Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice VP Singh
INDEX
Page numbers followed by b refer to box, f refer to figure, and t refer to table.
A
Abortion 15
Abscess 89
epidural 245
Abuse
substance 65
verbal 61, 107
Accident 336
aspiration, risk of 320
Accreditation Council for Graduate Medical Research 114
Acitretin 302
Acquired immunodeficiency syndrome 24
Active Surveillance Programs 96
Addressing patient's emotions 115
Adult medical service 277
Adverse drug reaction 195
Advisory committee 216
Age-related macular degeneration 272
Air conditioning
engineers 81
function of 81
Airborne communicable diseases 80
prevention of 81
Airborne Infection Control Program 81
Airborne infection isolation room 80
Alcohol 186
based preparations 213
consumption 321
Allergic reaction
history of 253
severe 309
Ambulatory care 87
American Association of Blood Banks 302
American Association of Orthopedic Surgeons 262
American Board of Internal Medicine's 114
American College of Obstetricians and Gynecologists 240
American College of Radiology 75, 290
American Society of Anesthesiologists 336
American Society of Heating 81
Amikacin 97
Aminoglycoside 97, 98
Amoxicillin 98
Anaphylactic reactions, severe 309
Anesthesia 338
awareness 331, 332
deaths 331
mishaps 245
procedure 336
refused 338
regional 256
related problems 337
role of 256
Anesthesiology
medicolegal issues in 328, 329
safety in 339
specialty of 328
Animal anatomical waste 219
Ankle injuries 264
Anonymity 18
Anorexia 280
Antenatal care, errors in 241
Antibiotic 43
choice of 97
resistant organism 88
therapy, initial 97
Anticipate violence, signs to 65t
Anti-hepatitis C virus 296
Antipseudomonal cephalosporin 97
Antipseudomonal penicillin 97
Anxiety 41
Anxiousness, signs of 65
Appeal 172, 218
Arthroplasty 264
Aseptic precautions 101
Aspergillus 81
Asphyxia 195197, 281
birth 241
Aspiration pneumonia 97
Atomic Energy Act 213
Atomic Energy Regulatory Board 75
Authorization Committee 207
Autopsy 331
B
Back disorders 264
lumbago 264
sciatica 264
Balloon pumps 43
Bile duct, common 257
Bio-medical waste 212214, 218, 224
bags, tracking 223
categories 219t
categories of 223
handling of 215
management 217, 226
and handling rules 213, 222, 225
safe 226
records of 225
treatment 217
and disposal facility 214
and disposal of 224
facilities, common 214
untreated 218
Biotechnology 221
waste 219
Birth, wrongful 241
Blood 43
administering 311
and blood components, guidelines for 304
and transfusion safety program 304
borne pathogens 302
components, administration of 306t
donate 297
issue and usage records 310
pack, checking 312
pressure 149
prior to transfusion, collecting 311
safety and availability 304
screening, challenges of 301
storage centres 302
supply, stewardship of 299
test 202
utilization 84
Blood bag 312b
number of 309
Blood banks 295, 302
activity of 295
Blood collection 297
records 309
Blood donation 297
and transfusion 294
camps 302
Façade of non-remunerated 297
informed consent in 301
non-remunerated 294, 297, 300
number of 302
regular 315
voluntary 297
Blood donor
selection and donor referrals, guidelines for 302
unpaid 315
Blood group
tested for 309
transfusion, wrong 314
Blood products 140, 302, 308
to transfusion, storing 311
Blood transfusion 140, 294, 300, 308, 313, 315
alternatives to 303
mismatched 295
practice
documentation of 309
litigation related to 313
medicolegal issues in 294
process 305
safety 304
services 294
system, conventional 303
Bloodstream 200
infection, central line-associated 91
Body tissues 18
Bolam's rule 165, 257
Bone marrow transplant 81
Bradycardia 245
Brain death, declaration of 206
C
Canadian Medical Protective Association 33
Canadian Patient Safety Institute 36
Canadian system, tests of 98
Candida 90
Carbapenems 97
Carbon dioxide 82
Cardiac arrest 195, 245
Cardiac surgery 332
Cardiopulmonary resuscitation 40, 140
event, documentation of 140
Care and liability, duty of 329
Carotid artery stenosis 321
Cataract 102
surgery 271
Cause-effect relationship 289
Cefepime 97
Cefoperazone 98
Cefoxitin 97
Ceftazidime 97
plus 97
vancomycin 97
Central Licence Approving Authority 296
Central Pollution Control Board 217, 218
Central Supervisory Board 230
Cephalometric radiographs, pretreatment 321
Cesarean section 243, 332
Chemical liquid waste 220
Chemical waste 213, 220
Children
diseases of 277
disorders of 277
Chlorinated plastic bags 223
Chromosomal abnormalities 241
Ciprofloxacin 97
Civil law 176
damages in 164
Clavulanate 98
Clindamycin 97
Clinical documentation guidelines 150
Clinical records 150b
Clinician satisfaction, improved 110
Clostridioides difficile infection 88
Clostridium difficile 99
Cognitive errors 74
Cognitive impairment 74
Communication 108, 275, 290, 305, 330
assessment tool 114
barriers 74, 113, 282
behavior change 297
channel 108
effective 108, 109
good 107
