Pediatrician & Pediatrician & MEDICAL MEDICAL NEGLIGENCENEGLIGENCE

DR.JAYANT NAVARANGE M.D.,D.C.H.,LL.B.

HON. PEDIATRICIAN,DEENANATH HOSPITAL

SAHYADRI HOSPITAL

SHREEVATSA, SASSOON HOSPITAL CAMPUS

B.S.S.K.

HON.SECRETARY, MEDICO-LEGAL CELL, IMA PUNE’S NEW BUILDING PROJECT & HOSPITAL WING OF IMA, PUNE

VISITING FACULTY, ILS LAW COLLEGE04/21/23 12:30 1DR JRN

Pediatrician is answerable toPediatrician is answerable to

1. Medical Council2. Civil Court3. Consumer Forum4. Criminal courts5. Human rights, Info. Act, POCSO, BMW,

BNHRA, POCSO etc…Janata Darbar!!

04/21/23 12:30 2DR JRN

Pediatric casesPediatric cases::Pediatric age is from birth to 18yrs as per IAP.

(up to 19 yrs-AAP), in fact from fetal life! It’s a developing creature—newborn Adulthood….

Special problems-1. Cases through parents or guardian2. Consenting age- >18, but bet 7-12, court’s

discretion, 12-18—always take child’s consent too

3. Period of limitation counted after 18 yrs, hence preserve documents for 21 yrs +

04/21/23 12:30 3DR JRN

CPA: 1986CPA: 1986

Easy procedure—lawyer NOT neededPractically, no stamp duty3 tier systemAppeal system is peculiarSummary procedurePecuniary jurisdictionComplicated cases to go for civil court

adjudication

04/21/23 12:30 4DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE

DR MODY’S TEXTBOOK NEGLIGENCE=WANT OF REASONABLE

DEGREE OF CARE AND SKILL OR WILLFULL NEGLIGENCE ON THE PART OF DOCTOR IN TREATING A PATIENT WITH WHOM A RELATIONSHIP OF PROFESSIONAL ATTENDANT IS ESTABLISHED, SO AS TO LEAD TO BODILY(+) INJURY OR DEATH.

DAMAGE TO PERSON OR PROPERTY Emotions, Psychology, Reputation, Financial etc04/21/23 12:30 5DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE CPA- S. 2(G)DEFICIENCY MEANS ANY

FAULT, IMPERFECTION, SHORTCOMING OR INADEQUACY IN QUALITY, NATURE AND MANNER OF PERFORMANCE WHICH IS REQUIRED OR UNDERTAKEN BY A PERSON BY CONTRACT OR OTHERWISE IN RELATION TO ANY SERVICE.

DO NOT CLAIM SERVICES WHICH YOU CANNOT PROVIDE! (e.g. 24 hours service etc.)

DEFICIENCY HAS WIDER APPLICATION THAN NEGLIGENCE

04/21/23 12:30 6DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE

MEDICAL NEGLIGENCE: TORT(CIVIL) + CRIMINAL + CONTRACTUAL

CLASSIFICATION:1.RES IPSA LOQUITOR-i.e.GROSS-(may

amount to criminal)2.SUBTLE-ACT OF OMISSION OR

COMMISSION-usually civil3.CONTRIBUTORY4. NON-NEGLIGENCE

04/21/23 12:30 7DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCEESSENTIAL COMPONENTS:-1. ESTABLISHED DOCTOR PATIENT

RELATIONSHIP2. ACT OF OMISSION/COMMISSSION

OR RES IPSA LOQUITIR 3. TEST OF PRUDENCY-Bolam’s

principle/test--HOW ANOTHER DOCTOR WOULD HAVE ACTED IN SIMILAR SITUATION-COMPARISON WITH AVERAGE PRUDENT DOCTOR

4. DAMAGE MUST HAVE RESULTED AS A DIRECT CONSEQUENCE OF THAT ACT, which itself must be proximate in time..Nexus

04/21/23 12:30 8DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCEWHAT IS NEGLIGENCE? S.C.,1969 in Dr

L.B.Joshi v T.B.Godbole has defined as followsA person who holds himself ready to give

medical advice and treatment impliedly undertakes that he possesses skill and knowledge for the purpose. Such a person owes his patients when consulted, certain duties, viz-

