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Journal of Indian Medico Legal And Ethics Association

Jan.-Mar.2018 01

EDITORIAL BOARDEditor-in- Chief Dr Asok Datta

Executive EditorsDr Anurag Tomar

Dr Alka KutheDr A S Jaggi

Managing EditorsDr Piyali Bhattacharya

Dr Manish Machwe

Associate editorsDr Vivekanshu

Dr T P Jayaraman

Legal IssuesDr Balraj Yadav

Dr J K Gupta

Ethical IssuesDr Ashish Jain

Dr Vishesh KumarExecutive Members

Dr Anurag VermaDr C M Chhajer

Dr Santosh PandeDr Prabuddh Sheel Mittal

Dr Anuradha ToteyDr Kritika Malhotra

Dr Anil LoharAdvisory Board

Dr Neeraj Nagpal (Chandigarh)Dr Piyush Gupta (New Delhi)Dr Rajesh Shah (Ahmedabad)Dr Mukul Tiwari (Gwalior)

Dr Mahesh Baldwa (Mumbai)Dr Sushma Pande (Amravati)

Journal of Indian Medico Legal

And Ethics Association

Journal of Indian Medico Legal And Ethics

AssociationVol.06 I Issue : 01 I Jan.-Mar. 2018

CONTENTS

Address for correspondence :Dr. Asok Datta, ULHAS GRAV, 01, Post Joteram,Dist. Burdwan - 713104 (WB).Email:[email protected] Ph. 08170993104.

1. Editorial: ... 04Medical Humanities: An Emerging Discipline- Dr. Donna Ropmay

2. Review Article :Legal Aspects of Medical Records ...06Management- Mr. Rajan Singh, Dr. Sudhir Mishra

3. Prospective :Medico-legal aspects of Cesarean section. ...14- Dr. Alka Mukherjee, Dr. Apurva Mukherjee

4. Laws and Acts :PCPNDT Act – Medico-legal Secrets ...19- Dr. Vivekanshu Verma

5. Medico-legal News ...24- Dr. Santosh Pande

7. Professional Assistance Scheme ... 28

8. IMLEACON 2018 Registration Form ...31

9. IMLEA Life Membership Form ...32

B To promote, support and conduct research related to medico-legal, ethical and quality care issues in the field of medicine.

B To help, guide, co-ordinate, co-operate and provide expert opinion to the government agencies, NGO, any semi-government, voluntary, legal bodies / institutions and judiciary in deciding settled or unsettled laws or application of laws / rules related to medico-legal or ethical issues.

B To train the medical professionals in doctor-patient relationship, communication skills, record maintenance and prevention of litigations.

B To promote and support the community members and individuals in amicable settlements of the disputes related to patient care, management and treatment.

B To provide specialized training in related issues during undergraduate or postgraduate education.

B To organize conferences, national meets, CME, updates, symposia etc related to these issues.

B To identify, establish, accreditate and promote organizations, hospitals, institutes, colleges and associations working on the related and allied issues.

B To promote goodwill, better care, quality care, professional conduct, ethical values.

B To establish and maintain educational institutes, hospitals, medical colleges, libraries, research centers, laboratories etc. for the promotion of its objects and to provide scholarships, fellowships, grants, endowments etc. in these fields.

B To print and publish the bulletins, books, official journal/newsletters or periodicals etc on related and allied subjects.

B To co-operate, co-ordinate, affiliate and work with other bodies, agencies or organizations to achieve the objects.

Aims & Objectives

Indian Medico Legal And Ethics Association


Jan.-Mar.201802

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Executive Board of IMLEA 2018-19

President :

IPP : Dr Rishi Bhatia

Secretary : Dr Rohini Deshpande (Sholapur)

Jt.

Zonal Chairmans :North Zone : Dr Balraj Yadav (Gurgaon)East Zone : Dr Sudhir Mishra (Jamshedpur)West Zone : Dr Alka Kuthe (Amravati)South Zone : Dr Shobha Banapurmath (Davangere)Central Zone : Dr Mukul Tiwari (Gwalior)

Treasurer : Dr Rajesh Boob (Amravati)

Executive Member : Dr Anurag Verma (Kashipur)Dr Sushrut Das (Bhubaneshwar)Dr B P Karunakara (Bengaluru)

Advisory Board : Dr Neeraj Nagpal (Chandigarh)Dr U R Deshmukh (Amravati)Dr K K Aggarwal (New Delhi)Dr Mahesh Baldwa (Mumbai)

Dr B B Sahni

Secretary : Dr. Rajesh Shah (Ahmadabad)

Indian Medico Legal And Ethics Association


Jan.-Mar.2018 03

Keywords: Medical Humanities, ATCOM module, Ethics, Medical EducationThe successful practice of medicine is both an art and a science. In the present day scenario, the rigorous schedule in medical schools compels students to focus more on scientific objectivity and less on the artistic subjectivity of learning the subject. The field of Medical Humanities bridges this gap as it explores and engages the interdisciplinary space between health sciences, social sciences and arts [1]. A doctor has a crucial role in society as people place their faith and trust to receive health and healing. According to the World Health Organization (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity [2]. In sociological terms, illness has a social and biological construct and is viewed as a disturbance that interrupts normal social functioning [3]. Doctors in training have to realize that patients are not just diseased organs but complete human beings with thoughts, feelings and emotions. It is important to see the person as a whole rather than confine to a specific part of the body anatomy. Healing is as much about understanding the individual and his/her social context as it is about excellent medical treatment. In 2015, the Medical Council of India introduced the ATCOM (Attitude, Ethics and Communication) module with a view to fulfill the goal of producing an Indian Medical Graduate who is qualified not just in terms of knowledge and skills but also has the right attitude towards patients, colleagues and co-workers [4]. Medical students in their initial years tend to go through a stage of ‘traumatic de-idealization’ as they detach themselves emotionally

from their patients in order to get on with the business of completing their course of study [5]. This phenomenon has led to loss of empathy and sensitivity on the part of the young doctors as they deal with their patients. Therefore, the need of the hour is to incorporate adoption of ‘soft skills’ such as ethical treatment and effective communication into the curriculum of medical education. The ultimate aim of the field of Medical Humanities is to make healthcare more humane. While the social sciences and arts present an outside-in perspective, the medical sciences give an inside-out perspective of the practice of medicine [1]. To be a good practitioner, one needs to have the right blend of both perspectives. In modern day healthcare, the patient’s perception often recedes to the background as the disease or medical procedure captures center stage. Within the framework of medical humanities, however, the narrative of the patient is critically important in the ongoing endeavor to add a human touch to healing. A patient who is given a chance to narrate and tell the story of what is happening to his/her body is already one step on the road to recovery. Hence, physicians need to develop the art of listening to their patients as a routine. In one sense, it is a form of giving them the respect and dignity that is due to them. Moreover, it conveys the message that every person is worth our time and attention.Another area that is gaining recognition in the world of humanities is the role of art therapy and applied arts in healthcare. The applied arts like creative writing, play, drama and art can be used as part of patient-centered treatment. Play and other forms of artistic expression can overcome language barriers, grief, trauma or in case of children, limited

Medical Humanities: An Emerging Discipline

Editorial :

Dr. Donna Ropmay

Asso.Prof. Dept. of For.Medicine, North East Indira Gandhi, RIMS, Shillong email : [email protected]

Received for publication : 6 Jan. 2018 Peer review : 31 Jan.2018 Accepted for publication : 25 Feb. 2018


Jan.-Mar.201804

empathy and compassion. The ailment or problem is viewed from the perspectives of both physician and patient, and the latter is given a chance to voice his/her fears and concerns. A creative mind can find answers to seemingly impossible questions in the most difficult of circumstances. Above all, arts can heal the healer by building up coping skills to deal with the stresses of professional life. References:1. Online course on ‘Medicine and the Arts:

Humanizing Healthcare’. Available from: www.futurelearn.com/courses/medicine-and-the-arts. Accessed on 25 Dec.2017.

2. Constitution of the World Health Organization (WHO), 1948. Available from:www.who.int/governance/eb/who_constitution_en.pdf. Accessed on 25 Dec.2017.

3. Derek D’Souza. Solidarity, Co-operation, Social Responsibility and Health. UNESCO Course on Bioethics, Aug-Nov 2017.

4. Medical Council of India (MCI). Attitude and Communication (ATCOM) Competencies for the Indian Medical Graduate, July 2015.

5. Russel D’Souza. Medical Education and the Ethics of Caring. UNESCO Course on Bioethics, Aug-Nov 2017.

6. World Heal th Organiza t ion (WHO), Department of Reproductive Health Research. Kangaroo Mother Care: a practical guide. World Health Organization, 2003.

communication skills, allowing patients to become active participants in their healing process [1]. This is one reason why pediatric wards are brightly painted and decorated in order to create a child-friendly atmosphere which is more aesthetic or attractive and less imposing or alienating. The role of play in clinical settings has been discussed as a potential resource for holistic healing of the integrated mind, body and spirit. The capacity to function well as a healthcare provider is not just dependence on hard scientific facts but an ability to apply one’s creativity, invention and innovation in a particular situation. A lone medical officer working in a rural health center may not always have access to the latest technological breakthroughs in medicine but that shouldn’t stop him/her from finding creative solutions to common problems. For example, where refrigerators are not available, ice boxes or vaccine carriers may be used for storing biological samples temporarily till they can be transported to the nearest laboratory. The concept of ‘kangaroo mother care’ in pediatrics evolved in the midst of limitations and shortage of incubators in a developing country [6]. Social innovation refers to ideas, activities and services motivated by the goal of meeting a social need to strengthen civil society. Thus, the discipline of medical humanities lends an artistic touch to the drudgery of day to day medical practice. It encourages an understanding of the person as a whole in addition to treating a diseased organ or part of the body. Through the arts, doctors in training learn to care for their patients with

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Contribution in JIMLEAAll the readers of this issue and the members of IMLEA are invited for contributing

articles, original research work / paper, recent court judgement or case laws in the forth

coming issues of JIMLEA. This is a peer-reviewed journal with ISSN registration.

Please send your articles to Dr Asok Datta, email : [email protected]


Jan.-Mar.2018 05

Keywords : Medical records, Hospital administration, Hospital statistics.

The history of medical records runs parallel with the history of medicine. Hippocrates (460 BC) kept medical records of fever cases treated by him. The first medical record unit was established in 1667 at St. Bartholomew’s hospital in England. In India, medical record keeping has not developed to the same extent as that in the western hospitals. Bhore Committee (1946) first stressed the importance of keeping adequate medical records which was also reiterated by Mudaliar Committee in 1962. Subsequent health and hospital review committee (Jain Committee, Rao Committee) highlighted the poor state of medical records in our hospitals and recommended establishment of proper medical record section in each hospital[1].

