should be obtained. If the information is telephonic one must note down name, buckle number and designation of the police.

Can a Doctor be Arrested

Doctors have no immunity against arrest (as any other citizen of India) for the various criminal acts as per the provisions of IPC or CPC of India. Illegal organ trading, unlawful sex determination etc. are non-bailable offenses. But the question is whether a doctor be arrested for:

(a) alleged medical negligence during day to day care of a patient,

(b) unexplained hospital deaths like SIDS etc.,

(c) postoperative complication or failure of operation;

(d) not attending or refusing a patient (who was not already under his care) who becomes serious or dies and

( f ) not attending a case of roadside accident.

Recently, the chairman of a hospital was arrested for not complying with the Supreme Court directives in a roadside accident. In this particular case the patient died while being shifted to other hospital. The Supreme Court directives (criminal writ petition no. 270 of 1988) in a roadside accident include:

• The medical aid should be instantaneous. It is the duty of the registered medical practitioner to attend the injured and render medical aid, treatment without waiting for procedural formalities unless the injured person or guardian (in case of minor) desires otherwise.

• The effort to save the person and preserve the life, should be top priority, not only of the doctor but also of the police officer or any other citizen who happens to notice such an accident.

• The professional obligation of protecting life extends to every doctor, whether at Government hospital or otherwise.

• The obligation being total, absolute and paramount, no statutory or procedural formalities can interfere in discharging this duty.

• Whenever better or specific assistance is required, it is the duty of treating doctor to see that the patient reaches the proper expert as early as possible.

• Non-compliance of these directives may invite prosecution under provisions of Motor Vehicle Act or IPC(7).

If FIR is lodged by patient or relatives then the police may arrest the doctor. Hence better approach in cases where we feel that the patients or relatives may create nuisance will be as follows:

1. The doctor should lodge a FIR that a particular incidence has happened in my hospital.

2. A crisis management committee may be formed at each Taluka or District level. The committee shall include doctors, social workers, legal personalities, politicians, press reporters etc. The committee members may meet the police officers and request them for complete investigation of the incidence and to avoid prosecution till the guilt is proved. The committee can also request the press reporters not to give unnecessary publicity to such cases. The Government of Kerala (G.R. no. 3231/SS-B4/92/Home dated 20.09.1993) has issued the following instructions if there are any cases of criminal negligence against a private practitioner, doctor or private hospital. According to G.R. the investigating Deputy Superintendent of Police shall refer the case to a panel of Superintendent of Police, commissioner of Police, District Medical Officer or Principal of Medical College. Still if the views differ, the opinion of an apex body consisting of Director of Health Services and expert in that particular speciality may be taken. The affected doctor is also free to approach the apex body with appeals(8).

Legal Rights of an Arrested Person

The arrested person shall be communicated with the particulars of offence and the ground for arrest. If the offense is bailable, then the person should be informed and the arrangement for the bail may be made. If the police officer refuses to release such person on bail, he will be liable for damages for wrongful confinement. Sometimes a police officer may register an offense under Sec. 304 of IPC instead of 304-A in order to detain the accused doctor. In such cases officer may have to face serious consequences. The person shall not be subjected to more restraint than necessary to prevent his escape. If there are any offensive weapons belonging to the arrested person, these weapons may be seized. The arrested person must be produced before a magistrate having jurisdiction in that case. No police officer shall detain in custody an arrested person for more than 24 hours unless a special order from a magistrate is obtained(9).

Anticipatory Bail: In order to avoid frivolous accusations, there is provision of anticipatory bail. This may be granted as a protection in offences which are non-bailable. It is direction to release applicant on bail, if there is arrest. Once granted it remains in force. Pre-requisites for anticipatory bail are: (i) there must be reasonable apprehension of arrest, (ii) the alleged offence must be non-bailable, and (iii) the registration of FIR is not necessary.

Procedure for Bail: The accused is required to execute his personal bond at the police station with or without surety. The surety may be a close relative, a friend or a neighbour, who is required to undertake to pay the said amount in case of absconding of the accused.

Do’s and Don’ts

• Inform police whenever necessary.

• Extend all possible co-operation to the police.

• Furnish copies of medical records to police, court or relatives whenever demanded. Consent of patient may be taken while providing information to police.

• Follow the legal procedures or provisions.

• Have a valid informed consent for the treatment(10).

• Preserve the documents, records specially in medico-legal, controversial or complicated cases.

• Insist for post-mortem examination if the cause of death can’t be ascertained.

• Involve medical associations, medico-legal cells, voluntary organizations whenever legal problem arises.

• Consult your lawyer before giving any reply.

• Don’t become panicky.

• Don't manipulate or tamper with the documents.

• Don’t do unlawful or unethical acts.