1.A duty of care in deciding whether to undertake the case

2. A duty of care in deciding treatment04/21/23 12:30 9DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE3. A duty of care in administering that treatment [ BREACH OF CONFIDENTIALITY may be=>Negli.] [NOT

MAINTAINING RECORDS=>Deficiency/Negli.] ANY BREACH OF ANY OF THESE DUTIES

BECOMES ACTIONABLE (IF THE BREACH RESULTS IN DAMAGE– PHYSICAL / MENTAL/ EMOTIONAL / ECONOMICAL)

NEITHER THE VERY HIGHEST NOR VERY LOW DEGREE OF SKILL/COMPETANCE IS EXPECTED-S.C.-BOLAM v FRIERN HOSPITAL COMMIITTEE,1957 McNAIR; HEWART

MORE THE EXPERTISE CLAIMED, MORE IS EXPECTED!—[Charlesworth and Percy](Smt Saroj Chandhoke vs Sir Gangaram Hospital—NC-OCT 2007)

CARE AND NOT CURE IS EXPECTED BY LAW-J. TINDALL04/21/23 12:30 10DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE2. GROSS NEGLIGENCE- IN SUCH CASES, THERE IS NO NEED FOR

ELABORATE ARGUMENTS- THE THINGS SPEAK FOR THEMSELVES, e.g. AMPUTATING WRONG LIMB; O.T.WITHOUT FUNCTIONAL SUCTION; O2;CROSS-PATHY(NEGLIGENCE PER SE); LEAVING SWAB IN WOUND; Incubator burns(Saren hospital v Palwinder Singh, Sept 2007, NC) ETC.

RASH, RECKLESS ACTS VERY DIFFICULT TO DEFEND

04/21/23 12:30 11DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE

– Street (1983) Test of res ipsa:– Where an unexplained accident occurs from a thing

under control of defendant and medical or other expert evidence shows that such accident surely won’t occur if due care is used, it is negligence

– P.M. Ashwin vs Manipal Hospital—Karnataka,C192/1993, decided 18-11-96: Hot water bag under feet of 2 mo old infant’s inguinal hernia surgery->burns of 3rd degree-5 lacs awarded against Ped Surgeon, Anesthetist and Hospital.

– Nurse etc freed-Vicarious liability04/21/23 12:30 12DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE2. GROSS NEGLIGENCE-Continued:New dimensions-> Failure to make or keep records- Not keeping records amounts to gross negligence (res ipsa

loquitur)-National Commission(Dr Gangavardhan v/s K A Abdul Salem, Kerala, July ’04 CTJ, p 688)Presumption in such case is-if records would have been produced, would go against doctor and hospital!

Consent-Documents: Not informing details of diagnosis-assessment, treatment/procedures, alt. methods, likely outcome etc. Dr Shyam Kumar vs Rameshbhai H Kachhiya, NCDRC-CTJ Jan 2007 (Glaucoma -operated thrice-lost BE vision)It must be written consent as observed in Saroj Chandhoke v Sir Ganga Ram, NC Oct.07—consent for abd. Hysterctomy—vg done—liable++04/21/23 12:30 13DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE3.ACT OF OMISSION:

e.g. NOT DOING BASIC INVESTIGATIONS FOR F.U.O., not

performing LSCS FOR PRIMI WITH BREECH Dr.Louie v K.PathummaLady in labour with

PROM and on Syntocinon was left unattendedrupture uterus –death, held negligent.

A LOT OF DELIBERATIONS AND PRODUCTION OF EVIDENCE NEEDED---JUDICIAL DISCRETION HAS A BIG ROLE04/21/23 12:30 14DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE 4.ACT OF COMMISSION:

e.g. Giving ß-blocker to an asthmatic; Radical mastectomy without histo-pathological evidence; Steroids in AGN etc.

