Textbook on Medicolegal Issues

Textbook on Medicolegal Issues

Related to Various Medical Specialties Second Edition Editors Satish Tiwari MD (Ped) LLB FIAP Founder President Indian Medicolegal and Ethics Association Mahesh Baldwa MBBS DCH MD LLB LLM FIAP PHD (Law) MBA Past President, Medicolegal Group of IAP Medicolegal Advisor and Senior Pediatrician Mumbai, Maharashtra, India Former Visiting Faculty, Department of Law, Mumbai University Mukul Tiwari MD DCH FIAP Consultant Pediatrician Gwalior, Madhya Pradesh, India Chairperson, Medicolegal Group of IAP 2015–2017 Zonal Chairman Indian Medicolegal and Ethics Association Alka Kuthe MBBS DGO LLM (Criminology) Consultant Obstetrician Member Ethics and Medicolegal Committee, FOGSI Zonal Chairman Indian Medicolegal and Ethics Association Chairperson Association of Maharashtra Obstetric and Gynecological Societies (AMOGS) Medicolegal Committee

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Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2019, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical and legal knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale. Inquiries for bulk sales may be solicited at: [email protected] Textbook on Medicolegal Issues First Edition: 2012 Second Edition: 2019

ISBN: 978-93-5270-515-3

Printed at Repro India Limited

Contributors Ajay Gambhir

Anju Gambhir

MD (Comm Med) MD (Ped) DHA FIAP FIAMS

MS MCH (Ped Surg)

Vice-President, IAP 2007 Member Technical Committee Immunization and Tel Medicine – GOI

Ajay Patil MBBS MD DNB (Forensic Medicine)

Professor, Department of Forensic Medicine Krishna Institute of Medical Sciences Satara, Maharashtra, India

Alka Kuthe MBBS DGO LLM (Criminology)

Consultant Obstetrician Member, Ethics and Medicolegal Committee, FOGSI Zonal Chairman, Indian Medicolegal and Ethics Association Chairperson, Association of Maharashtra Obstetric and Gynecological Societies (AMOGS) Medicolegal Committee

Amol Pawar MD DGO FCPS

Additional Professor GS Medical College and NW Wadia Maternity Hospital Mumbai, Maharashtra, India

Amrita Mishra BAMS MS MBA

Assistant Professor Department of Stree Rog Podar Ayurvedic Medical College Mumbai, Maharashtra, India

Anjan Bhattacharya

MBBS DCH (UK) MRCP (UK) MRCPCH (UK)

Consultant Pediatrician (Developmental Pediatrics) Head, Department of Academics Pediatric Apollo Gleneagles Hospital Kolkata, West Bengal, India Executive Member, GDBP Chapter IAP and West Bengal IAP

Senior Consultant (Ped Surg) Maharaja Agrasen Hospital and Apollo Clinic New Delhi, India

Archana Tiwari MS (Obs and Gyn)

Consultant Obstetrician Apex Hospital Gwalior, Madhya Pradesh, India

Arun Bal MS PhD

President Association for Consumers Action Safety and Health (ACASH) Mumbai, Maharashtra, India

Ashish Jain MBBS DCH

Consultant Pediatrician Gurugram, Haryana, India

Ashish Kale MD DNB MNAMS MICOG FICS

Fellowship in Endoscopy (Germany) Fellowship in IVF Cleveland (USA) Gynecologist, Endoscopic Surgeon and IVF Specialist Director Ashakiran Hospital, Pune Assistant Professor Maharashtra Institute of Medical Education and Research Pune, Maharashtra, India

Ashok Banga MD (Peds)

Consultant Pediatrician Astha Children Hospital Gwalior, Madhya Pradesh, India

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Ashwini Pawar MA LLB PGDMLE PGDCRL PGDSC

Consultant Counseling Psychologist Thane, Maharashtra, India

Avinash Bansal MD DHA PGD-AP

Head and Director, DNB Program Pediatrics Bharat Vikas Parishad Hospital Kota, Rajasthan, India

BB Sahni MD FIAP

Divyangi Kuthe

MBBS DNB (General Surgery) FMAS (MUHS)