in healthcare 109
ineffective 113
model, basic 108f
nonverbal 108
openness 74
practice good 282
principles of good 110
skills 62, 108, 109, 114, 115, 282
for doctors 109
in healthcare 107
lack of training in 113
of healthcare practitioners 107
of healthcare workers 114
types of 108
unambiguous 305
verbal 108
with attendants 111
with referring doctor and patient 290
Community
leaders 64
role of 63
Compensation 179
Competency assessment 306
Complainant's advocate 174
Complainant's allegation 101
Complaint Under Act 225
Conception, wrongful 242
Conducting medical interview 111
Confusion 41
Consent
age for 125, 279
role of 248
Consultation, conduct in 10
Consumer court 143, 172
function 170
pecuniary jurisdictions of 187
Consumer forum, members of 172
Consumer Protection Act 141, 142, 170
complaints under 170
in dental professionals 324
Contemplating suicide 61
Corneal flap 270
Corneal thinning 270
Corporate hospitals 61, 64
Cosmetic surgery 5, 270
Counseling
improper 53
techniques 115
Court of law, expert witness in 248
Criminal case, appearing in 173
Crisis reform models 181
Crooked tree, famous engraving of 261f
Cylinders, storage of 83
Cystic fibrosis 241
Cystic lesions 321
Cytomegalovirus 89
D
Dalfopristin 97
Data privacy and security 134
Death
certificate, cause of 137
wrongful 242
Decision making
capacity 52
assess 54
involve patient in 111
process, document shared 253
Defence lawyer, selection of 170
Delirium 41
Dental care, quality in 319
Dental pain 320
Dental practice
medicolegal aspects of 319
no negligence' occasions in 323
Dental practitioners 319
Dentistry
diagnosis of malignancy in 321
medicolegal issues in 319
negligence in 322
Depression 41
underlying 300
Diabetes 100
Dialysis 43
Diameter indexed safety systems 82
Director General Armed Forces Medical Services 218
Directorate General of Health Services 142
Disastrous consequences 173
Disc lesions 264
Discharge against medical advice
duty of doctor in 52
predictors of 50, 51t
validity of 52
Discharge notes 154
Discharge process, documented 140
Disease
emotional facet of 288
severity 40
transmission, risk of 81
Disposal facilities 217
Distressing symptoms 245
District Level Monitoring Committee 217
District-wise committee 68
Doctor's defence 101, 102, 196, 198, 201, 202
Doctor-patient
bonding 70
communication 114
relationship 157, 250, 290, 335
Doctors and professional association, code of conduct for 13
Doctors for criminal
negligence, prosecution of 167
rashness, prosecution of 167
Documentation 146, 275, 305, 330
adequate 56
and informed consent 265
benefits of good quality 147
errors in 148
incomplete 54
incorrect 54
legal importance of 146
of procedures 140
Documented policies 138, 139
Documenting instructions 157
Documenting patient's refusal 157
Donor
ethical principles relating to 299
maintenance charge 206
organ transplantation, deceased 210t
screening 302
Drugs 331
delivery systems 99
intoxications 65
resistant bacteria 98
Drugs and Cosmetics Act 15, 295, 296
Drugs and Cosmetics Rules 295, 296
Dryness 270
Dutasteride 302
Duty of care 162
Dyspnea 41
E
Eagle's eye 237
Easy to accept cause-effect relationship 289
Ectasia 270
Ectopic pregnancy 242
Effective laws, implementation of 69
Electronic health records 133
preservation 134
Electronic medical records 77, 144
Electronic protected health information 133
Emergency
acute 254
error in diagnosis during 280
medical care 283
surgery 332
Emergency department 50, 62, 74
safety factors in 74t
Empathy skills 62
Empiric therapy, principles of 97
Encephalocele 241
End of life
care 40
decisions 40
issues, legal aspects of 45
Endorsement 14
Endoscopy room 75
Engender litigation, complications 252
Engineering design plays 80
Enterobacter cloacae 98
Enterococcus 90
Environment Law 212
Environment Protection Act 213, 225
penalties under 225
Epidural hematoma 245
Epithelial cells 90
Equipment 330
disposable 101
Error and omission policy 186
Erythromycin 97
Esthetic dentistry 322
Ethics
advisory committee 47
law and policy 33
Etretinate 302
Euglycemia 256
Euthanasia 13, 44, 45
active 44
debate on 45
nonvoluntary 44
passive 44, 45
voluntary 44
Evolution 122
Eye surgery, types of 270
F
Facial trauma, cases of 320
Facility management and safety committee 84
Fallopian tubes 129
Family planning operation 247
Fascia 89
Fatigue 74
Faulty surgical technique 247
Fear 41
Female feticide, prevent 234
Femtosecond laser assisted cataract surgery 271
Femur, fracture of 264
Fetal anomalies, missed diagnosis of 244
Fetal autopsy 244
Fetomaternal disorders 240
Fetomaternal physiological derangement 240
Fight against violence, essential in 67
Finasteride 302
Fingerpointing, avoid 173
Fistula formation 258
Fluid replacement, adequate 256
Fluoroquinolone 97, 98
Foreign objects
ingestion of 320
inhalation of 320
Fractured surgical needle 321
Future litigation, protection against 51