Leaving foreign body inside,as in RBKabdi v Dr RT Kulkarni; Nihal Kaul v PGI Chandigarh etc.(here, it was discovered in ashes after cremation-held negligent)

Act of omission & commission are 2 sides of same coin---

Here too, detailed evidence is needed to be presented by either side to prove allegations or innocence. Judicial discretion has a big role04/21/23 12:30 15DR JRN

MEDICALMEDICAL NEGLIGENCE NEGLIGENCE5. NEXUS IN THE ACT AND DAMAGE: THE ALLEGED DAMAGE MUST HAVE

RESULTED AS A DIRECT CONSEQUENCE OF NEGLLIGENT ACT- AFTER THE PATIENT WAS DISCHARGED FOLLOWING SURGERY, SOME UNFORESEEN COMPLICATIONDEATH- HELD, NO NEGLIGENCE (VENKATAPPA v Dr Shallikeri, 1995, KARNATAKA)

IF NEGLIGENCE, BUT NO DAMAGE,IT IS CONSTRUED AS NON-NEGLIGENCE

04/21/23 12:30 16DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCECONTRIBUTORY NEGLIGENCE: PATIENT DOES NOT COMPLY WITH

INSTRUCTIONS-HE IS PARTLY OR WHOLLY RESPONSIBLE FOR DAMAGE-e.g.MD.ASLAM v IDEAL HOSPITAL, ORISSA,1994—PATIENT ATE HEAVY FOOD AND HAD LOT OF VISITORS->WOUND INF. & BURST ABDOMEN.->DEATH-NON-COMPLIANCE:HENCE NO NEGLIGENCE

AN ADVOCATE COMPLAINED ABOUT WRONG DISPENSING BY CHEMIST AND INJ.BY THE DOCTOR—ADVOCAE SHOULD HAVE READ IT!-HARI MOHAN CO.v K.PANDEY,BIHAR,1994

Nathuram Dhaka vs Jaipur Hospital—Ortho—nail—no follow up by patient—SC,Rajasthan—Sept.2007CTJ04/21/23 12:30 17DR JRN

Criminal v Civil NegligenceCriminal v Civil NegligenceSR. No.

CRIMINAL*Do NOT fear arrest*

CI VIL-incl. Consumer*Do not worry about practice,

adverse publicity*

1 Police (govt.) is a necessary party– of course private criminal is possible

It is between private party and may be Govt. is a party

2 Insurance, vicarious liability principles are NOT applicable

Insurance, vicarious liability principles are applicable

3 No period of limitation Period of limitation, 2 or 3 yrs

4 Aim: Deterrent, Punitive Aim: Compensation

5

6.

7

Establishes wrong doer

S.304 A2 of IPC saves doctors to a great extentStrictest proof beyond doubt needed

Establishes rights

No such need for civil, but needed for consumerProof of probability is enough

Friday, April 21, 2023 REMEMBER S. 304A HELPS DOCTORS—HAVE THE JUDGMENTS ON COMPUTER…

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE **BURDEN OR ONUS OF PROOF: IT RESTS ON THE COMPLAINANT AND

HAS TO PROVE WITH FACTS, SUPPORTING DOCUMENTS AND EXPERT EVIDENCE

**THE POSITION REVERTS IN SITUATIONS LIKE O.T./ICCU WHERE PATIENT HAS NO ACCESS-i.e. DOCTOR HAS TO PROVE HIS INNOCENCE ; & SO IS THE CASE WITH RES IPSA –Savita Garg v National Heart Institute, SC 2004

TEXT BOOKS; JOURNALS; AFFIDAVITS…04/21/23 12:30 19DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCENON-NEGLIGENCE- A> DIFFERENCE OF OPINION B> WRONG RESULT DESPITE DUE

CARE, SKILL AND DILIGENCE C>ONE OF THE 2 OR MORE STANDARD

METHODS OF TREATMENT WAS FOLLOWED(Subramanyam v Dr

Krishna-Sangstaken tube/sclerotherapy,1993) D> NEW MEDICINE/THERAPY GIVEN

AFTER FULL FORMALITIES E>FEES( Dr Bhattacharya’s appeal)

04/21/23 12:30 20DR JRN

Pediatric casesPediatric cases:: 1.Total free hospital: B.C. Joshi v Dr. Sandeep Kumar-

c-16 0f 02, N. Delhi, 2002— Only such facilities are exempt. Beware charity/trust hospitals. Govt. Hospitals NOT exempt in majority of situations

2. Check jurisdiction: Deepak Behl v Dr Narendra Rege-Maharashtra, 1999. Case treated in Mumbai and defendant doctor in Mumbai—district forum, Nashik wrongly entertained the case-Ped Orthopedic case

3. Check limitation period: Lalluram Mena v Dr S. Mathur, Rajasthan, c-69/1999, decided 16-11-2000-Neoneatal jaundice-kernicterus. Frivolous complaint + time-barred. Contributory negligence. Patient fined!

