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DEFENDING MEDICO-LEGAL CASES MD IN CONSUMER COURTS I …
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Dr. Arun Gupta MD President, DMC e-mail : [email protected] Ph.9811106056 I n previous two bulletins, we discussed the Consumer Protection Act, it's impact on medical professions and the mechanism of awarding compensation in cases of medical negligence. In this issue, we will discuss how to defend a case in Consumer courts. The number of cases filed in Cosumer Courts are far more than filed with State medical council. Basic difference between working of Cosumer Courts and Sate Medical Council is that, in Consumer courts the judgements are given by the Judge and members who are mostly non medicos and whether to take an expert medical opinion or not is entirely their discretion, as against State Medical Council, which is primarily manned by Medical experts only. Secondly, Consumer Courts award monetary compensation to the aggrieved party ,whereas state medical council have power to remove name of doctors from register in case of medical negligence. Earlier, there was no fee to file a complaint in consumer forum, but after the amendment in CPA, in 2003, there is minimal fee, as compared to civil court fee. In the civil court too, fee is 10 percent of the amount asked for compensation. Maximum penalty for filing frivilous complaint in Consumer Court is just Rs 10 thousands There is no need of a lawyer, to file or fight the case in consumer forum. Under CPA, a judgment is to be expected within 90 days of filing the case. But usual time taken is much more due large number of cases and inadequate staff and infrstructure in many Consumer Courts. Large number of patients are filing complaints directly to police This is commonly seen in cases of sudden death and serious patients. Therefore, its important, to make sure that case paper should be completed before declaring death or shifting a serious patient to another hospital, as the case records will be taken away by police. Laws every doctor must be aware of … The best defence in cases will be the observations of Supreme Court in Jacob Mathews vs State of Punjab and Anr. 2005 (3)CPR 70 SC . This case not only defines the medical negligence but also differentiate civil medical negligence from criminal medical negligence. These observations are the best defence in case of a negligence suit. For details of the principals of medical negligence please refer to DMA bulletin issue dated th 10 May 2018 Volume 03. Others are Martin F. D'Souza v. Mohd. Ishfq civil Appeal No 3541 of 2002 ( no doctor can give 100 % guarentee) Section 80 of IPC which defines accident MCI Code of Ethics Regulation2002 There are lots of acts and laws related to medcal professions. Every doctor must be familiar with them and should follow them. General Precautions. 'A Stitch in time Saves Nine' · Every doctor must have professional indemnity insurance of sufficient amount. The minimum amount should be 20 lakhs for physicians and 50 lakhs for surgeons. Those who are having nursing homes must opt for “Hospital Error and Omission Policy”. These two are different policies, the first one will take care of professional negligence and second policy will take care of deficiency of service. · Proper and regular communication between doctor and patient is most crucial factor for safe practice. It has to be regular during each stage of the treatment, not only when the patient is serious. · Maintaining proper records at each and every stage of patient's care is vital. · Patient's informed consent should always be taken. Consent for admission, surgical procedure, extended surgical procedure, anesthesia, blood transfusion should be separate and taken before actual procedures. For details of informed consent please refer to DMA bulletin th dated 25 april 2018 Volume 02. · All necessary equipments in hospitals must be in working condition. One must maintain the record of servicing of these instruments and gadgets. · Do not exceed the scope of treatment in term of professional capacity or facilities available. Do refer to specialst or higher centre whenever needed . · Do not display unrecognised degrees. · Follow all guidelines in issuing medical certificates. Time limit to file case As per CPA the time limit is two years from the incidence, but the judge has power to condone the delay. It is important for us to know that obstetrician and paediatrician should keep case paper of patient for minimum period of 21 years (18-Age of achieving majority and two years time limit). Documents should also be preserved In all those cases with mortality,cases with unsual complicatin or cases where relatives /patient seems unsatisfied . DEFENDING MEDICO-LEGAL CASES IN CONSUMER COURTS DMA NEWS BULLETIN 10 July, 2018 20
Transcript of DEFENDING MEDICO-LEGAL CASES MD IN CONSUMER COURTS I …
Dr. Arun Gupta
MD
President, DMC
e-mail : [email protected]
Ph.9811106056
In previous two bulletins, we discussed the ConsumerProtectionAct,it'simpactonmedicalprofessionsandthemechanismofawardingcompensationincasesofmedical
negligence.Inthisissue,wewilldiscusshowtodefendacaseinConsumercourts.
