Thread by @Hareshraichura

Thread for Doctors (a thread to be updated time to time)

I will write here about,
What doctors can do to protect themselves, against complaints under SC/ST Act, complaints in police for medical negligence, complaints for medical negligence in

#Doctors #MedTwitter #India

2/ police station, complaints filed in criminal courts, summons by court to private doctors to appear as a witness with medical record of a patient, cases in civil court for damages, steps a doctor can take if he perceives threats from a patient, etc.

#doctors #MedTwitter

3/ First basic principles : An error in diagnosis (or Judgement) is not by itself a negligence. If a patient dies during an operation or immediately after surgery, is by itself not a medical negligence.

4/ A mistake of Judgement during an ongoing surgery, is also not a per se medical negligence.

Unexpected death of family member, during surgery, often drives relatives of deceased to file complaints of medical negligence. The relatives do not know what is medical negligence.

5/ In rural areas, or even in areas of educated areas, often relatives call some friends or local politicians and try to attract the doctor or his family. It is possible to take preventive steps.

6/ While treating a patient of a SC/ST community, doctors should not live under fear that if something will go wrong, patient or his family will file case on them under SC/ST Act and they will be jailed. Doctors can take preventive legal steps while treating such patients.

7/ First be clear that "Medical Negligence Can Never Be A Cognizable Offence. It has to be a Non-Cognizable Offence because an Opinion of Civil Surgen or other doctor's opinion about negligence is first requirement."

8/ What is meaning of the above statement?

It means that a Police cannot say, "Yes, I think that medical negligence has happened, let me arrest you."

Only a Magistrate can say, "It appears to me that medical negligence has happened. Do you want bail by furnishing bail bonds?'

9/ Above is the difference between a "Cognizable Offense" and a "Non Cognizable Offense".

Only in cognizable offence a police can say, "Yes, it appears to me that you have committed crime. Let me arrest you".

10/ Relatives of deceased patient may be advised by their well wishers that police cannot arrest a doctor only on ground of medical negligence.

So they add other provisions of penal code, or SC /ST Act, so that police can get power to arrest and jail a doctor.

11/ Now the question is how a doctor can protect himself a) against attacks by relatives of a deceased patient and b) by a false police complaint, triggered by death of a patient ?

#doctors #india #MedTwitter

12/ One should first understand principles of Caveat.

In Civil law, a person can file caveat in court stating that certain person is likely to file a suit against him and no interim order should be passed in his absence.

But in criminal law, can a person file such caveat?

13/ There is one less used Register in every police stations. Police is required to maintain 3 things. A) Police diary recording steps of investigation B) A Register No. 1 of offences. All FIR are recorded here. C) All other types of information to be written in Register-2

14/ If a person informs to police station that certain person or some unknown person may attack him, then this cannot be registered in Register No.1, but such information has to be registered by police in Register No.2.

Few people know about this Register No. 2.

15/ Suppose before undertaking surgery on patient of SC/ST catagory, if a Doctor sends an email to police informing about the surgery and expresses his apprehension that if surgery is not successful, relatives may come to file a complaint under SC/ST Act. Then what?

16/ Then, police may have to make an entry in Register No. 2, recording fears of the doctor. Thereafter if any complaint is filed after unsuccessful surgery, police will have take into consideration this email entry also. And Courts will also double check the complaint. #Doctor

17/ Same can be said about general catagory patients. If doctor feels that the patient's relatives may make trouble if treatment fails, he can send an email to police expressing his fears and may request to make entry in appropriate Register.
#doctors #india #MedTwitter

18/ Initially, police may deny to record such emails in Register No. 2.

Because there is not much awareness and people and Register 2 is not frequently used.

But then Doctors' Association can take up this issue at political lever and some guidelines can be sent to police.

19/ Here again one more problem is there.

The Police is under State Subject. So such guidelines have to be issued by each States.

Central goverment have little say in this matter

#Doctors #India #MedTwitter

20/ What I talked about in previous tweets is about "Precautionary Emails" a doctor can make, while treating a patient who has relatives who can make troubles if treatment fails. Such emails can be sent, before treatment, during treatment or immediately after treatment. #Doctor

21/ Assuming that Police does not register such emails in Register No.2 and refuse to take note of such precautionary email, then what? Then this email can be sent to local association of #doctors or to any third party neutral body.

22/ Value of Such emails. All Judges are trained to see "What had happened immediately before the complaint and what had happened immediately after the complaint. So these precautionary emails helps a Judge to understand whether complaint is triggered by a #Medical event.

23/ Another advantage of precautionary email.

The police officer can be made accountable if any attack is made on #doctor by relatives of patient even after he had sent an email to police station. The court can also direct departmental inquiry against concerned police officer.

24/ Police is not supposed to register a criminal complaint of #Medical #Negligence without first obtaining a report from Civil Surgeon of Govt #Hospital. So the complainant often adds several other sections of penal nature to harass the doctor through police.

25/ In those circumstances, the doctor can apply for anticipatory bail even before FIR is registered and even after registration of FIR. He can also reach High Court to quash complaint on the ground that it is triggered by a medical event, addition of other sections is malicious.

26/ In such situation, the #Doctor can also file complaint for criminal #defamation if the averments in FIR are per se defamatory. It will be burden of complainants who filed false complaint, to prove that averments in #FIR were made in good faith and therefore exempt.

27/ Why difficult for Govt to pass special law for protection of #Doctors and #Health Workers?

These State Subjects.

So each State may have to pass such laws. To avoid passing of special law, the States can say that they are already protected under ordinary laws.

28/ The #Doctors can still press law maker to provide that complaints triggered by a medical treatment or against a doctor must be investigated by a Higher Police Officer.

This can reduce chances of misuse and this can be done by an ordinary order by State Govt

29/ It is also possible for State Governments to direct that complaints against #doctors under SC/ST Act be investigated only by a Higher Level Police Officer. This can also reduce chances of misuse of laws.

30/ Very often, private #Doctors are summoned in court in private cases, to come with papers of treatment and to give evidence about mental state of patient whom they may have treated in past. The courts are often not aware that Private doctors may not be required to keep records

31/ Therefore it is futile to give such summon orders routinely. The #Doctor can come and only identify signature on his past prescription. The procedures need to be simplified. This can be done by a #Judicial or Administrative order of #HighCourts.

32/ Dealing with prolonged perception of threats. #Doctors in big cities have their own muscle powers to deal with threat perceptions.

But think about a doctor in a small village. How would he be able to manage or to neutralise enmity arising from a medical mishap?

33/ In my own experiences, I have found that documentation of such enmity by way of affidavit or in other suitable helps. It has often deterrent or counter balancing effect on persons from who a #doctor may have fears. This point needs to be explored under legal guidance.

34/ Cases of Negligence against a #Doctor are hard to prove unless there is an adverse expert opinion by some other doctor or Doctors' body, or some knowledgeable medical student. It has to be proved that Due Care was not taken by the #Doctor.

35/ The words "Due Care" has to be interpreted with reference to Due Care usually taken by similar #doctors in the profession. For this purpose, both sides may have to lead evidence..

36/ There have been cases where complaints of rape have been filed against doctors. Here, the only safeguard a #doctor can have is to approach High Court to seek investigation by a higher rank police officer in order to protect against "blackmailing' complaints.

37/ It helps a Doctor to prove that there is no medical negligence if has previously prepared Check Lists and if he can show that he had done checklists before starting treatment. Dr. Atul Gawnde has written a detailed book to underline importance of checklists.