Time limit is 2 yrs in CPA and 3 yrs in Civil.

04/21/23 12:30 21DR JRN

Pediatric casesPediatric cases:: 4.Substitute medicine by hospital pharmacy + Not checked by

resident—Deepak Gokarna v Mahant Gurumukh Charitable hospital-c-191/1994, decided 2002. Instead of Monocef, Omnatex was given, 1 gm iv stat for a 4 yr old boy having tonsillitis; IV fluids showed reactions: taken as gross negligence. Rs 10,000 awarded

5. Appeal sos: Maharashtra, appeal 949/1999 Dr Mrs Bhatambre v baby Kolpe: Septicemia and Malaria.

(Jaundice) Distirct forum went against doctor-reversed by State forum. Now , you have to deposit amount and appeal within 1 mo.

04/21/23 12:30 22DR JRN

Pediatric casesPediatric cases::

6. Dr. Rakesh Jain v Rakesh Kumar Khare-MP-2001,decided 20-8-2002

Neonatal hyperbilirubinema-13mg at 1 day to 40 mg on D5->Kernicterus. 4.75 lacs compensation. Ref.:Meherban Singh: up to 1mg/100 gms wt is normal!

7. Jayendra Pandya v Dr. Lalit Trivedi C-84/1993 decided 1996-Gujrat:Measles diagnosed instead of SJS—1 day delay in diagnosis-Pediatrician fined-GP, hospital, eye specialist etc acquitted. Not suspecting a serious ailment by specialist not pardoned!

04/21/23 12:30 23DR JRN

Pediatric casesPediatric cases::

8. Pravinbhai Khubchandani v Dr Rajendra Sah, Gujrat-C-231/1993, decided in Nov 1997: Bronchiloitis baby left for monitoring to incapable and unqualified doctor—Rs 1,00,000/- awarded

So friends, cases are many! Be prepared! Forewarned is better prepared!

In Pune,case of 1.5 crores against Pediatrician. 6.5 crores against Neuro-surgeon and in Kolkata, 77.77crores against skin specialist Dr. Mukharji. These all are leading doctors!

04/21/23 12:30 24DR JRN

Pediatric cases;Pediatric cases; 9.Antenatal diagnosis—In a case against Dr . I.C.

Verma from AIIMS, the fetal diagnosis of a 2nd gestation was +ve for Thal. Major in AIIMS and –ve in UK. Hence the fetus was allowed to go to term—at 4 mo proved to be Thal. Major-National commission awarded full medical support all thro’ life, though No negligence was proved!Similar 2 more decisions (on compassionate ground)

GOVT HOSPITALS NOT EXEMPT FROM CPA 10. Newborn given Nalidixic acid for diarrhoea on

day4—alleged cause of seizures—prescribed by gynecologist—Cross-speciality

04/21/23 12:30 25DR JRN

.M. Mathew v. Director, Karuna Hospital1998 (1) CPJ 476:1998 (1) CPR 39 Kerla SCDRC 8½ years old son had fever and tonsillitis. On advise of pediatrician, staff nurse gave injection paracetamol on left buttock. Boy developed foot drop. Neurologist diagnosed sciatic nerve palsy. Dr. Lucy Jacob, pediatrician said this was accepted complication. Staff nurse was unqualified. So not qualified to administer injection. Actionable negligence. Hospital liable. Awarded 1.06 lakh 04/21/23 12:30 26DR JRN

TAKE CARE OF I V LINES:   IV CANULA CAUSING DEVELOPMENT Of

GANGRENE & AMPUTATION  Shivaji Gendeo Chavan v. Chief Director,

Wanless Hosp 1995 (3) CPJ 43 Maharashtra SCDRC 18 yr old son admitted for CRF. Advised kidney

replacement.-till then, Venous catheter in right thigh for regular dialysis. Lack of care caused infection in A V fistula-> Gangrene-> Leg amputated. Died 20 days later. Expert doctor’s witness submitted by patient. Awarded 2 lakhs

04/21/23 12:30 27DR JRN

Pediatric cases: LessonsPediatric cases: LessonsKnown complications:Dipti Sarkar v Sam-1993-Orissa-Neuroparalytic reaction to ARV—proper

ICU Rx given-patient died—Held Non-Negligent,

Non-anticipation of a common complication and failure to treat => Negligence

Dr Shah v Dr.Mukharji-SJS case—claim of 77,77,77,550/-SC has directed to fix compensation for negligence.Case pending for finalising the amount04/21/23 12:30 28DR JRN

Pediatric cases: LessonsPediatric cases: LessonsKG Sangavi v Chatrabhuj Hospital—Guj-1998:

Fever with Jaundice—Rx for Falciparum also given, though not proved—patient died. Text book reference shown that antimalarials in jaundice do not kill pateint. Hence, no negligence.

