Medical Negligence

1. Medical Negligence

2. Liabilities of a Doctor Control of professional conduct by PM&DC Civil law and action for damages brought by or on behalf of the patient Criminal liabilities Other aspects of professional conduct: confidentiality defamation gifts to doctors

3. Medial Negligence Historical aspects Code of Hammurabi 2200 BC “If the physician has treated the severe wound of a poor slave with a bronze lancet and has caused his death, he  shall  render slave for slave”.

4. Medial Negligence Historical aspects Code of Hammurabi 2200 BC “If the physician makes a deep incision upon a man with his bronze lancet and cause the man’s death, or operate on the eye socket of a man with his bronze l ancet and destroy the man’s eye, they shall cut off his hand”.

5. Medial Negligence Historical aspects Egypt 1700 BC In ancient Egypt, the medical man had to treat his patient in the ways laid down in the writings of the ancient physicians.  If the patient was treated otherwise - and died - the physician was guilty of capital crime.

6. Medial Negligence Historical aspects Ancient Persia Abortifacients were recognized and criminal abortion was heavily punished.

7. Medial Negligence Historical aspects Rome 572 BC If a slave had been wounded but the wound was not a mortal one, and the slave died as a result of negligence, the only action admissible was on the wounding, not on death. The law of negligence was applicable to the conduct of all individuals - whether laymen or professionals. The physician was no exception.

8. Medial Negligence Historical aspects Greece 355 BC Hippocratic oath included “I will not cut persons labouring under the stone, but will leave this to be done by the men who are practitioners of this work.”

9. Medial Negligence Definition of Medical Negligence of proper degree of in expected of a and repute leading to Lack of exercise skill and care diagnostic and/or therapeutic techniques physician of one’s own standing damage

10. Medial Negligence Medial Negligence Proof of Medical Negligence Proof of Medical Negligence 1 Duty of care 2 Breach of the duty of care 3 Damage resulting due to breach of duty 4 Proximate cause of damage - breach of that duty without any new intervening act 5 Foreseeability of damage resulting because of breach of duty of care

11. Medial Negligence Example of damages

12. Medial Negligence Types of Medical Negligence • Civil - resulting in damages against the doctor in a civil court for wrong treatment, undue prolongation of treatment, undue suffering • Criminal - cases against State resulting in punishment for criminal acts e.g. wrongful death, criminal abortion

13. Medial Negligence Other types of Medical Negligences • Contributory - by patient • Third party - by relatives, • nursing staff • 3 Comparative - patient and doctor

14. Medial Negligence Medial Negligence Issues involved in Medical Negligence Issues involved in Medical Negligence • Duty of care - to whom is it owed ?

15. Medial Negligence Issues involved in Medical Negligence • Duty of care • Termination of duty of care

16. Medial Negligence Issues involved in Medical Negligence • Duty of care • Termination of duty of care Mutual agreement

17. Medial Negligence Issues involved in Medical Negligence • Duty of care • Termination of duty of care Mutual agreement The discharge of physician by the patient

18. Medial Negligence Issues involved in Medical Negligence • Duty of care • Termination of duty of care Mutual agreement The discharge of physician by the patient Proper referral of patient with consent

19. Medial Negligence Issues involved in Medical Negligence • Duty of care • Termination of duty of care Mutual agreement The discharge of physician by the patient Proper referral of patient with consent Death of either the patient or the doctor

20. Medial Negligence Issues involved in Medical Negligence • Duty of care • Standard of care – locality rule vs community rule

21. Medial Negligence Issues involved in Medical Negligence • Duty of care • Standard of care • Duty to respond to emergency/night calls • Duty to exercise care and skill • Duty to obtain consent • Duty to keep abreast of technical knowledge • Duty to use indicated diagnostic aids • Defensive medicine ? • Respondeat superior • Res ipsa loquitur ? • Abandonment and further treatment ?

22. Medial Negligence Defences available in Medical Negligence cases 1 The patient's assumption of risk (by utilizing a properly executed informed consent). 2Contributory negligence on the part of the patient. 3 Alleging that the negligence was that of another party - a super intervening cause (actus novus interveniens - third party negligence). 4Law of respectable minority is also available in certain cases

23. Medial Negligence Examples of Medical Negligence 1 Unexplained leaving of rubber tube in patient's body 2 Allowing breathing tube to become lodged in patient's throat and failing to discover its presence 3   Leaving patient unattended (it fell and sustained injuries) 4 Administering morphine with constantly increasing frequency leading to addiction 5 Using liver extract known to have caused abscesses in other cases, resulting in abscess

24. Medial Negligence Examples of Medical Negligence • 6 Failure to diagnose fracture by not using xray • 7 Failure to diagnose hip fracture which a reasonable • examination could reveal • 8 Radiologist failing to take a lateral view of spine in • diagnosing an injury • 9 Failure of a fracture to unite for months under care of • an orthopaedic surgeon which healed in 2 months • under care of another orthopaedic surgeon • Severing radial nerve while performing operation on • patient’s arm

25. Medial Negligence Examples of Medical Negligence • 11 Tight bandages/casts resulting in gangrene • 12 Ligating artery by mistake for a vein • 13  Failure to notice fracture neck of femur while diagnosing fracture upper third of femur and treating only the latter • Diagnosing ovarian tumour, suspecting pregnancy, • patient miscarried (she testified she was not informed • of pregnancy) • 15 Failure to remove placenta, decomposition of which led to death

