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/

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

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

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.

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