You are on page 1of 13

www.

eastzon
emedico.com
www.eastzone
medico.in
To Crisis Trauma

To Be Continue........

Causes for lawsuits against


Some oforthopedic
the major reasons
behind why :orthopedic surgeons are subjected to
surgeons

lawsuits are:
Poor results obtained from treatments.
Improper treatment.
Improper communication/documentation.
Infection.
Diagnostic errors.
Wrong side/level surgeries.
Nerve/vessel injuries and Compartment Syndromes
Common injuries in legal Forums: The top ten conditions that lead to frequent
medico-legal cases in orthopedics are:
1. Fractures of femur.
2. Fractures of tibia.
3. Disc lesions.
4. Osteoarthritis (Arthroplasty).
5. Fractures of radius and ulna.
6. Ankle injuries.
7. Knee ligament/menisci injuries.
8. Back disorders, lubago sciatica.
9. Humerus fractures.
10. Hand injuries.

How to prevent or reduce medico-legal cases in


Orthopedics:
Here are some ways orthopedic surgeons can take precautions and
prevent their cases from ending up in legal battles:
Ensure clear and complete communication and Documentation: As
with any other fields, good communication and establishing a
friendly relationship with the patient is of paramount importance.
The patient should be explained thoroughly about the nature of the
injury, treatment options, and possible complications that are
serious and frequent. Every step taken from the time of examination
till the patient is last seen has to be documented properly. The
consent of the patient should be taken prior to each
procedure/surgeries individually. All the documentation should be
objective avoiding subjective documentation. Most importantly, be
sure to make all your documentation legible.
Do not hesitate to order for any required investigations, however
repeated, it may be: The essentiality is to avoid wrong diagnosis.
Always adopt a standard, universally accepted protocol during the
management of the Condition: While referring to procedures in a
standard textbook, due attention should be given to evidence-based
orthopedics. Update your knowledge periodically as and when
required .

Do not compromise on the OT setup: Never compromise


on the standards of the OT because more and more
evidences are available about avoiding infection in a
standard set-up.
Mark the side to be operated on: To avoid performing
surgeries on the wrong side, educate the supporting
staff about the method to identify the correct surgery
side and location. Additionally, just before the surgery,
double-check whether the correct side has been
marked.
Be sympathetic when things go Wrong: If complications
occur during the course of treatment be sympathetic
with the patient. Explain the complication and the
corrective plan required to handle the complication.
When in doubt, consult your seniors or colleagues about
the management of complication. Do not hesitate to
refer the case to the concerned expert when required.
Never get into any settlements without legal
Assistance: Paying some amount of money is as good as
accepting your negligence, whatever be your intention.
Always respond to the legal notice served by the
patient, because a non-response amounts to neglGENCY

Emergency case in a medical sector


When you arrive at emergency, whether by your own means
or in an ambulance, you are met by a specialized nurse. This
health professional, together with a resident doctor,
determines the severity of your case on the basis of your
complaints andfactors such as blood pressure, pulse,
temperature and pain.Following this assessment, you are
attributed a level of urgency. This establishes how quickly you
will receive medical care and the most appropriate place for
it.A resident regularly re-assesses the situation at the
patients request or as the nurse requiresAll life-threatening
cases are seen immediately by a doctor. In all other instances,
a doctor assesses your case as soon as one is available and in
the light of the services caseload. While you wait, a health
worker regularly re-assesses your condition and may, if
necessary, already start treatment for pain. If you feel worse,
it is important that you (or the person accompanying you)
inform the health staff.Your treatment may take time
because:each doctor supervises several patients at the same
time and gives priority to the most urgent casesin addition to
the medical assessment, your case may require lab tests, xrays or the intervention of a specialist who is not always
immediately available