Medical record of the patient stores the knowledge concerning the patient and his care. It contains sufficient data written in sequence of occurrence of events to justify the diagnosis, treatment and outcome. In modern days medical records have gained greater importance due to its utility in medico-legal cases. This is in addition to their traditional usages that are highlighted below.

Objectives of Medical Records

The primary objective of the Medical Record Department/Section is to develop good Medical Records containing sufficient data written in sequence of events to justify the diagnosis, treatment and end result of all patients treated in a hospital, keep them under safe custody and make it readily available as and when required. The records may be required for the purpose of [2]

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The Patients.The Doctors.Hospital administration.Complaint management.Medico legal purposes e.g Court of LawVarious Government authorities.

1. For Patient, it

Serves to document the clinical history and activities of patient treatment.

Serves to avoid omission or repetition of diagnostic and therapeutic measures.

Assists in continuity of care even in future illness whether it requires attention in or out of the hospital.

Serves as evidence in medico-legal cases.

Give necessary certification for employment purposes, medical status of individual regarding fitness for duty, disability etc.

2. For the Doctor, it

Acts as a tool for communication about the care being given – from one doctor to another and to and from other health workers, specially nurses.

Helps in recollecting the decisions taken in past and its logic / reason.

Assures quality and adequacy of diagnostic and therapeutic measures undertaken.

Serves as an assurance of continuity of medical care.

Evaluates medical practices. Protects in litigation.

3. For Hospital Administrator

To document the quality and quantity of work undertaken and accomplished.

Legal Aspects of Medical Records Management

* Mr. Singh ** Dr. Sudhir MishraRajan

Received for publication : 23 Dec. 2017 Peer review : 20 Jan.2018 Accepted for publication : 20 Feb. 2018

Review Article :

* Manager, Medical Records & Compliance, **Head Consultant, Incharge PICU and HOD Pediatrics , Medical Records Section & Dept. of Pediatrics, Tata Main Hospital, Jamshedpur. email : [email protected]


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To evaluate proficiency of medical staff for administrative and clinical purposes.

To evaluate the services of the hospital in terms of accepted norms and standards.

To serve as an administrative record and performance.

Helps in evaluating financial performance of the hospital and its various units.

Forms basis for planning of future developments of hospital.

Provides epidemiological data that helps in developing preventive programs at government level.

Helps in defining staffing requirements for various units of hospital.

Record review helps in undertaking clinical audits that help in improving quality of care.

4. For Medico Legal purposes, it serves

As an important documentary evidence in criminal cases for proving the nature, timing, gravity of the injuries, type of weapon used and the cause of death.

As an important documentary evidence in road traffic accident cases for deciding on the amount of compensation.

As important evidence in Labor Courts in relation to the Workmen's Compensation Act.

As an important evidence in insurance claims to settle the reimbursement or death claim as per Insurance policy.

As an important evidence documenting medical negligence cases under the Consumer Protection Act.

5. Development of Hospital Performance (Statistics)

Hospital performance only can be understood by hospital statistics. Statistics shows the actual picture of hospital performance and efficiency of operations. Hospital statistics indicate the area which requires greater attention of the management and at same time it reflects the areas which are doing well in the hospital. Hospital data are needed to implement and manage medical care planning as

well as non-medical operation planning. Thus to attain the effective management of hospital, performance indicators are required to be monitored. Some important hospital performance indicators are -

Bed Occupancy Rate

Bed Turnover Rate

Gross Death Rate

Net Death Rate

Percentage of LSCS

Average number of outpatients

Average number of admissions

Sex wise admissions

Age wise admissions

Average length of stay of patients

Number and types of operations performed

No. of laboratory tests.

Total number of babies born in a hospital

Dailyc Census of the hospital

Maternal Mortality Rate

Neonatal Mortality Rate

Bed turnover interval

Infection Rate

Department wise Gross Death and Net Death Rate

6. Reporting to various Government authorities.

This is the responsibility of any hospital to submit all relevant statistics to Civil Surgeon/ Govt. Authority as per government guidelines. Every state has its own guidelines but broadly all guidelines are drawn from central government guidelines. Hospital administrator should ensure the timely reporting of all data to Govt. agencies as per their guidelines. Noncompliance of this reporting is viewed very seriously by Government.

Although medical records are useful for so many purposes, two most important reasons for the doctors and hospitals to maintain proper medical records of patients are- it will help them in the scientific evaluation of their patient’s profile, which helps in analyzing the treatment results, and

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to plan treatment protocols. It also helps in planning the strategies for future medical care based on various statistical data generated through proper analysis of medical records. The second one is that properly documented medical records are the most important objective evidence that physicians and hospitals can offer in their defense against any claim of negligence in consumer forum, and also in other legal fora for conducting various enquiries.

Section of Medical Records

All entries made in the medical and nursing section of the patient record are entered by authorized care providers who authenticate the entries made so as to facilitate identification of the particular author of patient’s medical records. If we look at all medical records then we can broadly divide medical record in three sections for recording the information in medical records, these are [3] :

1. Identification

This sec t ion conta ins the pat ient ’s identification, demographical information and socio economic data. This data is entered at the time of registration in OPD and Indoor admission. All information in this section is provided by the patient/patient’s party to the hospital authority. Usually following information is part of this section:

Name of Patient.Father’s / Husband’s Name.Age & Sex of patient.Permanent / Emergency Address.Telephone / Mobile Numbers.Religion.Company / Organization name for corporate clients.General/Admission Consent.Admission prescription attached with case sheet Medico legal case stamp (In case of MLC).Medical registration numberDate and time of admission Name of admitting doctor.Name of admission counter staff who is

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admitting patients.

2. Medical/Treatment Section

The Medical/Treatment Section is filled up by the attending doctors including consultant and pertains to history, physical examination and treatment / progress notes of the patient. Where operation/procedure is performed, the operation notes are also recorded. This information is usually recorded in the following format :

Complete initial assessment (history and physical examination) and advice by doctor.

Doctor's notes with date and time from date of admission to date of discharge in chronological order including blood transfusion, procedure or operation notes.

Treatment plan.

Consents : Surgical consent, anesthetic consent, consent for procedure and blood transfusion consent

Blood transfusion paper, documents of implants/prosthesis etc.

Copy of discharged summary including medical advice and follow up instruction / death summary duly signed by doctor.

3. Nurses Section

The Nurses are responsible for filling up the following information in this section :

Nursing note (as per nursing assessment procedure)

Temperature chart- usually has records of nurse’s monitoring of other vital parameters. Format of this chart differs from hospital to hospital.

Intake and Output record form.

Treatment chart.

Oxygen administration chart.

Diet sheet.

Details of patient's admission, local transfer as well as discharge should be properly maintained by nursing staff in ward register.

Retention of Indoor Medical Records

Guidelines of Medical Council of India (MCI):

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As per Regulation 1.3.1 of Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment as per the standard Proforma laid down by the MCI. Standard Proforma (Appendix-3) includes name of patients, age, sex, address, occupations, reason of admission, diagnosis, follow up etc. This Proforma is the discharge summary of indoor patients in any hospital [4]. If a request is made for medical records either by the patients/ authorized attendants or legal authorities involved, the same should be duly acknowledged and documents shall be issued within the period of 72 hours.

Guidelines of Directorate General of Health Services regarding retention period for the government hospitals have been published by the DGHS (Directorate General of Health Services), MOHFW, Govt. of India, vide letter no-10-3/68-MH, Dated 31-8-68. It can also be found in the Hospital Manual published in 2002 by the DGHS (Directorate General of Health Services), MOHFW, Govt. of India. As per this Manual, guidelines regarding retention period

For Inpatient Medical Records (Case Sheets) 10 years

For Out Patient Records 5 years

For Medico legal registers 10 years

Present Statutory requirements related to Retention of Medical Records :

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Under the provision of Limitation Act 1963 no complaint can be entertained if it was made after three years of it’s happening.

Under Consumer Protection Act 1986, which indicates complaint can be entertained if it was made within two years of it’s happening. However the provisions of the Consumer Protection Act allows for condoning the delay in appropriate cases. This means that the records may be needed even after two years.

Under PNDT Act-1994 all the documents to be maintained for a period of two years.

Under Medical Termination of pregnancy Act, 1971 all the documents to be maintained for a period of five years.

The Income Tax Act stipulates that all records relating to accounts and money matters be kept for a period of seven years.

Under IPC, Disputes cases, MLC and Death Cases can reopen again and court can ask any time from concerned hospital .So it is advisable to keep them permanently.

The Maharashtra Government has issued a resolution (ref GR No. JJH-29 66/ 49733) which says that OPD paper should be kept for three years, indoor case papers for a period of five years and MLC up to 30 years.

A minor can sue any time after he has attained majority. So it is advisable to keep them till the patient attains the age of 21yrs.

Keeping in mind all the legal aspects and limitations of hospital's resources, the standard

S.No Particulars Periods

1. All documents(IP Case Sheet) having Medico legal Retained for 10years*implications

2. All documents where in death of patients has taken Retained for 10years*place in the hospital(Death cases)

3. Additional remaining Indoor Medical Documents Retained for 5 years*

*Any documents where legal action is initiated will be preserved separately until the final judgment is made by court.


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retention policy for indoor medical records could be-

Medical documentation to Legal documentation

Allegation was proved in absence of Medical Records Dr.Balagopal Perinthalmanna v. K.V. Radhakrishna Menon & Others [5].

A patient with a complaint of abdominal pain had gone to a Doctor wherein he performed exploratory laparotomy and removed the appendix. Subsequently the patient had to be re-admitted for abdominal pain in the same Nursing Home but as the situation did not improve she was taken to the District Hospital where surgery was performed for removing the gangrene and to rectify all the obstructions in the intestine and the patient died after about a month. A complaint was filed alleging medical negligence stating that the doctor did not even get the consent from the patient before conducting the first surgery and that he did not properly diagnose the disease. The doctors having failed to produce the consent form and also the detailed records of treatment in their Nursing Home, an adverse inference was drawn in favor of the complainants.

Weak medical records invariably handicap defense against litigation. Legal experts are convinced that poor medical records are leading reasons why so many questionable malpractice claims are filed and pursued, and why some of these cases ultimately are decided in the plaintiff’s favor. Poor medical records make it difficult to determine whether an adverse outcome resulted from factors beyond the physician’s control or from negligent medical care. A medical record is documentary evidence as per section 3 of the Indian Evidence Act, 1872, as amended on August 1, 1952 and 1961. In the court of law it has been said that good medical records means good defense, poor medical records means poor defense, and no records means no defense. Thus medical record is the greatest asset in defending against allegation of negligence.

