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Dr KK AggarwalPadma Shri and Dr B C Roy AwardeeSr Physician and Cardiologist, Moolchand MedcityPresident, Heart Care Foundation of IndiaGroup Editor-in-Chief, IJCP GroupChief Editor, [email protected]
IJCP Group of PublicationsDaryacha, 39 Hauz Khas Village, New Delhi - 110 016, IndiaBangalore, Chennai, Hyderabad, Kolkata and Mumbai
IJCP
Medico Legal AspectsFAQs in
Disclaimer: The copyright for editorial matter is vested in IJCP Group. Although great care has been taken in compiling and checking the information given in the book to ensure that it is accurate, the publisher/its agents and sponsors shall not be responsible for any error omissions or inaccuracy in this publication whether arising from negligence or otherwise. Inclusion or exclusion of any product does not mean that the publisher advocates or rejects its use either in general or particular.
Win-Medicare is in no way directly or indirectly responsible or liable for the development and/or accuracy of the information provided herewith.
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Uniform glamour, its authority
Q. Can a doctor issue a medical certificate without seeing the patient?A. Do not issue a certificate unless you have seen the patient in person. Physical presence of a person is important. There may be circumstances that the family might be asking for a certificate for the purpose of avoiding a court date.
Q. Can doctors issue a certificate of efficiency in practice of medicine?A. A registered medical practitioner shall not issue certificate of efficiency in modern medicine to an unqualified or non-medical person. However, this does not restrict the proper training and instruction of bonafide students, midwives, dispensers, surgical attendants or skilled mechanical and technical assistants and therapy assistants under the personal supervision of physicians.
Q. What guidelines should a doctor follow in signing of professional certificates, reports and other documents?A. Registered medical practitioners are in certain cases bound by law to give or may from time-to-time be called upon or requested to give certificates, notification, reports and other documents of similar character signed by them in
FAQs in Medico Legal Aspects
their professional capacity for sub- sequent use in courts or for adminis-trative purpose, etc. Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of similar nature that is untrue, misleading or improper is liable to have his name deleted from the register.
Consultation and prescription
Q. Should doctors give consultations on e-mail or telephone? A. If you give consultations on e-mail or telephone, you can be liable, if there is negligence. You should try to avoid giving such consultations, unless you are aware of all aspects of the case. For new cases, you should not give a prescription without seeing the patient physically.
Q. Can a doctor write a prescription without seeing the patient?A. This should never be done. Do not even repeat a prescription unless you have seen the patient in person as the patient may not be in the city on the day of your prescription.
Q. What are the norms that have to be followed for prescribing over-the counter (OTC) drugs? A. Any one can prescribe drugs which are OTC, as there are no prescription
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restrictions on these drugs. Most ayurvedic drugs are OTC drugs and there may not be any restriction in their prescriptions.
Q. Can an ophthalmologist prescribe amlodipine to a patient complaining of angina?A. Normally one should not go beyond one’s area of speciality. But as every one has done MBBS, there is no negligence as long as the person is clear for what condition he or she has given the medicine.
Q. If a doctor is not registered under Indian Medical Council (IMC) Act, can he / she write a prescription?A. No, a doctor cannot write a pre- scription in such a case.
Q. What should be the duty of a physician as regards to consultation?A. In cases of serious illness and in doubtful or difficult conditions, the physician should request consultation, but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration.
Q. Can doctors prescribe secret remedies or wonder drugs?A. The prescribing or dispensing by a physician of secret remedial agents of which he does not know the composition or the manufacture or promotion of their use is unethical and as such prohibited. All the drugs prescribed by a physician should always carry a proprietary formula and clear name.
Q. Can a physician called for consultation take charge of the case?A. When a physician has been called for consultation, the consultant normally should not take charge of the case, especially on the solicitation of the patient or friends. The consultant should not criticise the referring physician. He / she should discuss the diagnosis and treatment plan with the referring physician.
Q. What should be the conduct of a physician when called for consultation?A. In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed towards the physician incharge of the case and no statement or remark be made, which would impair the confidence reposed in him. For this purpose, no discussion should be carried on in the presence, of the patient or his representatives.