G
Gas cylinders rules 82
Gastrointestinal tract 88
Gene therapy 269
Generic names of drugs, use of 8
Genetic counseling center 229
Gifts 13
Glassware 221
Glaucoma 275
Glutaraldehyde 213
Good clinical records, advantages of 151t
Gossypiboma 246
Gossypium 246
Gram-negative organisms 98
combination therapy 98
monotherapy 98
Gram-positive organisms 98
Growth hormone 302
Gynecological causes 239
Gynecology, medicolegal issues in 245
H
Hand
hygiene 80
injuries 264
washing 99
Harassment 61
Haunting nightmare 175
Hazardous chemicals rules, storage and import of 213
Hazardous waste 212
Health
court 182
system 183
information
protected 133
technology 78
insurance
coverage 239
purpose 19
related literacy 69
low 63
Healthcare
commercialization of 287
cost
high 52
lower 181
delivery, aspects of 109
documentation in 145
establishments 212, 223
expenditure, escalating 87
expensive 239
facilities, implementation of rules in 217
organization 84, 104, 133
provider 134
research and quality, agency for 94
risk management in 83
sector 61
setting
anticipate violence in 64
managing violence in 65
preventing violence in 65
standards 73
strategies for safety in 74
system 33, 151
workers, occupational safety of 225
Healthcare-associated infection 79, 87, 88, 92, 93, 95, 96, 98, 100, 101
common 89
documented 97
indicators of 96
legal provisions applicable to 103
management of 97
medicolegal aspects related to 99
sources of 88
strategies for management of 97
type of 88
Heart disease, congenital 281
Hemolytic reactions, acute 308
Hemorrhage, postpartum 241, 246
Hemostats, application of 257
Hepatitis 302
antibodies 297
B 302
infection 295
surface antigen 296
C 101, 302
infection, suffered 101
test 101
virus 101
Herpes simplex 89
Herpes zoster 89
Hippocratic oath 5
Home care 87
Hormone
replacement therapy 246
secretion 245
Hospital acquired infections, prevent 95f
Hospital administrators, preventive tips for 67
Hospital management 338
Hospital readmissions 53
Hospital waste 212
management 212
Hospital-acquired infection
burden of 92
incidence, trend in 92t
indicators to control 96t
preventing 92
strategies for prevention of 93t
Hospitality 13
Hospitalization, reason for 154
Human anatomical waste 219
Human blood 295
Human embryos 303
Human immunodeficiency virus 24, 295, 302
infection 26, 313
risk of 23
transmission of 26
positive 23, 25
right of 23
status, disclosure of 24
screening 25, 26
status 23, 25
testing 24, 25
guidelines on 24
informed consent for 24
Human life, loss of 176
Human organ 207
Human Organ Transplantation Act 45
implications to 45
Human rights 13
Humerus fracture 264
Hydrocephalus 241
Hyperbilirubinemia, management of 281
Hypochlorite 213
Hypochondria 5
Hypoglycemia, neonatal 281
Hypotension 245
severe 309
Hypothetical considerations 179
Hypoxia 195
Hysterectomy 245
I
Ideal indemnity insurance policy 190
Imipenem 97
Immune systems 100
Incisional infection, superficial 89
Indemnity insurance policy 191
Indian Council of Medical Research 19
Indian Evidence Act 142
Indian Medical Association 217
Indian Medical Council 8
Regulations 8
Indian Penal Code
related to consent, sections of 126b
relevant sections of 196
section 269 104
section 270 104
section 304a 103
section 337 103
section 338 104
Indian Radiology and Imaging Association 228
Indian Society of Anesthesiologists 329, 336
Ineffective communication
consequences of 113
legal risks of 283
Infection 89, 270
anaerobic bacterial 97
bacterial 309
blood and urine 200
chain 80f
control 79, 84
aspect of 77
committee 104
measures 100
practical guidelines for 80
deep incisional 89
developing 87
exogenous 88, 102
eye 102
high risk of 302
hospital 88
organ surgical site 89
postoperative 96
prevent 80
prevention and control 80
initiatives 94
protozoal 309
spread of 80, 104
surgical site 87, 89
transmission of 91
type of 102
viral 309
Infectious agent 80
Infectious diseases 81
spread of 81
Infectious hazards of transfusion 309
Infectious waste 212
Inflammation 270
Influenza 81
Information
and communication technology 134
disclosure of 124
via speech 108
Informed consent 274
documentation of 128
medicolegal aspects of 121
role of 291
Injury, assessment of 162
Inpatient medical records 142
Institute of medicine 31, 32
Insulin 43
Insurance
factors influencing amount of 187
schemes 69
Intensive care units 62, 87
International Society of Blood Transfusion 298
Interpersonal behavior 324
Intoxicant 186
Intraocular lens implants 269
Intraocular pressure 272
Intra-operative monitoring, standards for basic 336
Intrauterine fetal death 243
Intrusive palliative procedures 43
Intussusception
case of 280
diagnosis of 280
Irrational implementation 234
Isolation rooms 77
Isotretinoin 302
J
Jecker's modification 41
Joint
commission 264
national patient safety goals 94
replacement 257
Judgment, error of 333
Judicial decision 25, 122
