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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.


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.


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