Consent approval
Q. In what form should the consent be taken?A. Consent of the patients, whenever the situation demands (surgical procedures that are complicated and might even result in complications, etc.) should be in writing. However, in most cases, a verbal consent or an assumed consent (the fact that patient has come to the doctor for treatment) is sufficient.
Q. Can a 16-year-old girl give consent for abortion?A. A minor cannot give consent.
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Q. Who gives consent in an operation which may / will result in sterility?A. In an operation, which may result in sterility, the consent of both the husband and wife is needed.
Q. Who gives consent for in vitro fertilisation or artificial insemination and what is the manner in which it is taken?A. No act of in vitro fertilisation or artificial insemination shall be under- taken without the informed consent of the female patient and her spouse as well as the donor. Such consent shall be obtained in writing only after the patient is provided, at her own level of comprehension, with sufficient information about the purpose, methods, risks, inconveniences, disappointments of the procedure, and possible risk and hazards.
Doctor’s judgement and its consequence
Q. If a doctor, in the emergency room, encounters a poisoning case, what should be his first responsibility, save the patient’s life or complete medico legal case (MLC) formalities?A. In an emergency, one should give priority to saving the life. MLC formalities can be done later. There are clear-cut Supreme Court guidelines for the same.
Q. What is an error of judgement?A. Error of judgement can be defined as a mistake committed by a doctor regarding the diagnosis or kind of
intervention required. It is excusable, provided it is done in good faith and the criteria of reasonable care and skill are adhered to.
Q. What should a doctor choose when there is a conflict between ethical and legal issues?A. When there is a clash of ethical versus legal issues, the legal aspects should prevail over the ethical aspects.
Q. Should a patient be told about his condition / illness even if it is a very serious one? Is it necessary for a doctor to explain the outcome of a test / intervention to the patient?A. Doctors must give sufficient dis- closure of the condition of the patient either to the patient or to the relations. The outcome of the surgery or a test must be explained to the person.
Q. In case of poisoning, what should the doctor do with the gastric lavage sample?A. A doctor should not destroy the evidence in any medico legal case and the lavage sample should be preserved and handed over to the police as it may be used as evidence in the court of law.
Q. Should the police be informed about a suspected case of suicide?A. The police should always be informed about every suspicious case coming in the emergency room, whether suicidal, accident or homicidal.
Q. In case an error has been committed by a doctor, should he / she tell it to
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his patient considering that there is risk of patient filing a case against the doctor?A. A doctor is not supposed to hide anything from his patient. Any mistake on part of the doctor has to be told to the patient by the doctor himself.
Q. Is it necessary to inform the police about the discharge of a MLC patient?A. All MLC patients have to be dis- charged only after the police have been informed about the same.
Q. If a patient is alone and no consent is available for doing a lift-saving procedure, what procedure should be adopted?A. The doctor should proceed with such a procedure. Although taking consent is very important, in a case where it is not obtainable and time becomes a factor, the doctor should get down to saving the life of the patient.
Q. If a doctor is issuing a medical certificate, is he supposed to keep a copy?A. Yes, the doctor should keep a copy of the medical certificate he / she issued.
Q. Should a patient / his relatives be made known about the prognosis of the patient’s condition? What should be the principles followed in doing so?A. The physician should neither exaggerate nor minimise the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such
knowledge of the patient’s condition as will serve the best interests of the patient and his family.
Q. How should a doctor handle a brought-in dead patient in the emergency department?A. In such cases, the emergency room doctor should first of all try to ascertain the duration the patient has been dead. A dead patient may be revived if death happened 1-5 minutes before. Then the doctor should assess the cause of death. If doctor has a slightest degree of suspicion about the cause of death (suicide, homicide, etc.) he / she should inform the police about it.
Responsibilities and Liabilities
Q. If a chemist ends up giving a wrong drug on a doctor’s prescription due to illegible handwriting, who is responsible for the mistake?A. If a chemist gives a wrong medicine on a doctor’s prescription, he is liable and not the doctor. It is the duty of the chemist to call the doctor and clarify, if he has any doubt on the prescribed drug.
