Medico-Legal Issues | Jindal Chest Clinic

Overview on "Medical-legal issues" including consent, legal and wthical issues, etc. For more information: reach us: www.jindalchest.com

2. Medico-Legal Issues
1.Consent
2.Handling‘medico-legalcases’(Medicaljurisprudence)
3.Record-keeping–dulycataloguedandindexed
4Court–attendance
5.Adequatecare–Medical-negligence

3. Do Not Record (on Files) / Must to avoid
1.Allegations,disputesandanger
2.Agitatedcounter-opinions
3.Whatelsecanbedone?
4.Whatelsecouldhavebeendone?
5.Justifications
6.LaterAlterations/Deletionsofinformation

4. Record-Keeping : Importance
1.Treatmentofpatient–daytodayprogress–toguideself,others(e.g.
thosecalledforconsultation)
2.Follow-upmanagement
3.Medico-legalpurposes
4.Insurance/Paymentdisputes
5.MedicalResearch–dataanalysis(ICDIndexCodes)
6.‘RighttoInformation’(RTI)ACT
7.Consumer-CourtrequirementsunderCPA-MedicalNegligence

5. What to Record?
1.CompletionofPage1(Admn.Records)onthefile
LegibleName,Age,Sex,Addressdetails
AccuratedatesofAdm/Dis/Death
ComprehensiveDiagnosis
Signatures
2.Detailedcasehistoryandexamination
3.Dailyprogress(Medical)notes,opinions,consultation,Decision-making
4.Investigations–Makeanoteofimportanttestsinthefile

6. Consent
Expresswillingness/Agree/Givepermission
Voluntaryagreement
1.Informed-Doctor’sresponsibilitytodisclosethenecessary
informationtosecureconsent
2.Realconsent-Doctormustwarnhispatientofthe(Bolam’sLaw)
inherentrisksoftherecommendedtreatment;Inaccordancewiththe
acceptedpracticeconsideredproper(byaresponsibleMedicalBody)

7. Real Consent
i.Voluntary
ii.Capacityandcompetencyofpatient
iii.Adequatelevelofinformation(Remoteriskofharm,1-2%risk,need
notbedisclosed)
 SupremeCourtofIndia
 SamiraKohlicase(2008)

8. Medical Negligence

9. Incompetent Patient
1.Children
2.Mentallydisadvantaged(DownSyndrome)
3.Unconscious/Alteredsensorium
4.Prisoners
5.Mentaldisorders/Schizophrenia(Propercertification)
6.Unabletohear/understood–languagebarrier

10. Seeking Consent
1.Fromthepatient(competent)
2.Attendants(closerelative)ifincompetentpatient
Properidentificationandrecordingofname,address,relationship
Betterifattestedbyothers
3.ConsentforSurgery/Riskymanagement/Resuscitation/Postmortem

11. Summons
1.Tobeaccepted,always
2.TobereturnedwithrequesttotheCourtincaseofincompleteand
untraceableinformation(Politelanguage)
3.ExtremecareforsummonsfromtheSessionsCourt/HighCourt–Must
attend.
4.Requestforpostponementifnoticeis‘tooshort’or‘veryurgentwork’
5.Mustattend,ifsummonedsecondtime.

12. Medico-legal Cases
Typeofcases
i.Grievousinjuries–Drowning,hanging,rape,attemptedsuicide
ii.Poisoning,evenifaccidental
iii.Grievoustrafficinjury(duetopatient’smistake)
iv.Extensive(>40%)burns,evenifaccidental
v.Grievousinjuries–evenifaccidental
Fallfromaheight
Underearthmoundburial,Electricshock,Lightening
vi.Attemptedabortion(unauthorized)

13. Procedure
1.InformationtothelocalPolicePost
2.Putanoteaboutthisinthefile.Mark“M.L.C.”onthefile.
3.MLCProformatobeprepared
4.‘Notfittomakestatement’–recordingandreporting
5.Patientstatementanddyingdeclaration,preferablyinthepresenceofa
Magistrate/othersavailable(Dulysigned)
6.Informpolicebeforedischarge(andondeath)

14. Consent -Issues
1.ConsentvsMedicalAdvice
2.Freeandvoluntary
3.Competent(vsincompetent)patient
4.Proxyconsent
5.Withdrawlofconsent

15. WHO Declaration on Promotion of patients’
rights
“Patientshavetherighttobefullyinformedabouttheirhealthstatus,including
themedicalfactsabouttheirconditions;abouttheproposedmedical
procedurestogetherwiththepotentialrisksandbenefitsofeachprocedure;
aboutalternativestotheproposedprocedures,includingtheeffectofnon-
treatmentandaboutthediagnosis,prognosisandprogressoftreatment”.

16. Withholding / Withdrawing life-supportive
treatments
Assistedventilation
Otherlife-supports
Resuscitation
“DoNotResuscitate”
Whennottoresuscitate

17. Ethical (Moral) Issues
Legaloverlap/contradictions
Resuscitation
Withholding/withdrawaloflifesupportivetreatments
MedicalResearch(Theses)
Publications-Copyrights