26. Medial Negligence Examples of Medical Negligence 16 Failure to call on a patient merely because he was in an excellent hospital with a resident physician 17 Failure to locate missing needle, knowing/believing it to be in patient’s eye 18  Positive assurance of cure in an incurable injury –a fraud 19 Ligating a child’s penis instead of umbilical cord 20 Failure to use xray to discover a piece of steel in patient’s eye

27. Medial Negligence Examples of Medical Negligence 21 Surgeon liable for hospital nurse preparing patient under his immediate supervision 22 Spinal puncture of wrong patient 23 Performing gall stone operation in the office 24 Failure to discover foreign body in the eye 25 Failure to discover infection in a wound at an early stage

28. Medial Negligence Examples of Medical Negligence 26 Failure to take adequate steps to check infection when it first developed 27 Failure to make a sufficient pre-operative examination 28 Death due to wrong blood transfusion 29 Treating excessive looseness of skin with carbon dioxide snow – experimentation 30 Treating small pox pits with acid without sanction of medical science - experimentation

29. Medial Negligence Examples of Medical Negligence • 31 Failure to take a biopsy in a nasal growth • 32 Failure to go through with an operation • 33 Removing uvula and part of soft palate while performing tonsillectomy – unauthorized surgery • Bleeding to death after tonsillectomy • 35 Spilling carbolic acid by accident on a patient by a dentist

30. Medial Negligence Examples of Medical Negligence 36 Leaving patient unattended in labour 37 Leaving patient without reason or sufficient notice 38 Leaving town without providing for attendance by another physician 39 Diagnosing dislocation in place of fracture – no xray was taken 40 Removing tonsils while patient consented for operation on her nose – unauthorized surgery

31. Medial Negligence Examples of Medical Negligence 41 Mutilating the body and carrying away some parts –no consent for autopsy was taken 42 Overlooking a fracture, diagnosing another 43 Erroneous diagnosis of VD leading to breakage of an engagement to marry 44 Failure to administer insulin pre- and postoperative to a known diabetic 45 Failure to administer prophylacticanti-tetanic serum - tetanus developed

32. Medial Negligence Examples of Medical Negligence 46 Failure to use prophylactic silver nitrate in eyes of a new born 47 Failure to report inflamed eyes in a new born (by law) to save a child from blindness and burdening the society with another blind person 48 Forceps found in abdomen at autopsy 6 days after operation 49 Operating without consent and using general anaesthesia when local was consented to 50 Delay in performing necessary operation

33. Medial Negligence Examples of Medical Negligence • Failure to discover a hemorrhage after having caused it or refusing to suture a wound • 52 Using non-sterile instruments • 53 Failure to keep himself informed of patient’s condition or progress • 54 Failure to give follow-up care instructions, resulting in bending of a leg which had to be amputated • 55 Negligent application of x-ray leading to severe burns and death

34. Medial Negligence Examples of Medical Negligence • Patient receiving shock at x-ray table; setting • fire to clothes and sustaining burns • Faulty and erroneous diagnoses avoidable by exercise of ordinary skill and care • Removing a tooth without consent • An optometrist held liable for prescribing improper glasses • 60 Burns caused by negligent application of an electrical heating pad to legs

35. Medial Negligence Examples of Medical Negligence • Pretending to be a physician • Fee-splitting is malpractice • 63 Leaving sponge inside abdomen in a case of gratuitous surgery • Failure to give needed care under obligation to do so • Ordering removal of a patient from a private to a state hospital (60 miles away), knowing • the patient to be suffering from pneumonia leading to his death

36. Medial Negligence Examples of Medical Negligence • Failure to check tight plaster cast leading to • development of necrotic spots and cellulitis necessitating amputation • 67 Allowing a contagious disease to spread • 68 Causing another fracture in a child while manipulating leg during examination • 69 Failure to effect a warranted cure ever though the highest degree of skill and care were utilized – a fraud • 70 Neglecting patients on the plea of having more patients than could be taken care of

37. Medial Negligence

38. Medial Negligence Legibility of prescriptions

39. Medial Negligence Legibility of prescriptions

40. Medial Negligence Medical Negligence Prophylaxis 1 The doctor must not neglect or abandon his patient 2 He must give his patient sufficient attention 3 He must not experiment 4 He must proceed diligently without unnecessary delay 5 He must follow good practice in diagnosis and treatment

41. Medial Negligence Medical Negligence Prophylaxis 6 He must find or anticipate any condition reasonably determinable or reasonably likely to develop 7 He must obtain informed consent 8 He must utilize indicated diagnostic aids 9 He must give proper instructions for the care of the patient and for protection of those coming in contact with the patient 10 He must fulfill the terms of a special contract, if he makes one

42. Medial Negligence Some rules to guard against Medical Negligence • Engage and train office assistants by direct • supervision • 2 Take precautions to eliminate hazards on the premises • 3 Get office equipment checked periodically

43. Medial Negligence Some rules to guard against Medical Negligence • Avoid placing technical medical literature within easy reach of the patients - they are apt to misconstrue it • Avoid giving a diagnosis over telephone • Do not prescribe without examining the patient

44. Medial Negligence Some rules to guard against Medical Negligence 7 Do not guarantee results of treatment or operation 8 Keep confidential interviews/records of your patients 9 Keep complete records 10 Do not use symbols/codes/abbreviations

45. Medial Negligence Some rules to guard against Medical Negligence • 11 Do not abandon your patient • Use language understandable to the patient. Do not assume patient knows already • Avoid arguments over charges. Have understanding before hand in this regard

46. Medial Negligence ABC of medical practice But ABC No No Care Consent Competence Consideration (and in trouble) Courtesy Bull Bunkum Boorishness Badbehaviour Alcohol Abortion Adultery Association Advertising Abuse of privileges