• Don’t issue false or bogus certificates. Certificate was issued on request is no defense.

• Don’t neglect the treatment while completing legal formalities specially in serious or emergency situation.

Acknowledgment

We are thankful to Dr. Mrs. P. Chaturvedi (Professor and Head of Department of Pediatrics, M.G.I.M.S. Sewagram) and Dr. K.Y. Vilhekar (Professor of Pediatrics) for the constant encouragement, guidance and help given by them in writing this article. We also acknowledge the help given by Dr. Uddhav Deshmukh in writing this article.

Contributors: SKT reviewed the literature, designed and drafted the article. MB assisted, guided and evaluated the article.

Funding: None

Competing interests: None stated.



References
1. Tiwari SK, Baldwa M. Medical Negligence. Indian Pediatr 2001; 38: 488-495.

2. Joshi MK. Doctor and Medical Law. 2nd edition, Ahmedabad, 1995, pp 4-6.

3. Behre SB, Navrange JR. In: MAH.IMA, The Newsletter of Maharashtra State IMA Branch, Pune vol 3, June 2001, p 10.

4. Lele RD. The medical profession and the law: An overview. In: The Medical Profession and the Law, 1st edition, Mumbai, Sajjan Sons, 1992; p 9.

5. Pandit MS, Pandit S. Medico-legal systems module I Pune, Symbiosis Center of Health Care. Medico-legal cell 1998; pp 13-17.

6. Jhabwala NH. Indian Penal Code, 13th edition, Mumbai, C. Jamnadas & Company 1997; pp 17-18.

7. All India Reporter. Supreme Court Section, Nagpur 1989, 76: 2039.

8. IMA News. IMA house, New Delhi, Sept. 2001 vol 34, p 39.

9. Shivade S. Medico-legal systems module IX Pune, Symbiosis Center of Health Care. Medico-legal cell 1999, 15-26.

10. Tiwari SK, Legal aspects in medical practice. Indian Pediatr 2000; 37: 961-966.

From http://www.indianpediatrics.net/dec2002/dec-1119-1125.htm

Saturday, November 10, 2007

Instructions of Director General of Police, Tamil Nadu

Office of the Director General of Police,
Admiralty House, Govt. Estate,
Anna Salai, Chennai - 600 002.

S.NO. 119825/1 &0/CON.97. -Dated : 27.05.97

MEMORANDUM

Instructions were issued in Chief office Memo vide (C.N.) 8523/1 & O Confd 1/91) dated 6.4.91 that when complaints of cognizable offences are received against Medical Practitioners relating to criminal negligence in the course of Medical treatment arrests need not be resorted to as a matter of course. It was also emphasized in the memo that when the Medical practitioner is involved in such police complaint the fact should be brought to the notice of higher supervisory Officers who will keep a close watch on the progress of the case to ensure that there is no vindictive or vexations action.

2. Inspite of these specific instructions an instance has come to notice where in a similar complaints of negligence on the part of a Medical Practitioners arrests have been made resulting in avoidable criticism against the Police. It is once again reiterated that in such cases arrests should not be resorted to as a matter of course. The cases will be duly investigated and any action should be fully supported by a documentary evidence, supervisory approval strengthened with the opinion of the Law office.

3. These instructions will be followed in future.

4. Please acknowledge the receipt.

Friday, November 02, 2007

Medico-legal curriculum draft release today

Bangalore: Only nine per cent of doctors know that there is a protocol introduced by National Human Rights Commission on how a post-mortem should be conducted. Less than 10 per cent of medical professionals are well-versed in preparing an age estimation certificate for medico-legal cases.

No wonder then that very few doctors in the country have adequate knowledge about recording evidence in a medico-legal case and presenting it before a court of law.

Addressing this need, the Ministry of Justice and United Nations Development Fund (UNDP), under the “Strengthening Access to Justice in India” programme has entrusted the Swami Vivekananda Youth Movement to take the lead in restructuring the medico-legal curriculum (Forensic Medicine and Toxicology) for MBBS students in India.

The draft curriculum will be released here on Friday at a workshop for doctors.

Speaking to presspersons here on Thursday, Flt. Lt. M.A. Balasubramanya, Secretary of Swami Vivekananda Youth Movement, a voluntary organisation which has taken the initiative to train doctors across the country to empower them for holistic and humane management of medico-legal cases, said the present medico-legal curriculum had not been revised since 1997.

“The curriculum has been developed by an expert panel headed by former Chief Justice of India M.N. Venkatachalaiah, after a field study of knowledge, attitude, skills and practice among doctors and medical students. The panel includes judges, forensic medicine experts and police personnel,” Dr. Balasubramanya said. He added that the organisation had already trained around 900 doctors across the country in dealing sensitively with medico-legal cases and to look at them with a social perspective. P.K. Devdas, one of the experts in the panel and head of the Department of Forensic Medicine at Victoria Hospital, said the curriculum has to be approved by the Medical Council of India and then by the Central Government and may be adopted by 2009.



