Ethics/Law
• Ethics are moral principles/self imposed code of conduct which guide a person in his or her day to day activities. Breaking an ethics is not a crime and is not punishable by law, but the society can censure the person for the same.
• Laws are regulations imposed by the government and passed through legislature. Breaking the law is a crime and is punishable under the law.
Professional Misconduct
• It is an act done by a medical man that may be reasonably regarded as disgraceful and dishonorable by his professional brethren of good repute and competence.
• Acts which constitute professional misconduct.
– Adultery, Advertisement, Abortion, Alcoholism, Addiction, Association.
– Dichotomy or fee splitting, Recruiting touts and agents, Disclosing the patients secret, Refusal to treat, Issuing false certificates, etc.
Medical ethics
• These are moral principles that guide a medical men in pursuit of his profession.
• Though breaking ethics is not a crime unless that coincided with any law, he or she may be censured by his professional brethren.
Negligence
• Professional negligence: is defined as
“ want of reasonable care and skill or willful negligence on the part of the medical man while treating a patient resulting in bodily injury, ill health or death.
• Justice Baron Alderson defined it on 1856 as “The omission to do something which a reasonable man could do or doing something which a prudent and a reasonable man would not do.”
• Duty of care.
– All doctors have a duty to become and remain competent at their job and they should be diligent in providing those skills to those who need them.
– Medical council set the minimum standards necessary.
– The level of skill and proficiency will vary with experience, continuing education and seniority.
• Breach of duty of care
– A doctor breaches his duty of care if he fails to reach the level of proficiency of his peers.
– It applies equally to the duty to diagnose, treat and give advice.
– Ignorance is no defence in negligence.
• Lord Wright defined it on 1934 as i) There must be a duty owed ii) Breach of that duty either by omission or commission iii) Direct causation iv) Damage.
• For an allegation of negligence by a healthcare professional to succeed, the claimant must prove the following
– The doctor owes a duty of care towards the patient,
– There was a breach of that duty of care.
– The patient suffered actionable harm or damage.
– The damage was caused by the breach (causation).
• Genuine errors of clinical judgement are not same as negligence.
• The breach can be something:
– Done (commission) e.g. forceps/ gauze left at operation site after surgery.
– Not done (omission), e.g. failure to attend a sick patient.
• Actionable harm or damage
– This is the disability, loss or injury suffered by the claimant.
• Causation.
Case--2
• On
• Autopsy revealed:
• External examination-
– The body was that of a healthy male.
– There was a healed scar on the left side of back of the chest just below the angle of the scapula.
• On dissection-
– All the abdominal organs were pale.
– Stomach contained about 800 ml of clotted blood.
– Examination of the chest cavity revealed the left lung to be consolidated in the posterior basal part and there was haematoma.
• On thorough dissection of the left lung a wooden spike was recovered from the posterior part of the base. The spike was about 8 cm long and 1 cm in diameter at the base, where it was irregular suggesting it to be a broken tip of a longer weapon. It was made of betel nut tree trunk.
• When queries were made with the accompanying relatives they provided with 4 discharge certificates three of them were issued by NMC and the last one issued by the Kathmandu Modernized hospital.
1st discharge certificate
- Patient admitted on 24.12.10 in the casualty ward and discharged on 03.1.11
• Injury note:
• Penetrating injury on the back of chest (left).
• Extensive emphysema on left side of the chest.
• Right limb movement –restricted.
• Pain in the right side of the pelvis.
• O.T. note- date – 24. 12. 07.
• Chest drain was fixed under
• Removal of the drain on 21.01.11.
2nd discharge certificate
• Patient admitted on 15.2.11 in the medical ward and discharged on 23.2.11. He was treated for Dieulafoy’s lesion in stomach with H/O haematoma in left lung due to assault by stab.
– Case summery: Admitted with complain of haematemesis for several times for 15 days.
– Pain in the lower left chest. (patient gave history of stab injury and treatment in the hospital)
– On examination
• Patient anaemic, B.P. 110/70 mmhg.
• Movement of the chest was restricted on left side.
• There is a scar on the back of left side of chest.
• Trachea centrally placed. Vocal fremitus and vocal resonance diminished on the left side.
• On Endoscopic examination of the stomach Dieulafoy’s lesion of the stomach with mild antral gastritis was revealed.
• BT: 7 min 30 sec. CT: 8 min 4 sec. N-66%, L-26%
• CT scan of lung reveals collapse consolidation associated with intra lesional haematoma in left lung
(medial & post. basal region).
• Adrenal injection in Dieulafoy’s lesion was done.
• Patient discharged on 23.02.11 after improvement.
3rd discharge certificate
– The patient was admitted on 21.02.11 and discharged on 29.02.11.
– He was treated for Dieulafoy’s disease with PUD.
– Endoscopy on 29.02.08—Dieulafoy’s disease.
– Endoscopy on 02.03.08 Normal upper GIT.
• 4th discharge certificate
– Admitted in Kathmandu Modernized Hospital on 01
to sum up it up, Medical negligence claim (also referred to as clinical negligence claims) can vary from incorrect prescriptions, a delay in diagnosis which resulted in an injury, misdiagnosis of an illness or disease, surgical errors during an operation, or neglect and injuries during childbirth, for either mother or baby.
Ref: www.medicalnegligenceclaims.com