Q. Who is liable for mistakes made by the employees of a hospital? A. The hospital is liable for the mistakes done by its paid employees e.g. a nurse, technician, residents, etc.
Q. As most surgeries carry a risk of failure, can a patient hold the doctor liable for an unsuccessful surgery?A. In any surgery, there are chances of
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failure. The patient should be explained about the procedure completely, all possible complications should be explained before hand and a written consent should be taken. A doctor can- not be held liable for any complications as long as he / she has committed no gross negligence. Reasonable care and skill should be maintained at all times.
Q. Can media publish any report against a doctor without consulting him / her? What happens if the doctor is unavailable for comments?A. Media cannot publish a report against a doctor without verifying from him and putting his version also, unless they write that the doctor was not available for comments. In that case, the doctor must write to the editor and ask for the publication of his version in the front page.
Q. If a doctor has clearly made a mistake (drug overdose, wrong drug, etc.) but no harm has resulted to the patient, can the doctor still be held liable?A. A doctor is not liable for the com- pensation if the negligence on his / her part has not caused any harm to the patient.
Q. If a postoperative patient fails to come for a review in the hospital and develops complications later, who is liable?A. In this situation, the patient is responsible for whatever complication occurs provided he / she has been properly explained about the need and frequency of follow-up visits.
Q. What liability is on the part of a patient, if he falsely accuses a doctor?A. In such a case, the patient not only faces dismissal of his case but also a punishment in the form of imprisonment and / or fine.
Some direct legal fallout
Q. If a patient dies when he / she is being transferred from the casualty ward to the intensive care unit, what are the legal liabilities?A. Deaths during transfer can occur in the normal course of action. It should be assessed if reasonable care and skill were provided during all times during the transfer. If the patient was properly attended to and was receiving adequate care and treatment then the medical establishment cannot be held for medical negligence.
Q. Is a doctor bound by any legal guidelines? A. Where clear-cut legal guidelines (an act) are available, one has to abide by them. For example, when to do medical termination pregnancy (MTP) and when not to do. There should be no violation of the legal procedure or the laid down guidelines.
Q. In case of a suspected suicide where the relatives do not want to have a MLC filed, what should the doctor do? What are the legal implications?A. In a case of suspected suicide, even if the relatives do not want to have MLC, the police have to be informed, as
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the doctors will have no defence if the person dies later.
Q. How can a doctor guard himself / herself against a negligence suite?A. Always take indemnity insurance to cover for negligence risk.
Q. If a patient with minor injury comes to a medical establishment, does it come under MLC or not?A. It is not important that the injury is minor or major rather the manner in which the injury was inflicted decides whether it should come under an MLC or not.
Q. What precautions should a doctor take to avoid litigation?A. Besides following the principles of reasonable care and skill, the doctor should have professional indemnity insurance.
Q. What is the procedure followed before suspension of doctor from any medical council?A. It is made clear that any complaint with regard to professional misconduct can be brought before the appropriate medical council for disciplinary action. Upon receipt of any complaint of professional misconduct, the appro- priate medical council would hold an inquiry and give opportunity to the registered medical practitioner to be heard in person or by pleader. If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate medical council may award such punishment as deemed necessary or may direct the removal
altogether or for a specified period, from the register of the name of the delinquent registered practitioner. Deletion from the register shall be widely publicised in local press as well as in the publications of different Medical Associations / Societies / Bodies.
Professional obligation
Q. What should be the difference in the kind of care given by doctors of different qualifications? A. The magnitude of care may be different but the standard of care must be same when treating a patient.
Q. What should be a doctor’s objective besides providing treatment to his patient? Does he have any responsibility towards the patient’s relatives?A. Always provide a human touch to the patient. The objective should be to satisfy the patient and his / her attendants.
Q. If no bed is available in the hospital and the patient is serious, what are the responsibilities of the emergency room (ER) doctor? A. No emergency patients can be refused admission due to lack of beds. It is the duty of emergency room doctor to stabilise the patient first before thinking about transferring the patient to another centre.
