Tuesday, 9 July 2013

Uttarakhand State to fire 190 docs who didn’t report to work in flood crisis

The Uttarakhand government is set to terminate the services of 190 doctors who have failed to report for duty in flood-affected villages despite cancellation of leave of all medical personnel.

Services of doctors still within the probation period of two years will be terminated “immediately” while show-cause notices would be issued first to senior doctors “as per protocol” before the termination orders.
Of the 1,200 doctors under the state government, only 30 per cent were specialists, and several of them were missing when they were needed.

Legal points (also read What are doctor’s responsibilities in any disaster?

Can we refuse treatment in emergency?

1. Article 21 of the Constitution Lasts the obligation on the State to preserve life. The patient whether he be an innocent person or be a criminal liable to punishment under the laws of the society, it is the obligation of those who are in charge of the health of the community to preserve life so that the innocent may be protected and the guilty may be punished. 

Every doctor whether at a government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. The obligation being total, absolute and paramount. Laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way.  (See question 194) 

2. AMA Code of Medical ethics talks about this in opinion 9.067 - Physician Obligation in Disaster Preparedness and Response

“National, regional and local responses to epidemics, terrorist attacks, and other disasters require extensive involvement of physicians. Because of their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters. This ethical obligation holds even in the face of greater than usual risks to their own safety, health or life. The physician workforce, however, is not an unlimited resource; therefore, when participating in disaster responses, physicians should balance immediate benefits to individual patients with ability to care for patients in the future.

In preparing for epidemics, terrorist attacks, and other disasters, physicians as a profession must provide medical expertise and work with others to develop public health policies that are designed to improve the effectiveness and availability of medical care during such events. These policies must be based on sound science and respect for patients. Physicians also must advocate for and, when appropriate, participate in the conduct of ethically sound biomedical research to inform these policy decisions. Moreover, individual physicians should take appropriate advance measures to ensure their ability to provide medical services at the time of disasters, including the acquisition and maintenance of relevant knowledge. 

3. MCI Code of Medical ethics talks about this in 5.2 Public and Community Health: 

“Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself.”

MCI: 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except – In a court of law under orders of the Presiding Judge; in circumstances where there is a serious and identified risk to a specific person and / or community; and Notifiable diseases.

In case of communicable/notifiable diseases, concerned public health authorities should be informed immediately.

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