ThenumberofcasesfiledinCosumerCourtsarefarmorethanfiled with State medical council. Basic difference betweenworkingofCosumerCourtsandSateMedicalCouncilisthat,inConsumercourtsthejudgementsaregivenbytheJudgeandmemberswhoaremostlynonmedicosandwhethertotakeanexpertmedicalopinionornot isentirelytheirdiscretion,asagainstStateMedicalCouncil,whichisprimarilymannedbyMedical experts only. Secondly, Consumer Courts awardmonetarycompensationtotheaggrievedparty,whereasstatemedicalcouncilhavepowertoremovenameofdoctorsfromregisterincaseofmedicalnegligence.
Earlier,therewasnofeetofileacomplaintinconsumerforum,butaftertheamendmentinCPA,in2003,thereisminimalfee,ascomparedtocivilcourtfee.Inthecivilcourttoo,feeis10percent of the amount asked for compensation. MaximumpenaltyforfilingfrivilouscomplaintinConsumerCourtisjustRs10thousands
Thereisnoneedofalawyer,tofileorfightthecaseinconsumerforum.
UnderCPA,ajudgmentistobeexpectedwithin90daysoffilingthecase.Butusualtimetakenismuchmoreduelargenumberof cases and inadequate staff and infrstructure in manyConsumerCourts.
Large number of patients are filing complaints directly topoliceThis is commonly seen in casesof suddendeathandseriouspatients.Therefore,itsimportant, tomakesurethatcase paper should be completed before declaring death orshifting a serious patient to another hospital, as the caserecordswillbetakenawaybypolice.
Lawseverydoctormustbeawareof…
ThebestdefenceincaseswillbetheobservationsofSupremeCourt in Jacob Mathews vs State of Punjab and Anr. 2005(3)CPR 70 SC . This case not only defines the medicalnegligencebutalsodifferentiatecivilmedicalnegligencefromcriminalmedicalnegligence. Theseobservationsarethebestdefenceincaseofanegligencesuit.FordetailsoftheprincipalsofmedicalnegligencepleaserefertoDMAbulletinissuedated
th10 May2018Volume03.
Othersare
MartinF.D'Souzav.Mohd.IshfqcivilAppealNo3541of2002(
nodoctorcangive100%guarentee)
Section80ofIPCwhichdefinesaccident
MCICodeofEthicsRegulation2002
Therearelotsofactsandlawsrelatedtomedcalprofessions.Everydoctor mustbefamiliarwiththemandshouldfollowthem.
GeneralPrecautions.'AStitchintimeSavesNine'
· Every doctor must have professional indemnityinsurance of sufficient amount. Theminimum amountshould be 20 lakhs for physicians and 50 lakhs forsurgeons.Thosewhoarehavingnursinghomesmustoptfor“HospitalErrorandOmissionPolicy”.Thesetwoaredifferent policies, the first one will take care ofprofessionalnegligenceandsecondpolicywilltakecareofdeficiencyofservice.
· Properandregular communication betweendoctorandpatientismostcrucialfactorforsafepractice.Ithastobe regularduringeach stageof the treatment,notonlywhenthepatientisserious.
· Maintainingproperrecordsateachandeverystageofpatient'scareisvital.
· Patient's informed consent should always be taken.Consent for admission, surgical procedure, extendedsurgicalprocedure,anesthesia,bloodtransfusionshouldbe separate and taken before actual procedures. FordetailsofinformedconsentpleaserefertoDMAbulletin
thdated25 april2018Volume02.
· All necessary equipments in hospitals must be inworking condition. One must maintain the record ofservicingoftheseinstrumentsandgadgets.
· Do not exceed the scope of treatment in term ofprofessional capacity or facilities available. Do refer tospecialstorhighercentrewheneverneeded.
· Donotdisplayunrecogniseddegrees.
· Followallguidelinesinissuingmedicalcertificates.
Timelimittofilecase
AsperCPAthetimelimitistwoyearsfromtheincidence,butthejudgehaspowertocondonethedelay.Itisimportantforustoknowthat obstetricianandpaediatricianshouldkeepcasepaperofpatientforminimumperiodof21years(18-Ageofachievingmajorityandtwoyearstimelimit).