Q. Is it necessary for a doctor to accompany a patient during a transfer from one nursing home to another, if facilities for treating such a patient are not available in the nursing home?A. A doctor should accompany a patient
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in such cases. Once a patient is admitted in a nursing home / hospital, he / she becomes its responsibility. If the patient is transferred to another centre then he remains that hospital’s responsibility till the time he / she is accepted by the referral hospital and during this period, the principles of reasonable care and skill have to be maintained.
Q. Can a doctor receive rebates, com-missions, etc. for recommending / referring patients?A. A physician should not give, solicit or receive nor should he offer to give solicit or receive any gift, gratuity, commission or bonus in consideration of or return (or referring, recommending or procuring of any patient for medical, surgical or other treatment). A physician shall not directly or indirectly participate in or be a party act of division, trans-ference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment.
Q. Is it necessary for a specialist to come in the night even if a resident doctor has already seen the patient?A. Principles of reasonable care and skill come into play once more. If it necessitates that a specialist see the patient at night, then it should be done. However, if the resident doctor has seen the patient and the patient manage- ment is adequate, then there is no such a need.
Q. What is the duty of a doctor towards a traffic victim on the road?A. Ethically, a doctor should attend to a traffic victim on the road, but
legally, he is not bound to do so. In this situation, a doctor cannot be held liable for any mistakes he / she might commit till the time he / she does not charge a fee for his / her services.
Q. Should a doctor actively expose unethical conduct of his colleagues?A. A physician should expose without fear or favour any incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.
Q. Should a patient be specifically told about the possibility of ana-phylaxis. How should a doctor deal with such cases?A. Any drug can cause anaphylaxis and the same should be explained to the patient before injecting any drug. It should also be told that a negative sensitivity does not ensure complete protection from the possibility of anaphylaxis. If even after that the patient dies, the doctor is not negligent.
Q. Ethically, what are the obligations of a doctor towards the sick?A. Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated
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to the patient. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency; a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However, for good reason, when a patient is suffering from an ailment that is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.
Q. How should a doctor deal with issues of patience, delicacy and secrecy? A. Patience and delicacy should characterise a physician. Confidence concerning individual or domestic life entrusted by patient to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless the laws of the State require their revelation. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instances, the physician should act, as he would wish another to act towards one of his own family, in like circumstances.
Q. In what circumstances can a doctor break a patient’s confidentiality?A. The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except;
In a court of law under orders of the residing judge
a)
In circumstances where there is a serious and identified risk to a specific person and / or community; andNotifiable diseases.
In case of communicable / notifiable diseases, concerned public health authori t ies should be informed immediately.
Q. Can a medical practitioner without the consent of his / her patients publish their photographs or case reports?A. A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed.
Q. What are the guidelines to be followed for clinical drug trials?A. Clinical drug trials or other research involving patients or volunteers as per the guidelines of Indian Council of Medical Research (ICMR) can be undertaken. Violation of existing Indian Council of Medical Research guidelines in this regard shall constitute mis- conduct. Consent taken from the patient for trial of drug or therapy which is not as per the guidelines, shall also be considered as misconduct.
Q. What is the role of a doctor as regards to euthanasia?A. Practicing euthanasia shall constitute as an unethical conduct. However, on specific occasions, the question of withdrawing supporting devices to
b)
c)
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sustain cardiopulmonary function even after brain death shall be decided only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare withdrawal of support system. Such team shall consist of the doctor incharge of the patients, Chief Medical Officer / Medical officer, incharge of the hospital and doctor nominated by the incharge of the hospital from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994.
Q. Is a doctor liable for disciplinary action, if he indulges in adultery or improper conduct?A. Abuse of professional position by committing adultery of improper conduct with a patient or by maintaining an improper association with patient will render a physician liable for disciplinary action as provided under the Indian Medical Council Act, 1956 or the concerned State Medical Council Act.
Q. Can doctors indulge in prenatal sex determination tests? A. On no account sex determination test shall be undertaken with the intent to terminate the life of a female foetus developing in her mother’s womb, unless there are other absolute indications for termination of pregnancy as specified in the Medical Termination of Pregnancy Act, 1971. Any act of termination of pregnancy of normal female foetus amounting to female foeticide shall be regarded as pro-fessional misconduct on the part
of the physician leading to penal erasure besides rendering him liable to criminal proceedings as per the provisions of this act.
