Doctors Apprehensions :-
• Bad doctor-patient relationship. • Tendency for extensive laboratory investigation. • Tendency to make different Indemnity/Insurance policy for paying compensation. • The treating Physician will charge more from the general patients.
MEDICAL COUNCIL. • A patient can file a complaint with the respective council for doctor’s negligence. Unfortunately the council has power to punish the doctor but does not have the power to order compensation even if the negligence is proved. • The punishment which can be given to the doctor by the Medical Council/state Medical Council – • Issuing a warning notice. • Temporary erasure of name from Medical Registrar. • Permanent erasure of name from Medical Registrar.
OTHER LAWS : • Under M.T.P. Act, Drug Act, Bombay Nursing Home act etc. patient can file a complaint to the respective authority. Here also they do not have power to order compensation
CONCLUSION :- • TO AVOID ALL THE MEDICOLEGAL PROBLEMS CERTAIN PRECAUTIONS TO BE TAKEN :-
• Keep full and accurate Medical Records. • Employ standard care and skill • Do not fail to get written informed consent. • Diagnosis to be confirmed by laboratory tests. • Proper investigation to be advised. • Proper immunization schedule to be followed. • Sensitivity tests to be done where applicable. • When diagnosis is obscure consult another senior/specialists. • Do not criticize another practitioner. • To check the condition of the equipment frequently. • The drug to be identified with expiry date before introduction. • The patient must not be abandoned. • No female patient should be examined without any female attendant. • Anaesthesia should be given by a qualified person. •
NEVER GUARANTEE A CURE. PROTOCOL FOR POLICE CASES & RAPE/SEXUAL ASSAULT. •
A patient when comes to ER/OPD of Govt. Hospital C/O any injury/Accidental/SelfInfected/Homicidal/Poisoning/Sex assault/Burn injury etc. proper reporting in papers supplied from Police Dept. – the named as indoor Police cases/outdoor police cases where history taken and other points are written. • The form should be properly filled up with signature of patient/patient party and witness should be taken marks of identification of patient should be noted. • The size of injury in which part of the body the injury is present. Age of injury, type of weapon used should be noted. • If there are minor injury patient should be treated properly at ER with advice to attend SOPD/OPD next morning and or to attend ER in necessary. If patient is unconscious and unknown then • Name of persons brought the patient should be noted with full address and their signature should be taken. • The valuable materials with the patient should be seized. These should be properly packed labeled and handed over to Ward Master with records kept in the ward. Other special points which should be done in the ward. • After receiving the patient in the ward the doctor and Nurse should note for – – Airway – if obstruction, proper management – Bleeding – if present, proper management – Cardiac – condition of the heart should be noted with B.P./Pulse. • The weapon should be seized. It should be noted that whether the patient come alone or with some persons. • If police personnel brought the patient then his name should be written in the form.
RAPE/SEXUAL ASSAULT •
The victims and accused should be examined as per written prayer or/and order from Honorable Magistrate (S.D.J.M.). • The written consent of victim and accused must be taken in form. According to the Bureau of Police research and Development the number of rape cases per lakh population has risen continuously in India over the year, • the highest volume of rape cases was registered in Sikkim followed by Jammu and Kashmir, Madhya Pradesh, Assam and West Bengal. • Among the major cities in India Delhi has shown the highest number of rape cases in one year followed by Bombay compared to other metropolitan cities in the world. What is Rape? • Rape is defined as an unlawful carnal knowledge of a female for and against her will. • Carnal knowledge is defined as penetration of genitalia no matter how slight by the penis occurs while the female is sleeping unconscious or under the influence of alcohol or drugs. • A male who is sexually assaulted is sodomized. • Sodomy is oral or anal penetration. Nursing Alert :- • The management of the sexual assault is important but immediate physical health should be ensured first. • A complete primary and focused assessment should take place being alert for signs of internal haemorrhage, shock or respiratory distress but victim is suffering from trauma in the form of physical assault the trauma should be managed in the order of established priorities. • Most emergency department have commercially prepared rape evidence collection kits as well as written protocols for the treatment of injuries, legal documentation and sexually transmitted disease and pregnancy prevention. Interviewing the patient :- • Consent should be obtained for the examination of collecting of swab/evidence for release of information to law enforcement agencies. • Record history of event in the patient’s own words. • Ask the patient has bathed, gargled or brushed teeth changed clothes or urinated defaecated since attack – may alter interpretation of subsequent findings. • Examine rectum for signs of trauma, blood and semen stains. Interviewing the patient :- • Record time of admission, time of examination, date and time of sexual assault and the appearance of the patient. • Document any evidence of trauma – dislocation, bruises, laceration, secretion, torn and bloody clothing. • Record emotional state. • All collected samples & records to be enveloped by sealed. Intervention : Preparing for