Consent THIS ONE WORD PLAYS VERY IMPORTANT ROLE IN CASES AGAINST DOCTORS

(read with care)

According to Sec. 90 IPC, a person who consents can’t complain. Giving a consent is a an act of reasoning and deliberations after balancing the good and evil. The various types of consents can be: (a) Implied consent; (b) Blanket consent; (c) Written consent; and (d) Informed consent. A valid consent is that which is given voluntarily (without pressure), by an adult of sound mind who is not under any intoxication. The consent is obtained after explanation and reasonable understanding of facts and not by hiding facts or mis-representation of facts. Consent should be informed and preferably in writing. The consent should preferably be taken in presence of witness (two from patient side and two from hospital side).

Sometimes a child is brought to pediat-ricians by neighbors (parents of child are immediately not available for consent). In such situations if it is a genuine and real emergency, the child can be managed even without con- sent. The neighbors consent doesn’t have legal validity.

Exception to Consent

In the following situations it may not be necessary to take the consent: (i) if you are managing a patient in an Emergency situation; (ii) While working in situations of public interest like during floods, cyclones, earthquakes, etc.; (iii) Treating patients in places like mental asylums, orphanages, etc.; and (iv) Working under Court order, e.g., in case of smuggling, operations are done for detecting narcotics or gold kept in intestine or other parts of body.

Documents (Sec. 29 IPC)

Documents can be friend as well as foe of medical personnel. Documents are property of hospitals and should be produced on written requests only. Documents carry confidential information of patients and should be released with consent. Well maintained documents may be helpful in most of the cases of negligence. Care should be exercised to ensure that documents are clean, complete, chronological, comprehensive, correct and without manipulations. Docu- ments can be asked for: (a) Outdoor patients, indoor admissions; (b) Medical termination of pregnancy, medicolegal cases, operations, (c) death certificates; and (d) other certificates.

(Consumer Protection Act)

was enacted in 1986. As far the medical services were concerned, different courts had different rulings till the Supreme Court in November 1995 by its ruling included medical services in COPRA. A consumer can approach District Forum, State Commission, National Commission and finally the Supreme Court according to jurisdiction or amount of damage claimed(4,5). The limitation period is two years but can be extended if the judge thinks so in a particular case (after recording the reasons).

A complainant can be consumer himself, any beneficiary, voluntary consumer organization or Government. The complaint can be filed for the consideration which may be paid/promised, part paid/part promised or even deferred payment. The complaint can be for any fault, deficiency, shortcomings in quantity, quality or standard of work performance.

Goodfaith as per Sec. 52 of IPC means any work done/believed to be done with due care and attention.

According to analysis of compiled cases under CPA by Dr. Jagdish Singh (Personal communication) the maximum number of cases are from Obstetrics and Gynecology and Surgery branches. The hospital covered under CPA include all private hospitals, ESIS, SAIL, Corporate hospitals and even Government hospitals where some facilities are on payment. Government and charitable hospitals where all the services are totally free, at present are not covered by CPA. The outcome of about 202 cases was as follows: (i) Negligence held 28.4%; (ii) Negligence not held 62.3%; and (iii) No negligence compensation granted to Doctors/Hospitals 9.3%.