Q. Can a doctor refuse to attend to a patient who is under his charge?A. If a patient is under your charge you cannot refuse to attend him, espe-cially if there is an emergency.
Q. Can a doctor refuse to see a patient / can a doctor choose his patient?A. A doctor is free to choose his or her patient but not in an emergency setting.
Establishment responsibility
Q. In case of a disputed death, can the medical establishment insist for a post mortem?A. Yes, the medical establishment can do so in deaths where the relatives threaten the establishment of a lawsuit so that it is able to present a suitable defence as and when required.
Q. Can medical establishments refuse an admission on the basis that ‘no beds are available’?A. Yes, a medical establishment can refuse admission in nonemergency cases. The patient may either be asked to come later or be referred to another hospital.
Q. If an establishment does not have angiography or bypass surgery facilities, can the establishment admit a patient with heart attack?A. The establishment can admit a patient in these circumstances and adequate
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treatment and care should be provided after fully explaining to the patient about the lack of these facilities in the hospital. As and when the patient is in need of angiography or bypass surgery he / she should be transferred to higher centre and the possibility of the same should be made known to the patient before hand. It is always better to have such tie-ups.
Q. How long is a hospital supposed to keep the case records of an admitted patient?A. Records for an admitted patient should be kept for a minimum of 3 years.
Q. Should medical records of a patient be released, if patients / attendants or legal authorities make a request for doing so?A. Patients / authorised attendant or legal authorities involved in the same may be duly acknowledged and documents should be issued within a period of 72 hours.
Q. When a road traffic accident patient is brought to a nursing home without any attendants, and first-aid has been provided but further facilities are not available in that medical establishment, what role should the medical establishment play at that moment?A. In such cases, medical authorities should try their best to stabilise the patient within their limitations adhering to the principles of reasonable degree of skill and care. After having done this, medical establishment should make all the necessary arrangements to shift the patient to a better-equipped centre.
Q. If multiple victims of a natural disaster are brought to medical establishment, what are the duties of the establishment?A. Every medical establishment should have a disaster management programme and a disaster management team. In situations where multiple victims of a natural disaster are brought in, these programmers should come into play without any delay and the principles of optimum care and skill should be adhered at all times.
Q. Is it necessary for a medical establishment to have an ambulance of their own?A. It is not necessary. However, the establishment should have a tie-up in such cases with any organisation that can provide ambulance services as and when needed without delay.
Q. Is it necessary for a medical establishment to have blood bank or CT scan centre of their own?A. The above mentioned principle would also apply for blood bank and CT scans. The hospitals should be able to provide these services by having a tie-up with another organisation.
Q. If a patient dies while being transferred from home to the hospital in an ambulance, what are the responsibilities of the hospital?A. It is the responsibility of the hospital to provide reasonable care and skill at all times to its patient. If a patient dies in an ambulance due to want of essential medical care (which may be due to lack
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of basic medical facilities or competent medical personnel in the ambulance) then the responsibility of such a death falls solely on the hospital. If such a mishap occurs in spite of the hospitals best efforts to provide optimum care to the patient, then it cannot be held responsible.
Q. If an establishment does not have a bed in ICU; can they admit the patient in the ward and provide the complete treatment?A. Yes, after informing the patient’s relatives, and provided the patient is getting complete treatment as might be necessary in a given case. There should be no deficiency of services in a ward as compared to the intensive care unit (ICU) and principles of reasonable care and skill should be followed.
Q. If a specialised nursing home without gynaecology services receives a pregnant lady with labour, what should be done?A. Any case of normal labour does not need specialist handling. Nursing homes without gynaecology services can handle such cases. However, it should be explained to the patient and relatives that the nursing home does not have gynaecology services, and as and when specialist care might be required, the patient will have to be shifted to another centre.
Q. What are the circumstances under which a doctor / medical establish- ment cannot refuse treatment?A. A doctor / medical establishment cannot refuse treatment to patients who require emergency care.