Aside from medico-legal considerations, the most important reason for physicians to maintain accurate, credible medical records is that good documentation protects patients. Medical records

contain information required to inform physicians of past and present treatment decisions, and to provide evidence that such care was appropriate in all respects [6].

Always use blue or black ink unless hospital personnel are using a computer or hospital uses a special ink color common for all personnel in the hospital.

Not to use pencil or ink that can be erased after writing like fountainpen or most gel pens.

Advisable to write legibly, sloppy writing causes errors.

All notes should be with date and time of writing.

Signature should be with full name and designation (Stamp may be used).

Where corrections are made, a single strikethrough should be done to cut the part that is not required rather than whitening or blackening it.

Corrections can be made at a later time. In such an event the date and time of actual event and date and time of correction –both should be recorded.

Telephonic conversation / prognostication with patient should be documented at next visit with date and time of conversation.

Many times patient / attendants may meet a specialist in his chamber where case record may not be available. Such conversation should be documented at next visit to ward with actual date and time of conversation and where possible signature of the patient / guardian taken.

Always write follow notes.

ll physicians and Nurses are advised not to use abbreviation unless they are accepted for use by your hospital.

Never allow anyone to touch or look at your medical records unless they are a healthcare worker assigned to take care of the patient.

Keep all medical records in a safe and secure place.

Medical records are confidential. It should not disclose or discuss any facts of the patient or their care with anyone other than the assigned hospital

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staff or the patient themselves.

Medical Records Deficiency Checking

Medical Record Department/Section must ensure the Deficiency Checking of all medical records after receiving files from different parts of hospitals. If a hospital resource does not permit for checking all files, deficiency check can be performed on randomly selected files of certain fixed proportion of cases. These should include

discharged and death files. Deficiency analysis should be based on a check list. A Sample format is provided below. Additional parameters can be incorporated/removed as per the need of hospitals and the target should be 100%. Analysis of the same should be shared with all departments on monthly basis through medical records committee of the hospital.

Sample Format of Medical Records Deficiency Checklist

To,

Dr.______________________

Dept.____________________

Dear Sir/Ma’am,

The following deficiencies have been found during the random deficiency checking of case sheets. This is for your perusal please.

Particulars Patient-1 Patient-2 Patient-3 Patient-4 Patient-5 Patient-6

Discharge Summary signed by Doctor (In case of Discharge)

Death Summary duly signed by Doctor (In case of Death)

Admission Prescription

General Consent

Prognostication form

Complete Initial Assessmentand Advice by Doctor

Date and Time are mentioned in the initial assessment

H\O Allergy Documented

Nutritional Assessment

Care Plan Documented

Surgical Consent

Anesthetic Consent

Procedural Consent

Blood Transfusion Consent

Blood Transfusion Paper

Blood Transfusion Note with Doctor’s signature


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Chronological Doctor’s notes from DOA to DOD on Continuation sheets

Discharged Notes in Case sheet (In case of Discharged)

Death Note in case sheet (In case of Death)

Investigation Reports ( In Case of MLC)

Legible Nurses Notes

Signature with full name, date and time of the nurses doing the assessment

IV Chart, TPR Chart, Treatment Chart

Chronological Page no, Patient’s Name ,IP No, Ward and Bed No on every Page

Legible doctor’s signature with name on Continuation sheets

Medicine advice by doctorson continuation sheet in block letter from DOA to DOD

Medicine advice on treatment card in block letter

(Note- For each parameters in patient’s column, kindly mention “Y” for Yes, “N” for No and “NA” for Not Applicable)

As per Government of India Guidelines [9]- The medical record department in each Medical/Health institution should be given highest priority and be headed by a senior level expert/officer of the same rank as in other existing clinical departments in the same institution. The medical record department should be equipped with requisite number of trained personnel of different categories like medical record officer, Dy. Medical Record Officer, Assistant Medical Record Officer, Sr. Medical Record Technician, Medical Record Technician and other support staff in order to efficiently handle and manage the medical record system of the institution. The standardized

staffing pattern of medical record department, keeping in view the bed strength in an institution be worked out by the concerned State/UT authorities and medical record departments in various medical and health institutions be equipped accordingly. Hospital Administration literature suggested that the staff will vary with the need, program and policies of the individual hospital. However, a suggested minimum for the average general hospital might be one for each 50 beds. Teaching and research hospital will require more [3]. MCI recommendations for teaching hospitals advises 17 person medical records department for 500 bedded hospital admitting 100 students as well as 1100


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bedded hospital admitting 250 students [10,11].

Medical records, whether computer or paper based, hold very important information about the patient’s health and medical condition. This information is not only vital to their medical treatment but is also highly confidential and private. This information cannot legally be shared with anyone other than the assigned medical staff and the actual patient. All records must be completed accurately, completely, timely, legally and in a professional manner.

The medical record is the property of the hospital. The chief value of medical records as evidence is that they contain unbiased statements the doctors, nurses and other concerned with entering the content at the time of the patient’s hospitalization, do not have litigation in mind. Public awareness of medical negligence in India is growing. The hospital medical record is not merely a collection of papers recounting the tale of patients sojourn under the care of his physician in a hospital. It is an inpatient document and is frequently used in the court. Therefore, Medical profession and medical establishment needs to understand the importance of maintaining a strong medical records to be on a legally safer side rather than feeling that consumer forum and other legal fora is a curse on the medical profession.

References

1. Medical Record Services Chapter XII. http://mohfw.nic.in/sites/default/files/12%20Ch.%20XII%20Meical%20Record.pdf. Last accessed on 19.9.2017 p 79.

2. Sakharkar BM. “Principles of Hospital Administration and Planning”, 2nd Edition, “Medical Records” Jaypee Brothers Medical Pub (p) Ltd, 2008,New Delhi. p 235-241.

3. Chandorkar AG. “Hospital Administration &

Planning “, “Organization of Medical Records” Paras Medical Publisher, 2009. p 63-82.

4. Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002. https://www.mciindia.org/ActivitiWebClient/rulesnregulations/codeofMedicalEthicsRegulations2002. Last accessed on 21.12.2017.

5. Dr Balagopal Perinthalmanna v. K.V. Radhakrishna Menon & Others: (2007) CPJ 244 NC. https://indiankanoon.org/doc/1552580/. Last accessed on 21.12.2017.

6. “A hand book for Physician and Medical official staff “, MIES, California, January 2008 p 4-13

7. Ind ian Evidence Act , 1872 . h t tp : / / lawmin.nic.in/ ld/ P-ACT/1872/A1872-1.pdf. Last accessed on 21.12.2017.

8. Information Technology Act, 2000. http:// www.dot. gov.in/ sites/ default/ files/ itbill 2000_0 .pdf.

9. Improving and strengthening the use of ICD 10 and Medical Records System in India. Report & Recommendation, CBHI, Ministry of Health & Family Welfare, New Delhi (2004-2005). http://cbhidghs.nic.in/writereaddata/linkimages/Combined107166151888.pdf. Last accessed on 21.12.2017.

10.Minimum Standard requirements for the medical college for 250 admissions annually. Regulations 1999. https:// www. mciindia. org/ documents/ information Desk/ standard-for-250.pdf. Last accessed on 14.12.2017.

11.Minimum Standard requirements for the medical college for 100 admissions annually. Regulations 1999. https:// www.mciindia. org/ documents/information Desk/ Minimum %20 Standard %20 Requirements %20 for % 20100 % 20 Admissions.pdf. Last accessed on 14. 12. 2017.

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Keywords: Cesarean section, Litigation, Negligence, Medico-legal.

Obstetrics is the most litigation prone branch of medicine because of two precious lives and two potent litigants – mother and baby. Secondly, patients are usually young and healthy. Third thing, patients and relatives consider pregnancy as physiological process. But at the same time obstetrics is full of unpredictability and unforeseen fatal complications can happen anytime. And bad outcome is absolutely not acceptable to relatives and they always label this as negligence and litigate the treating doctor.

The first recognized case of obstetric litigation was in 1980, Jordan Vs White House, since then the obstetric litigation are on rise [1]. Cesarean section (CS) is the abdominal route of delivery after fetal viability. It is most common operation in obstetrics practice. Nowadays the incidence of cesarean section is very high due to several reasons –

Women becoming mother at a late age because of education and career are more likely to undergo LSCS.

Large size babies in mothers with DM/GDM are common.

Safe surgeries because of safe anesthesia.

CS gives protection to pelvic floor, prevent incontinence of stool, flatus, urine and pelvic organ prolapse [2].

Increased rate of nulliparous pregnancy who are at increased risk of CS.

Maternal autonomy and informed choice in favor of CS [3-4].

Increased risk of litigations has forced obstetrician in to defensive practice, which leads to

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more CS [5].

Early diagnosis of fetal distress as better monitoring facilities available.

CS on maternal request

This is a recently introduced indication of CS, raising the incidence of CS from 19.37% in 1994 to 28.7% in 2007. But the risks of CS are higher than vaginal delivery; there is medico-legal problem in doing medically un-indicated operations for delivering the baby. There is lack of information and guidelines for non-medical indication of CS. Royal College of Obstetrics Gynecology (RCOG) advices for taking 2nd opinion, whereas many others consider it as ethical. But looking towards ethical codes in practice and evidence based medicine, the financial aspects and limited resources; we should stick to indicated CS only.

It is a major abdominal surgery with many complications involved like those related to anesthesia, surgery and postoperative problems and maternal mortality is still 5 times higher in elective CS and 18 times higher in emergency CS than after vaginal deliveries. There is increased maternal morbidity in present pregnancy and potential risk of post CS in future pregnancy[6].

Prerequisites to be fulfilled for performing CS – 8 ‘P’ are important to remember.

Person – ideally CS is expected to be performed by a Gynecologist. If a general practitioner with MBBS degree or a surgeon with MS degree does it, he or she should have approved qualification, training from recognized centers approved by MCI is must.

B Place – well equipped infrastructure with all essential equipments like oxygen cylinders,

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Perspective :

Received for publication : 23 Feb. 2018 Peer review : 15 Mar. 2018 Accepted for publication : 20 Mar.2018

Medico-legal aspects of Cesarean section.

* Dr. Alka Mukherjee** Dr. Apurva Mukherjee

* Consultant obstetrician , Mukherjee multi-speciality hospital, Nagpur. Email: [email protected]


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Boyle’s apparatus and defibrillator.