MEDICAL EMERGENCIES

It is an accepted norm across the world that in injured and critically ill patients, the priority of
the doctor is to save life. However, often there is reluctance on the part of doctors to attend to
the emergency needs of patients who, in medical jargon, are medicolegal cases. This
unwillingness is largely due to medical professionals being unaware of their ethical and legal
duties concerning the treatment of those brought to an emergency department. Also, there is an
instinct among doctors to evade the inconvenience associated with subsequent lengthy and
tiresome legal proceedings. This is despite of the fact that the Supreme Court of India has clearly
stated that the first obligation of a doctor is to save life and documentation and paper work
could be performed later on. The court ruled that zonal regulations and classifications regarding
the jurisdictions of specialized police stations and government hospitals in a given area could
not operate as fetters in the process of discharge of this obligation (to treat an
emergency/injured victim). In a concurring judgment, the court observed that when a man in a
miserable state, hanging between life and death reaches the medical practitioner (either in a
hospital run or managed by the state, public authority, or a private person or a medical
professional doing only private practice), he is always called upon to rush to help such an injured
person and to do all that is within power to save life. It is a duty coupled with human instinct
which needs neither decision nor any code of ethics nor any rule or law.
Another factor for showing reluctance to serious emergency cases is to avoid the mortality in
one's own hospital, particularly in case of private hospitals. More complicated cases are referred
to higher center, particularly the government sector, because death of patient in their own
hospital would bring bad name to the reputation of the hospital. Also, in case of death of their
patient, the relatives often restores to manhandling of doctor/paramedical staff and damaging
the hospital property. The action of police and local government administration like immediate
arrest of doctor under mob/public pressure is another important issue. These kinds of incidences
are increasing day by day and thus are responsible for doctors not handling the emergency
cases (particularly medicolegal cases). This practice further leads to frequent referral of
emergency patients to government hospitals, thus wasting the crucial time during which the
serious patients could have been saved. Also, at government hospitals, there are no clear-cut
demarcation of duties and responsibilities in emergency department. This leads to further delay
in timely emergency services.

India is a country of paradoxes. On one hand, it has new corporate hospitals for
attracting medical tourism and on the other hand, it has not been able to provide the
basic primary health and necessary emergency services to the masses. There is a
serious scarcity of working diagnostic machines, medicines, and infrastructure in its
hospitals. Following are some issues related to emergency services which should be
seriously discussed involving various stake holders without any further delay.
Trauma continues to be one of the major causes of death in India. To avoid
preventable deaths and disabilities, India needs a common effective system that
could provide quality emergency care with equity of access. As compared with
developed countries with proper emergency systems in place, there was no single
system which could play a major role in managing EMS in India. There was a
fragmented system in place to attend the emergencies in the country. In a bid to
address this problem, the Centralized Accidents and Trauma Services were set up by
the Delhi Government in the early 1990s. This service was later expanded throughout
the country. Unfortunately, it did not succeed despite having a toll free number -102
which is the emergency telephone number for ambulance in parts of India.But, there
are different emergency numbers in different states and Union Territories. So, there is
an urgent need of a centralized Medical Emergency body which could provide
guidelines for setting up emergency services with a single telephone number across
the country. The centralized body should be involved in preparing protocols, imparting
technical assistant, training, capacity building, and accreditation of emergency
services. Procedures, protocols, and personal skills need to be standardized along with
formation of legislation in parliament to provide legal protection for the providers of
emergency services. The initiative taken by the Gujarat state government in setting
up the Gujarat Emergency Medical Services Authority is a welcome step in right
direction. This was the first state to actually pass emergency services regulation in the
country. By bringing together government, non-government organizations (NGOs), and
other private agencies, a state-wide system of emergency care has been set up in
Gujarat. If India could have Securities and Exchange Board of India, Telecom
Regulatory Authority of India, and Insurance Regulatory and Development Authority to
regulate share market, telecom, and insurance services, respectively, then setting up
a regulatory body for regulating the health services, particularly emergencies, could
also be considered seriously.