DocumentsshouldalsobepreservedInall thosecaseswithmortality,cases with unsual complicatin or cases whererelatives/patientseemsunsatisfied.
DEFENDINGMEDICO-LEGALCASESINCONSUMERCOURTS
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HowtoSuspectLitigantPatient?
Everypatientshouldbeseenasapotential litigant.Butthisthoughtshouldbetakeninapositivesense,tomanageallcasecarefullywith proper protocols and standard practice. Thisthoughtshouldnotbethebasisofstartingdefensivemedicine.The possibility of litigation is very high in cases withunexpected results or unsual complications, but caseswithexpectedoutcomearealsonotimmunetolitigations
Sometimes overenthusiasticpatientcanbemisinformedbytheirwell-wishers and lodge a complaintwhen there is nodamagealso.Itisimportant,therefore,thatourattitudetoallpatientsshouldbesameandthoroughlyprofessional.
OnceyoureceiveaLEGALNOTICE
· Inmostofthecasespatient/relationsconsulttheirlawyerorsomeknowndoctorsfriendorrelativebeforefilingacomplaint.Chances of litigations are high wherepatient/relativehaslawyerordoctorinfamily.
· Thepatientorhislawyercanfiledirectcaseinconsumerforum and doctor will receive a notice from consumerforum.
· Patientcan alsosendanoticethroughalawyerora byhimself.
· Patient can send notice by just an ordinary letter,speedpost, registered post, courrier or any othermeans.Pleaserememberthemodeofsendingnoticeisnotimportant.Usualtendencyisthatifaletterisbyregisteredor speed post, then it is given importance and if it isreceived by an ordinary post its ignored. Every noticeirrespective ofmode of sendingmust be taken equallyseriously.
· Onceyoureceivethenotice,makesuretopreservebothnotice paper and the envelope.Write date and timeonbothenvelopeaswellasonthenoticepage.
· Thenoticemaybeaddressedtothedoctororitmaybeonthenameofhospital. Ifitisinnameofhospital,thanalsodoctorisresponsibleifheispartoftreatingteam.
· Collectallthematerialsrelatedtothesaidcase.Arrangeitinachronologicalorderandgo through it torevise thecase.
Personsyoumayneedtofightyourcase…
1. InsuranceCompany'sBranchManager
2. Expertwitness
3. MedicoLegalConsultant
4. Lawyer
InsuranceCompany
Once you receive written notice from complainant, informyour Insurance Company's Branch Manager. In a letteraddressedtotheBranchManager,attachthephotocopyoftheletterthatyouhavereceivedfromthepatientandphotocopyofthefirstpageofyourindemnityinsuracepolicy.
There is no need of writing anything in detail about thepatient'streatmentoryourreplytothenotice.Itissufficientjusttodenythesame.
Take acknowledgement on the photocopy of the letter andpreserveitcarefullyalongwiththeothercasepapers.
ItistheBranchManagerofthatinsurancecompany,whoisthe
soleresponsiblepersonandheshouldadviseyoubyawrittenreply.Youragenthasnoauthorityofanysorttoadviseyou.Donot settle for verbal communication, take everything inwriting.
ExpertWitness
OpinionofanExpertwitnessisofimmensevalueinmakingyourcasestrong.
Select an expert witness from your area, where you arepracticing. If you have Governmentmedical college nearby,thenselectapersonfromthatcollege.
IfthereisnoGovernmentmedicaloranyothermedicalcollege,thenpreferablyselectaseniorspecialistfromthatarea.
An expert opinion is given in an affidavit format. Swornstatementandexpertmaybecalledtocourtorforumtogiveevidenceandshouldbeavailableforcross-examination.
Medico-LegalConsultant
It isadvisabletoconsultamedicolegalperson, inpreparingyourwritten reply. Lawyersdonot have detailedmedicalknowledge so guidance of a medico legal cosultant is veryimportant. Remember, your first written statement is thefoundationofthecaseandultimatefatewillbedependentonthistoalargeextent.
