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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