From http://www.hindu.com/2007/11/02/stories/2007110254350500.htm

Monday, October 29, 2007

200 Point Roster : G.O.Ms.No. 241 Dated 29.1 0.2007


Public Services - Reservation of appointments in Public Services - Fixation of 3.5 
percentage reservation for Backward Class Christians and Backward Class Muslims 
respectively - Revised Roster - Orders - Issued.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PERSONNEL AND ADMINISTRATIVE REFORMS (K) DEPARTMENT
G.O.Ms.No. 241 Dated 29.1 0.2007

Read:
1. G.O.Ms.No.85, Personnel and Administrative Reforms(R) Department, dated 6.5.2000.
2. G.O.Ms.No.105, Personnel and Administrative Reforms(S)Department, dated 20.6.2000.
3. Tamil Nadu Ordinance No. 412007.
4. From the Secretary, Tamil Nadu Public Service Commission Letter No.442URND-D2107, dated 18.10.2007.

In the Government Order first read above, orders were issued providing 2 turns for Most Backward Classes and De-notified Communities within every 10 turns. In the Government order second read above amendments were issued to General Rules for Tamil Nadu State and Subordinate Services that the vacancies arising on and from the 6th May 2000 be filled up as per Schedule 111 and all selections for appointment be started afresh from serial number one in the said Schedule III with effect on and from the said date.

2. In the Tamil Nadu Ordinance No. 412007 third read above, His Excellency, the Governor of Tamil Nadu has promulgated the Tamil Nadu Backward Class Christians and Backward Class Muslims (Reservation of seats in Educational Institutions including private Educational lnstitutions and of appointments or posts in the services under the State) Ordinance, 2007 providing reservation for appointments or posts in the services under the State for the Backward Class Christians and Backward Class Muslims at three and one-half percent and three and one-half percent, respectively, within the thirty percent reservation for Backward Classes.

3. In pursuance of the above ordinance, the Government direct that the existing 100 point roster prescribed in Schedule-III to the General Rules for Tamil Nadu State and Subordinate Services be revised into 200 point roster as in the annexure to this Government order so as to provide reservation for the Backward Class Christians and the Backward Class Muslims at three and one-half percent and three and one-half percent respectively, within the thirty percent reservation available for Backward Classes. The Government also direct that the above 200 point roster shall be given effect from 15.9.2007 and the vacancies arising on and from the 15'September 2007 shall be filled up as per the 200 point roster and all selections for appointment shall be started afresh from serial number one of the 200 point roster with effect on and from the said date.

4. Necessary amendments to the Tamil Nadu State and Subordinate Services Rules shall be issued separately.

//BY ORDER OF THE GOYERNOR//
T.S.SRIDHAR
SPECIAL COMMISSIONER AND
SECRETARY TO GOVERNMENT
To
All Secretaries to Governments, Secretariat, Channaj-9,
All Head of Departments,
All District Collectors,
All Public Sector Undertakings,
The Secretary, Tamil Nadu Public Service Commission , Chennai-2,
The Registrar, High Court, Chennai-104,
All District Magistrates and District Judges.
Copy to:
The Secretary-II to the Chief Minister,Chennai-9,
The Senior Personal Assistant to the Minsters,
(Electricity / Backward Classes / Adi Dravidar Welfare) Chennai-9,
The Private Secretary to Secretaries to Government,
(P&AR/BC,MBC and MWIAD&TWILaw) Chennai-9,
Personnel and Administrative Reforms (S) Department,
Chennai-9 (for issue of amendments to the Tamil Nadu State and Subordinate Services Rules),
All Sections in Personnel and Administrative Reforms Department, Chennai-9.
All Departments of Secretariat, Ghennai-9.
SECTION OFFICER

