DR. A.K. Khandelwal

CIVIL AND CRIMINAL NEGLIGENCE- PROBLEMS IN PRIVATE PRACTICE

DR. A. K. KHANDELWALMEDICAL SUPERINTENDENT

Paramount HospitalCONSULTANT IN HOSPITAL MANAGEMENT

NABH ASSESSOR

DR. A.K. Khandelwal

INTRODUCTION

The Doctor patient relationship in our country has undergone a sea change in the last decade and a half. The lucky doctors of the past were treated like God and people revered and respected them.

Aryans embodied the rule that, Vaidyo narayano harihi (which means doctors are equivalent to Lord Vishnu).

We witness today a fast pace of commercialization and globalization on all spheres of life and the medical profession is no exception to these phenomena.

DR. A.K. Khandelwal

CPA,

Consumer awareness and

Commercialization has changed the scenario.

All these 3C has adverse effects on DOCTOR AND PATIENT RELATIONSHIP.

It's a common observation that medical practitioners,

hospitals are being attacked by family members of

patient for alleged medical negligence.

DR. A.K. Khandelwal

Section 304-A of IPC is a sword hanging above the doctor,

working both in government hospitals and in the private

sectors.

Doctors are considered as soft targets by the law enforcing

agencies and being harassed by unsatisfied patients.

Moreover complainants often use criminal cases to

pressurize medical professionals and to extract unjust

compensation

DR. A.K. Khandelwal

Allegations of rashness or negligence are often raised against doctors by persons without adequate medical knowledge, to extract unjust compensation.

This results in serious embarrassment and harassment to doctors who are forced to seek bail to escape arrest. If bail is not granted, they will have to suffer incarceration. 

They may be exonerated of the charges at the end; but in the meantime they would have  suffered a loss of reputation

DR. A.K. Khandelwal

Public awareness of medical negligence in India is growing.

Hospital managements are increasingly facing complaints regarding the

Facilities,

Standards of professional competence, and

The appropriateness of their therapeutic and diagnostic methods.

DR. A.K. Khandelwal

Currently, approximately 10,000-15,000 medico-legal

cases are pending in various courts of our country, a rise

of almost 25 per cent in the last five years. (2005)

Worldwide and in India, gynaecologists and obstetricians

top the chart when it comes to the number of cases filed

against medicos.

Anaesthesiologists and ophthalmologists follow.

DR. A.K. Khandelwal

The severity of the punishment depends on whether

the case is civil or criminal.

Compensation range from a meagre Rs 10,000 to

several lakhs. The average compensation ranges

from Rs 4 lakh to Rs 5 lakh.

If it's a civil case, which most are, then if proven

guilty the State Commission might debar the doctor

from practice.

DR. A.K. Khandelwal

Around 10 per cent of cases are based on very

'gross' negligence

More than 20 to 30 per cent of cases fall into

mild or moderate category.

Ratio of relevant cases to the number of

frivolous cases is 50:50.

DR. A.K. Khandelwal

One in every four doctors has been sued in his lifetime in the US.

The US may be a consumerist country, but in India the consumer is no less powerful.

It's easy in India to file a case in the CC with a low litigation fee and because one can fight one's own case without the help of an advocate.

In the US, the litigation fee costs around $25,000. Also, in the US it is not easy to file a criminal case against a doctor, but in India it can be done under IPC 304-A.

DR. A.K. Khandelwal

A- AWARENES OF NEGLIGENCY

B-BUILD STRONG STRUCTURE, PROCESS,

C- COMMUNICATION

D-DOCUMENTATION

E-EMPHATHETIC ATTITUDE

ABC FOR DEALING WITH COMPLAINT OF NEGLIGENCE

DR. A.K. Khandelwal

AWARENESS

Healthcare institutions of today are complex matrix organisations. Errors are bound to occur in any complex human endeavour, and healthcare is no exception

Around 100 000 patients a year die from preventable errors in hospitals in America .

Medical error is the third most frequent cause of death in Britain after cancer and heart disease and kills four times more people than die from all other types of accidents

Be careful and implement Risk Management Strategy to minimize error/negligency

DR. A.K. Khandelwal

BUILDING OF STRONG STRUCTURE

Man power- Right Man at Right Place

Method- Right Method

Machine-Right Machine

Material-Right and adequate

DR. A.K. Khandelwal

COMMUNICATION

This is the key to doctor-patient relationship.

Communicate effectively to prevent error.

communication failures is at the root of over 60% of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations

Communicate effectively to prevent dissatisfaction in patients and family members.-

Patients who are well informed about treatment options, the course of care ,expected out comes, and possible complications, more satisfied and less likely to file malpractices.

DR. A.K. Khandelwal

DOCUMENTAION

(l) A complete history with a description of the present ailment or injury, recorded as nearly as possible in the patient's words; (2) The report of a physical examination revealing objective findings regarding objective complaints and including significant negatives; 

(3) A record of diagnostic tests and all similar reports received concerning the patient; 

DR. A.K. Khandelwal

(4) An impression or a diagnosis (when a physician is able to form only an impression in the absence of additional diagnostic procedures, the word "diagnosis" should be avoided); 

(5) A record of treatment, with medications prescribed and procedures recommended or performed; and 

(6) The patient's response to treatment along with any indicated alterations in the treatment plan.

(7)Please make sure that your handwriting is legible

DR. A.K. Khandelwal

EMPHATHY

The human face of medical care decides the

patient’s /attendant’s reaction towards on medical

mishap/untoward reaction. The whole system of

medical establishment should made courteous, and

polite. The special training should be imported to

staffs from HRD experts about dealing with

patients/relatives under grievous mental stress due

to some loss/injury.

DR. A.K. Khandelwal

DEALING WITH MEDIA

Often doctors are hounded by the media for an alleged case of medical negligence.

The first issue that needs to be addressed is when a reporter wants to have your version of alleged act(s) of negligence committed by you. The answers are not easy but some guidelines are possible.

DR. A.K. Khandelwal

BASIC GUIDELINES FOR DEALING WITH NEWS MEDIA

Be Honest

Be accurate

Be concise and professional

Be appreciative

DR. A.K. Khandelwal

THANKS

THANKS

DR. A.K. Khandelwal