Dr. MC Gupta, a physician turned lawyer and medicolegal consultant provides answers to queries posted by M3 India doctors on a recent survey.

QUESTION-1: Do I have to register an MLC for a chemical injury to eye?

ANSWER:

An injury is an injury, whether mechanical, chemical, thermal or electrical. There is no reason why a chemical injury, to eye or any other organ, should be ignored for the purpose of the MLC. As a matter of fact, there are special provisions in the IPC for acid attacks.

The Section 326 A in the Indian Penal Code lays down the punishment for acid throwing. The minimum punishment is 10 years' imprisonment. It can extend up to life imprisonment with fine. A separate law to punish offenders in such cases was passed along with amendment of law on sexual offences.

QUESTION-2: Do patients have the right to demand a photocopy of the indoor case record (including the record regarding doses/time of injections & IV fluids) or to take instant photographs of the same using their mobile phones?

[NOTE--We give complete discharge summary at the time of discharge.]

ANSWER:

1. Yes, the patients have a right to demand a photocopy of the complete medical indoor case record (including the record regarding doses/time of injections & iv fluids). For this purpose, they should make a written request to the hospital and should offer to pay the necessary photocopying charges etc. It is clarified that the patients do not have a right to demand original record, which is a property of the hospital.
2. Patients or their attendants do not have a right to take, without permission, a photograph of the hospital property /records by whatever means, including a mobile phone.
3. It is the duty of the hospital to give discharge summary at the time of discharge. Doing so is no excuse for not providing a copy of the patient’s hospital record.
4. There is an order of the Central Information Commission that the patients even have a right (and hospitals have duty to provide) indoor case record on a daily basis. However, this order is not being followed in actual practice. [NOTE—I do not think this is a rational or proper order. However, this has not been apparently challenged by anybody.]

QUESTION-3: Is there a common/universal consent form for surgical procedures?

ANSWER:

1. There is no common/universal consent form for surgical procedures? As a matter of fact, there is no need/feasibility to have such a common/universal consent form. There are several different types of diseases and surgical procedures and no attempt should be made to devise a common form for all surgeries. Different hospitals use their own consent form and that’s fine as long as the consent form contains the necessary basic ingredients.
2. A good consent is that where the consent is given by the patient after understanding the relative risks and advantages of the proposed procedure. The facts that such information has been given and has been understood must be established. These can be established if the consent is in writing and is given after necessary information has been given to the patient in the language that he understands. If he cannot read or write, or if he does not understand the language or dialect spoken by the information giver, the facts that information has been given and has been understood must be certified by another person, preferably two persons, that the information was given to the patient by him and the patient had consented in his presence.
3. The information given should contain the following aspects:
   1. What is the procedure to be performed?
   2. By whom is it to be performed?
   3. Under what conditions (GA, spinal, local anesthesia etc.) is it to be performed?
   4. Why has it to be performed? [Advantages; alternative possible procedures; Why the proposed procedure might be more appropriate? What may be the risk if the procedure is not performed?]
   5. What is the risk inherent in the proposed procedure?
4. The consent form should never consist only of the printed form and the signature of the patient. It is always highly preferable that the patient writes in his own handwriting something like the following—“I have read and understood what is written here and what has been told to me verbally by my doctor. I have understood the risk and I consent freely for the same.”
5. It is not advisable to have the same standard consent form from all patients.
6. Consent is very important. The following SC judgment was based mainly on the concept of consent:
7. Samira Kohli v. Dr. Prabha Manchanda & Anr., decided on 16/01/2008, SC; 2008 AIR 1385, 2008 (1) SCR719 , 2008 (2) SCC1 , 2008 (1) SCALE442 , 2008 (1) JT399; http://indiankanoon.org/doc/438423/
8. It is a sad fact that, in actual practice, proper informed consent is seldom taken in hospitals in India. The whole process consists of the admission clerk or a staff nurse asking the patient to sign a printed form. Even this is not done properly in many cases.
9. Please remember that consent must be given by the patient himself / herself unless the patient is incapacitated to give consent by reason of age, mental condition etc.
10. It is best to use bilingual consent forms so that most persons can read and understand it before giving consent.

QUESTION-4: Should consent be taken for reusing a device that is actually meant for single use?

ANSWER:

1. In general, multiple use of a single use device is an invitation to be entrapped in a charge of medical negligence.
2. If there is a situation when a single use device has to be used again in a patient, the reasons, full information and consent must be documented well and in detail.
3. Situations where a single use device may have to be used again in a patient may be as follows:
   1. When the use of the device is urgently needed but the unused device is not available.
   2. When the fresh unused device is so much more costly than the used device that the patient opts for a used device after he has been explained the risk involved (and after the doctor / doctors concerned reach a written conclusion that, in the circumstances, it may be permissible to use a used device).
   3. When the used device is being used after obtaining written concurrence of the hospital administrator.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Content from the writer has been directly replicated on the website. No edits have been made.

The writer, Dr. MC Gupta is a practising lawyer specialising in medical negligence cases. He also has an MD Medicine from AIIMS, Delhi where he also worked as a faculty member for 18 years, later working another 10 years as a Professor and Dean at National Institute of Health and Family Welfare, New Delhi, before pursuing law.