TapanKr Nayak v Orissa State-Fever with seizures followed DPT. Later MR, CP. Alleged, all due to DPT. Proved that MR must have been pre-existent. Non-negligence.

04/21/23 12:30 29DR JRN

Pediatric cases: LessonsPediatric cases: LessonsM.Parimana v Dr. CP Jagannath-TN-1998-Complainant’s son diagnosed as “rabies” on

clinical grounds—no path. Confirmatory test. OK-No Negligence

Law permits logical diagnosis and diagnosis by exclusions of diseases based on history and clinical examination. However, whenever possible, have proofs too!

04/21/23 12:30 30DR JRN

POCSO--POCSO--Health ProfessionalsHealth Professionals1. Recognise signs of sexual violence in a child

victim.2. Report cases of sexual violence against

children.3. Know the legal procedures in cases of sexualviolence against children.4. Know and respect the rights of children.5. Keep in mind the best interests of the child

while conducting a medical examination.S.19-21 Doctor faces jail (6-12 months)/fine for

failure to inform police…04/21/23 12:30 31DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE Quackery: Unqualified person knowingly transgressing the

limits—it is a crime under IPC—it is never taken as acts in “good faith”.

Crosspathy-Dr. Ashwin Patel vs Poonam Verma (SC1994), cross-speciality or unqualified persons giving treatment

LSCS done by a qualified surgeon and not gynecologist taken as quack—G Sukumar v Dr Bodiga—3 lacs awarded—Aug. 2007—SCDRC, Andhra

Now, Bombay HC-2007- DMLTs not allowed to run labs of their own.

04/21/23 12:30 32DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCELIABILITY IN DIAGNOSIS, TO

WARN OF INHERENT RISKS(of course, not each and every one and the remote one) & IN RESPECT OF TREATMENT—inform about ROP for preterm needing O2—1.8 crores/April 2015 for not informing for fundoscopy on discharge…

A CONSULTANT IS NEGLIGENT WHEN HE DELEGATES RESPONSIBILITY TO HIS JUNIIOR WITH THE KNOWLEDGE THAT HE IS INCAPABLE.04/21/23 12:30 33DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE DEFENCES FOR DOCTOR: 1. MISTAKE OR MISADVENTURE 2. INHERENT RISK IN MANAGEMENT 3. VOLUNTIA NON-FIT INJURIA (consent) 4. ACTS DONE IN GOOD FAITH 5. ACCIDENT 6. TAKEN ALL PRECAUTIONS 7. PERIOD OF LIMITATON—usually from

date of discharge(Oct 2007-NC-Saroj Chandoke vs Sir Gangaram)

8. CONTRIBUTORY NEGLIGENCE 9. ERROR OF JUDGEMENT-NOT GROSS 10. ACTED ADEQUATELY AND ON SCIENTIFIC

FOOTING—Should be explainable logically04/21/23 12:30 34DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE LORD DENNINGROE V MINISTRY OF HEALTH: WE

SHOULD BE DOING DIS-SERVICE TO SOCIETY IF WE WERE TO IMPOSE LIABILITY FOR EVERY THING THAT HAPPENS TO GO WRONG..

WE SHOULD NOT JUDGE 1949 ACT WITH 1954 SPECTACLE!-The case of Xylocaine ampoule crack .RETROSPECTIVE WISDOM!

J.BERRRIE in Moore v Lewishan Group-if there are 2 schools of treatment, adhering to 1 is not negligence.

