Contents

Section I Medical Ethics and Law

1. The Ethics of Medical Practice

VP Singh, Parmod Goyal

Medical Ethics 3;Autonomy3;Beneficence4;Nonmaleficence4

Does Paternalism Really Serve the Purpose? 5
Should Physicians do Whatever Patients Say? 6; What Serves the Patient Best? 6
Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations 7

2. Confidentiality and Disclosure in Medical Practice

VP Singh, Akashdeep Aggarwal

When Confidentiality may be breached? 17; Guidelines on Medical Confidentiality 18

Right to Information Act and Medical Confidentiality 19
Medical Confidentiality and HIV Status 21; Guidelines on HIV Testing (March 2007) 22
Judicial Decisions on Medical Confidentiality and HIV Status 23
HIV Testing of Patients Prior to Surgery 23

3. Disclosing Medical Errors: Why, When and How?

VP Singh, Gautam Biswas

Medical Errors 26; Disclosure of Medical Errors 27

Consequences of Disclosing Medical Errors 28
Guidelines on Disclosing Medical Errors 29

4. End of Life Care Decisions: Ethical and Legal Issues

Rashmi Datta, Pradeep Sreevastava, Arvind Kumar Singh

Palliative Care at the End of Life 35; Magnitude of the Problem 36

Medical Futility 36; Withholding or Withdrawal of Life Support 37
Advanced Directives and Do-Not-Resuscitate Orders 38;Euthanasia39
Implications to Human Organ Transplantation Act 39
Legal Aspects of End of Life Issues in India 40

5. Medical Professionalism: Focus on Communication Skills

Shalini Ratan

Physician and the Patient: A Changing Relationship 43; The patients Perception 44
Engaging Patients Through Effective Communication 45
Miscommunication to Litigation 46; Physician-patient Communication in Practice 46

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Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice

Section II Documentation of Patient Care: The Legal Aspects

6. Medicolegal Aspects of Informed Consent

51

VP Singh, Dasari Harish

Evolution
51;Objectives52;Meaning53

What Makes the Consent Legally Acceptable? 54;Exceptions57

Obtaining Consent: The Procedure 57; Documentation of Informed Consent 57

Judicial Decision on Informed Consent 58

7. Medicolegal Aspects of Medical Records

Joseph Thomas, Arun Mavaji Seetharam

Types of Medical Records 61

Electronic Health Records: An Emerging Trend in India 62
Guidelines on Medical Records 64; MCI Guidelines 64
NABH Guidelines 64; Medicolegal aspects of Medical Records 69
Ownership of Medical Records 69; Summoning Medical Records by Courts 70
Judicial Decisions Related to Medical Records 70

61

Section III Litigation Against Medical Practitioners

8. Medical Negligence: Meaning, Scope and Legal Interpretation

VP Singh, Vivekanshu Verma

What is Medical Negligence? 75; Essential Components of Medical Negligence 75

Types of Medical Negligence 77; Burden of Proof of Medical Negligence 78
Yardstick used to determine Medical Negligence: The Bolams Rule 79
Criminal Liability of Medical Professionals 80
Guidelines: Prosecution of Doctors for Criminal Rashness or Criminal Negligence 81

9. How to Defend Medical Negligence Lawsuit?

VP Singh, MC Gupta

Pattern of Complaints against Medical Practitioners 83

Complaints under Consumer Protection ActStep-by-Step Approach 83
Facing the Court: Medicolegal Tips and Advice 86

10. Compensation in Medical Negligence: How much is Justified?

VP Singh, Mukesh Yadav

Compensation in Medical Negligence 89

Multiplier Method: Can it be Used in Medical Negligence Cases? 89
How Much Compensation is Just and Adequate? 92
Impact of High Quantum of Compensation 92
Medical LiabilityA Future Crisis: Learning from the Other Countries 93
Crisis Reform Models 93; Caps on Noneconomic Damages 93
No-fault Compensation 94; Health Courts 94

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11. Professional Indemnity Insurance: Better Safe than Sorry

Rajendra S Bangal

Professional Indemnity Insurance 97; What does it Cover? 98

What it Does not Cover? 98; AOO: AOY Ratio 100
Premium Rates (Individuals) 100; Premium Rates (Individuals) 100
Premium Rates (Clinical Establishments) 100; Retroactive Date 101
An Ideal Indemnity Insurance Policy: Proposed Components 101

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Section IV Medical Laws and Judgments Governing the Medical Professionals