Lawyer
Selectlawercarefully.Chooseonewhohasbeentakingcasesofmedical litigations. Choose lawyer working in ConsumerCourt,CivilCortorCriminalCourtsasthecasemaybe.UnderCPA lawyers can represent you in consumer forum. Yourphysicalpresence isnotmandatory.But itshighlydesirablethatyouattendallcasesandkeepaclosewatchoverprogress.
Howtoproceed
· Once you have selected a Medico legal and a Lawyer explainthecasetothemandhandoverthenoticeforreply.
· Thelawyerwilldraftareply.Itisnotmandatorytoreplytopatient's notice or his lawyer's notice however, it isadvisabletoreplytothenoticewithinstipulatedtime.
· In your reply restrict youself in denying allegation andchargesmade in thenotice.It isobservedmanya timesthat if you give detailed reply to the notice, a smartprosecution lawyerwillpick-upyourweakpoints fromthe reply and accordingly he will file the plaint (acomplainttothecourt).
· Thereplytolegalnoticeisthefoundationofyourdefense.Therefore, without disclosing controversial points andusingproperwordsandnotcommittingornotadmittingyourerrorsormistakesreplyshouldbedrafted.Onehastoremember that your reply to notice should reach thecomplainantorhislawyerswithingiventime
· You had informed branch manager of an insurancecompanyandhehadgivenyouthelawyerofyourchoice,withtheapprovalofhiscompany,thenalsoyoumustkeepthem informing at every stage and ask for thereimbursementoflawyerschargesateverystage.
OnceCaseisFiledinConsumerCourt.
If the complainant has decided to file complaint underConsumer Protection Act. 1986 (CPA) complainant candemandthedamageinhisnotice,dependingupontheamount
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ofthesame,complaintwillbefiledinDistrictForum,ifitislessthan20lakhs;intheStateCommission,ifitislessthan1crore and if it is more than 1 crore than in the NationalConsumer Redressal Commission. This figuremay changesoonwithproposedfigureforuoptoRs1crore,1Croreto5crores and above 5 crore for District, State and NationalConsumerCourtsrespectively.
DoctororHospitalwill getacomplaintfromthatparticularforumandreplyhastobefiledwithin30daysofreceiptofthenotice.Hereagainonemustpreservecomplaintandtheenvelopeandwritedateandtime,onboth.Onecangetonlyoneextensionofdate,i.e.for15days.Thatmeans,inanycase,replytothecomplaintinwritinghastobefiledinmaximum45days.Ifone failstocomplywiththis,thenforummighttakeadecision,“ExParte”thatmeanswithoutconsideringyour defense. Forum will decided on the complainant'scomplaintalone,inyourabsence.
Afterthediscussionandinthelinewiththereplysentearliertothelegalnotice,prepareadraftreply.Thengotothelawyerandgiveyourdraftreplyandthenlethimprepareafinalreplyalongwithyouandyourmedicolegalconsultant.
Aftertheamendments inCPA,it isnotnecessarythatallcomplaints will be admitted. Along with your writtenstatement one must give expert witness opinion and allpossiblemedicalreferencesofthecase,alongwithwrittenstatementtosupportyourlineofmanagement.
Whileselectingreferences,firstchoiceshouldbeTextbooksofIndianauthors,nextwillbetextbooksofforeignauthors.Thirdcomesjournals.Referencesfrominternetaregiventheleastimportance
Whateverdocuments,referencesorexpertopinonyouwanttoprovide,doitatthisstageonly.Ifthecaseislostandgoesinfavourofcomplainantandifdefendantwantstogoforanappeal, please keep in mind, in appellate forum onlyargument will take place and no new evidence will beacceptedinanyform.
Your complainant, after receiving written statement, maysend rejoinder. In that rejoinder complainant is notallowedtobringnewissues,ifhedoessodefendantmustbringittonoticeofforum.
When the judgment comes in favour of doctor andcomplainantdoesnotgoforanappealthelitigationisover.Ifjudgment goes against doctor and he wants to go for anappeal,thenthelitigationwillgofurther.UnderCPA,onecanappealonlytwicesoattheendoftwoappealsfromeithersidelitigationwillbeover.
Dr.ArunGuptaMDPresident,DelhiMedicalCouncil
Ps. soon will start articles on medico-legal casespertainingtovariousspecialties.Ifyouhaveanyqueryrelated to your specialty please mail i t to [email protected]
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