TY - BOOK AU - Singh, VP TI - Legal Issues in Medical Practice SN - 9789389776058 U1 - 614.44 SIN CY - New Delhi PB - Jaypee Brothers Medical Publishers (P) Ltd KW - Modern Science N1 - Contents Section 1: Ethies in Healthcare: The Guiding Values! 1. The Ethics of Medical Practice VP Singh, Parmod Goynt Medical Ethics 3 Autonomy Beneficence Nonmaleficence 4 Conflict Between Autonomy and Beneficence/Nonmaleficence 5 Justice 5 Paternalism versus Autonomy: What Serves the Patient Best? 5 Does Paternalism Really Serve the Purpose? 6 Changing Ethos, Paternalism to Patient Autonomy 6 Should Physicians do Whatever Patients say? 7 What Serves the Patient Best? 7 Ethical Guidelines for Medical Practitioners B Indian Medical Council (Professional conduct. Etiquette and Ethics) Regulations 8 Chapter 1: Code of Medical Ethics 8 Chapter 2: Duties of Physicians to their Patients. 9 Chapter 3: Duties of Physician in Consultation 10 Chapter 4: Responsibilities of Physicians to Each Other 10 Chapter 5: Duties of Physician to Public and Paramedical Profession 11 Chapter 6: Unethical Acts 11 Chapter 7: Misconduct 14 Chapter 8: Punishment and Disciplinary Action 16 2. Confidentiality and Disclosure in Medical Practice VP Singh, Akashdeep Aggarwal When Confidentiality may be Breached? 19 Legal Requirement/Administration of Justice 19 Guidelines on Medical Confidentiality 20 Medical Council of India Regulations 20 Right to Information Act and Medical Confidentiality 21 RTI and Medicolegal Cases 22 Medical Confidentiality and HIV Status 23 NACO Guidelines on Confidentiality in HIV-positive Individuals Operational Guidelines for ICTCS: (July 2007) Guidelines on HIV Testing (March 2007) Judicial Decisions on Medical Confidentiality and HIV Status Mandatory HIV Screening HIV Testing of Patients Prior to Surgery xx | Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice Section 2: Medicolegal Menace: Let's Face The Truth, 3. Disclosing Medical Errors: Why, When and How? VP Singh, Gautam Biswas Medical Emors 31 Disclosure of Medical Errors 32 How did it Start? 32 Ethics, Law and Policy 33 Consequences of Disclosing Medical Errors 33 Benefits of Disclesure to the Patient 33 Harms of Disclosure to the Patient 34 Harms of Disclosure to the Medical Practitioner 34 Benefits of Disclosure to the Medical Practitioner 34 Guidelines on Disclosing Medical Errors 34 How to Handle Medical Errors in Practice? 34 When Disclosure should Take Place? 35 Timing of Disclosure 35 Stages of Disclosure 35 What to Say? 36 4. End of Life Care Decisions: Ethical and Legal Issues Rashmi Datta, Pradeep Sreevastava, Arvind Kumar Singh Palliative Care at the End of Life 40 Magnitude of the Problem 41 Medical Futility 41 Withholding or Withdrawal of Life Support 43 Advanced Directives and Do-not-resuscitate Orders 43 Euthanasia 44 Active Euthanasia 44 Passive Euthanasia 44 Voluntary Euthanasia 44 Nonvoluntary Euthanasia 44 Implications to Human Organ Transplantation Act 45 Legal Aspects of End of Life Issues in India 45 5. Medicolegal Aspects of Discharge Against Medical Advice Krishnadutt H Chavali, Swapnil S Agarwal, VP Singh How Prevalent is Dama? 49 Causes and Predictors of Dama 50 Why Patients Leave Against Medical Advice? 50 Who is at Risk of DAMA? 50 Legal Status of DAMA 51 Dissolution of the Therapeutic Relationship 51 Is there any Protection Against Future Litigation? 51 Validity of DAMA 52 Duty of Doctor in DAMA Consequences of DAMA Risk to the Patient Risk to the Doctor/Hospital Contents xx Managing DAMA A Practical Approach 54 Artess Decision-making Capacity 54 If Patient Lacks Capacity 54 6. Violence Against Doctors: Causes, Effects, and Solutions Sundeep Mishrn Definition 61 Factors Predisposing to Violence 61 Situation Unique to India 62 What Leads to Violence by Attendants/Relatives? 62 Physician Related Factors 62 Patient Related Factors 62 Hospital Related Factors 63 Role of Community 63 How to Anticipate Violence in Healthcare Setting? 