04/21/23 12:30 35DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE VICARIOUS LIABILITY:

WHAT EVER IS DONE BY AGENTS, SUBORDINATES, CONTRACTORS, EMPLYEES, WHICH RESULTS IN INJURY TO PATIENT, BECOMES LIABILITY OF DOCTOR+/-HOSPITAL—RESPONDENT SUPERIOR IS THE PRINCIPLE—HARJOT AHLUWALIA VS SPRING MEADOWS HOSPITAL-2000(SC) Rs. 1,700,000/- awarded

LIABILITY EXISTS DESPITE ABSENCE OF BLAMEWORTHY CONDUCT OF MASTER

Legal principle: Respondent Superior04/21/23 12:30 36DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE

VICARIOUS LIABILITY EXAMPLES: HARJYOT AHALUWALIA v SPRING

MEADOWS HOSPITAL, N. DELHI

CHILD GIVEN I.V.LARIAGO-BRAIN DEATH-Rs.17 LACS AWARDED

K.K.RADHA v SEKHAR EVEN IF DR. IS ONLY A PANEL DR., HOSPITAL IS VIAIOUSLY LIABLE AS BILL AND DISCHARGE CARD ISSUED BY HOSPITAL-NATIONAL COMMISSION,1997

04/21/23 12:30 37DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE SOME POINTS TO REMEMBER 1. ALL CAN MAKE A MISTAKE-MOST

SENIOR & LEARNED CAN PROVE NEGLIGENT

2. IF YOU DIAGNOSE BRILLIANTLY, IT’S YOUR DUTY-DON’T TAKE CREDIT-BUT IF YOU COMMIT PALPABLE MISTAKE, IT’S LIKELY TO BE NEGLIGENCE.

IT MAY BE YOUR FIRST NEGLLIGENCE, IT IS NEVER PARDONED, EVEN IF INTENTION IS GOOD.

04/21/23 12:30 38DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE IF ONE TREATS HIS PATIENTS AS IF HE IS

TREATING HIS DEAR AND NEAR PERSON, WITH LOVING CARE AND SCIENTIFICALLY

AND ADEQUATELY, IT IS UNLIKELY, HE WILL PROVE NEGLIGENT, PROVIDED

DOCUMENTS ARE WELL MAINTAINED. REVISE DIAGNOSIS IF NO RELIEF—

Additional opinions-but their must be collective decisions and actions—Nandakishor Verma v Batra Hospital-NC-Sept 2007

MIND YOUR BEHAVIOUR!04/21/23 12:30 39DR JRN

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE PREVENTION OF ALLEGATIONS:- AATTENTITION; ADDITIONAL OPINION BBEHAVIOUR; BILLS CCOMMUNICATION; CONSENT(or denial); COMPASSION; Consent for vaccines too. DDOCUMENTS= YOUR FRIENDS/FOES! EEXPERTISE; EFFICIENCY I Indemnity Insurance-Adequately and

Continually; Check identity—KYC!Be careful of SJS, Dengue & H1N1 infection—

also TB—follow Govt. guidelines Adverse media publicity cannot be avoided by and large

04/21/23 12:30 40DR JRN

INSURANCE--INDEMNITYINSURANCE--INDEMNITYHave a continued indemnity coverage of 40 lacs and

continue uninterruptedly at least 3 yrs after you stop practice!

Rate is 1.5Rs/1000 covered + ST—very low premium and is deductible expense for your income tax

Keep the insurer informed of any problemFuturistic(?):1. Arbitration clause 2 May be we ask patient to have his disease

pertaining mediclaim for each admission in hospital

04/21/23 12:30 41DR JRN

Crosspathy:Crosspathy:1. Poonam Verma V Dr Ashwin Patel-

1996-SC- MMC Act 1965- S2(d)Medical practitioner must restrict to his pathy.

2. Dr. S. N.Nambudri vs Haneefa—Kerala: Appeal 533,662/1995, decided 14-5-1997-

Hep B jaundice->coma->death. The Ayurvedic doctor used both Allopathic and Ayurvedic drugs

+ Under-investigations, that too from non-standard lab=> Negligence +deficiency

04/21/23 12:30 42DR JRN

Quackery:Quackery:Quack is a person who does not have

knowledge of a particular system of medicine but practices in it. They are guilty of NEGLIGENCE PER SE. It violates A21 of constitution of India-Right to life. Inform them to Civil Surgeon of local area– Punjab SC, 2000 in Avtar Sing Bhatora V Dr Swaran P Garg

Dr Baleshwar Prasad vs F D Mahant-Jharkhand

KM Balkrishnan V Padma Ayurveda Vaidyashala for claiming medicines for cancer cure…And many other cases!04/21/23 12:30 43DR JRN

THANK YOUTHANK YOU

04/21/23 12:30 44DR JRN