Dr. Anant Deshpande
Head, Indian Medico Legal Consulting Services Pvt. Ltd.
Dr. Krishna Prasad Kudlu
Director, Prasad Nethralaya,
Udipi, Karnataka
Dr. T Nirmal Fredrick
Managing Director, Nirmals Eye Care Hospital, Tambaram, Chennai
Dr. Anant Deshpande, a medico legal consultant and Chairman of the legal Committee AIOS and MOS as well as head of Indian Medico Legal Consulting Services Pvt. Ltd gives an insight into the world of medicolegal issues.
Dr. Anant Deshpande has seen it all when it comes to medicolegal situations in ophthalmology. Whether it is tumultuous cases or bizarre judgments or some unnecessary actions, the outcomes help guide future course of action when it comes to intermingling of legality with medicine.
With respect to ophthalmology, Dr Deshpande recalls a few situations which the doctors need to be aware of. He says “Because of amendment to section 354 in the Indian penal code, that is, the section dealing with women’s modesty, there is a need for ophthalmologists to be alert.” He recounts a case and refers to “State of Punjab vs. Major Singh, where a three judge bench of the supreme court held that “The modesty of an adult female is writ large on her body, young or old, intelligent or imbecile, awake or sleeping, the women possesses a modesty capable of being outraged and outraging her modesty commits an offence punishable under section 354”. The relevance is that if an ophthalmologist touches her leg by mistake while examining on slit lamp and she wants to extract money from him she can complain of immodesty. In such situation, what should he do? “Cases of this sort have been lodged” he recalls. CCTV cameras go a long way in safeguarding doctors and one may place it strategically but clearly visible in order to prevent and protect from such situations.
He adds, “In my opinion, the best way to avoid and tackle litigation is to have a good system of documentation in place. Always complete your documents, no matter what the hurry.” A few cases which exemplify this are Nihal Kaur vs. Director PGI Chandigarh where the state commission held negligence on the basis in which records seemed to be manipulated with.
Another case which exemplifies this is Force vs. M Ganeswara Rao where the state commission held that there was medical negligence as the case sheet did not have a proper history, history of prior treatment and investigations. Even the consent forms were missing. Not only is it important to document findings but in certain situations, the report needs to be given to the patient as well. A case which exemplifies the need to provide reports and films of investigations to patients is VP Shanta vs. Cosmopolitan Hospitals (P) where the state commission held that failure to deliver X-ray films is deficient service. The patient and his attendants were deprived of their right to be informed of the nature of injury sustained.
“Because of Amendment to Section 354 in the Indian Penal Code, that is, The Section Dealing with Women’s Modesty, there is a need for Ophthalmologists to be Alert.”
“Accreditation cannot prevent the Medico Legal incidence, but it is definitely useful to change the opinion about the Standards of your hospital in the mind of judges, which may affect the result of the case.”
Dr Deshpande, while emphasising the need for proper documentation says “Consent forms cannot reduce the litigation, they may help in the Court. In criminal cases it helps definitely but in consumer court it has little value. As the consent may be exuberant to cover all possible complications but in the consumer court, case is lodged on the basis of negligence and not on the basis of complications. Complication is not negligence but not knowing the complication and not taking proper steps to rectify or not referring the patient at right time and right place is negligence. Doctors should keep the record of referral with signature of patient with, time and date of referral. This can be produced in the court and that can save the doctor.”
When questioned regarding whether getting an eye centre/clinic accredited helps reduce the risk of a medicolegal incidents, Dr Anant says “Accreditation cannot prevent the Medico Legal incidence. But it is definitely useful to change the opinion about the standards of your hospital in the mind of judges, which may affect the result of the case.” Dr T Nirmal Fredrick, who is a Principal Assessor with NABH QCI and practices in Tambaram, Chennai strongly recommends NABH accreditation and states that “The good practices which accreditation enforces go a long way in being a legal safeguard. Accreditation ensures patient satisfaction through better communication, documentation and improved outcomes. Most of the medicolegal risks are due to poor communication, poor maintenance of facility and equipment, improper consent, patient safety events and healthcare associated infections. A well-structured and monitored accreditation reduces these risk factors and improve patient safety.”
Despite best efforts, litigations are a reality that doctors have to deal with and this makes it imperative to have an indemnity insurance which would take care of legal expenses and any compensation claims that may arise. Most hospitals now mandate the need for an indemnity insurance prior to onboarding or hiring a doctor. Dr Krishna Prasad Kudlu, director of Krishna Prasad Nethralaya in Karnataka feels that AIOS should tie with insurance companies and provide a uniform indemnity insurance platforms to its members. This will ensure that AIOS members get adequate protection and the insurance firm is pressured to give good service. AIOS does have a legal cell and looks at matters which involves majority of its members such as the new regulations within the gambit of the PNDT act.