Emedinews:Insights on Medicolegal Issues: Government of India / Medical Council of India should give Statutory Rules or Executive Instructions on medical negligence – Supreme Court of India

The Honorable Apex court said that so long as it is not done we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient.

• A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.
• The investigating officer should, before proceeding to act against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice That doctor can normally be expected to give an impartial and unbiased opinion applying Bolam’s test to the facts collected in the investigation.
• A doctor accused of rashness or negligence, may not be arrested in a routine manner simply because a charge has been leveled against him
• The doctor should never be arrested in case of medical negligence since the basic rule of mens rea means any criminality to harm the patient always remain absent
• The exceptional ground and necessity of arrest of doctor is required to be deliberated; it must be transparent/well-justified before the police if unavoidable for furthering the investigation or for collecting the evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make him available to face the prosecution unless arrested, the arrest may be withheld.  

Emedinews:Insights on Medicolegal issues:Investigation and medical negligence

The Supreme Court of India noted:

“The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of criminal law under Section 304-A of IPC. We have noticed hereinabove that the cases of doctors being subjected to criminal prosecution are on an increase. Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken.

The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient. All that we are doing is to emphasize the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions. Many a complainant prefers recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.”

Emedinews:Makesure: A patient was brought to the ICU in cardiogenic shock.

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Emedinews:Inspiration:We Live by Faith

A man's daughter had asked the local minister to come and pray with her father. When the minister arrived, he found the man lying in bed with his head propped up on two pillows. An empty chair sat beside his bed.

The minister assumed that the old fellow had been informed of his visit. "I guess you were expecting me," he said. "No, who are you?" said the father. "I'm the new minister at your church," he replied. "When I saw the empty chair, I figured you knew I was going to show up." "Oh yeah, the chair," said the bedridden man. "Would you mind closing the door?"

Puzzled, the minister shut the door. "I have never told anyone this, not even my daughter," said the man. "But all of my life I have never known how to pray. At church I used to hear the pastor talk about prayer, but it went right over my head." "I abandoned any attempt at prayer," the old man continued, "until one day about four years ago my best friend said to me, "Joe, prayer is just a simple matter of having a conversation with Jesus. Here is what I suggest. Sit down in a chair; place an empty chair in front of you, and in faith see Jesus on the chair. It's not spooky because he promised, "I'll be with you always." Then just speak to him in the same way you're doing with me right now."

So, I tried it and I've liked it so much that I do it a couple of hours every day. I'm careful though. If my daughter saw me talking to an empty chair, she'd either have a nervous breakdown or send me off to the funny farm."

The minister was deeply moved by the story and encouraged the old man to continue on the journey. Then he prayed with him, anointed him with oil, and returned to the church. Two nights later the daughter called to tell the minister that her daddy had died that afternoon.

"Did he die in peace?" he asked. "Yes, when I left the house about two o' clock, he called me over to his bedside, told me he loved me and kissed me on the cheek. When I got back from the store an hour later, I found him dead. But there was something strange about his death. Apparently, just before Daddy died, he leaned over and rested his head on the chair beside the bed. What do you make of that?" The minister wiped a tear from his eye and said, "I wish we could all go like that."

Emedinews:Insights on Medicolegal issues:What are resuscitative injuries?

The injuries produced in human body when attempting resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or noted in inquest by the investigating law enforcement agency.

Before making an interpretation of these injuries during autopsy, the doctor should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these had been documented in the clinical sheets or not.
A doctor should always document any resuscitative injuries in detail in case of death.
Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries.
The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

• The method generally used for life saving attempts by non–medical persons who are nearby to the critical patient is mouth to mouth respiration and manual chest massage may causes contusions.
• Resuscitation in hospitals include bag and mask intubations, endotracheal tube, obdurate airway are used for respiratory ventilation.
• The mechanical methods like thumper, active compression–decompression device, and defibrillator are used in resuscitation. The closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
• The injections and closed–chest cardiac massage and other resuscitation procedures to the patients may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and of spleen.
• Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age.
• Resuscitative fractures of rib No. 1, 8 and 12 are very rarely seen in autopsy.
• The number of fractured ribs ranged up to 16, mainly 3-8 ribs was fractured.
• The site of rib fractures after heavy blunt thoracic injuries was preferably found in the dorsal region.
• The injuries which are received/inflicted on body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifact.

Emedinews:Makesure: A patient with rheumatoid arthritis developed deformity.

Situation: A patient with rheumatoid arthritis developed deformity.
Reaction: Oh my God! why was treatment not started early?
Lesson: Make sure all patients are started with specific treatments within 3 months of diagnosis of rheumatoid arthritis.

Emedinews:Inspiration:Value Every Minute

To realize the value of one year: Ask a student who has failed a final exam.

To realize the value of one month: Ask a mother who has given birth to a premature baby.

To realize the value of one week: Ask an editor of a weekly newspaper.

To realize the value of one hour: Ask the lovers who are waiting to meet.

To realize the value of one minute: Ask the person who has missed the train, bus or plane.

To realize the value of one second: Ask a person who has survived an accident.

To realize the value of one millisecond: Ask the person who has won a silver medal in the Olympics.

Time waits for no one. Treasure every moment you have. You will treasure it even more when you can share it with someone special.