Protocol – for checking the expiry dates of drugs, oxygen cylinder filling dates and annual maintenance contracts should be maintained; standards should be followed while deciding the list of drugs, disposables and equipments to be available in the OT.

Preoperative precautions – is absolutely must like proper history of previous surgeries and medical problems ideally to be taken by the operating doctor. The minimum preoperative investigations like grouping, cross-matching, hemogram, BT, CT, urine examination are mandatory. Documentary evidence of preoperative instructions to the patient like pre-op starvation, medication etc is essential.

Proper indication and its documentation -very important to avoid the allegations of unnecessary CS or late CS and baby suffering. Our documents should corroborate with indications. e.g. FHR records should prove that it was a case of fetal distress.

Proper and informed consent is a must. Usual allegations are consent not taken, consent taken under pressure, delay in operation after giving consent etc.

Presence of neonatologist during CS is a necessity specially if CS done for fetal indication.

Possibility of bleeding in all cases of CS is there and hence it is prudent to send blood for cross matching for all cases of CS. In case blood bank is far away, one should ascertain the availability of blood in blood bank by tele-communication and it should be documented on blood transfusion consent form which is a separate consent form and in emergency we might forget to take consent for blood.

Reasons for CS litigation:

Contrary to common belief, the high CS rate has not contributed to improved pregnancy outcome[7]. The litigations were limited to western world initially but now it is rapidly increasing in India.

In case of maternal death due to any cause.

If asphyxiated baby is delivered by CS at term

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and dies. Here allegation is made for doing late CS.

If baby delivered by CS suffers from cerebral palsy.

Doctor is held liable if he fails to arrange blood for transfusion at the time of actual need.

If a foreign body is left inside the abdomen.

In case of anesthetic complication, operating doctor is held jointly liable.

Injury to urinary bladder or ureter may not be held as negligence but failure to recognize and manage the injury is negligent.

Injury to the baby during delivery may lead to litigation.

In case of delay in initiating CS after fetal distress is recognized leading to poor outcome.

If a complication occurs during CS and the doctor manages it with reasonable degree of skill, knowledge and care, without doing or omiting anything that a reasonable competent obstetrician would do, then also he is not held responsible for the untoward outcome.

There are different types of negligence:

1. Res Ispa Loquitur: Meaning the thing speaks for itself, here the negligence resulted in such an injury that even a layman can recognize. For example: causing burn to a patient during anesthesia, leaving sponge or instruments within the body cavity, handing over wrong baby to patients.

2. Contributory negligence : It is the concurrent negligence by patient and the doctor, which causes harm to patient. It is the good defense for the doctor. However, in criminal cases, such defense cannot be taken by the doctor.

3. Professional misconduct : It is the violation of medical code of ethics which may not cause damage to the patients. It is brought before state or central medical council. Punishment is by warning notice or by removing name from medical council register.

Course after litigation:

There may be letter from the complainant or court stating that an obstetrician has been sued. The reply should be sent within 30 days of receipt of

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notice. The obstetrician should put up all possible points for defense in the first instance during a reply. If points which are not mentioned during reply are put during hearing, they are liable to be rejected. Some points of queries may come in the complaint and even if they are not asked in complaint letters, obstetrician should mention some points during reply to the complaint. They are as follows:

1) Was the CS indicated? What was the indication?

2) Was it done at proper time?

3) Was it done by competent surgeon with competent anesthetist?

4) What was the type of anesthesia used? Whether it was appropriate for surgery?

5) Was the set-up appropriate for CS?

6) Were all the precautions taken to prevent complications (anticipated or unforeseen)?

7) Was the problem leading to mishap (either of baby or mother) detected at a proper time?

8) Was the patient referred to other specialties in time when input was needed?

9) Was the situation conveyed to the relatives in time and from time to time?

10) Was blood available at the time of need?

The other things should be mentioned in reply are:

a) Qualification, training, experience and expertise of obstetrician with relevant documents.

b) Infrastructure of the clinic or hospital and special facility available.

c) Some facts regarding previous illness or treatment which might have been omitted in the complaint.

d) Inconsistencies in the complaint at different levels through CPA, complaint in court if any.

e) Written evidence of the consent of patient and relatives, stating the inherent or special risks involved in CS is important.

f) Situation of the case e.g. emergency situation, lack of facilities should be mentioned.

g) Evidence that reasonable, knowledge, skill and

care exercised by the doctor ( matter should be quoted from standard textbooks).

h) Negligence on the part of patient or patient party, if any, in acceptance of facilities should be mentioned.

The same queries are also made during hearing. There should not be any discrepancy between reply during hearing and that in the written reply to the complaints.

Compensation:

If the obstetrician is found guilty or negligent in a case of CS, Consumer Court may direct doctor to pay an amount as compensation to the consumer. In case of civil law (The Law of Tort), punitive compensation may also be asked for.

The damages for which compensation is claimed are loss of future earning, cost of future care, cost to cover physical and mental sufferings, etc.

In case of vicarious liability out of action or omission of duties of other subordinate of deputy staff, the doctor along with the wrong doer compensate jointly.

Steps to minimize CS litigations –

MCI approved qualification of operating doctor is a must.

Judicious and balanced decision for CS considering the wellbeing of both mother and fetus is ethical.

Clear, proper and timely communication with patient and her relatives about need of CS, possible complications and long term effect, if it is done or not done, in the language which they understand. Sympathetic attitude and solving all queries of patient and her relatives with patience helps to minimize litigation. In fact the whole medical establishment should be made courteous and polite in communication and dealing with party in a case of mishap in CS. Proper training to handle aggrieved patient and relatives should be imparted to all staffs.

Consent – in the Sameera Kohli vs Dr Prabha Manchanda, SC Jan 2008 case, the three bench judgment, given some guidelines regarding consent

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1) Consent of patient herself is most important. Others are signing as witness (unless patient is insane / minor)

2) It should be an informed consent with detailed explanation of: nature of treatment, benefits and possible side effects (balanced information, not to frighten her), available alternatives, consequences of refusal of treatment. All this can be accomplished during the antenatal classes if taken.

3) Consent of CS does not imply consent for other associated procedures like appendicectomy or hysterectomy unless it was a life saving step.

4) With proper mention in the consent, associated procedure can be done like tubectomy or appendicectomy.

5) Consent can actually be taken by our resident doctors.

If patient refuses to give consent-

Document informed refusal signed by the patient.

If patient refuses to sign the refusal of consent get an undertaking about the incident signed by a neutral bystander. In Mr Sakil vs Dr P Irani 1992, doctor documented refusal of consent for CS as patient insisted on waiting for her father in law and hence negligence could not be proved in spite of hypoxic damage to the newborn.

Once consent is given there should be no delay in doing CS. In K Murugesan vs Dr Sarladevi (1999) COJ 542; Doctor waited for anesthetist husband for 4 hours and did not call any other local anesthetist till then. There was fetal death and intraoperative bleeding and patient had to be shifted to Madras in ambulance. Patient died on the way and doctor was a held liable.

Another area prone for litigation is vaginal birth after CS (VBAC). Documents should be able to prove that labor was meticulously monitored and OT was kept ready for emergency CS.

Blood not arranged in spite of rare blood group (A negative) 2.35 lacs of compensation awarded in DK Nayak vs Dr Kalyani case (1997) CPJ 103.

Self audit and updating and staff knowledge and skill updating from time to time is prudent and

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essential.

If a case needs second opinion or the patient demands, the doctor should take second opinion.

There is a tendency to avoid doing tubectomy with CS, especially with a high-risk patient because of fear associated with inquiries of tubectomy complications and deaths.

Following the GOI guidelines of 2006, death or complications due to CS will not be considered as sterilization complication. Insurance has been started by the Govt. of India for doctor’s indemnity and patients for any complication or death and failure.

One of the most common complications prone for litigation is sepsis. The documents which can save us in these cases are:

1. Autoclave register

2. Fumigation register

3. Purchase vouchers of disposals

4. Operative notes and postoperative instructions for common gynecological operations including CS

5. Checklist of antenatal investigations

6. Hospital documents

7. Anesthesia-related documents

Exercising skill and care in deciding and performing CS. Documentation is the only proof of standard of care a patient has been provided. All records should be legible, correct, complete, chronologically placed. Professional indemnity cover is very important. The company should be informed when a complaint or notice is being served. Opinion of senior and experienced doctors should be sought about the merits of case. A strong peer support is very helpful.

Conclusion –

Obstetric litigation has a very grave impact on obstetrics practice. A recent audit of obstetrics medico-legal claims showed that half of all litigations are misguided allegations which could have been resolved by counselling. CPA is making doctors to practice defensively, the burden of investigations, total cost of healthcare has

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increased. Still proper documentation, proper counselling, sympathetic approach, honest and sincere attitude in treating the patient, can go a long way in averting any medico-legal problem in CS.

Some Important medico-legal cases of CS:

1. Smt. Reena Prakash v/s Dr. Dechi III (1994) CP 358 Kar. Alleged sponge left after LSCS – removed by other doctor who was her cousin and postoperative sonography was normal- not liable.

2. Devendra Naik v/s Dr. Kalyani Dhruva I (1997) CPJ 103 Guj. Death after cesarean- PM show intra-abdominal hemorrhage- following negligent surgical procedure & repair- no blood was kept ready- medical record not believed- Rs 2.35 lakh awarded.

3. Aleyamma Varghese v/s Dewan Bahadur III (1997) CPJ 165 Ker. In a hospital foreign body left after cesarean – held: normally counting is done by nurse and surgeon cannot be expected to do that – surgeon but not hospital is vicariously liable – Rs 98,500.

4. Harwinder Kaur v/s Dr. Sushma Chawda III (2001) CPJ 143, Punj. Pain after cesarean – other doctor operated- found sponge- certified that-

held liable as not investigated- relied on certificate of surgeon.

5. Dr. Anush kumari v/s N. Thangaraja (2003) CPJ 341 TL. Death after cesarean- caused DIC & amniotic fluid embolism- known complication- not liable.

References:

1. Jordan v/s White House All ER 261,1981.

2. Harper MA. Byington RP, Estiland MA. Pregnancy related death and health care services. Obstet Gyanecol 2003;102:273.

3. Prophylactic cesarean section. N Eng J of Med 1985;312:1264-1267.

4. Delivery or request CS – where do we go from here? JR Scott.Obst Gynecol 2005;107(6):1222-1223.

5. Villar J, Vallarades E, Wojdyla, Zavaleta N, Carroli G, Velazco A, et al. Cesarean delivery rates and pregnancy outcomes: Lancet 2006;367:1819-29.