12. Landmark Judgments Related to Medical Professionals

VP Singh, Krishnadutt Chavali

Dr Suresh Guptas Case 105; Jacob Mathews Case 107

Supreme Courts Observation on Negligence 108
Martin DSouzas Case 109; V Kishan Raos Case 111
Supreme Courts Observation on Expert Medical Opinion 111
Supreme Courts Observation on Martin DSouzas Case 112

13. Medicolegal Outlook on Transplantation of Human Organs Act

Sunil Shroff, Sumana Navin, Hemal Kanvinde, Sujatha Niranjan, Christopher Barry

Transplantation of Human Organs and Tissues Rules 2014 113

Medicolegal Aspects of Living Donation and Transplantation 115
Medicolegal Aspects of Deceased Organ Donation and Transplantation 116
Future Challenges 117

14. Medicolegal Outlook on Biomedical Waste Management Act

VP Singh, Pardeep Singh

Biomedical Waste 120; Biomedical Waste (Management and Handlings)

Rules, 1998 121; Penalties under the Environment Protection Act 130

15. Medicolegal Outlook on PC-PNDT Act

Chandrashekhar A Sohoni

Preconception and Prenatal Diagnostic Techniques Act in a Nutshell 132

PC-PNDT ActControversies and Practical Difficulties: Safety Measures to be
taken by the Doctors 135

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Section V Medicolegal Issues in Various Specialties

16. Medicolegal Issues in Obstetrics and Gynecology

Charu Mittal, Prabuddh Sheel Mittal

Medicolegal Issues in Obstetrics 144; Medicolegal Issues in Gynecology 148

Medicolegal Issues in Perioperative Patient Care 148
Surgical Complications: Medical and Legal Implications 150

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Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice

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Specialist as an Expert Witness in a Court of Law 151

General Precautions during day to day Practice:
Avoiding Malpractice Lawsuits 152

17. Medicolegal Issues in Surgery

Manu Shankar

Preoperative Period in Surgery 154; Peroperative Period 156

Postoperative Period 156; Consent in Surgery 157
Role of Anesthesia 157; Surgical Complications 158
Never Events in Surgery 159; Take Home Message for the Surgeons 160

18. Medicolegal Issues in Orthopedics

Sarvdeep S Dhatt, Siva Swaminathan S

Why Orthopedicians are Vulnerable to Malpractice Lawsuits? 162

Consent in Orthopedics 163; Complications in Orthopedics 164
Wrong-Site Surgery 164; Avoiding Malpractice Lawsuits 164

19. Medicolegal Issues in Ophthalmology

Dinesh Verma, Amandeep Singh

Medicolegal Issues in Ophthalmology 167

Vulnerable Domains in Ophthalmic Practice 168
Managing the Risk of Lawsuits 171

20. Medicolegal Issues in Pediatrics

Yogesh Dave

Why Study Medicolegal Issues in Pediatrics? 175

Informed Consent in Pediatrics 175
Error in Diagnosis during Emergencies 176
Patient Safety in Pediatrics 177
Neonatal Intensive Care: Vulnerable to Malpractice Lawsuits 177
Communication SkillsKey Role in Pediatrics 178

21. Medicolegal Issues in Radiology

Chandrashekhar A Sohoni

Errors in Radiology 181; Judicial Decisions on Radiological Errors 184

Why Radiology is Vulnerable to Medicolegal Conflicts? 182
Avoiding Litigation in Radiology 186

22. Medicolegal Issues in Blood Transfusion Practice

Ranabir Pal, Gautam Sarker, Debashis Sinha

Where we Stand as of Now in India? 189; National Blood Policy 189

Medicolegal Aspects in Blood Transfusion Services 191
Challenges of Blood Screening 192; Who will Bell the Cat? 193
Take Home Message 194

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23. Medicolegal Issues in Dentistry

Shilpa Pharande

Medicolegal Aspects of Dental Practice 197; Medical Emergencies in Dentistry 198

Protection Against Litigation 201; How to Avoid Litigation? 201

24. Medicolegal Issues in Anesthesiology

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205

Manpreet Singh, Ajay Kumar, Lakesh Anand

Standard of Care 205; Duty of Care and Liability 206

Medicolegal Issues in Anesthesiology 206; Error of Judgement 209
Mistake
210; Burden of Proof 210; Res ipsa loquitur 210

How to Decrease the Likelihood of a Lawsuit? 211

Accepted Practices and Procedures 212

Accidents, Misadventures, and Mishaps 212

Inherent Risks 213; Choice of Treatment 213

Keeping the Professional Knowledge and Skill up-to-date 213

Cases to Observe 213

Index 217