Mumbai, Maharashtra, India

Dnyanesh Kambli MBBS MD (Ped) LLB

Consultant Pediatrician and Pediatric Intensivist KLE Hospital Belagavi, Karnataka, India Professor Jawaharlal Nehru Medical College Belagavi, Karnataka, India

President Indian Medicolegal and Ethics Association 2018–2019 Chief Consultant Tata Central Hospital Dhanbad, Jharkhand, India Past President, IAP Jharkhand CIAP Executive Member 2005, 2010

Gautam Biswas

Balraj Yadav

MD (Peds)

MD (Peds) FIAP LLB

Joint Secretary IYCF, Chapter IAP and Human Milk Banking Association Honorable Secretary, Indian Medicolegal and Ethics Association Senior Consultant Pediatrician and Director, Gurugram Chairman, Smt Santra Devi Health and Educational Trust (Regd) Gurugram, Haryana, India

Charu Mittal MD DNB MICOG MNAMS

Consultant Obstetrician and Gynecologist Gwalior, Madhya Pradesh, India Member, Medicolegal and Ethics Committee, FOGSI Member, Public Awareness Committee, FOGSI

CM Chhajer

Professor and Head

Department of Forensic Medicine and Toxicology Dayanand Medical College and Hospital Ludhiana, Punjab, India

Geeta Bansal Director and Senior Consultant Nishtha Shishu and Kishore Swasthya Kendra Kota, Rajasthan, India

Girish Kumthekar

MD (Obs and Gyn) LLB (Spl)

Associate Professor Department of Obstetrics and Gynecology Dr VM Govt Medical College Director and Partner, Navjeevan Fertility and IVF Center Convenor, Medicolegal Cell, IMA Solapur Branch Legal Advisor to Solapur Obstetric and Gynecological Society Solapur Hospital Owners’ Association Solapur, Maharashtra, India Member, Executive Committee, IMA Maharashtra Member, Medicolegal Ethical Committee FOGSI

MD FIAP

Geeta Guin

Assistant Professor Department of Pediatrics Tripura Medical College Agartala, Tripura, India

MS (Obs and Gyn) LLB FICOG

Associate Professor Government NSCB Medical College and Hospital Jabalpur, Madhya Pradesh, India

Dilip Walke

Gouri Gore

MD (Obs and Gyn)

MS

Chairperson – AMOGS, Medicolegal Cell Practicing Obstetrician and Medicolegal Consultant Pune, Maharashtra, India

Consultant Obstetrician and Gynecologist Founder, Vytal Healthtech Private Limited Mumbai, Maharashtra, India

Contributors

Indrajit Khandekar

Kritika Tiwari

MBBS MD (Forensic Medicine) Assistant Professor

MBBS DNB (Peds)

Department of Forensic Medicine Mahatma Gandhi Institute of Medical Sciences Sevagram; Wardha, Maharashtra, India

Ira Shah MD DNB FCPS DCH (Gold Medalist) DPID (UK)

Consultant Pediatric Infectious Diseases and Hepatology Nanavati Hospital Mumbai, Maharashtra, India Professor (Additional), Department of Pediatrics and In-Charge Pediatric HIV, TB, Liver Clinics BJ Wadia Hospital for Children Mumbai, Maharashtra, India

Jayaraman Thrikkovil Pisharam MD DCH Dip NB

Consultant Pediatrician Thangam Hospital Palakkad, Kerala, India

Jyotika Kalsy MBBS MD

District Leprosy Officer (DLO) Civil Surgeon Office Amritsar, Punjab, India

Kalpesh Shah

Clinical Associate Jaslok Hospital and Research Center Mumbai, Maharashtra, India

Mahesh Baldwa MBBS DCH MD LLB LLM FIAP PHD (Law) MBA

Past President, Medicolegal Group of IAP Medicolegal Advisor and Senior Pediatrician Mumbai, Maharashtra, India Former Visiting Faculty, Department of Law Mumbai University

Milind Shah MD DGO DFP FICOG

President, ISOPARB (2016–2018) Vice-President, FOGSI (2011) Past Chairman, Rural Obstetrics Committee FOGSI (2004–2008) Professor and Head Department of Obstetrics and Gynecology Gandhi Natha Rangaji Homoeopathic Medical College Solapur, Maharashtra, India Executive Committee Member – ISPAT, ISAR, IAGE