6. Ceasarean section – patient choice. J of Banglore society of Gynecology and Obstetrics.

7. Ethical dimension of elective primary caesarean delivery. Obstet Gynecol 2004;103:387-392.

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Medico-Legal Curricullum

Keywords : Abortion, sex selection, Female fetus, Female feticide, Genetic counselling, Appropriate Authority, Good Faith, Cognizable, Bailable.

Pre Conception and Prenatal Diagnostic Techniques (Prohibition of sex selection) Act 1994 regulates “Testing and Telling”. Law regulates fetal testing, what is prohibited is disclosure of sex of fetus [1]. The Act includes the following:a) Permitted - name, place, person, indication,

method, duration etcb) Punishment for doing act which are not

permitted in the Act.c) Document what you do, when and why.d) Take documented permit license authorized by

o Legal Limiting body, o for limited period, o by limited doctors, o using limited technology, o for limited indications, o in limited population, o at limited place and o in limited surroundings.

Changes in Rules with time: Before 1971, Abortion was illegal as per IPC. In 1971, Abortion was legalized to control population. In 1994 Sex selective Abortion (Amniocentesis) was illegal. In 2003 Sex selection with USG, Genetic studies for abortion was illegal [2]. In 2016- IVF for sex selective reproduction is illegal. Doctors need to be legally controlled, regulated and prohibited: Because there are increasing incidences of Sex Selection in choosing male child, Pre- implantation genetic diagnostics for perfect child, Infertility management by Assisted reproduction (IVF), intrauterine insemination -

surrogacy in infertile couples and wanting child in single parent family. There has been growth of technology for getting rid of unwanted pregnancy like- unwanted fetus – feticide, unwanted female fetus – Female feticide and wanted “Designer” child. Forms to be filled in PCPNDT Act: Maintain “ABC” in your USG center • Form ‘A’- Application for registration of an

USG center• Form ‘B’- Batch displayed of registration

certificate• Form ‘C’- Cancelled- Rejection of application

for renewal of registrationMaintenance of Records - Form D-G• Form ‘D’- DNA diagnosis in family - Genetic

Counseling centers• Form ‘E’- Examining DNA for abnormalities-

Genetic Laboratories• Form ‘F’- Fetus USG- Detail address of fetus

family• Form ‘G’ - Gravida –Pregnant consent form

The “Added” powers for Appropriate Authority (AA) in PCPNDT amendments in 2003: The Appropriate Authority can:- • Suspect PCPNDT violation on receiving

complaint• Sting operation with decoy clients for

Sonography• Suspend the sonography registration• Summon the sonography owner• Suo Motto cognizance• Show Cause Notice for temporary suspension

of registration• Search warrant of Sonography center,

PCPNDT Act – Medico-legal SecretsLaws and Acts :

Dr. Vivekanshu Verma

Received for publication : 21 Mar. 2017 Peer review : 22 Dec. 2017 Accepted for publication : 15 Jan.2018

* Asso. Consultant Medanta - The Medicity, Gurugram, Email: [email protected]


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• Seizure of Sonography Machine • Seal the Sonography machine• Sale and purchase monitoring of Sonography

machine • Scrutinizing Records- Form F • Statement Recording from accused and co-

accusedThe misuse of “License Raj” related to

PNDT: PNDT officers victimize doctors, many complaints have been made by doctors to Government including that there are allegations of extortion of money from Gynecologists for renewing license and allegation of blackmailing Radiologists to seize the USG machine. Because of these, doctors suffer from irreparable loss, financial hardships, penal erasure, defamation, outcaste from medical community and harassment of doctors by AA in PCPNDT in undemocratic way and violation of article 21 of constitution of India.

Acts in Good Faith: A thing shall be deemed to be done in good faith, where it is in fact done honestly whether it is done negligently or not. Absence of “personal malice” may be relevant fact in dealing with the plea of good faith, but its significance or importance can’t be exaggerated. The following persons can act in Good Faith as AA under PNDT: Doctor, CMO, Police, Magistrate, IAS and a Judge. Specific sections of Protection of Legal Action taken by AA in Good faith:• PCPNDT- Section 9 and 31• MTP – Section 8• HOTA- Section 23• Registration of Births and Deaths Act- Section 28• Mental health Act amendment -2017• MCI Act- section 31

No suit, prosecution, or other legal proceeding shall lie against any officer for anything which is in good faith done or intended to be done under this Act.Expert Specialist to become AA in PNDT : Good faith gives immunity – RMP can do surgery in good faith in emergency situation to save a life, as per law; and no qualification is asked, no experience questioned and no expertise expected. Unlike acts

done by doctors working AA in MTP, PNDT and HOTA, Doctor should have minimum qualifications as Expert Specialist, experience and expertise, before he does abortion, does USG, does amniocentesis, does transplant etc. So, doctor has to do specialized course before he can be authorized to do transplant. But any government MBBS doctor can be appointed as AA- legal bodies to regulate illegal acts of abortion, transplantation.

PNDT Crime is called a Racket or Scam in News because: Daily USG for sex determination is a continuing offence, Section 178 (c) CrPC deals with a situation where an offence is continuing one, and continues to be committed in more local areas than one. A continuing offence means that if an act or omission on the part of the accused constitutes an offence and if that act or omission continues from day to day, then a fresh offence is committed every day on which the act or omission continues.

The PCPNDT act is configured against an Illegal Act of Selective Child killing. The Crime is selective child making, killing unwanted gender. Tools of crime are USG, ECHO, Amniocentesis, CT, MRI etc. Alleged Criminal are Gynecologists, Radiologists, Cardiologist, Sonologists, Veterinary Doctors etc. Govt Hospital CMO/ District Magistrates can be Appropriate Authority(AA). IAS officer team is Authorizing committee. Legal Cell – the Advisory Committee advises AA.The “Gender specific Medico-legal Crimes” are:-• What’s the crime- Sexual assault, Induction of sex selective Abortion.• Who did it• Where- place of crime• When- time and date• Why did the crime i.e. Intention• Whom- To Whom- women• Who is killed- would be a woman(female fetus)• Witness of crime- pregnant woman- Hostile

Hospital owner is arrested by the police in illegal organ transplant rackets and illegal abortion and sex determination, although he has done no illegal abortion himself because owner of place of illegal work, allowed occurrence of repeated


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crimes, maximum money sharing in the deal and was the mastermind in procuring patients.

Dilemma’s related to PNDT Act:- “Dilemma of AA - to report or not.”“Dilemma of Police- to arrest or not (Cognizable)”“Dilemma of Court – to bail out or not (non-bailable and non-compoundable)”

Role of AA, Police and court is to save life of female fetus. In human body related crimes like attempt to murder, physical torture, sexual assaults etc., police can immediately arrest the suspect without warrant, to prevent destruction of evidence or further attempts to harm victim and witnesses. Duty of Police is to maintain law and order in society, by stopping further crime by arresting the suspected criminal (Doctor/ nurse). But to justify arrest, police need documentary evidence by an independent witness, so reporting by AA needed. Arrested Doctor/nurse can be bailed out in hours by court and can attempt to kill the female fetus again. So, to decide whether the accused can be bailed out or not, court needs expert opinion whether the criminal act was an attempt to diagnose gender for aborting female fetus.

Police shouldn’t register FIR in PCPNDT act violation (as per Standard Operating Guidelines for District Appropriate Authorities by MOHFW issued in 2016). FIR should not be filed for any act of violation of PNDT. Instead, the Police should work with AA to file a court case against the alleged doctor, as per the complaint by victim [3,4]. Decoy “sting operation” by AA is legally permitted. AA can conduct decoy operation to generate evidence, when intelligence has been gathered about a centre or a facility that is conducting or aiding illegal sex selection.PNDT Offence: cognizable, non-bailable and non-compoundable

Cognizable offence is in which police can arrest without warrant from magistrate. Some examples of Cognizable offences are:-? Removal of female fetus illegally (illegal abortion)? Removal of organ from human body illegally

(illegal organ transplantation)? Robbing right to life / property by illegal means? Rape, sexual assault.? Rash driving, Recklessly causing death due to Roadside accident ? Rashful medical treatment causing death of patient (death due to medical negligence)? Robbing life of victim illegally- Murder? Rape of minors/ females in custody of ICU doctor/police custody/ custody remand homes Bottle necks and Clutches for doctors in PCPNDT Act:- • Pregnant needs Prenatal investigation for fetal well being• Prohibition of female feticide• Prohibition of sale of sex identification device- Sonography• Prohibition of advertisement of sex selection• Prevention of misuse of sex selection• Punishment for sex selection by prosecuting only doctors • Penalties to doctors – Penal erasure of registration to practice • Permission to detect fetal anomalies• Pro-life and pro-choice issues • Public display of signboard- No fetal sex detection • Public obligation of reporting PCPNDT violation• Patrilineal inheritance in society• Prescription for doing prenatal procedures- USG• Portable USG can’t be shifted out from registered premises• Protection of doctors against violence by patients is lacking in act• Presumption by AA that every doctor doing USG does sex determination, until proven otherwise• Paperwork – documentation of Form F, consent• Preservation of records

Doctors want that the following provisions shall be added in PNDT Act:- Protection from getting arrested, prevention of legal hassle, progression in


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clinical practice and career, permission to independent decision making in critical situations in emergency, doctors want to become whistleblowers and inform AA, if any pregnant asks for fetal sex.

Difficulties for Doctors under PCPNDT Act:- Presumption about doctors alleged to be guilty -Section 24 – PCPNDT, Presumption by AA that every doctor doing USG is guilty of sex determination, until proven otherwise, Burden of proof is not on the prosecution. It’s the Doctor, who has to prove that he is not guilty just like in Rape and Dowry deaths. Offence under the PCPNDT act is cognizable, non bailable and non-compoundable. But AA has no power to take any legal action against pregnant lady. Police do not take any action against pregnant, has no legal provisions for preventing abortion and MTP Act allows pregnant to seek abortion for controlling family size.

Problem with the PNDT Act: PNDT Act is still toothless piece of legislation for quacks in villages. PNDT is misused against doctors by pregnant mother’s family - False allegations for Extortion of money from doctor, blackmail for Disclosure of gender of unborn fetus and alleged negligence in prenatal care.