64 Role of Media 64 Managing Violence in Healthcare Setting 65 At the Time of Violence 65 Preventing Violence in Healthcare Setting 65 Preventive Tips for the Physicians 65 Preventive Tips for the Hospital Administrators 67 Strong and Effective Laws: Essential in Fight Against Violence 67 Strengthening the Law Against Violence 67 implementation of Effective Laws 69 Role of Media in Preventing Violence 69 Health Related Literacy 69 Insurance Schemes 69 Section 3: Patient Safety Initiatives: A Key to Medicolegal Safety 7. Patient Safety and Risk Management Sameer Mehta Strategies for Safety in Healthcare 74 Emergency Care and Patient Safety 74 Possible Solutions 74 Radiology and Imaging 75 Counseling Rooms-Informed Consent 76 Isolation Rooms 77 Medical Records 77 Patient Accessibility 78 Patient Handling and Movement Assessment 79 Infection Control 79 Monitoring Differential Pressure 81 Medical Gases 82 Safety Measures Related to Medical Gases 82 Storage of Cylinders 83 Smart Hospitals 83 Risk Management 83 The Process of Risk Management 83 wall) Cegal fee in Medical Practice Mertolingaf Guidelines for Safe Practice Heature axuntated Infections: A Threat to Patient Safety What are the Sources of Healthcare associated com Pace Related to Plealthcare associated infection m When are not Healthcare-errociated as Common Healthcare associated Infertions 89 Veneta neociated Condition 90 Transmission of Infection 97 Source of Microorganisms Surceptible Host 9) Means of Transmission 92 The Burden of Hospital-acquired Infection 92 Preventing Hospital-acquired Infection 92 Infection Prevention Initiatives 94 Recommendations by Agency for Healthcare Research and Quality 94 Initiative by the World Health Organization 94 The Joint Commission's National Patient Safety Goals 94 Active Surveillance Culture 95 Indicators of Healthcare-associated Infections 96 Management of Healthcare-associated Infections 97 Strategies for Management of Healthcare-associated Infections 97 Principles of Empiric Therapy 97 Specific Empiric Situations 97 Initial Antibiotic Therapy 97 Therapeutic Strategies of Documented Healthcare-associated Infections 97 Gram-negative Organisms 98 Gram-positive Organisms 98 Newer Research Related to Healthcare-associated Infection 98 99 Medicolegal Aspects Related to Healthcare-associated Infection All Healthcare-associated infections are not Preventable! 100 101 Medical Negligence Cases Related to Healthcare-associated Infection Case 1: Patient Suffered Hepatitis Cinfection 101 Case 2: Patients Lost Vision due to Eye Infection 102 Legal Provisions Applicable to Healthcare-associated Infection 103 Section 304A IPC (Causing Death by Negligence) 103 Section 337 IPC (Causing Hurt by Act Endangering Life or Personal Safety of Others) 103 Section 338 IPC (Causing Grievous Hurt by Act Endangering Life or Personal Safety of Others) Section 269 IPC (Negligent Act Likely to Spread Infection of Disease Dangerous to Life) 104 Section 270 IPC (Malignant Act Likely to Spread Infection of Disease Dangerous to Life) 104 9. Communication Skills in Healthcare: A Tool to Ensure Patient Satisfaction Archana Kumari, Piyush Ranjan What is Communication 108 Types of Communication 108 Communication in Healthcare 109 Importance of Communication Skills for Doctors 109 Basic Principles of Good Communication 110 Tips for Good Communication in OPD Setting 110 The Medical Interview with Patient Cantenty xxx Tips for Geisel Communication in an Indeer and Sating l Commenting with the Atey Barriers to Camermusic113 Comequences of ineffective Communication 111 How to Access the Communication Skills of Healthcare Workers (14 Breaking Raid News18 Teaching Communication Skills and Medical Curriculum 113 ALTCOM An miliative try Medical Council of tree 115 Section 4: Medical Records: A Double-edged Sword 10. Medicolegal Aspects of Informed Consent VP Singh, Dasan Hansh Judicial Decisions Introducing the Concept of Informed Consent 122 Objectives 123 Meaning 123 Evolution 122 Implied Consent 124 What makes the Consent Legally Acceptable? 124 Express Consent 124 Conditions for a Valid Consent 125 Age for Consent 125 Duty to Warn a 'Material Risk 127 Exceptions 128 Obtaining Consent: The Procedure 128 Documentation of Informed Consent 128 Judicial Decision on Informed Consent 129 Samira Kohli Case: Landmark Judgment on Informed Consent 129 Extracts from the Supreme Court's Judgment (Samira Kohli's Case) 129 11. Medicolegal Aspects of Medical Records Joseph Thomas, Arun Mavaji Seetharam, Rajesh Kumar Sinha Ownership of Data 134 Data Access and Confidentiality 134 Electronic Health Records Preservation 134 Data Privacy and Security 134 Categories of Medical Records 135 Guidelines on Medical Record 136 NABH Guidelines 136 Medicolegal Aspects of Medical Records 141 Preservation of Records 141 Ownership of Medical Records 142 Summoning Medical Records by Courts 142 Judicial Decisions Related to Medical Records 143 121 132 Component of Medical Records 132 Electronic Health Records: An Emerging Trend In India 