on informed consent 129
on radiological errors 289
Judicial precedents 195
Judicial process, lack of faith in 64
Justice
administration of 19
legal requirement of 19
K
Karmachari of hospital 155
Kidney transplant 200
Klebsiella 95
Knee ligament 264
L
Laryngeal nerve injury, recurrent 257
Laser assisted in situ keratomileusis 270
complications 270
Laudable pus 257
Law against violence, strengthening 67
Lawful Act 196
Lawsuit
claim 56
managing risk of 274
Legal liability 186
Legal restrictions, evasion of 9
Legionella 90
Legionellosis infection 97
Life, wrongful 241
Life-prolonging interventions, guidelines for limiting 42b
Life-saving surgery 43
Life-support
withdrawal of 42, 43
withholding of 42, 43
Life-threatening
illness 41
reaction 308
situations 300
Linezolid 98
Lion's heart 237
Liquid waste, disposal of 215
Listen actively 111
Litigation
causes of 263
in orthopaedics, causes of 264b
process, key role in 146
protection against 323
risk of 53
Living donation and transplantation, medicolegal aspects of 207
Loneliness 41
M
Macula 272
Malaria 296, 302
parasite 202
Malpractice
crisis reform, part of 182
liability crisis 180
litigation 269
Malpractice lawsuits 169, 249
obstetric cases vulnerable to 240
prevent risk of 123
risk of 319
vulnerable to 281
Measles 80, 81
Media
in preventing violence, role of 69
role of 64
Medical acts 8
Medical advice
cases of Discharge against 52
causes of discharge against 50, 50b
compliance with 109
consequences of discharge against 52
discharge against 49, 51, 52, 55, 55b, 56, 57t
leave against 49, 51, 56, 140
legal status of discharge against 51
managing discharge against 54
medicolegal aspects of discharge against 49
reason for discharge against 53
risk of discharge against 50
Medical air 82
Medical and legal implications 241
Medical care 132
continuity of 146
Medical certificate 155b
issuing 155
of cause of death 137
Medical condition 74
complex 74
Medical confidentiality 4, 23, 25
guidelines on 20
Medical Council for Issuance of Medical Certificate 156b
Medical Council of India 115, 138, 155b
guidelines 136, 150
regulations 20, 143
Medical decision 6
making 18
Medical Defense Union 270
Medical documentation 145, 147
critical issues in 154
good 152
illegible 149
quality of 146
Medical documents, cases compelling 147
Medical education, competency-based 116
Medical emergencies 128, 320
Medical errors 3133, 113
consequences of disclosing 33
disclosure of 32, 33
guidelines on disclosing 34
types of 32b
Medical establishments 186
Medical ethics 3, 6
code of 8
Medical futility 41, 44
Medical gases 82
safety measures related to 82
Medical Injury Compensation Reform Act 181
Medical interview
prior to start of 110
with patient 110
Medical jousting 266
Medical laws, awareness of 325
Medical liability 180
crisis 183
Medical literature, basis of 5
Medical maloccurrence 249
Medical malpractice
insurance 180, 183
liability crisis 180
litigation 107, 169
Medical negligence 157, 161, 163, 165, 176179, 183, 185, 253, 270
allegations of 190
burden of proof of 164
cases 68, 101, 142, 176, 182
compensation in 176
crime 163
essential components of 161
guilty of 201
issue of 143
lawsuits of 170, 291
liability lawsuits, cases of 190
types of 163
vital issues in 164
Medical practice
confidentiality in 18
disclosure in 18
ethics of 3
part of good 17
Medical practitioner 5, 53, 175
benefits of disclosure to 34
care required by 200
complaints against 169
ethical guidelines for 8
feels 15
harms of disclosure to 34
Medical profession, values of 7
Medical professionals 291
criminal liability of 167
for criminal negligence 198
landmark judgments related to 195
Medical Protection Society 270
Medical record 77, 132, 135, 144
categories of 135
complete and accurate 137
component of 132
confidentiality of 135
department 137
destruction of 173
guidelines on 136
judicial decision related to 143
maintenance of 8
medicolegal aspects of 132, 141
reflects continuity 137
regulation governing 147
review of 138
Medical research 13, 19
Medical science and technology, recent advancement in 85
Medical specialty 66
Medical Teaching Program, integral part of 115
Medical termination of pregnancy, incomplete 241
Medical vacuum 82
Medication
confusion 74
errors 283
management of 141
Medicine 3, 285
branches of 240
defensive 180183
discarded 220
expired 220
incorporate philosophy of 66
neonatal 281
practice of 3, 121
safe practice of 203
tradition of 60
Medicolegal
aspects 208, 297
autopsy 258
awareness 239
cases 138, 208
claims against gynaecologists, survey of 240
conflicts 287
in orthopedics 264b
preventing 265
donations 206
examination 125
implications 253
issues 237, 245, 283
recent trends of 3
risk factors 252
safety 71
Meningitis 281
Meningomyelocele 241
Meniscal injuries 264
Meropenem 97
Metallic body implants 221
Metronidazole 97
Microbiological examination 102