PNDT is misused against doctors by pregnant in making– False allegations related to

Demanding son’s birth preference instead of daughter

• Dowry Prohibition act, 1961• Dowry Harassment- 498A• Dowry Death- 304B• Domestic violence act• Discrimination by family members• Disclosure of gender of unborn fetus • Discard the pregnant, forcing her to abortAllegations framed by patient’s lawyer against

Doctor doing illegal abortion causing PNDT violation. Gynecologist gets maximum allegations of misuse of PCPNDT because of “Documentary evidence” of meeting the patient, registration of patient, documentation of consultation, medical investigation report like USG or amniocentesis mentions name of doctor reported and patient

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examined, CCTV camera in public places.Evidence of Crime in PNDT: Documentary evidence (link between accused doctor and victim patient and unborn fetus) include Hospital Registration form, Prescription, USG report and Forms, Receipt of payment to Hospital, Discharge summary of pregnant patient proves that doctor treated the pregnant. All above are missing in quacks doing female feticide, so AA fails to prove the crime in quacks and raids genuine doctors to complete monthly targets and finds faults in documents.

Doctors doing USG face negligence charges under Consumer Protection Act, unlike doctors doing sterilization under Family planning scheme, Because in family planning, doctor is working for the government to control population, unlike doing USG for wellbeing of fetus and pregnant. PCPNDT act doesn’t protect the doctor from Consumer Protection Act. Faulty USG procedure in diagnosing congenital abnormalities is negligence [3].

Doctors doing illegal sex selection and abortion is considered as “heinous crime” because both PCPNDT and MTP are regulating doctors taking care of pregnant, because identifying sex of fetus and doing abortion of unwanted sex is contradictory under medical obligations of doctor of saving lives.

AA’s response to a complaint regarding violation of the PCPNDT Act:- AA should as far as possible, not involve police for investigating cases under the Act as the cases under the Act are tried as complaint cases under the Code of Criminal Procedure, 1973 (2 of 1974). AA should investigate all the complaints within 24 hours of receipt of the complaint and complete the investigation within 48 hours of receipt of such complaint [4].

Pregnant mother is never arrested in illegal abortion of female fetus in PCPNDT and any illegal abortion under MTP, because Court’s sympathy for pregnant patient’s critical state, why would a mother will kill her own child and no financial gain to mother. There is no motive to directly harm the fetus, public sympathy for pregnant and no documentary evidence of the act committed, if


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pregnant tries to abort by self-medication.Catch “22” situation for Radiologists in

PNDT act is that “Prescription” is required by Registered Gynecologist for doing prenatal procedures in pregnant. A catch-22 is a paradoxical situation from which an individual cannot escape because of contradictory rules. Catch-22 often results from rules, regulations, or procedures that an individual is subject to but has no control over because to fight the rule is to accept it. If radiologist refuses to attend midnight obstetric emergency without prescription, he is guilty of breaching medical ethics. Whereas if he performs USG without prescription; he becomes culprit in PCPNDT. Self-referral can’t be done by Radiologists unlike Gynecologists, as they are not clinicians. Anger and aggression results among pregnant and her relatives (lay persons) against radiologist for refusing USG.

Horrible case reported of Radiologist murdered for refusing USG: Gruesome murder of Dr. Manish Garg at a small place in Jind in 2014. Dr. Garg was earlier beaten up and his hospital vandalized as he had insisted on asking for photo ID proof from a patient before conducting an obstetric ultrasound. Requirement of photo ID proof is as per PCPNDT Act. Dr. Garg had lodged an FIR and had provided CCTV footage of the incident but no action was taken against those responsible. This is not the first incidence of a doctor's murder in Haryana, giving example of Dr. Ranveer Choudhary who was killed around five years ago and Dr. Raman, who was murdered in Bhiwani. State government which on one side asks doctors to work in rural and backward areas and on the other side does not give them even a semblance of a sense of security through its law and order machinery [5].

Do’s and Don’ts for Doctors in PNDT Act [6]:-• Register the Center dealing with pregnancy• Renewal of Registration before expiry date • Registration certificate copy display in center• Rejection of Registration – do not continue

USG • Register the Doctor doing USG- Gynecologist,

Sonologist • Radiologist should update Resignation to AA• Records maintenance up-to-date • Report to AA monthly• Retain all documents for at least 2 years• Receive Declaration from pregnant, that no sex

detection• Remain alert and careful for protecting your

career • Refrain from disclosing sex of fetus.References:- 1. PCPNDT Act and Rules 1994.2. PCPNDT amendments 2003.3. Medico-legal outlook in PC PNDT. In: Legal

issues in Medical Practice. Dr VP Singh. Jaypee publishers. 1st Ed. 2016. p 138.

4. Standard Operating Guidelines for District Appropriate Authorities by MOHFW -2016

5 Medicos body condemns killing of doctor in Haryana. TNN | Sep 12, 2014.https://timesofindia. indiatimes. com/ city/ chandigarh/ Medicos- body- condemns- killing- of-doctor- in- Haryana/ articleshow/ 42310639.cms. Accessed on 15 Nov 2017.

6. PCPNDT amendments 2014. http:// cg.nic.in/ health/ pcpndt/ Documents/ GuidLine_ 02_ 21072016. pdf. Accessed on 15 Nov 2017.

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Court pronounces 5 year jail-time, Rs 21,000 fine for a Quack

In a strong act of justice, the Chief Judicial Magistrate (CJM) court in Dehradun had pronounced 5 years of rigorous imprisonment and a fine of 21,000 on a quack who had been practicing in the area, claiming himself to be an epilepsy expert.

The quack, one Rajesh Kumar Gupta, who ran Neeraj Clinic in Rishikesh, was indeed one of the popular “doctors” in the area. He had numerous pictures with prominent people and heavily advertised practice, including daily articles that aimed to prove him as an Epilepsy Expert. However, he did not escape the wrath of the local Indian Medical Association branch who, taking cognizance of his extravagant advertisements, investigated his claim, only to finally declare him as a quack in the year 2000.

Despite this, the man continued to practice, only to be finally arrested in 2014, when a Canadian patient of his, complained to the state government that he was ‘dubious’ and was allegedly giving medicines laced with sedatives. HT reports that he went underground but was arrested soon after in Dehradun.

Such was his clout that when the police tried to arrest him people of Rishikesh protested and an angry crowd managed to free him. He was later arrested and now the CJM on Wednesday finally found him guilty under section 224 (resistance or obstruction by a person to his lawful apprehension), section 420 (cheating) of IPC and section 7 of The Drugs and Magic Remedies (Objectionable Advertisements) Act 1954, reports TOI. The court also convicted 14 others and sentenced them to

one-year jail term for helping Gupta flee from the police in 2014. Gupta is now at the Dehradun district jail. But the others managed to secure bail, reports HT.

Ref: ht tps: / /medicaldialogues . in /court -pronounces-5-year-jail-time-rs-21000-on-quack/ . Accessed on 6/1/18

Uneventful Squint Surgery: Doctor cannot be held negligent, holds NCDRC

A good beginning of the year for Medicos. The apex Consumer court, in a recent judgment, was seen upholding that merely because the patient did not respond favorably to the treatment, cannot be a ground to fasten the liability upon the medical professional

Facts in short:

1. The Complainant, a Practicing Advocate himself, went to the Opponent Hospital and after investigation, his left eye was found with a cataract as well as a squint. He was advised to undergo first squint removal surgery and then cataract surgery.

2. It was alleged that after the surgery, there was no Doctor to look after the patient. Even the injection was given by the chowkidar. After the removal of stitches it was found that the squint was not removed and the complainant lost his left eye vision and when the complainant approached other Hospitals, it was found that the retina was completely detached to be cured. Thus it was clear cut negligence.

3. Thus he field the case in District Forum alleging that due to loss of vision, his professional career got ruined and his monthly income came down to Rs.3000/- from Rs.15,000/-. However he was awarded Rs. 1 lakh compensation. Against the

Medico Legal NewsDr. Santosh Pande

Consultant Anesthetist, President IMLEA, Amravati Branch. E-mail : [email protected]


Jan.-Mar.201824

decision of the district forum, the Doctors approached for reversal of the order and the complainant approached for enhancement of the compensation. But, the Doctors appeal was allowed and complainant’s appeal was dismissed and hence he approached the National Fora.

Defense :

1. The Hospital and Doctors resisted the case of the complainant. The Doctors submitted that the right vision of the Complainant was 6/60 and correction with glass was 6/12. Whereas his left eye vision was ZERO and as per WHO guidelines he was Blind.

2. There was only a perception of light and the projection of rays was inaccurate. Moreover, Fundus examination revealed that there was old Retinal Detachment (R.D.)in his left eye. Accordingly, the patient was advised that the vision cannot be restored, but squint may be cured that too only for cosmetic purposes. Moreover, the patient was not charged for diagnosis and only material costs were recovered.

Held :

1. The National Commission after perusing the medical record and medical literature dismissed the revision petition of the Complainant.

2. It observed that none of the other hospitals/ Doctors in its prescriptions that later saw the patient ever mentioned that RD was due to negligent or careless operation of squint correction. The Operative notes also revealed that there was old RD.

3. The squint removal was only for cosmetic purpose and the Complainant failed to prove that there was any negligence nor he produced any expert evidence.

4. It was lastly observed that Hon’ble Supreme Court in a catena of judgments have made elaborate observations on the medical negligence that for the complainant to succeed in the claim of alleged medical negligence, he has to prove the essential ingredients of medical negligence like Duty, Dereliction of duty of care (breach) and resultant Damage (injury). In the instant case, the complainant failed to prove those elements.

5. At the end, the Commission observed that it should be borne in mind that merely because the patient did not respond favorably to the treatment, cannot be a ground to fasten the liability upon the medical professional.

Important judgment for day to day practice; this judgment has hidden message for Doctors that proper record keeping could save Doctors from damages. Always remember, “NO RECORD MEANS NO DEFENSE & POOR RECORD MEANS POOR DEFENSE.”

Ref: https://medicaldialogues.in/uneventful-squint-surgery-doctor-cannot-be-held-negligent-holds-ncdrc/ . Accessed on 22/01/18.

Max Hospital told to pay Rs 30 lakh compensation for negligence during delivery

The Delhi state consumer commission had directed the Max Hospital in Pitampura here to pay Rs 30 lakh to a 10-year-old boy and his parents for negligence at the time of delivery leading to the permanent abnormality in the child’s left arm. The Delhi State Consumer Disputes Redressal Commission bench imposed the hefty amount on the private hospital saying this may serve the purpose of bringing about a “qualitative change” in the attitude of hospitals of providing “service to the human beings as human beings”. The commission awarded a compensation of Rs 20 lakh to Sonepat-based Ritesh Kumar Garg, Aarti Garg and their son Kush Garg for the suffering, mental pain and agony caused to them. Besides this, it also directed the hospital to pay Rs five lakh to the mother as incidental expenses incurred from the time she was admitted for delivery till the child’s check up at a hospital in Mumbai and another Rs five lakh to them as litigation cost.

