Negligence claim

The doctor had a duty to provide care to the patient (duty of care)
The doctor failed to reach the standard of care expected of him/her (breach of duty)
The failure of the doctor caused harm to the claimant (causation)

Purposes of the law of medical negligence

Compensate loss
Punish doctors
Provide accountability
To make money for the claimant
Get assurance that the same thing does not happen again
Create safer systems
Getting and explanation
Wanting an apology

Problems with the current system

Takes a long time
Immediate need for fair compensation
Claimants do not have easy access to expert advice and information both medical and legal
Costs
Defensive medicine

avoid litigation
Communication with patient
- Before, during and after treatment
- Especially after something has gone wrong proper complaints process accompanied by swift and
appropriate action
Communication within the team doctors, nurses, therapists, all care givers
Ask for help or advice if you are uncertain
Be aware of relevant guidelines and ethical rules
Incidence reporting

Principles of reporting
Should be
Contemporaneous
Adequate and accurate
Objective
Legible and clear
DO NOT
Obliterate mistakes
Rewrite recordss
Report or sign on behalf of another staf

Risk of Harm

Four Features of Primary Care Setting

 Building relationships long term relationships which are open and significant are built over the
dimension of time,
The infrastructure for care is familiar for a friendly atmosphere for a stable relationship with the
primary care team,
Patients are seen at a time when stage of the disease is undiferentiated
Primary care providers integrate care from multiple disciplines

Risks of the Four Features

Patient variation
Caring
Comforting,
Diagnosing,
Carrying out procedures,
Treating
Counselling

Person Approach
Assumes that:
a. the person is the root cause of the error the provider or the patient
b. Efort is made to correct the cause
c. Efort is made to avoid the error
d. Further efort is made to improve the person/patient behaviour/practice
System Approach
a. Looks at the system as a whole
b. Looks for latent or hidden causes in the system that contribute to the error
c. Looks for active or visible causes of error.

Modalities of Management
Pharmacological
- simple analgesics
- NSAIDS
- opiates/opioids
- antidepressants, anticonvulsants
- Local analgesics, neurolytics, chemotherapy

Surgical
Non-surgical
- radiotherapy
- TENS (transelectrical nerve stimulation)
- Cryotherapy
- acupuncture
- physiotherapy
- massage, reflexology
- hypnosis

When can pregnancies be terminated?

Up to 20 weeks gestation
With the consent of the women. If the women is below 18 years or is mentally ill, then with
consent of a guardian
With the opinion of a registered medical practitioner, formed in good faith, under certain
circumstances
Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks

Indications of TOP
 Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental
health of woman
Substantial risk of physical or mental abnormalities in the fetus as to render it seriously
handicapped
Pregnancy caused by rape (presumed grave injury to mental health)
Contraceptive failure in married couple (presumed grave injury to mental health)

Place for conducting MTP

A hospital established or maintained by Government
or
A place approved for the purpose of this Act by a District-level Committee constituted by the
government with the CMHO as Chairperson

Who can perform

who has a recognized medical qualification
Whose name has been entered in a State Medical Register and
Who has such experience or training in Gynecology and Obstetrics
For termination up to 12 weeks:
A practitioner who has assisted a registered medical practitioner in performing 25 cases of MTP
of which at least 5 were performed independently in a hospital established or maintained or a
training institute approved for this purpose by the Government
For termination up to 20 weeks
A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology
A practitioner who has completed six months house job in Obstetrics and Gynecology
A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at
a hospital which has all facilities
A practitioner registered in state medical register immediately before commencement of the Act,
experience in practice of Obstetrics and Gynecology for a period not less than three years.

Approval of a place by trimester

For sites up to 12 weeks (1st trimester):
Gynecology examination/ labor table
Resuscitation and sterilization equipment
Drugs & parental fluids
Back up facilities for treatment of shock
Facilities for transportation
For sites up to 20 weeks (1st and 2nd trimester):
All requirements for up to 12 weeks +
Operation table and instruments for performing abdominal or gynecological surgery
Anesthetic equipment, resuscitation equipment and sterilization equipment
Drugs & parental fluids notified for emergency use

Acting as Medical Expert

1. Lawyers write to Expert with relevant case notes/documents
2. Expert Studied documents made available and sends a written Expert Opinion (stating the fee)
3. Lawyer decides whether written opinion will HELP his case
Some lawyers or claimant/defendant approached the Expert to Strengthen the opinion! Or to
reduce the charges! Some lawyers end their connection with the Expert (opinion unsuitable)
4. Legal Sparring
to go to court or not
to settle out of court

Presentation of Expert Evidence in Court

1. Application to court by respective Lawyers (Defense/Claimant) for acceptance as Medical Expert
Expert might be asked to take the stand to answer questions by both sides (lawyers) and the judge
to establish credibility as an Expert
2. Giving Evidence as an Expert
- Examination in Chief
- Examination in Cross
- unbiased (sometimes morally and ethically difficult) opinion to assist the court
- focus on standards and basic evidence-based principles of patient-care
- Preventable harm should have been prevented
- focus should NOT be on what will happen to me if others are implicated or how can I protect others
- short relevant answers, not straying outside ones area of expertise
- DO NOT fantasise that one is a lawyer or even a medical investigator (TV influence). DO NOT try to
be too smart.
- The Medical Expert is required to give an Expert opinion when so asked
- Respect the Court and the Court will respect You!