This article enlightens us with a case in which the division bench of the Madras High Court reprimanded the doctor for his role in providing a bogus medical certificate, upholding the Tamil Nadu Medical Council (TNMC) judgement prohibiting him from practising medicine for two years.

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The Madras HC division bench consisting of Chief Justice Munishwar Nath Bhandari and Justice Bharatha Chakravarthy recently stated that the doctor had betrayed all of the medical training he had received.

The bench remarked,

"When the appellant has forfeited all of the education he acquired from these institutions just because the real estate value of these sub-urban properties has skyrocketed beyond their value, we believe that doubles the gravity of the misconduct, and consequently, we do not find the appellant's punishment to be in any way disproportionate or excessively severe."

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The case

In 2015, a surgeon from Coimbatore was accused of giving a fraudulent medical certificate. It is claimed that the family of the patient used a false certificate to record a settlement deed for around Rs 50 crore, transferring significant assets into the relative's name.

In response, the patient's daughter contacted the Tamil Nadu Medical Council in 2018, and after receiving the complaint, the Council formed a disciplinary committee to investigate the petitioner doctor and others.

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Investigation

Following an investigation, the Tamil Nadu Medical Council learned that the doctor had noted in the certificate that the patient was conscious despite being unwell. This allowed the patient's kin to register a property worth 50 crore rupees in his name.

When the subject was brought before the Council, the doctor said in his defence that the medical certificate was granted in good faith by complying with the regulations. He also mentioned the complainant's delay in registering the complaint.

A letter from the hospital where the dead was treated afterwards was also presented by the doctor, noting that on October 8, 2015 (the day the petitioner doctor issued the certificate), the deceased was conscious and oriented. The doctor from Coimbatore was suspended from the medical register for two years on May 4, 2021, after the Council had found him to be guilty.

As a matter of fact, the TNMC had instructed the Karnataka Medical Council to suspend two further physicians connected to the city hospital for "falling short of the standard of care, honesty, and behaviour." The state medical council advised deleting the names of the previous medical superintendent and treating physician for one year and six months, respectively.

The petitioning physician challenged the suspension order dated 04/05/2021 by petitioning the High Court. Previously, the single-judge bench of the Madras High Court considered the case and affirmed the Medical Council's ruling. The single judge bench found that the doctor's conduct of giving a bogus medical certificate to a patient for the purpose of transferring his property constituted a compelling storyline for a crime thriller and confirmed the two-year suspension of the doctor's licence.

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Court ruling

The court ruled that the sentence imposed on the doctor by the Medical Council was appropriate, and the single-judge bench said:

"Such punishment imposed on the petitioner, in the opinion of this Court, does not need intervention."

The doctor disagreed with the ruling, nonetheless, and went before the Madras High Court's Division bench. The experienced Senior Counsel representing the physician cited the hospital records and the testimony of physicians. The doctor's attorney mentioned these and said that the patient's state was described as "Sensorial," which indicates that the patient was conscious.

Thus, the doctor's attorney said that the patient's hospitalisation and many visits to the intensive care unit would only attest to the accuracy of the doctor's claim that he was confined to his bed, and the certificate's only purpose was to certify that he was unable to go to the Sub-Registrar's office. Counsel for the physician argued in this submission that the certificate was neither fraudulent nor deceptive.

Since the physician was a relative and an expert in the area, he was often called and confided in by other treating physicians at the hospital, the doctor's attorney contended that there is no clear need that only the treating doctor may provide a medical certificate.

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In addition, the doctor argued that the approach employed by the TNMC Disciplinary Committee was a flagrant breach of the norms of natural justice since he did not have the opportunity to cross-examine the treating physician. It was the treating physician's remark that suggested the patient was unconscious.

On the other hand, the counsel for TNMC argued that both the form and the substance of the medical certificate were severely unsuitable and directly violated the rules. Claiming that the doctor had engaged in grave professional misconduct, the Council argued that they had considered every aspect of the doctor's explanation during the investigation, that the Disciplinary Committee had called the relevant witnesses, and that the appellant had participated in the investigation. Additionally, the counsel contended that there was no particular request for treating physician cross-examination.

The doctor was not a stranger, according to the attorney representing the dead patient's daughter, since he was the father-in-law of the patient's son. He had not treated the patient, with the exception of paying a visit to him in the intensive care unit, and he had no reason to provide the medical certificate.

After reviewing all of the parties' arguments, the HC division bench went to the relevant regulations and took notice of the typical practice criteria for granting a medical certificate to any patient.

Referring to the regulations, the bench said, "Clearly, the medical certificate produced by the appellant, which is excerpted above, is not in compliance with the aforementioned standards and Regulation 1.3.3."

The court resorted to Regulation 7.7 and Appendix 4 (m) of the regulations to determine whether the physician had provided a false and misleading certificate.

"Any registered practitioner who is established to have signed or given his name and authority to a comparable certificate, notice, report, or document that is false, deceptive, or inappropriate is responsible to have his name removed from the register," states the relevant regulations.

Court observations 

"The goal of the certificate was to excuse the patient's participation in the public office, particularly before the Sub-Registrar. However, certifying that the patient is fit for the stated purpose but unable to travel is plainly deceptive, since the facts are otherwise."

"In addition, the document states falsely that the patient is orientated, despite the fact that the patient was confused entirely and even senseless. Thus intentionally false information is stated on the certificate. In this light, the aforementioned charges, which constitute a blatant violation of regulation 7.7, constitute misconduct.

In reality, Regulation 7.1 specifies that any infringement of the regulations constitutes misconduct. In line with the Tamil Nadu Medical Council (ProfessionsConduct, Etiquette and Ethics) Regulations of 2003, the panel concluded that the appellant was guilty of professional misconduct.

The fact that he could not even sign and just his left thumb imprint was taken on every page of the paper, and that too in a way that suggests it was not created by the same person, but rather with the assistance of another in odd and reverse directions, proves he was confused. The learned Senior Counsel, arguing on behalf of the appellant, constantly emphasised the term "Sensorial" to indicate that the patient was conscious, but neglected to mention that the patient was obviously confused.

The bench noted:

"Therefore, when the hospital records requested by the first and second respondents and produced before this court continuously, clearly, and categorically indicate that the patient was disoriented throughout, there is ample evidence on file that the certificate is not only deceptive but also contains false information."

The court also determined that the TNMC had not breached any regulations, noting that "even in the absence of treating physician testimony, the falsehood of the certificate is shown by the hospital's own records.

"This certificate was issued understanding the actual situation of circumstances. This certificate is granted to a close relative with the nefarious intent of giving his son-in-law an unwarranted part in the 19 properties listed above. Therefore, the nature of the appellant's conduct is grave." the bench stated.

The bench also took into account the physician's academic credentials from the beginning.

"We do not believe that the appellant's sentence is unfair or overly harsh given that he has disgraced all the education he received at these schools."

 

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.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.