Q. If a medical establishment does not have a blood bank of its own and a patient dies before the blood is procured from another institution, does it come under medical negligence?A. An emergency case of acute blood loss can be managed on fluids alone. However, if death does occur before procurement of blood and it is established that the hospital during this period did not adhere to the principles of reasonable care and skill, it can come under medical negligence, otherwise not.
Q. If there is a delay in starting an antibiotic, can the hospital be liable?
A. If it has been clearly established that the patient requires antibiotics and there has been a delay in starting the same resulting in deterioration of patients’ health as a direct result of this act (of omission) then it will be consi-dered negligence. The hospital will be held liable in this situation.
Q. In case of a blood transfusion reaction, who is liable, the hospital or the blood bank from where the blood was procured?A. Everyone, as there are safeguards at every level and a transfusion reaction occurs if there is a lapse at any level.
Inter doctor relationships
Q. If there is a difference of opinion between doctor and the consulting physician, should it be divulged to the patient?A. Differences of opinion should not be divulged unnecessarily; however, when
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there is an irreconciliable difference of opinion, the circumstances should be frankly and impartially explained to the patient or his relatives or friends. It would be then open to them to seek further opinion, if they so desire.
Q. Should there be a dependence of physician on each other?A. A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family, dependents.
Q. Can a physician play the substitute for another physician during his absence?A. Whenever a physician requests another physician to attend his patient during his temporary absence from his practice, professional courtesy requires the acceptance of such an appointment only when he has the capacity to dis- charge the additional responsibility along with his / her other duties. The physician acting under such an appoint-ment should give the utmost consi-deration to the interests and reputation of the absent physician and all such patients be restored to the care of the latter upon his / her return.
Publicity and advertisement
Q. Can a doctor indulge in any sort of publicity or advertisement?A. Publicity is strictly prohibited. There are clear cut guidelines in the Medical Council of India (MCI) act as to when and how one can use publicity modules for his start or change of practice.
Q. In what circumstances can doctors advertise?A. Soliciting of patients directly or indirectly by a physician, by a group of physicians or by institutions or organisations is unethical. He / she cannot advertise his practice in any way. Neither can a doctor recommend / endorse any particular drug or product. However, medical practitioner is permitted to make a formal announcement in press regarding the following;
On starting practiceOn change of type of practiceOn changing addressOn temporary absence from dutyOn resumption of another practiceOn succeeding to another practicePublic declaration of changes.
Q. Is a doctor supposed to display his / her registration number?A. Every physician should display the registration number accorded to him by the State Medical Council / Medical Council of India in his certificates and in all his prescriptions, certificates and money receipts given to his patients.
Q. Doctors display as suffix various degrees / honours. What should be the code followed in this regard? A. Physicians should display as suffix to their names only recognised medical degrees or such certificates / diplomas and memberships / honours which confer professional knowledge or recognise any exemplary qualification / achievements.
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Q. Can a doctor patent or copyright any thing?
A. A physician may patent surgical instruments, appliances and medicine or copyright applications, methods and procedures. However, it shall be unethical if the benefits of such patents or copyrights are not made available in situations where the interest of a large population is involved.
Q. Can a physician talk to the press about diseases and treatments? What are the guidelines to be followed?
A. A physician should not contribute to the lay press articles and give inter-views regarding diseases and treatments, which may have the effect of advertising himself or soliciting practices, but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio / TV / internet chat for the same purpose and send announcements of the same to the lay press.
Q. Can doctors advertise an institution run by him?A. Institutions run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution, etc. may be adver- tised in the lay press, but such adverti-sements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees.
Practice competency
Q. Is a medical practitioner allowed to practise, if he develops an incapacity or handicap? A. Medical practitioner having any incapacity detrimental to the patient or which can affect his performance vis a vis the patient is not permitted to practise his profession.
Q. Can a physician claim to be a specialist in a branch only because he has experience of working in that field?A. A physician shall not claim to be a specialist unless he has a special qualification in that branch. Mere experience does not mean that a doctor can call himself a specialist.
