Complaint
To Be Filed Before CCPA
(Draft
Letter)
MS Nidhi Khare
Dy Secretary
Central Consumer Protection Authority
Ministry of Consumer Affairs, Govt. of India
Krishi Bhawan
Subject:
Method of Training to Medical interns / student by Senior Doctors at hospitals.
Undersigned is a
registered NGO named as VOICE, an
acronym for Voluntary Organization in Interest of Consumer Education which has
pioneered the protection of consumers in India. Over the years, VOICE has been
representing consumers and protecting their interests with policy-makers, the
judiciary and statutory regulatory bodies. VOICE has worked relentlessly for
the cause of consumers among its stakeholders, many reputed Indian and international
organizations supporting social causes, academicians, professionals and
volunteers
For the above purpose our organization through our video
channel and legal desk helpline is getting number of complaints/questions from
the consumers who want advice
for filing medical negligence case against doctors finding them negligent while
treating their patient. In some of the complaints they state that doctors
confess their mistake while talking to their fellow doctors. They have gathered
an impression through the conversation between two doctors that there could be
a better way of treatment in their case. They seek legal advice on the issue
from legal desk of our organization.
We tried to find out as to how an impression of negligence crept into the
minds of patients from conversation between two doctors. It has been observed
that some medical institutes /hospitals etc. teaching their internes before the
patients and taking their brigade of ten-fifteen doctors in the ICU and
explaining them about their case in detail before them. Though it must be their
academic discussion but a layman and specially patient who is under treatment gets
panicky without understanding the medical know how
An example case:
We have a case in hands which is an example how patient becomes panicky
when comes across a situation a doctor teaching his students in ICU
A patient had undergone open heart surgery for valve repair. Initially
doctors had suggested to replace the valve. Best quality of valve was also
chosen to be replaced. During another Eco test before surgery, it was found a
lot of calcium around the valve and team of doctors consulted on the issue
whether calcium could be removed safely before removing valve from its place
and how it will be managed to replace successfully. It was informed to the
relatives of patients about the risk and also told about other option of repairing
of valve which had less risk if valve could be repaired. This was agreed by the
family and valve was successfully repaired. Patient was unaware of this
development on the last moment. Valve was repaired successfully
After surgery in the recovery room, senior doctor with team of interns
explains the students that this is the case where initially it was decided to
replace the valve but later on it was decided to repair only. He explained the
complications in the case, other remedies etc. This was all their academic
discussion but patient was horrified with the idea doctors changed the
treatment he desired and may be something is wrong with his health which
doctors are discussing. Patient suspected some medical negligence in his case
It is pertinent to mention that out of bulk cases
coming to the consumer commission for medical negligence, fifty percent cases
are actually not negligence cases and are rejected at the stage of admission
only. Consumers have complaints that Doctors are influential persons of the society
and their cases are not taken up seriously. A layman does not understand that
every unsuccessful treatment is not negligence. Most of the patients or their
families are innocent about the law but when they hear from doctors while
teaching students they get impression that there could be better way to treat
them. With this notion in mind, any small problem during the treatment gives
them feeling they are not treated properly.
Practice being followed by Medical entities for
training their interns
We have gone in to details to find out practices being followed by
various medical entities to give training to their interns in order to
understand the real issue. There are number of methods followed by various
institutes depending upon their system and set up. They are –
a)
Batches of 10-15 doctors given
weekly classes, discussing current cases under treatment in their Hospital.
b)
Batches of intern doctors accompany senior doctors when they take routine
round to their patients and interns are made to watch & learn how senior doctors treat the patients
c)
Batches of intern doctors are made to sit with senior doctors siting in OPD,
They watch every patient and understand their problem .Senior doctor explains
the case to interns after patient leaves. This batch continue their learning
process next time also
d)
Batches of 10-15 doctors come with Senior Doctor to ICU where patients
after surgery are kept in recovery room and explain about the disease
&surgery performed
Since we are not in
authoritative position to conduct any authenticated survey on the issue, the matter is directly concerning
large number of consumers taking treatment in the hospitals and nursing homes.
Voice is dedicated to work for welfare of consumers hence this matter is being
referred to your good office for your investigation in this matter and may
direct Medical Council of India to set guidelines for the purpose.
Relevant Law laid down by Supreme Court about
conduct of Doctors during treatment:
V.Shantha V/S Indian Medical Association, 1965 SC
Dr. J. 23 J. Merchant and others vs. Shrinath Chaturvedi reported in (2002) 6 SCC 635.
Achute Hari Bhau Khodwa V State Of Maharashtra SC 1996
Dr. Laxman Balkrishan Joshi v. Dr. Trimbak Bapu
Godbole and Anr. AIR 1969 SC
SC in the
above cases had observed as follows:
“The duties which a doctor owes to
his patient are clear. A person who holds himself out ready to
give medical advice and treatment impliedly undertakes that he is
possessed of skill and knowledge for the purpose. Such a person when consulted
by a patient owes him certain duties, viz., a duty of care in
deciding whether to undertake the case, a duty of care in deciding whether
treatment to give or a duty of care in the administration of that treatment
once decided. A breach of any of those duties gives a right of action
for negligence to the patient.”
When doctor is
negligent
!) Damage to organ due to negligence
!!) Wrong treatment due to wrong diagnosis
!!!)When treatment not chosen as per accepted and
established norms / medical research/available medical literature.
When doctor is not negligent
!) If five methods available
for treatment, one chosen, doctor not negligent
!!) Doctor not guarantor for
curing the ailment.
!!!) Error of judgment different from wrong
diagnosis
Three steps to be observed by
the doctor:
!) To decide whether he has to
take up the case or not.
!!) If taken up the case, he is
to decide what treatment is to be given.
!!!) Whether the treatment given as per the
diagnosis made.
Complaint for deficiency in
Paramedical services
!) Money receipt if refused
!!) Prescription or case history if refused on
request
!!!) Discharge summery
or test reports when not provided
!V) Equipment short causing
damage to patient or interrupt medical services
V) Infrastructure not up to
mark
V!) Staff, doctors, nurses not
available
Theory of res ipsa loquitur [a
thing speaks of itself]
!)Where
deficiency is obvious like removal of wrong lib , performance of operation on
wrong patient , giving injection without allergic test, use of wrong medicine
or leaving swabs or other items inside the body during operation ,in such a
situation there no need to further prove the negligence and this theory is
recognized as res ipsa loquitur
We have
observed that consumers/patients are misinformed most of the times from the
surroundings, one of those is teaching medical students before the patients and
this leads to many false cases of medical negligence. When the cases fail,
consumer gets disheartened due to their own misunderstanding
Keeping
in view the above circumstances, we urge your good office to direct Indian Medical
Association to conduct a survey and set some guidelines for training method for
interns keeping away patients from the scene.
Regards,
Applicant/Complainant
CEO, VOICE
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