Microbiology 221
Micro-chip implants 269
Microorganism
infecting 87
source of 91
Ministry of Environment, Forest and Climate Change 217, 218
Ministry of Health and Family Welfare 78, 215, 296
Ministry of Urban Development 79
Misadventures 336
Misconduct 14
adultery 14
conviction by court of law 14
improper conduct 14
sex determination tests 14
violation of regulations 14
Mishaps 336
Missed ectopic pregnancy 241
Missed test results 74
Modern medicine 73
Morbidity, high 53
Morphine, high dose of 5
Mortality 53
Motor Accident Claim Tribunal Act 142
Motor Vehicles Act 219
Multidrug-resistant organisms 96
Multiple anecdotal reports 60
Multiple gestation 241
Myomectomy 246
N
Nasal septum, margin of 195
National Academy of Sciences 31
National Accreditation Board for Hospitals and Healthcare providers 136
guidelines 136
National Acquired Immunodeficiency Syndrome Control Organization 295
guidelines 23
National Blood Policy 294296, 298, 301
and guidelines 301
National Blood Program, development of 295
National Blood Transfusion
Council 294
Program 294
National Commission 129, 143, 173
National Consumer Dispute Redressal Commission 179, 278
National Healthcare Safety Network 88
National Patient Safety
agency 264
goals 95
Nature of disease, diagnosis and 127
Nature, multidisciplinary in 139
Nausea 41
Negligence 197, 199
by professionals 199
causing death by 103, 196
per se 164
test for establishing 166
Negligible health impacts 224
Neonatal intensive care 281
Neonatal resuscitation 281
Neuromuscular blocking agent 332
Nitrogen 82
Nitrous oxide 82
No objection certificate 207
No-fault compensation 182
Non-hazardous waste 212
Non-heart-beat donors 45
Noninjurious assault 61
Nonmonetary incentives 297
Nonseasonal perspiration 65
Nontransplant organ retrieval centers 206
Normothermia, maintaining 256
Nosocomial infection 88
Numerous medicolegal issues 259
O
Obstetric
case, engagement for 10
medicolegal issues in 240
regional anesthesia, complications of 245
ultrasonography in 244
Obstetric anesthesia 244
practice of 244
Obstetrics and gynecology
medicolegal issues in 239
practice 239
Ocular diseases 269
Ocular trauma 272
Offence
and penalties 230
cognizance of 68
penalties for 225
Omission, allegation of 286
Oncology 81
Oopherectomy 245
Operation table, death on 329
Operation theater 330
Ophthalmic practice, vulnerable domains in 270
Ophthalmology 269
medicolegal issues in 269, 270
Oral care 41
Oral cavity 90
Organ donation 209, 273
and transplantation 208
programme 211
counseling for 206
deceased 209
Organ failure, number of 211
Organ retrieval
centers 209
charge 206
Organ transplant 204
surgery 257
Organization
policy 139
services of 139
Original complainant 202
Oropharynx 321
Orthodontic
practice 320
therapy 321
treatment, complication of 320
Orthodontists 321
Orthopedia 261
Orthopedic
medicolegal issues in 261
medicolegal risks in 262
practice evidence-based 266
scope of consent in 263
surgeons, reasons of litigation against 263
surgery 261
Orthopedist in court of law 267
Osteoarthritis 264
Ovaries 129
Oxygen 82
P
Pacemakers 43
Pain
and suffering 181
component 181
persistent 320
treatment of 41
Palliative care
at end of life 40
wards 41
Paraverbal communication 108
Parental permission 279
Parental refusal to medical treatment 282
Parenteral and enteral fluids 43
Patent and copyrights 12
Paternalism 5, 6
versus autonomy 5
Paternalistic philosophy 6
Patient burden 113
Patient centered documentation and record keeping 152
Patient handling and movement assessment 79
Patient related factors 62
Patient safety
and risk management 73
in pediatrics 280
initiatives 71
Patient's allegation 102, 196, 198, 201, 202
Patient's interest 19
Patient-doctor relationship 267
Patient-physician relationship 107
PC-PNDT Act 227, 229, 230, 234, 292
Pediatrician 278
Pediatrics, medicolegal issues in 277, 278
Pelvic
hemorrhage, uncontrolled 246
inflamatory disease 246
pain syndrome 246
Penalty and compensation 68
Permanent vegetative state 46
Personal document 135
Personal information 134
Persons with Disabilities Act 79
Persons with Disabilities, rights of 79
Phacoemulsification 271
Phagocytes 98
Phenolic derivatives 213
Physical assault causing injury 61
Physician
duties of 9
in consultation, duties of 10
preventive tips for 65
related factors 62
responsibilities of 10
to public and paramedical profession, duties of 11
Piperacillin 97, 98
Placenta
adherent 241
microscopic examination of 244
previa, undiagnosed 241
Placental umbilical cord blood transfusion 303
Plaintiff sought damages 129
Planned surgery, deviation from 254
Plasma
pyrolysis 224
regain, rapid 296
Plasmodium falciparum 202
Pneumonia
atypical 97
ventilator associated 90
Poddar's treatment 23
Pollution Control Committee 216, 219
Poor clinical records, disadvantages of 151t
Poor insurance claim settlement 53