Q. Can an HIV positive doctor continue practice?A. Yes he can, only if he indulges in practices / procedures which do not put his patients at any risk of contracting the virus from him.
Call of duty
Q. What should be done, if a doctor is called upon to attend an emergency when he is attending a social gathering and has consumed alcohol?A. A doctor cannot attend to an emer- gency under the influence of alcohol. Always arrange for an alternative.
Q. Can an ayurvedic doctor prescribe an allopathic medicine?A. A doctor should not prescribe
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drugs from those branches of medicine they have not studied.
Q. If a doctor is unwell / sick, is he still bound to attend to his patient?A. If a doctor is unwell, he is not bound to attend his patient. He should ideally arrange for a replacement to manage his patient.
Billing
Q. If a patient refuses to pay for the treatment in the medical establish-ment, what should be the course of action taken by a doctor?A. In such an eventuality, the doctor can go to the civil court or take help of the Consumer Protection Act.
Q. Can the services provided in the casualty or emergency room be charged?A. Yes, these services can be charged. However, emergency care should be provided irrespective of the ability of a patient to pay.
Q. What can be the maximum fee of a specialist?A. There is no such limit. Any doctor should announce his fees clearly to the patient before rendering his services and the same should be charged. A doctor can refuse to treat a nonemergency patient if he / she is not in a position to pay the doctor’s fee, though this practice may be considered unethical.
Q. At the time of the death of a patient in the hospital, if a blood relation
refuses to pay the hospital bill, what action can the hospital take?A. In such a situation, the hospital can approach the civil court or fight the case under the provisions of Consumer Protection Act. It cannot refuse to release the body of the patient.
Q. Can a hospital insist on advance payment at the time of admission?A. A hospital can do so in a nonemer-gency setting.
Q. Can a doctor charge more money for a night visit?A. There is nothing illegal in such a practice. A doctor should announce such a demand before starting the treatment clearly to the patient and the same amount should be charged on finishing the treatment.
Going by definition
Q. What is negligence, how will you define it?A. Medical negligence is different from error of judgement. Any difference of opinion is not negligence. Negligence is always a deficiency. The same can be delay in starting the treatment, omission or commission of something, which a reasonable man would not have done.
Q. How is ‘SERVICE’ defined under Consumer Protection Act (CPA)? Who comes under the preview of CPA?A. Under Section 2(1) (0) of CPA 1986, private hospitals and many medical professionals fall within the scope of the expression called ‘SERVICE’. In
the event of any deficiency in the performance of such services, the aggrieved party can invoke the remedies provided under CPA. Three categories have been broadly defined:i) Where services are rendered free
of charge to everybody falling in said services;
ii) Where charges are required to be paid by everybody falling in the services; and
iii) Where charges are required to be paid by persons falling in services but certain categories of person, who cannot afford to pay, are rendered services free of charges.
As per the Supreme Court, the services rendered by first category of doctors and hospitals would not fall within the ambit of ‘SERVICES’ under Section 2(1) (0) of the Consumer Protection Act, 1986. On the other hand, the services by the second and third categories of doctors and hospitals would fall within the ambit of services as defined by the CPA, 1986.
Q. Can a doctor run a full fledged shop to dispense drugs and appliances?A. A physician should not run a full fledged shop for sale of medicine for dispensing prescriptions prescribed by doctors other than him or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances
as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formula as well as generic name of the drug.
Q. How is reasonable degree of skill and knowledge defined?A. Courts have dealt with such pro- blems having regard to the peculiarity of each case and relevant law on the subject, particularly the common practice in vogue. In most cases, the expert evidence plays a vital role and experts on the line are examined in detail to asses the treatment of omission or commission, which would be expected from any reasonable man. These may be analysed in light of the various writings by the learned members of the profession.
Q. What can be done about drugs with similar sounding names which can cause confusion to a pharmacist / patient?A. The use of generic names of drugs rather then trade names should also be encouraged amongst doctors. There are a lot of drugs with similar spelling (e.g.) Dynasprin is an aspirin containing drug, and Dynapress is used in benign prostatic hyperplasia (BPH). The association should approach the government so that such similar names are not permitted.
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