physical examination – Assist the patient to undress over a sheet large piece of paper to obtain debris. – Protect patient against sexually transmitted diseases such as gonorrhoea, H.I.V. etc. – Immediately obtained (positive swab taken in the immediate post rate period will only reflect existing disease). – Place each item of clothing in a separate paper bag (plastic bags promote moisture retention which may lead to formation of mold and mildew which can destroy evidence). • Label bags appropriately : give to appropriate law enforcement authorities and has to be sealed Physical Examination. • Examine the patient ( from head to toe) for injury especially to the head, neck, breasts, thigh, back and buttocks. • Assess for external evidence of trauma (bruises, laceration, stab wounds). • Inspect fingers for broken nails and tissue and foreign materials under nails. • Document evidence of trauma with body diagrams or photographs. • Assist in conducting oral examination to determine secretion status of patient compared with that of assailant. • obtain a saliva specimen • take prescribed cultures of gum and tooth areas. Providing follow-up services. • Make an appointment for follow up surveillance for pregnancy, sexually transmitted disease and HIV counseling. • The patient should be accompanied by family member or friend when leaving the health care facility. • Inform the patient for counseling services to prevent long term psychological effects. Counseling services should be made available to the family. Obtaining Laboratory Specimen • Collect vaginal aspiration which is examine for presence or absence motile/non-motile sperm. • Use sterile swab to draw from vaginal pool for acid phosphatase, blood group, antigen of semen and precipitation test against human sperm and blood. • label all specimens with name of patient, date, time of collection, body area from which specimen was obtained and names of personnel collecting specimens to preserve chain of evidence, give to designated person (crime laboratory) etc. and obtain an itemized receipt. • Examination of the Victim : • It must be remembered that the police or court has no power of compelling a women to show the private parts of her person for examination of medical practitioner, male or female. • Conclusion : • Rape has been described as :- • “ not an act of sex but an act of violence with sex as the primary weapon”. It may lead to a wide variety of physical and psychological reactions.
• Bad doctor-patient relationship. • Tendency for extensive laboratory investigation. • Tendency to make different Indemnity/Insurance policy for paying compensation. • The treating Physician will charge more from the general patients.
MEDICAL COUNCIL. • A patient can file a complaint with the respective council for doctor’s negligence. Unfortunately the council has power to punish the doctor but does not have the power to order compensation even if the negligence is proved. • The punishment which can be given to the doctor by the Medical Council/state Medical Council – • Issuing a warning notice. • Temporary erasure of name from Medical Registrar. • Permanent erasure of name from Medical Registrar.
OTHER LAWS : • Under M.T.P. Act, Drug Act, Bombay Nursing Home act etc. patient can file a complaint to the respective authority. Here also they do not have power to order compensation
CONCLUSION :- • TO AVOID ALL THE MEDICOLEGAL PROBLEMS CERTAIN PRECAUTIONS TO BE TAKEN :-
• Keep full and accurate Medical Records. • Employ standard care and skill • Do not fail to get written informed consent. • Diagnosis to be confirmed by laboratory tests. • Proper investigation to be advised. • Proper immunization schedule to be followed. • Sensitivity tests to be done where applicable. • When diagnosis is obscure consult another senior/specialists. • Do not criticize another practitioner. • To check the condition of the equipment frequently. • The drug to be identified with expiry date before introduction. • The patient must not be abandoned. • No female patient should be examined without any female attendant. • Anaesthesia should be given by a qualified person. •
NEVER GUARANTEE A CURE. PROTOCOL FOR POLICE CASES & RAPE/SEXUAL ASSAULT. •
A patient when comes to ER/OPD of Govt. Hospital C/O any injury/Accidental/SelfInfected/Homicidal/Poisoning/Sex assault/Burn injury etc. proper reporting in papers supplied from Police Dept. – the named as indoor Police cases/outdoor police cases where history taken and other points are written. • The form should be properly filled up with signature of patient/patient party and witness should be taken marks of identification of patient should be noted. • The size of injury in which part of the body the injury is present. Age of injury, type of weapon used should be noted. • If there are minor injury patient should be treated properly at ER with advice to attend SOPD/OPD next morning and or to attend ER in necessary. If patient is unconscious and unknown then • Name of persons brought the patient should be noted with full address and their signature should be taken. • The valuable materials with the patient should be seized. These should be properly packed labeled and handed over to Ward Master with records kept in the ward. Other special points which should be done in the ward. • After receiving the patient in the ward the doctor and Nurse should note for – – Airway – if obstruction, proper management – Bleeding – if present, proper management – Cardiac – condition of the heart should be noted with B.P./Pulse. • The weapon should be seized. It should be noted that whether the patient come alone or with some persons. • If police personnel brought the patient then his name should be written in the form.