Postanalysis disclosure 36
Post-traumatic stress
disorder 331
syndrome 61
Pre-anesthesia assessment 140
Preconception and Prenatal Diagnostic Techniques Act 227, 285
Preconception and Prenatal Diagnostic Test Act 142
Pregnancy
high-risk 243
hypotensive syndrome of 245
medical disorder in 243
Premature baby 242
Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act 147, 227
Pretransfusion blood sampling 308
Pretreatment screening, incidental findings on 321
Professional indemnity 185
insurance 185, 325
policy 190
Professional practices 337
Professional services, payment of 9
Proliferative diabetic retinopathy, stage 272
Proliferative vitreoretinopathy 272
Proxy, consent by 279
Pseudomonas aeruginosa 97, 98
infection 98
Public and community health 20
Public health authorities 15
Public hospitals, problems of 63
Public lectures 15
Public safety 19
Publishing diagnostic errors regularly 291
Punishment and disciplinary action 16
Pyrexia 280
Q
Quality healthcare 180, 283
Quasi-judicial courts 170
Quinupristin 97
R
Radiation dose 76
Radioactive waste 213
Radiological errors, types of 286
Radiological negligence 289
Radiologist's rapport 288
Radiology
average diagnostic standard in 287
avoiding litigation in 290
errors in 285, 291
limitations of 288
medicolegal issues in 285
Radius and ulna, fractures of 264
Reaction, severe 308
Reasonable care 166
Reasonable skill and care 325
legal relevance of 325
social relevance of 325
Rebates and commission 12
Record
disposal of 310
keeping 228
preservation of 141
storage of 310
Recording information, process of 145
Red blood cells 303
sources of 303
Red Crescent Societies, league of 298
Registered medical practitioner 207
Registration numbers, display of 8
Rejoinder and affidavits 171
Renal failure, acute 149
Res ipsa loquitor 165, 247, 334
doctrine of 335
Resident doctor 112
Respiratory rate 295
Respiratory suppression 5
Respiratory syndrome, severe acute 81
Respiratory trouble 202
Retina 272
artificial 269
Retinal conditions 272
Rheumatic fever, acute 149
Rhythm abnormalities 140
Rifampicin 97, 98
Right to Information Act
and medical confidentiality 21
and medicolegal cases 22
Risk identification 84
sources of 84
Risk management 83
activities, evaluation of 84, 85
practice 320
process of 83
programs, implementation of 85
strategy
development of 84
implementation of 84
Robust system 294
Root resorption 320
Rubbing hands, frequently 65
Rubella 89
Rupture uterus 246
S
Sadness 41
Safe blood administration 308
Safe handling of treated wastes 224
Safe operation theater setup 266
Safe transfer, methodology of 139
Safer healthcare system 182
Safety encourages teamwork 74
Safety habits, certain 66
Sands of Sahara syndrome 270
Scope and legal interpretation 161
Secrecy and data security 18
Sedation, consent for 140
Seizures, neonatal 281
Sensitive personal information 134
Sepsis 281
Serratia marcescens 98
Sex determination tests 20
Sex ratio, declining 234
Sex, prenatal determination of 231
Sexual harassment 61
Sexual offenses 162
Sexual violence, victims of 279
Shock 309
Sick, obligations to 9
Single photon emission 75
Skill and care, medical relevance of reasonable 325
Skin 258
incision 89
problems 41
Smoking
habits 100
history of 321
Soiled waste 219
Solicit patient assent 279
Spondylolisthesis 321
Standard operative procedure 295
Staphylococcus 90, 200
aureus 95, 98
State blood transfusion councils 295
State Commission 173
State Consumer Dispute Redressal Commission 323
State Pollution Control Board 216, 218, 219
Stem cell 269
derived blood cells 303
Sterilization operation, cases of 248
Stillbirths 243
Streptococcus pneumoniae 98
Strong and effective laws 67
Strong paternalism 6
Stylohyoid ligaments 321
Suboptimal visual outcome 270
Suicide, physician assisted 45
Sulbactam 98
Summoning medical records by courts 142
Supreme Court's observation 201
on criminal negligence 197
on expert medical opinion 203
on negligence 199
Surgery
consent in 256
medicolegal issues in 252
never events' in 258
preoperative period in 253
wrong site 258, 259, 264
wrong-procedure 265t
Surgical complications 248, 256
Surgical items, retained 258
Surgical mishaps 245
deaths due to 331
Surgical objects, retained 246
Surgical procedure, documentation before 141
Surrogate decision-maker 54
Susbequent and postanalysis disclosure 38
Sword of Damocles 263
Syphilis 89, 302, 303
Systemic diseases, missing serious 273
Systemic lupus erythematosus 273
T
Tapping hands 65
Tarasoff case 23
Tay-Sachs disease 241
Tazobactam 98
Teaching communication skill 115
Technical mishaps 331
Teicoplanin 98
Temporomandibular disorder 319, 320
cause of 320
Testis, torsion of 280
Therapeutic interventions 87
Therapeutic privilege 128
Therapeutic relationship, dissolution of 51
Threatening behavior 61
Tibia, fracture of 264
Tonsils, removal of large 280
Toothache 320
Tort system 183
