my patients attnedants are planning a litigation; how should i be prepared

litigations in medical practice and measures to be ready for it

1. MY PATIENT’s ATTENDANTS ARE PLANNING FOR LITIGATION: WHAT PREPARATION I HAVE TO DO Dr Aditya Nath Shukla Regency Hospital Ltd Kanpur

2. Incidence of Litigation

3. Incidence of Litigation

4. Incidence of Litigation

5. Incidence of Litigation

6. Reasons for litigation Mortality Complications leading to prolonged suffering/ disability/death Unsatisfied patient/ family

7. Unsatisfied family: barrage Physical aggression Threatening calls Social media abuse and misinformation Bad press and publicity Complaints with Police Human rights commission Prime Minister/ Chief Minister grievance portal Medical council ethics committee Consumer forum Criminal court

8. Physical aggression Identify the problem early Non responding patient Exceptionally high expectations New attendant every other day Feigning and complaining nothing was informed Large unpaid dues Prepare Inform administration of hospital Seek help of colleagues Give option of second opinion explanatory summary, document receiving Document the counselling, prognosis and option of second opinion Refer the patient to other hospital Arrange Support Staff and security of hospital Police IMA & Professional colleagues

9. Threatening Calls Avoid calls from unknown numbers Record calls esp. those from unknown numbers/ identified numbers Complaint to legal authorities Gather social support ± meeting the aggrieved family members with colleagues/ support

10. Legal Notice First legal recourse taken by aggrieved family Contents: Mostly describing the circumstance The complaints and demands, listing the alleged shortcoming on treating team Gives an account of complaints and demands Provides an opportunity to prepare demands on the lines of complaints To respond depends on the circumstances Mostly the only step taken by family

11. Civil Suits Consumer Redressal forums/ courts District : up to 50 lakhs State: 50 to 200 lakhs National: above 200 Lakhs

12. Criminal complaints Through Police/ Criminal courts Medical enquiry committee constituted by CMO to look in allegations on medical grounds of the case Constituted on the basis of SC judgement in the case of “ Jacob Matthews Vs State of Punjab & others 2005 (the power greatly enhanced by SC judgement of 2022 case in front of Bench headed by Justice A S Bopanna) The results of CMO enquiry forms the framework on which judgements are delivered largely

13. Preparation for Defence Identify every patient as a potential litigant: adequate care and caution in treatment, communication and documentation Better and Clear Communication Better and near complete documentation Always document the reasons behind the drug/ intervention/ treatment offered Obtain Informed consent

14. Documentation Chronological Plan of care along with problems documented Crisp and clear Little or no overwriting Proper informed consent from patient if capable or surrogate as per legal chain of succession Documentation of daily progress and problems encountered Instructions and treatment as per prevalent guidelines Should be able to defend use of a drug or technique if questioned later on

15. Documentation & Referrals Proper referrals to specialists for the problems encountered Referral to a facility with infrastructure and specialist support in case it is not available in present facility. Only in places patient is unstable for transport and non availability of specialist facility should continue to treat the patient aiming for stabilization In Case an indicated therapeutic option is there for a disease condition and facility not available the patient should be referred to facility with the treatment

16. Consent Informed consent is the cornerstone of defence Should be taken from patient if capable Surrogate if patient is not capable to give consent Surrogate hierarchy Demographic variants, diagnosis, treatment offered, common complications, alternative treatment options, adverse consequences of refusing treatment Name,Signature and registration number of treating doctor

17. Preparation for Defence Follow up and Seek Feedback Identify and manage expectations of patient and family Be Direct and Honest even when things go wrong Embrace and use feedback

18. Prepare Defence Adequate Medical Indemnity Insurance cover Inform Indemnity Insurance company in writing giving complete details Take a receiving from insurance company office Enquire about the lawyer appointed by company Can take personal lawyer but the insurance company needs to be informed about it and seek his/ her renumeration from insurance company if possible Discuss the case details in detail with attorney, explain the medical condition, treatment and complications if any in clear terms without any ambiguity

19. Prepare Defence Collect medical literature in support of treatment plan, known complications (textbook> guidelines> drug monographs> journal articles) Follow up the case as it progresses in court. Details available online in most cases (higher courts). Seek the certified copy of file from court to confirm the progress if unable to follow up regularly Change the attorney if need arises or suspicion of failure is there Be present in the court at time of oral arguments to assist the lawyer in explanation of medical records to the court bench

20. Thank you for your attention