RAPE/SEXUAL ASSAULT •
The victims and accused should be examined as per written prayer or/and order from Honorable Magistrate (S.D.J.M.). • The written consent of victim and accused must be taken in form. According to the Bureau of Police research and Development the number of rape cases per lakh population has risen continuously in India over the year, • the highest volume of rape cases was registered in Sikkim followed by Jammu and Kashmir, Madhya Pradesh, Assam and West Bengal. • Among the major cities in India Delhi has shown the highest number of rape cases in one year followed by Bombay compared to other metropolitan cities in the world. What is Rape? • Rape is defined as an unlawful carnal knowledge of a female for and against her will. • Carnal knowledge is defined as penetration of genitalia no matter how slight by the penis occurs while the female is sleeping unconscious or under the influence of alcohol or drugs. • A male who is sexually assaulted is sodomized. • Sodomy is oral or anal penetration. Nursing Alert :- • The management of the sexual assault is important but immediate physical health should be ensured first. • A complete primary and focused assessment should take place being alert for signs of internal haemorrhage, shock or respiratory distress but victim is suffering from trauma in the form of physical assault the trauma should be managed in the order of established priorities. • Most emergency department have commercially prepared rape evidence collection kits as well as written protocols for the treatment of injuries, legal documentation and sexually transmitted disease and pregnancy prevention. Interviewing the patient :- • Consent should be obtained for the examination of collecting of swab/evidence for release of information to law enforcement agencies. • Record history of event in the patient’s own words. • Ask the patient has bathed, gargled or brushed teeth changed clothes or urinated defaecated since attack – may alter interpretation of subsequent findings. • Examine rectum for signs of trauma, blood and semen stains. Interviewing the patient :- • Record time of admission, time of examination, date and time of sexual assault and the appearance of the patient. • Document any evidence of trauma – dislocation, bruises, laceration, secretion, torn and bloody clothing. • Record emotional state. • All collected samples & records to be enveloped by sealed. Intervention : Preparing for physical examination – Assist the patient to undress over a sheet large piece of paper to obtain debris. – Protect patient against sexually transmitted diseases such as gonorrhoea, H.I.V. etc. – Immediately obtained (positive swab taken in the immediate post rate period will only reflect existing disease). – Place each item of clothing in a separate paper bag (plastic bags promote moisture retention which may lead to formation of mold and mildew which can destroy evidence). • Label bags appropriately : give to appropriate law enforcement authorities and has to be sealed Physical Examination. • Examine the patient ( from head to toe) for injury especially to the head, neck, breasts, thigh, back and buttocks. • Assess for external evidence of trauma (bruises, laceration, stab wounds). • Inspect fingers for broken nails and tissue and foreign materials under nails. • Document evidence of trauma with body diagrams or photographs. • Assist in conducting oral examination to determine secretion status of patient compared with that of assailant. • obtain a saliva specimen • take prescribed cultures of gum and tooth areas. Providing follow-up services. • Make an appointment for follow up surveillance for pregnancy, sexually transmitted disease and HIV counseling. • The patient should be accompanied by family member or friend when leaving the health care facility. • Inform the patient for counseling services to prevent long term psychological effects. Counseling services should be made available to the family. Obtaining Laboratory Specimen • Collect vaginal aspiration which is examine for presence or absence motile/non-motile sperm. • Use sterile swab to draw from vaginal pool for acid phosphatase, blood group, antigen of semen and precipitation test against human sperm and blood. • label all specimens with name of patient, date, time of collection, body area from which specimen was obtained and names of personnel collecting specimens to preserve chain of evidence, give to designated person (crime laboratory) etc. and obtain an itemized receipt. • Examination of the Victim : • It must be remembered that the police or court has no power of compelling a women to show the private parts of her person for examination of medical practitioner, male or female. • Conclusion : • Rape has been described as :- • “ not an act of sex but an act of violence with sex as the primary weapon”. It may lead to a wide variety of physical and psychological reactions.
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