“Human touch is necessary; that is their code of conduct; that is their duty and that is what is required to be implemented,” a bench of member (judicial) O P Gupta and member Anil Srivastava said. It said proper and due care was not exercised while conducting the woman’s delivery leading to shoulder dystocia (when baby’s head passes through the birth canal and their shoulders become


Jan.-Mar.2018 25

stuck during labor) resulting in permanent disability. “The negligence on the part of the hospital is writ large of the face and is established…,” the commission held. The parents had approached the commission alleging medical negligence on the part of the hospital at the time of delivery, damaging the neuromotor functioning of the child’s left arm. The child was born at the hospital on June 5, 2007, and the doctors had claimed that everything was fine but soon after the birth, the abnormality was discovered in the child’s left arm allegedly due to crude and violent pulling of the baby. The parents consulted various other hospitals but the damage could not be rectified and the child showed no improvement, the complaint said. The hospital, however, claimed that the allegations of negligence and deficiency of service were false and baseless. It also maintained that the doctors had taken the utmost care and due precaution in handling the delivery of the baby and no malfunctioning in the child’s left arm was discovered at the time of delivery.

Ref : https://medicaldialogues.in/max-hospital-told-to-pay-rs-30-lakh-compensation-for-negligence-during-delivery/. Accessed on 3/3/18.

Radiologist, tout arrested for sex determination in Rajasthan

A doctor and a tout were arrested in Rajasthan’s Kota district for allegedly conducting sex-determination tests. The PCPNDT Bureau of investigation (PBI) — a special team of the state Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) cell — arrested Dr Mukul Kokas, a DMRD and ultrasonography specialist; and a tout, Ameen Mohammed, last evening from a diagnostic center ( Suvidha diagnostic and sonography center) in Nayapura area here, said Rajiv Lochan, a member of the operation team. Acting on a tip-off, a team, led by PBI inspector Sitaram, laid a trap around six days ago. Ameen and another tout, Mahaveer, were contacted over the phone and they agreed to a sex-determination test for Rs 50,000, which included an abortion charge if the test confirmed a girl child, Lochan said. The test was conducted yesterday by Kokas at the center

after the touts received the sum. Kokas and Ameen were arrested, while Mahaveer managed to flee from the spot with Rs 35,000 as the PBI team could not identify him, the officer added. The two would be produced before a court in Bundi district later today, Lochan said, adding that it is the 107th such decoy operation by the PBI. The PCPNDT Act, 1994, was enacted to prevent female feticide and confers wide powers to the appropriate authority to ensure that diagnostic techniques are not misused for sex selection. Earlier this month, a 50-year-old woman, identified as Shanti Rani, was arrested for allegedly carrying out a sex-determination test in Kota.

Ref: https://medicaldialogues.in/radiologist-tout-arrested-for-sex-determination-in-rajasthan/. Accessed on 5/3/18.

Bihar: Life imprisonment to those who kidnapped 2 doctors

A court here today sentenced eight people to life imprisonment for abduction of a city-based doctor couple three years ago. Additional District and Sessions judge Sachhidanand Singh awarded life term to the eight people who had been convicted on February 20.A fine of Rs 50,000 was also slapped on each of them. TOI reports that the accused were held guilty under sections 364A, 395 and 412 of the Indian Penal Code (IPC) The incident goes back to May 1, 2015 when posing as policemen, the eight people kidnapped Dr Pankaj Gupta and his wife Dr Shubhra Gupta from Barachatti, when the couple were returning from Giridih district of Jharkhand. The doctor couple had gone there for a wedding and were on their way back home in their newly purchased Audi car, when they were kidnapped by heavily armed criminals from GT Road in broad daylight. The kidnappers drove the captive couple in their own car and held captive in an apartment at Gomti Nagar area of Lucknow. A special investigating team had rescued the couple from a hideout in Lucknow, a week after the abduction, and had arrested the eight people. The eight were identified as Ajay Singh, Amit Kumar Singh, Sunil Kumar Singh, Anil Singh, Mrityunjay Singh, Vijay Singh, Rahul Kumar Soni


Jan.-Mar.201826

and Shravan Paswan.

Ref: https://medicaldialogues.in/bihar-life-imprisonment-to-those-who-kidnapped-2-doctors/. Accessed on 7/3/18.

Tamil Nadu: Medical Council Suspends 3 doctors in cases of attempt to murder, negligence

MBBS with IGNOU PGDCC performing Echo: Hospital fined Rs 20 lakh

The state medical council has pronounced suspension orders to three medical practitioners and given a stern warning to two doctors, in two different cases that had been before the council pertaining to allegations of attempt to murder and gross medical negligence respectively The first case before the council was that of Dr Jayasudha and her son Dr Hari Prasad, both of whom are accused in the attempt to murder of her ailing father.

Medical Dialogues team had earlier reported about the incident where the woman doctor, Dr Jayasudha Manoharan, along with her son Dr Hari Prasad visited her ailing father, Dr E Rajagopal, in her brother Dr R Jayaprakash’s Aditya Hospital in Kilpauk, Chennai. After getting thumb impressions on certain documents, Jayasudha allegedly yanked the IV line of her ailing father. When the nurses and staff observe the blood trickling down the patient’s body, they intervened, following which the accused are seen rushing out of the hospital. The entire incident was caught on CCTV camera and had gone viral on social media at that time. Her brother had filed an FIR against the culprits. Responding on the case, the disciplinary committee at the Tamil Nadu medical council recommended action against Coimbatore-based Dr Jayasudha Manoharan, and following the general council meeting, the doctor has been. The council also issued a warning to her husband Dr U Manoharan and son Dr Hari Prasad

suspended for one year. The second case, where the council pronounced action is on a medical negligence case. It is reported that last year, Tamil Nadu Medical Council received a complaint from the state health department, about one, Santosh Kumar, a medical student from Madras Medical college, who underwent hair transplant at the Advanced Robotic Hair Transplant Centre and passed away due to complications. It is reported that the hair transplant was performed by an MBBS doctor, Dr Vineeth Suryakumar, in the presence of an anesthetist, Dr Hariprasad Kasturi who had allegedly left the salon in between the surgery. The salon had been sealed by the authorities following the case. Holding the two guilty for medical negligence death of the medical student, the council has barred the Dr Hariprasad Kasturi, an anesthetist, from practice for six months, while Dr A Vineeth Suryakumar, an MBBS graduate from a Chinese university, has been barred for a year. Speaking to Medical Dialogues team, Dr K Senthil, President, Tamil Nadu Medical Council told Medical Dialogues team,” The decision pertaining to these cases had been made by the earlier office bearers but the decision was pending for the want of the final meeting of the General Council. The first meeting took place yesterday and the said decisions were ratified.” Observing the delay that had come in passing the decision, the council has also passed a resolution to the effect stating the disciplinary committee can henceforth initiate action against violators after an investigation is conducted, and not to wait for the concurrence of the entire council. A similar methodology is also followed by the Medical Council of India.

Ref: https://medicaldialogues.in/tamil-nadu-medical-council-suspends-3-doctors-in-cases-of-attempt-to-murder-negligence/. Accessed on 7/3/18.

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The Members of Professional Assistance Scheme

S.No. Name Place Speciality1 Dr. Dinesh B Thakare Amravati Pathologist2 Dr. Satish K Tiwari Amravati Pediatrician3 Dr. Usha S Tiwari Amravati Hospi/ N Home4 Dr. Rajendra W. Baitule Amravati Orthopedic 5 Dr. Yogesh R Zanwar Amravati Dermatologist6 Dr. Ramawatar R. Soni Amravati Pathologist7 Dr. Rajendra R. Borkar Wardha Pediatrician8 Dr. Alka V. Kuthe Amravati Ob.&Gyn.9 Dr. Vijay M Kuthe Amravati Orthopedic 10 Dr. Neelima M Ardak Amravati Ob.&Gyn.11 Dr. Vinita B Yadav Gurgaon Ob.&Gyn.12 Dr. Balraj Yadav Gurgaon Pediatrician13 Dr. Dinakara P Bengaluru Pediatrician14 Dr. Shriniket Tidke Amravati Pediatrician15 Dr. Shraddha Tidke Amravati Gen Practitioner16 Dr. Gajanan Patil Morshi Pediatrician17 Dr. Madhuri Patil Morshi Obs & Gyn18 Dr. Pitabas Rautray Bhubneshwar Pediatrician19 Dr. Jagdish Sahoo Bhubneshwar Pediatrician20 Dr. Menka Jha (Sahoo) Bhubneshwar Neurology21 Dr. Sitanshu Kumar Meher Bhubneshwar Pediatrician22 Dr. B. B Sahani Bhubneshwar Pediatrician23 Dr. Poonam Belokar(Kherde) Amravati Obs & Gyn24 Dr. Sandeep Dankhede Amravati Pediatrician25 Dr. Ashish Dagwar Amravati Surgeon26 Dr. Ashish Varma Wardha Pediatrician27 Dr. Anuj Varma Wardha Physician28 Dr. Neha Varma Wardha Ob & Gyn29 Dr. Ramesh Varma Wardha Gen Practitioner30 Dr. Kiran Borkar Wardha Ob & Gyn31 Dr. Prabhat Goel Gurgaon Physician32 Dr. Sunil Mahajan Wardha Pathologist33 Dr. Ashish Jain Gurgaon Pediatrician34 Dr. Neetu Jain Gurgaon Pulmonologist35 Dr. Bhupesh Bhond Amravati Pediatrician36 Dr. R K Maheshwari Barmer Pediatrician37 Dr. Jayant Shah Nandurbar Pediatrician38 Dr. Kesavulu Hindupur AP Pediatrician39 Dr. Ashim Kr Ghosh Burdwan WB Pediatrician40 Dr. Archana Tiwari Gwalior Ob & Gyn41 Dr. Mukul Tiwari Gwalior Pediatrician42 Dr. Chandravanti Hariyani Nagpur Pediatrician43 Dr. Gorava Ujjinaiah Kurnool(A.P) Pediatrician44 Dr. Pankaj Agrawal Barmer Pediatrician45 Dr. Prashant Bhutada Nagpur Pediatrician46 Dr. Sharad Lakhotiya Mehkar Pediatrician47 Dr. Kamalakanta Swain Bhadrak(Orissa) Pediatrician48 Dr. Manjit Singh Patiala Pediatrician49 Dr. Harpreet Singh Ludhiana Pediatrician50 Dr. Mrinmoy Sinha Nadia (W.B) Pediatrician51 Dr. Ravi Shankar Akhare Chandrapur Pediatrician52 Dr. Lalit Meshram Chandrapur Pediatrician53 Dr. Vivek Shivhare Nagpur Pediatrician54 Dr. Ravishankara M Banglore Pediatrician55 Dr. Bhooshan Holey Nagpur Pediatrician56 Dr. V P Goswami Indore Pediatrician57 Dr. Sudhir Mishra Jamshedpur Pediatrician58 Dr. Shoumyodhriti Ghosh Jamshedpur Pediatric Surgeon59 Dr. Banashree Majumdar Jamshedpur Dermatologist60 Dr. Lalchand Charan Udaipur Pediatrician61 Dr. Sunil Sakarkar Amravati Dermatologist62 Dr. Mrutunjay Dash Bhubaneshwar Pediatrician63 Dr. J Bikrant K Prusty Bhubaneshwar Pediatrician64 Dr. Ashish Satav Dharni Physician65 Dr. Kavita Satav Dharni Opthalmologist66 Dr. D P Gosavi Amravati Pediatrician67 Dr. Narendra Gandhi Rajnandgaon Pediatrician68 Dr. Chetak K B Mysore Pediatrician69 Dr. Shashikiran Patil Mysore Pediatrician70 Dr. Bharat Shah Amravati Plastic Surgeon71 Dr. Jagruti Shah Amravati Ob & Gyn72 Dr. C P Ravikumar Banglore Ped Neurologist73 Dr. Apurva Kale Amravati Pediatrician74 Dr. Prashant Gahukar Amravati Pathologist75 Dr. Asit Guin Jabalpur Physician