133 Confidentiality of Medical Records 135 Medical Council of India Guidelines xxiv | Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice 12. Documentation in Healthcare: Standards and Guidelines Utsav Parekh Medical Documentation 145 Documentation not Directly Retoted to the Patient 146 Legal Importance of Documentation 146 Rey Role in Litigation Process 146 Standard of Continuum of Core 146 Regulation Governing Medical Recordi 147 Cases Compelling Medical Documents 147 Benefits of Good Quality Documentation 147 Errors in Documentation 148 Vacuum in Clinical Documentation 148 Falling to Write a Complete Note 148 Failing to be Concise 149 Illegible Medical Documentation 149 Medical Council of India Guidelines on Prescription Writing 150 Use of Unsafe Abbreviations 150 Clinical Documentation Guidelines 150 Guiding Principle 1: Comprehensive and Complete Record 151 Guiding Principle 2: Patient Centered and Collaborative 151 Guiding Principle 3: Ensure and Maintain Confidentiality 152 Key Points for Good Medical Documentation 152 Critical Issues in Medical Documentation 154 Discharge Notes 154 Written Feedback from Patient/Attendants 155 Issuing Medical Certificate 155 Documenting Adverse Events 155 Documenting Instructions to the Patient 157 Documenting Patient's Refusal 157 Section 5: Litigation Against Medical Practitioners: Let's Take the Bull by the Horns 13. Medical Negligence: Meaning, Scope and Legal Interpretation VP Singh, Vivekanshu Verma What is Medical Negligence? 161 Essential Components of Medical Negligence 161 Duty of Care 162 Dereliction in Duty of Care 162 Damage 163 Direct Causation 163 Types of Medical Negligence 163 Medical Negligence as a Tort 163 Medical Negligence as a Crime 163 Negligence Per Se 164 Vital Issues in Medical Negligence 164 Burden of Proof of Medical Negligence 164 Reasonable Care 166 Criminal Liability of Medical Professionals 167 Guidelines: Prosecution of Doctors for Criminal Rashness or Criminal Negligence 34. How to Defends Medical Regi Cantons Y 169 Pattere of Compli Complains under Cолен The Complaint form the ence Ompany 1 the Written Statement 171 rand Amur Rejoindera 171 172 Exemetipo or Witnesses Argumenth 172 The Order 172 Anal 172 Facing the Court: Medicolegal Tips and Advice 173 Avoid Talking to the Complainant or his Advocate 173 Avold Fingerpainting 173 Avoid Alteration or Destruction of Medical Records 173 Appearing in a Criminal Case 173 15. Compensation in Medical Negligence: How much is Justified? VP Singh, Mukesh Yadav Compensation in Medical Negligence 176 Multiplier Method: Can it be Used in Medical Negligence Cases? 177 Multiplier's Method is not Applicable in Medical Negligence Cases 178 How much Compensation is Just and Adequate? 179 Impact of High Quantum of Compensation 180 Medical Liability-A Future Crisis: Learning from the Other Countries 180 The Crisis 180 Crisis Reform Models 181 Caps on Noneconomic Damages 181 No-fault Compensation 182 Health Courts 182 6. Professional Indemnity Insurance: Better Safe than Sorry Rajendra S Bangal Professional Indemnity Insurance 185 What does it Cover? 186 What it does not Cover? 186 Factors Influencing the Amount of Insurance 187 Some Important Information 188 AOO: AOY Ratio 188 Premium Rates (Individuals) 189 Premium Rates (Clinical Establishments) 189 Retroactive Date 189 An Ideal Indemnity Insurance Policy: Proposed Components Medical Emergencies in Dentistry 320 frihlatten/insgestion at Pareign je 370 Incidental Findings on Petreatment Screen 121 Dlagreich of Malignancy in Dentistry 321 Esthetic Dentistry 322 Naghigence in Dentchy 332 No Negligence Occaslom in Dental Practice 323 Protection Against Litigation 323 How to Avold Litigation? 324 Steps et Personal Level 324 Interpersonal Behavior 224 Academic and Technical Update 324 Awareness of Medical Laws 325 Reasonable Skills and Care 325 29. Medicolegal Issues in Anesthesiology Manpreet Singh, Ajay Kumar, Lakesh Anand Standard of Care 328 Duty of Care and Liability 329 Medicolegal Issues in Anesthesiology 329 Death on Operation Table 329 Witnessed Death on Operation Table: Recommendations for Doctors 329 Anesthesia Deaths 331 Awareness During Anesthesia 331 Error of Judgment 333 Mistake 333 Burden of Proof 334 Res Ipsa Loquitur 334 How to Decrease the Likelihood of a Lawsuit? 335 Accepted Practices and Procedures 336 Accidents, Misadventures, and Mishaps 336 Inherent Risks Choice of Treatment Keeping the Professional Knowledge and Skill up-to-date Cases to Observe ER -