How to prevent / face mishaps.

How to safeguard the interests (including professional indemnity)

1.0 treat cases which fit in your:

1.1 qualifications
1.2 infrastructure
1.3 competence and skill

2.0 why? Because legal rule is:

2.1 if your treat beyond the area of qualification, competence and skill then you are negligent per say

2.2 higher the risk under taken higher degree of qualifications, skill and competence is legally required

Treating with inadequate infrastructure may amount to deficiency in service except in emergency

1.0 recognize complications and
1.1 prevent or treat them as soon as possible yourself, if not possible then
1.2 refer to appropriate specialist or
1.3 transfer in a well equipped ambulance, preferably accompany patient yourself or rmo
1.4 to a hospital / place with better infrastructure to monitor and treat.

2.0 why? Because legal rule is

2.1 your are suppose to reduce risks to health of a patient by giving medical care and
2.2 you do not guarantee or warrantee cure,that is what is legally required.

How to protect RMP in cases of death?

which are

(a) Sudden and unexpected death
(b) Death after a procedure or after surgery or after iv and im injection and
(c) In an expected death where a lot of complications have occurred and huge amount of money is spent in treating them then

1.1 if possible call some doctors to see even when you know that they can not do any thing further or help the patient
1.2 never ever transfer a dying or dead patient to other hospital
1.3 complete your notes and records first to your satisfaction till then
1.4 let terminal oxygen, iv ect. Continue till doctors have completed records
1.5 you finally declare death, but how ?

How to declare death?

1. Ensure your notes and records are complete
2. Take some relatives in confidence and talk to them about certainty of death. Be tactful and empathetic while declaring death,show genuine sorrow.
3. Ensure that chief / main doctor is present to declare death and do not do through your junior doctor to prevent later on lots of heartaches and headaches.
4. While declaring death do not irritate them with pending bill, proposed postmortem, information to police, harsh language, arrogance,pointing out relatives negligence,gloat with “that you have done everything”

How to inform police and ask for postmortem?

1. You need not inform or take consent of relatives for informing police or asking pm. It is the job of police to ask for consent. When the relatives come back from police station they have cooled a bit and are in a requesting mood.
2. Law does not recognize, if you give death certificate in lieu of patients relatives giving a clean chit of “no negligence” to doctor.

How to protect yourself from black mail of police, pm doctors, local newspapers, local politicians and local goondas

1. Police-file a written reply rather than oral statement with indoor case papers
2. pm doctors- meet them with two three of your friends and relatives and if they ask for money then file a complaint with acb
3. local newspapers- file a case with cjm under s. 499 and 500 ipc
4. local politician- file a case under s. 383,384 and 506 ipc
5. local goondas file a case under s. 383,384 and 506 ipc
6. inform local ima or iap branch and ask them to appoint a three member expert committee and get yourself exonerated medically from problem.

How to protect yourself from courts.

1. Receive and reply notices and comply with summons/dates.
2. Seek advice of good medicolegal expert/opinion.
3. take medical indemnity insurance for minimum 20 lakhs.
4. Seek expert witness affidavits.
5. Submit eye witness to avert allegations of “was not present during emergency”.

Which are the health related insurance sectors which will change the practice of medicine in future?

There are two broad areas of insurance sector which will affect the practice of medicine in india,they are
1. Mediclaim policies with third party administrators acting as cashless treatment providers to policy holder patients
2. Medical indemnity and hospital error and omission policy and its variants like comprehensive insurance for doctors covering property, vehicle, indemnity, errors and omissions along with medi-claim.

Contract of insurance is also known as insurance policy

Contract of insurance has following elements:

  • Insured has to fill a proposal form disclosing all the true facts about insured objective/thing-life or non life
  • Insured pays consideration known as premium in proportion to amount of insurance as per the tariff.
  • Liability of insurer company arises when the loss occurs to insured due to contingencies described in insurance policy up to insured limit.contract of insurance is known insurance policy,which is the document which regulates the claims to be processed.

What is the basis of insurance?

  • Basis of insurance is to cover the happening of risk by paying for loss suffered by insured party.
  • For example doctors pay for indemnity policy premiums and out of that insurance companies pays to doctors against whom medical negligence claims are decreed.
  • Law of average of happening of a risk is very rare so insurance companies can afford to disburse claims to those unfortunate doctors against whom claims are decreed by courts.
  • It is like several people bearing a burden of one unfortunate.

What is a risk?

  • Risk is attached to all the activities of our life and events and living and non living things,however small the nature of it may be. Like a surgeon operating on deviated nasal septum has risk of local anesthetic causing anaphylaxis inspite of test dose
  • Risk by its nature is an event which is harmful to some one some where,rare but does happen in reality.
  • Risk is an event which is unpredictable chance event.
  • Risk can be expressed in percentages.
  • It may or it may not happen with the insured person.
  • If it happens then risk gets converted in damage and brings in action for compensation.

Difference between life and non life insurance?

  • Life insurance products are not pure insurance products.
  • All life insurance products are mixed with investment proposals.
  • Life insurance products are for 5,10,15,20,25 years or even more longer terms and if person survives he gets the sum insured with investment benefits.
  • If insured dies then survivor nominees get sum insured before maturity.

Non life insurances give no returns except when claim arises

  • In non life products like mediclaim and medical indemnity and similar insurance products require you to pay premium is for one year,which needs to be renewed on yearly basis otherwise continuity lapses.
  • If any claim arises then insurance company pays otherwise there is no return on premium paid.
  • Most of us are used to life insurance so when we pay premium we are in habit of asking what do i gain after paying the premium? In non life insurance you don’t get anything except when claim arises on happening of the event.

What is the difference between medi-claim and medical indemnity policy?

  • Mediclaim policy is to cover hospitalization expenses of a sick patient of takes insurance.
  • Cashless services of mediclaim policy are managed by third party administrators(tpa)
  • Medical indemnity policy covers claims arising out of medical negligence case against doctors
  • Hospital error and omission policy covers all errors and omissions of various categories of staff employed by a hospital including medical doctors.
  • Comprehensive policy for doctors cover in addition to indemnity,errors and omissions covers property,fire, riot,theft and various other perils

What is the role of TPA's?

  • Tpa will empanel the hospitals for cashless services to be provided under mediclaim policy.
  • Tpa shall sign a separate mou with hospitals.
  • Tpa are dictating their own charges to hospitals.
  • If hospital do not agree to their charges prescribed by tpa then those hospitals are not empanelled.
  • Quality of patient care with low cost will go down
  • It will have cascading effect on bringing in more medical negligence cases.
  • Tpa’s will not share burden of compensation granted in medical negligence cases by courts.

What does medical indemnity policy cover?

  • It covers medical negligence claims awarded by courts against doctors
  • It covers defense cost as per the tariff as prescribed for different courts
  • Insurance companies have their panel of advocates who are appointed to defend for that specified fees.
  • Tariff of fees for advocates is so low that good advocates refuse to work for that amount.
  • Medico-legal experts are not on their panel.
  • There is lot of red tape and bureaucratic system which frustrates the doctor in trying to take legal assistance from insurance companies.
  • There is no door step service. There is no 24 hours help line to cover legal emergencies.

Hospital error and omission policy

  • This policy is for hospitals and nursing homes where number of doctors are visiting
  • This covers unqualified and unqualified hospital nursing and other staff for specified premium.
  • It covers professional medical and paramedical staff
  • It covers all types of errors and omissions by hospital
  • It also covers medical negligence cases
  • It does not cover criminal cases
  • It is not cashless,it has no door step service.
  • There is no 24 hours help line
  • One has to choose from prescribed panel of advocates for prescribed fees.