Medico - legal Aspects

Law
• The law is a system of rights and obligations
which the state enforces

• –Green
• Definition:

• Defined as the sum total of rules and

regulations by which a society is governed,
law is created by people and exist to regulate
all persons

• Guido
 Medico legal issues
• Any case of injury or ailment where some
criminality is involved is called Medico legal
cases(MLC)
• It is legal presumption That medical officer is
capable of identifying such cases.
• Medico legality is judged by the history
furnished by the patient coupled with the
finding in the physical examination
 Medico legal issues and emergency
department
Following categories of cases coming to casualty
or brought to casualty are to be labeled as
medico legal:

• 1.Cases of injuries and burns, circumstances of

which make it probable that someone has
committed an offence
• 2.All cases of suspected or evident poisoning
or intoxication
• 3.All vehicular, factory or unnatural accident
cases, where there is likelihood of patient’s
Death
• 4.Suspected or evident criminal abortions
5.Suspected or evident sexual assault
• 6.Unconscious cases where its cause is not
clear or not natural
• 7.Cases brought dead with improper history,
creating suspicion of an offence
• 8.Cases referred from court or otherwise age
estimation
 Disposal of medico legal case
• a)The above cases whether brought by the
police or somebody else ,must be labeled as
medico legal in casualty department , if not
registered else where
• b)Request of the patient or the accompanying
relatives or friends for not registering the case
as medico- legal, should not be agreed
• c)Any case among the above list even if brought several
days after the incident, shall be registered as medico-
legal and an opinion regarding the case be given
according to the present condition of the patient
d)A fresh medico- legal report may not be prepared if
the case brought had been registered as medico- legal in
some hospital
e)Treatment in all medico- legal cases takes
precedence over medico- legal formalities especially
when the condition of the patient is serious
 Procedure of medico
legal cases
• All medico- legal cases are supposed to be
register and then inform to the police
Appropriate prescription forms are to be filled
for preparing medico legal reports. In such
cases, identification data, date and time of
arrival, date and time of examination, name
and address of the attendant of the patient is
to be recorded in each and every case.
• Specimens relevant to the case should be
properly sealed, labeled and send for
investigation, eg: in a stabbed victim the injury
should be encircled, signed and then the
specimen should be handed over to the police
in a sealed cloth parcel
 Negligence And Malpractice
• Negligence is the failure/ omission of an
individual to do something which a reasonably
prudent person would do, or doing something
which a prudent & reasonable man would not
do.
• In other words negligence is conduct that falls
below the standard of care which is
established by the law for the protection of
others against unreasonable risk or harm
• It is characterized chiefly
inadvertence,thoughtlessness or inattention
What constitutes deficiency in service
or negligence
• Deficiency of service means any fault
imperfection shortcoming or inadequacy in
the quality, nature and manner of
performance which is required to be
maintained
What constitutes deficiency in service
or negligence
• Reaction of injection
• Patient left unattended
• while there were complications.
• Leaving patient in care of unqualified
compounder.
• Foreign material left inside during operation
What does not constitute deficiency in
service or negligence
• Death during operation.
• Post operative care.
• Refusal to admit the patient.
• Performance of duty to the best of ability.
• Adopting one out of two recognized schools of
medicine.
• Complainant failed to establish deficiency in
service.
• Patient having some medical history.
• Patient of heart attack.
 Common problems for which the
nurses are often found negligible are
• 1.Failure to use aseptic technique where
required
• 2. Leaving a foreign object in a patient’s body
during surgery, ie: errors in sponge,
instrument or needle count in surgical cases
• 3.Failing to respond promptly to patient
symptoms of impending disaster
• 4.Failing to protect an infirm patient from
falling
• 5.Administering wrong medicine to a patient
• 6.Administering a medication
inappropriately,IV therapy, errors resulting
infiltration or phlebitis
• 7.Administering a care in such a manner that a
patient suffers injury, eg improper handling of
hot water bags – burn to patient.
• If nurses give care that does not meet the
standards, they may be held liable for negligence.
• Nurses are responsible for performing all
procedures correctly
• And exercising professional judgment as they
carry out doctors orders and duties not ordered
by for which they have authority.
• Any nurse who does not meet accepted
standards of practice or care or who performs
duties in a careless fashion, runs a risk of being
found negligent.
 Hospital and its negligence
• It is not only the medical practitioner who
may be found negligent, the hospitals are also
bound by the law and in certain circumstances
the hospitals are also found negligent or
deficient in services.
 Malpractice
• Malpractice is a negligence or carelessness by a
professional person.
• So, it concerns professional action and in the
failure of a person , with professional education
and skill to act in a reasonable and prudent
manner.
• In other words , it is unreasonable professional
conduct, lack of skill or fidelity in professional
duties, evil practice or illlegal or immoral conduct.
 Six elements of malpractice suit
• 1.The nurse(defendent) owed a duty to the
client(the plaintiff),ie. There should be an
evidence that the nurse owed a duty to the client
,eg: failure to monitor client’s response to
treatment
• 2.Breach of the duty of care owed to the patient,
• ie. There should be an evidence that the nurse
failed to meet the prevailing standards of
care.e.g. failure to communicate change in status
to other care provider
• Foreseeability not maintained: Foreseeability include
the concept that certain events may reasonably be
expected to cause specific results. For example, in
children wards, falling of children from bed is common,
i.e. There should be an evidence that the client
suffered due to lack of foreseeability by the nurse
• 4.Evidence of causation which means that the nurse's
action or lack of action directly caused harm to the
patients and not merely that patient had some type of
harm. So there should be an evidence that nurses
failure to meet their duty are likely to cause client
injury, i.e failure to provide patient education
• 5.Evidence that nurses failure was direct cause
of client injury,e.g. if a client falls
• 6.There should be an evidence of damage.
Damages are valid as malpractice which is
intentional and unintentional
Measures to overcome malpractice
• Follow standard of care, give competent
healthcare, and develop an empathetic
interpersonal relationship with the client
• Follow careful and accurate documentation
• Be up to date with current practices
• Be sensitive to common sources of client’s
injuries like fall
 Legislations And Regulations Related
To Critical Care
• Legal safeguards in nursing practice:

•Licensure
•Good Samaritan law
•Good rapport
•Standards of care
•Standing orders
• Contracts
• Consent for operation and other procedures
• Correct identity
• Counting sponge, instruments and needles
• Drug maintenance
• Professional confidence
• Documentation
Legal safeguards in nursing practice

• Licensure:
• All nurses who are in nursing practice have to posses a
valid licensure from State Nursing Council/INC
• Good Samaritan law: In response to health care
professionals f ear of malpractice claims, most states
enacted "Good Samaritan law "that exempt doctors
and nurses from legal liability when they render first
aid during emergency. A nurse who renders assistance
at an accident scene is to held same standard of skill,
competence and judgment that would be applied to a
reasonably prudent person with the same preparation.
Legal safeguards in nursing practice
• Good rapport:Developing good rapport with
the client is very important to prevent
malpractice
• Standards of care:
• All professionals practicing in medical field are
held to certain standards when administering
care. It is always better to follow standards of
care to avoid malpractice and do not attempt
anything beyond the level of competence.
• Standing orders:
• Nurses can apply standing orders in emergency.
Administration must be documented by the
administering staff & should include date, time of
administration, name of medication, dosage ,
reference to Standing Order and signature.
• The client assessment, treatment and, if
necessary,any monitoring and follow-up must be
documented in the clinical record.
• Issuing Doctor must countersign the charted
treatment within 72 hours of administration