IPC 45 OF 1860 SECTION 304-A


Section 304 A IPC Causing death by negligence Whoever causes the death
of any person by doing any rash or negligent act not amounting to culpable
homicide, shall be punished with imprisonment of either description for a term
which may extend to two years, or with fine, or with both. The negligence which
would justify a conviction must be culpable or of gross degree and not the
negligence founded on a mere error of judgment or defect of intelligence. In a
civil suit it is sufficient to prove negligent of duty by consideration of the
probabilities of the case but in criminal law it is necessary to prove beyond
reasonable doubt the degree of gross negligent act. Section 88 and 92 of IPC
provide for exemption for acts done in good faith for the benefit of a person
.Section 88 I.P.C. Act not intended to cause death, done by consent in good
faith for persons benefit Nothing which is not intended to cause death is an
offence by reason of any harm which it may cause or be intended by the doer to
cause or be known by the doer to be likely to cause, any person for whose
benefit it is done in good faith, and who has given a consent whether express or
implied to suffer that harm. Section 92 I.P.C. Act done in good faith for benefit
of a person without consent Nothing is an offence by reason of any harm which
it may cause to a person for whose benefit it is done in good faith, even without
that persons consent, if the circumstances are such that it is impossible for the
person to signify consent, or if that person is incapable of giving consent, and
has no guardian or other person in lawful charge of him from whom it is possible
to obtain consent in time for the thing to be done with benefit.

Offence and description


Punishment

Section 354 : Assault or criminal force to woman with intent to outrage her modesty
Section 354 A (1): Sexual Harassment man committing any of the following acts: (i) Physical
contact or advances which include unwanted sexual overtures, (ii) Request for sexual favors,(iii)
Showing pornography against will, (iv) Making sexually color demarks.
Section 354 B: assault or use of criminal force to any woman or abetment to such act with the
intention of disrobing or compelling her to be naked.
Section 354 C: Voyeurism - Any man who watches, captures or disseminates the image of a
woman engaging in a private act in circumstances where she would usually have the
expectation of not being observed.
Section 354 D: Stalking(1) Any man who: (i) follows a woman and contacts, or attempts to
contact such woman repeatedly despite a clear indication of disinterest or (ii) monitors the use
by a woman of the internet, email or any other form of electronic communication. Such conduct
shall not amount to stalking if (i) it was pursued for the purpose of preventing or detecting crime
by a man entrusted with such responsibility by the State (ii) it was pursued under any condition
or requirement imposed by any person under any law; or (iii) in the particular circumstances
such conduct was reasonable and justified. Imprisonment not less than 1 year but which may
extend to 5 years and fine .
Section 354 A (2): An offence specified in clause (i), (ii) or (iii) of subsection(1) shall be punished
within presentment which may extend to three years and/or fine.
Section 354 A (3): An offence specified in clause (iv) of sub-section(1) shall be punished within
presentment which may extend to one year and/or fine.

Section 354 B: imprisonment for a term not less


than three years but which may extend to
seven years, and shall also be liable to fine.
Section 354 C: on first conviction
:imprisonment for a term not less than one
year, but which may extend to three years, and
fine. On a second or subsequent conviction:
imprisonment of for a term not less than three
years, but which may extend to seven years,
and fine .On first conviction: with imprisonment
for a term which may extend to three years,
and fine. On a subsequent conviction: within
prisonment for a term which may extend to five
years, and fine

Section 376 (A) If in the course of commission of an offence under


376(1) and (2), the man inflicts an injury which causes the death of
the woman or causes the woman to be in a persistent vegetative
state.
Section 376 (B) Imprisonment for a term not less than two years but
which may extend to seven years, and fine.

Section 376 (C) Whoever, being in a position of authority or in a
fiduciary relationship; or
a public servant; or superintendent or manager of a jail, remand
home or children's institution; or on the management or staff of a
hospital abuses such position or fiduciary relationship to induce or
seduce any woman under his charge or present to have sexual inter
course with him, such sexual inter course not amounting to the
offence of rape.

Section 376 (D): Gang Rape Where a


woman is raped by one or more persons
constituting a group or acting in
furtherance of a common intention, each
of those persons shall be deemed to have
committed the offence of rape.
Sect ion 376 (D) Rigorous imprisonment
for a term not less than twenty years, but
which may extend to life which shall mean
imprisonment for the remainder of that
person's natural life, and fine.
Section 376 (E): Repeat Offenders
Whoever has been previously convicted of
an offence punishable under section 376
or section 376A or section 376D and is

You might also like