ANNEXURE
1. General Turn
2. Scheduled Castes
3. Most Backward Classes and De~otifiedC ommunities
4. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
5. General Turn
6. Scheduled Castes
7. Most Backward Classes and Denotified Communities
8. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
9. General Turn
10. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
11. General Turn
12. Scheduled Castes
13. Most Backward Classes and Denotified Communities
14. Backward Class Christians
15. General Turn
16. Scheduled Castes
17. Most Backward Classes and Denotified Communities
18. Backward Classes (Other than Backward.Class Christians and Backward Class Muslims)
19. General Turn
20. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
21. General Turn
22. Scheduled Castes
23. Most Backward Classes and Denotified Communities
24. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
25. General Turn
26. Scheduled Castes
27. Most Backward Classes and Denotified Communities
28. Backward Class Muslims
29. General Turn
30. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
31. General Turn
32. Scheduled Castes
33. Most Backward Classes and Denotified Communities
34. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
35. General Turn
36. Scheduled Castes
37. Most Backward Classes and Denotified Communities
38. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
39. General Turn
40. Backward Class Christians
41. General Turn
42. Scheduled Castes
43. Most Backward Classes and Denotified Communities
44. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
45. General Turn
46. Most Backward Classes and Denotified Communities
47. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
48. General Turn
49. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
50. Scheduled Tribes
51. General Turn
52. Scheduled Castes
53. Most Backwarti Classes and Denotified Communities
54. Backward Class Muslims
55. General Turn
56. Scheduled Castes
57. Most Backward Classes and Denotified Communities
58. Backward Classes (Other than Backward Class Christians and Backward Class ,Muslims)
59. General Turn
60. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
61. General Turn
62. Scheduled Castes
63. Most Backward Classes and Denotified Communities
64. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
65. General Turn .
66. Scheduled Castes
67. Most Backward Classes and Denotified Communities .-
68. Backward Class Christians
69. General Turn
70. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
71. General Turn
72. Scheduled Castes
73. Most Backward Classes and Denotified Communities
74. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
75. General Turn
76. Scheduled Castes
77. Most Backward Classes and Denotified Communities
78. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
79. General Turn
80. Backward Class Muslims
81. General Turn
82. Scheduled Castes
83. Most Backward Classes and Denotif~ed Communities
84. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
85. General Turn
86. Scheduled Castes
87. Most Backward Classes and Denotified Communities
88. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
89. General Turn
90. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
91. General Turn
92. Scheduled Castes
93. Most Backward Classes and Denotified Communities
94. Backward Class Christians
95. General Turn
96. Most Backward Classes and Denotified Communities
97. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
98. General Turn
99. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
100. General Turn.
101. Most Backward Classes and Denotified Communities
102. Scheduled Castes
103. General Turn
104. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
105. General Turn
106. Scheduled Castes
107. Most Backward Classes and Denotified Communities
108. Backward Class Muslims
109. General Turn
110. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
1 1 1. General Turn
112. Scheduled Castes
113. Most Backward Classes and Denotified Communities
114. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
1 15. General Turn
116. Scheduled Castes
117. Most Backward Classes and Denotified Communities
118. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
119. General Turn
120. Backward Class Christians
121. General Turn
122. Scheduled Castes
123. Most Backward Classes and Denotified Communities
124. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
125. General Turn
126. Scheduled Castes
127. Most Backward Classes and Denotified Communities
128. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
129. General Turn
130. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
131. General Turn
132. Scheduled Castes
133. Most Backward Classes and Denotified Communities
134. Backward Class Muslims
135. General Turn
136. Scheduled Castes
137. Most Backward Classes and Denotified Communities
138. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
139. General Turn
140. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
141. General Turn
142. Scheduled Castes
143. Most Backward Classes and Denotified Communities
144. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
145. General Turn
146. Most Backward Classes and Denotified Communities
147. Backward Class Christians
148. General Turn
149. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
150. Scheduled Tribes
1.51. General Turn
152. Scheduled Castes
153. Most Backward Classes and Denotified Commun~ties
154. Backward Classes (Other than Backward.Class Christians and Backward Class Muslims)
155. General Turn
156. Scheduled Castes
157. Most Backward Classes and Denotified Communities
158. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
159. General Turn
160. Backward Class Muslims
161. General Turn
162. Scheduled Castes
163. Most Backward Classes and Denotified Communities
164. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
165. General Turn
166. Scheduled Castes
167. Most Backward Classes and Denotified Communities
168. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
169. General Turn
170. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
17 1 . General Turn
172. Scheduled Castes
173. Most Backward Classes and Denotified Communities
174. Backward Class Christians
175. General Turn
176. Scheduled Castes
177. Most Backward Classes and Denotified Communities
178. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
179. General Turn
180. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
181. General Turn
182. Scheduled Castes
183. Most Backward Classes and Denotified Communities
184. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
185. General Turn
186. Scheduled Castes
187. Most Backward Classes and Denotified Communities
188. Backward Class Muslims
189. General Turn
190. Backward Classes (Other than Backward ClassChristians and Backward Class Muslims)
191. General Turn
192. Scheduled Castes
193. Most Backward Classes and Denotified Communities
194. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
195. General Turn
196. Most Backward Classes and Denotified Communities
197. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
198. General Turn
199. Backward Classes (Other than Backward Class Christians and Backward Class Muslims)
200. General Turn.

Special Commissioner and
Secretary to Government
// True Copy //
SECTION OFFICER