Total hip replacement 263
Total knee replacement 263
Toxic waste 213
Toxoplasmosis 89
Transfusion 310
adverse effects of 308
associated circulatory overload 308
medicine
code of ethics relating to 298
practice of 295
noninfectious hazards of 308
process, documenting 312
reaction 313
acute 308
adverse 302
investigation of 313
technology 294
transmitted diseases, risk of 294
Transient neurologic complications 245
Transmission 80, 92
Transplant coordinators in hospitals 206
Transplantation of Human Organ Act 204, 273
Transplantation of Human Organ and Tissues Rules 204
Treatment after consultation 10
Treatment and disposal 218
Trisomy 21 241
Trypanosoma cruzi 303
Tuberculosis 80, 81, 89
U
Ultrasound machine, registration of 227
Unethical Acts 11
Unethical conduct, exposure of 9
Unipolar electrocautery 257
Unique hospital identity number 137
Upper respiratory tract 90
Urinary tract infection, catheter-associated 91
Urticaria 309
Uterine bleeding, dysfunctional 246
Uterus 129
V
Vaccine injury 283
Vaginal birth after cesarean 240, 243
Valid consent, conditions for 125
Vancomycin 97, 98
resistant enterococci 95
Vasopressors 43
Venereal disease 25
Ventilation, function of 81
Ventilator 43
Vertebra 321
Violations, penalties for 231t
Violence
against doctors 60
factors predisposing to 61
prohibition of 68
Vis-à-vis parenteral nutrition 281
Vis-à-vis surgery 280
Vision, lost 102
Vitreoretinal surgeons 272
Voluntariness 124, 125
Vomiting 280
W
Waste
clinical laboratory 221
contaminated 221
management rules 225
pharmaceutical 213
Water (Prevention and Control of Pollution) Act 215
Weak and ineffective laws 63
White blood cell 90
Wisconsin Department of Regulation and Licensing 289
Wisconsin radiologist 289
Witness
death on operation table 329
examination of 172
World Blood Donor Day 315, 316
World Federation of Society of Anesthesiologists 329
World Health Assembly 308
World Health Organization 41, 79, 94, 215, 258, 298, 302
×
Chapter Notes

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LEGAL ISSUES IN MEDICAL PRACTICE Medicolegal Guidelines for Safe Practice
LEGAL ISSUES IN MEDICAL PRACTICE Medicolegal Guidelines for Safe Practice
Second Edition
Editors VP Singh MD (Forensic Medicine) LLB Professor Department of Forensic Medicine Dayanand Medical College and Hospital Ludhiana, Punjab, India Foreword SM Kantikar
Jaypee Brothers Medical Publishers (P) Ltd
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© 2020, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice / VP Singh
First Edition: 2016
Second Edition: 2020
9789389776058
Printed at
All those who strongly feel that Medicolegal awareness is a must for all involved in patient care and to all the Medical Practitioners who want to practice their professional skills conscientiously and fearlessly and are ambitious to promote quality in healthcare
Contributors
Editors
Contributing Authors
Foreword
Dr SM Kantikar
MD (Path) LLB PGDMLE
Member
National Consumer Disputes
Redressal Commission, New Delhi
Upbhokta Nyay Bhawan
F-Block, General Pool Office Complex
INA, New Delhi-110023
Tel/Fax: 011-24608811, 24651505
Mobile: 9999110833
It is my great pleasure to go through this authoritative treatise on medicolegal issues commonly encountered by the doctors in their day-to-day clinical practice.
Doctors are known to use their skills to solace the sufferings of their patients; but, sometimes, they are unable to do the full justice and become liable to face medicolegal conflicts on account of medical mistakes. Currently, doctors as well as healthcare establishments are facing numerous litigations related to medical malpractice. The doctors must understand that ignorance of law is no excuse, and medicolegal awareness is extremely important.
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice has presented essential medicolegal information that can be used as guidelines for safe clinical practice. Chapters on various medicolegal issues are written by the specialists who are well experienced in clinical as well as medicolegal domains. Most of the pertinent issues such as medical ethics, informed consent, medical documentation, medical negligence, and various laws applicable to the medical professionals have been elaborated in the book. A separate section on medicolegal issues related to various specialties has presented practice management strategies for safe clinical practice.
VP Singh has used his academic and research experience to edit the detailed views of the authors and presented a reliable medicolegal book with a problem-solving approach. The guiding principles recommended in the book are well supported by relevant judgments from Indian Courts. I am sure that medical fraternity would find the book very handy allaying their unfolded fears about legal implications and more particularly Consumer Protection Act.