S.No. Name Place Speciality76 Dr. Sanjeev Borade Amravati Ob & Gyn77 Dr. Usha Gajbhiye Amravati Pediatric Surgeon78 Dr. Kush Jhunjhunwala Nagpur Pediatrician79 Dr. Anil Nandedkar Nanded Pediatrician80 Dr. Amit Toshniwal Nanded Pediatrician81 Dr. Shrikant Kokadwar Nanded Pediatrician82 Dr. Satish Agrawal Amravati Pediatrician83 Dr. Ravi Motwani Gadchiroli Pediatrician84 Dr. Ashwin Deshmukh Amravati Ob & Gyn85 Dr. Anupama Deshmukh Amravati Ob & Gyn86 Dr. Aanand Kakani Amravati Neurosurgeon87 Dr. Anuradha Kakani Amravati Ob & Gyn88 Dr. Sikandar Adwani Amravati Neurophysician89 Dr. Seema Gupta Amravati Pathologist90 Dr. Pawan Agrawal Amravati Cardiologist91 Dr. Madhuri Agrawal Amravati Pediatrician92 Dr. Rupesh Kulwal Pune Pediatrician93 Dr. Jyoti Agrawal Amravati Pediatrician94 Dr. Sonal Kale Amravati Ob & Gyn95 Dr. Gopal Belokar Amravati ENT96 Dr. Amit Kavimandan Amravati Gastroenterologist97 Dr. Vinamra Malik Chhindwara Pediatrician98 Dr. Shivanand Gauns Goa Pediatrician99 Dr. Rishikesh Nagalkar Amravati Pediatrician100 Dr. Rashmi Nagalkar Amravati Ob & Gyn101 Dr. Vikram Deshmukh Amravati Urosurgeon102 Dr. Raj Tilak Kanpur Pediatrician103 Dr. Ramesh Tannirwar Wardha Ob & Gyn104 Dr. Sameer Agrawal Jabalpur Pediatrician105 Dr. Sheojee Prasad Gwalior Pediatrician106 Dr. V K Gandhi Satna Pediatrician107 Dr. Shyam Sidana Ranchi Pediatrician108 Dr. Umesh Khanapurkar Bhusawal Pediatrician109 Dr. Sushma Khanapurkar Bhusawal Gen Practitioner110 Dr. Sameer Khanapurkar Bhusawal Pediatrician111 Dr. Samir Bhide Nashik Pediatrician112 Dr. Rajendra Vitalkar Warud Gen Practitioner113 Dr. Kalpana Vitalkar Warud Ob & Gyn114 Dr. Shweta Bhide Nashik Opthalmologist115 Dr. Nabendu Chaudhuri Burdwan WB Pediatrician116 Dr. Sushma Kirtani Goa Pediatrician117 Dr. A. O. Nazareth Goa Pediatrician118 Dr. Madhav Wagle Goa Pediatrician119 Dr. Preeti Kaisare Goa Pediatrician120 Dr. Varsha Amonkar Goa Pediatrician121 Dr. Varsha Kamat Goa Pediatrician122 Dr. Harshad Kamat Goa Pediatrician123 Dr. Siddhi Nevrekar Goa Pediatrician124 Dr. Dhanesh Volvoiker Goa Pediatrician125 Dr. Pramod Shete Paratwada Pediatrician126 Dr. Bharat Shete Paratwada Surgeon127 Dr. Poonam Sambhaji Goa Pediatrician128 Dr. Kausthubh Deshmukh Amravati Pediatrician129 Dr. Pratibha Kale Amravati Pediatrician130 Dr. Milind Jagtap Amravati Pathologist131 Dr. Varsha Jagtap Amravati Pathologist132 Dr. Rajendra Dhore Amravati Physician133 Dr. Veena Dhore Amravati Dentistry134 Dr. Satish Godse Solapur Physician135 Dr. Pinky Paliencar Goa Pediatrician136 Dr. Kripasindhu Chatterjee Burdwan WB Pediatrician137 Dr. Chittaranjan Rath Bhubaneshwar Pediatrician138 Dr. Nilesh Toshniwal Washim Orthopedic 139 Dr. Swati Toshniwal Washim Dentistry140 Dr. Subhendu Dey Purulia Pediatrician141 Dr. Laxmi Bhond Amravati Pediatrician142 Dr. Sangeeta Bhamburkar Akola Dermatologist143 Dr. Aniruddh Bhamburkar Akola Physician144 Dr. Nilesh Dayama Akola Pediatrician145 Dr. Paridhi Dayama Akola Pediatrician146 Dr. Shreyas Borkar Wardha147 Dr. Vivek Morey Buldhana

PediatricianOrtho.Surgeon

148 Dr. Arti Murkey Amravati Ob & Gyn149 Dr. Nitin Bardiya Amravati Pediatrician


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IMLEACON 20184 th National Conference of Indian Medico Legal & Ethics Association

Venue: J.B. Auditorium, Ahmedabad Management Association Complex,Vikram Sarabhai Marg, Near Indian Institute Of Management, Atira, Ahmedabad-380015

Date : December 1 & 2, 2018 - Saturday & Sunday

ADDRESS FOR CORRESPONDENCE : Prof. Dr. Rajesh C. Shah4, Paraskunj Society-1, Satellite Road, Near Zansi Queen Statue;Ahmedabad-380015 (Gujarat) India Email:[email protected]

REGISTRATION FEES : Upto31 May 2018 1 Jun 2018 To 15 Nov.2018 16 Nov.2018 To Spot

SINGLE RS.2000/- RS.2500/- RS.3000/-

COUPLE RS.3000/- RS.4000/- RS.5000/-

STUDENT* RS.1500/- RS.2000/- RS.2500/-

PATRON RS.10000/- RS.12000/- RS.15000/-

CHEQUE/DRAFT IN FAVOR OF : IMLEACON 2018 PAYABLE AT AHMEDABAD (OUTSTATION CHEQUE RS.200/- ADDITIONAL)

Prof.Dr.Rajesh C. ShahOrg. Chairman

Dr. Jagdeep J. PanditOrg. Secretary

Prof.Dr.Saumil Merchant Org. Jt. Secretary

Dr.Parul ShahOrg. Treasurer


Jan.-Mar.2018 31

INDIAN MEDICO-LEGAL & ETHICS ASSOCIATION[Reg. No. - E - 598 (Amravati)]

Website - www.imlea-india.org , e mail - [email protected]

LIFE MEMBERSHIP FORM

Name of the applicant : ____ __________________________________________________________

(Surname) (First name) (Middle name)

Date of Birth : __________________________________ Sex : ____________________________

Address for Correspondence: _____________________________________________________________________________

__________________________________________________________________________________________________

Telephone No.s : Resi. : ________________ Hosp. : ______________________ Other : ___________________________________

Mobile : ______________ Fax : ________________________ E-mail :___________________________________

Name of the Council (MCI/Dental/Homeopathy/Ayurved /BAR/Other) : _________________________________________________________

Registration No.: ____________________________________________ Date of Reg. : ______________________________________________

Medical / Legal Qualification University Year of Passing

____________________________________________ _____________________________________________

Name, membership No. & signature of proposer Name, membership No. & signature of seconder :

__________________

A) Experience in legal field (if any) : _____________________________________________________________________________________

B) Was / Is there any med-legal case against you /your Hospital : (Yes / No) : ___________________________

If, Yes (Give details) _________________________________________________________________ (Attach separate sheet if required)

C) Do you have a Professional Indemnity Policy (Yes / No) : ___________________________

Name of the Company : _____________________________________________________________ Amount : ________________________

D) Do you have Hospital Insurance (Yes / No) : ________________________


E) Do you have Risk Management Policy (Yes / No) : ________________________


F) Is your relative / friend practicing Law ( Yes / No) : _________________________

If Yes, Name : ________________________________________________________________________________________________________

Qualification : _________________________________________ Place of Practice : _________________________________________

Specialized field of practice (Civil/ Criminal/ Consumer / I-Tax, etc) : ______________________________________________________

G) Any other information you would like to share (Yes / No) ____________________________ If Yes, please attach the details

_____________________________________________________________________________________________________________________

I hereby declare that above information is correct. I shall be responsible for any incorrect / fraudulent declarations.

Place : __________________ ____________________________________

Date : __________________ (signature of applicant)

Enclosures: True Copy of Degree, Council Registration Certificate & photograph.

Life Membership fee (individual Rs.3500/-, couple Rs.6000/-) by CBS (At Par, Multicity Cheque) in the name of Indian Medico-legal & Ethics Association (IMLEA) payable at Amravati. Send to Dr.Satish Tiwari, Yashodanagar No.2, Amravati-444606, Maharashtra.


Jan.-Mar.201832

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Special Features of 2nd Edition :-B About 10 new chapters

B Previous Chapters revised & updated

B Many news sub specialities included

B More than 70 national faculties / contributors

B Many important & vital topics covered.

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