SM Kantikar MD LLB
Member
National Consumer Disputes
Redressal Commission
New Delhi, India
Endorsements
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice is a valuable gift to Indian doctors to help them practice confidently without fear of medicolegal problems. The valuable tips doled out, bring in the impeccable knowledge and vast practical experience of the authors and editorial team. Dr VP Singh, an authority in medical law, as Editor of the book has ensured that it remains useful in day-to-day practice. This book is a must-have for all doctors today.
Shri Mahendrakumar Bajpai, Advocate, Supreme Court of India
Hon Director, Institute of Medicine and Law, Mumbai, Maharashtra, India
Editor, Medical Law Cases—For Doctors (www.mlcd.in)
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice provides valuable tips and information on various medicolegal aspects involved in day-to-day practice. It gives facets of medical laws, ethical aspects of dealing with patients as well as ways to exercise abundant caution while dealing with patients.
Dr Suganthi Iyer MBBS DHA LLB PGDMLE PDCR
Assistant Director (Legal and Medical Services)
Hinduja Hospital, Mahim, Mumbai, Maharashtra, India
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice is well-written and contains useful information on medicolegal issues, which have become very relevant today. I recommend this book to all medical practitioners, for empowering themselves for difficult situations.
Dr PK Kohli MBBS MS MNAMS PhD LLB PGDMLS PGDHHM
Senior Surgeon and Medicolegal Expert, Editor
Indian Journal of Healthcare Quality and Management
Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice deals with the medicolegal and complex ethical issues encountered by clinicians during their day-to-day practice. I firmly believe that the book will promote the good medical practice leading to patient- centred approach. In nutshell, this book is a must read for every healthcare professional who is ambitious to deliver high standards of care for patients.
Dr Arvind Arora MBBS MRCP (UK)
Consultant Medical Oncologist
Nottingham University and Hospitals
NHS Trust, Nottingham, UK
Preface to the Second Edition
Today, medicine has become a prevailing and complex part of our society. The patient–doctor relationship has become more formal and structured. Doctors are no longer regarded as infallible, and are exposed to more liabilities and restrains, than privileges. However, in spite of all the vicissitudes, the practice of medicine is capable of healing the ailing mankind, provided it is practiced with due care, sincerity, and efficiency. Anyone who practices medicine must be aware that there are unique ethical and legal issues which evolved relative to the recent time. Medical laws have emerged as a vast specialization that regulates the practice of medicine. As law evolves with time, we need to understand and follow the medicolegal principles applicable in the practice of medicine. Providing best possible care is not enough. Even the best care provided will be considered inadequate, if the applicable legal principles are not followed. As law is never static, physicians must learn, unlearn, and relearn the up-to-date medicolegal principles.
For a busy clinician, this book is a handy guidance for effective management of medicolegal conflicts confronted in day-to-day clinical practice. In this book distinguished subject experts have provided the evidence-based guiding principles to tackle with such issues. I hope medical practitioners will find this book very useful in their practice.
In the 4 years since the first edition of this book was published, I have received numerous messages from readers discussing various aspects of the book. I have also built up ideas based on my experiences in reading, writing, and editing. With the aid of all this information all chapters have been thoroughly revised and updated. The most obvious change in the current edition is addition of six new chapters.
New chapters added:
  1. Medicolegal Aspects of Discharge against Medical Advice
  2. Violence against Doctors and Hospitals
  3. Patient Safety and Risk Management in Healthcare
  4. Healthcare Associated Infections: A Preventable Threat to Patient Safety
  5. Communication Skills in Healthcare: A Tool to ensure Patient Satisfaction
  6. Documentation in Healthcare: Standards and Guidelines
I express my gratitude to all the contributors and to the publisher for their support. I am also grateful to all our readers for placing their reliance on us and for sharing our optimism. Feedback and suggestions from the esteemed readers are welcome.
VP Singh
MD (Forensic Medicine) LLB
Preface to the First Edition
“The illiterate of 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn”
—Alvin Toffler
In the modern world of consumerism, the status of a physician has changed from savior to service provider. The privilege of being a physician has bestowed more liabilities than immunity. Providing best possible care to the patient is not enough. Physicians must regain the faith of their patients, without whom they could never transform from a disciple to a master of the noble medical profession.
Medical laws have emerged as a vast specialization that regulates the practice of medicine. A physician, ignorant toward the medical laws is an illiterate in the eyes of law, though he may be the master in his profession. Quality healthcare is incomplete without adapting to the legal principles. A physician must always be willing to learn, unlearn and relearn.
For a busy medical practitioner, who finds legal language to be perplexing, Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice is a humble presentation of the medicolegal principles in a lucid and easily understandable language. The book has thoroughly discussed all essential medicolegal issues and has provided the evidence-based guiding principles to tackle the actual medicolegal issues. This authoritative treatise is written by 38 distinguished experts who are authorities in their fields of specialization. I am confident that medical practitioners will find this book useful to prevent as well as solve the medicolegal conflicts.
I express my gratitude to all the authors and to the publisher for their cooperation. I am also grateful to all our readers for placing their reliance on us and for sharing our optimism. Feedback and suggestions from the esteemed readers is welcome, and will be a boon to further improve the quality of this treatise.
VP Singh