Mukul Tiwari MD DCH FIAP

Director of Plexus Anesthesia Solutions Consultant Anesthetist Namaha Hospital Mumbai, Maharashtra, India

Consultant Pediatrician Gwalior, Madhya Pradesh, India Chairperson, Medicolegal Group of IAP 2015–2017 Zonal Chairman, Indian Medicolegal and Ethics Association

Kanya Mukhopadhyay

Namita Padvi

MD DNB DM

MBBS MD (Anesth) DNB

MD (Anesthesia) DA

Professor (Neonatology) Department of Pediatrics Postgraduate Institute of Medical Education and Research Chandigarh, India

Kiran Borkar MBBS M D (Obs and Gyn)

Associate Professor Department of Obstetrics and Gynecology Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha, Maharashtra, India

Fellowship in Pediatric Anesthesia Assistant Professor TN Medical College Mumbai, Maharashtra, India

Nilofer Mujawar MBBS MD (Peds)

Professor Department of Pediatrics NKP Salve Institute of Medical Sciences Nagpur, Maharashtra, India

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Neetu Jain

Rajendra Bangal

MBBS DNB

MBBS MD DNB (Legal Medicine) LLB

Assistant Professor Department of Pulmonary Medicine and Critical Care Pt BD Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India

Professor and Head Smt Kashibai Navale Medical College Pune, Maharashtra, India

PK Nigam MD MAMS MBA PGDIHL FIAD FRCP (Glasgow)

Director Professor and Head Department of Dermatology, STD and Leprosy Pt JNM Medical College Raipur, Chhattisgarh, India

Piyali Bhattacharya DCH MD (Peds) FCCM PGDMLS PGDGC (Jamia Millia) FIAP

Pediatrician Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow, Uttar Pradesh, India

Prabuddh Sheel Mittal MD LLB

Chief Consultant Gynecologist Sahara Hospital Gwalior, Madhya Pradesh, India

Prakash Pawar MD DGO DFP FICOG PGDMLS

Associate Professor Department of Obstetrics and Gynecology Terna Medical College Navi Mumbai, Maharashtra, India Chairperson, Ethics and Medicolegal Committee, FOGSI (2003–2007)

Pukhraj Bafna MD DCH FIAP MA

Senior Consultant and Adolescent Counselor Rajnandgaon, Chhattisgarh, India

Purendra Bhasin MS (Ophthal)

Director Ratan Jyoti Netralaya Ophthalmic Institute and Research Center Gwalior, Madhya Pradesh, India

Rajendra Borkar MBBS MD (Peds)

Associate Professor Department of Pediatrics Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha, Maharashtra, India

Rajesh Upadhyay BMS (Lucknow)

General Secretary Foundation Society Vasundhara Raje Homoeopathic Medical College and Hospital Gwalior, Madhya Pradesh, India

Rajinder Gulati MD (Paed) FIAP

Senior Medical Officer I/C Civil Hospital Khanna, Ludhiana, Punjab, India

Rakesh Bharti MD

Bharti Dermacare and Research Center Amritsar, Punjab, India

Rakesh Kumar Srivastava BSC LLB MLIBSC PhD

Additional Registrar Supreme Court of India New Delhi, India

Rishi Bhatia MBBS MS (Surgery) LL B PGDMLE PGDMLS

Laparoscopic and General Surgeon Medicolegal Advisor, UPIMA and UPNHA

Riya Kaur Kalra MBBS Final Year

Government Medical College Amritsar, Punjab, India

Contributors

Ruchita Shukla

Shivali Vaidya

MBA (HR)

BDS MDS

Director Human Medicolegal Consultants Ltd Amravati, Maharashtra, India

Samyr Dalwai MD DNB LLB

Honorary Consultant LD Clinic, LT Municipal Hospital and Medical College Sion, Mumbai, Maharashtra, India Director, New Horizons Child Development Centre Member, Committee Juvenile Justice Reforms National Commission Protection of Child Rights GOI

Sandhya Khadse MBBS MD (Ped) FIAP

Ex-Professor Department of Pediatrics BJ Medical College Pune, Maharashtra, India Presently, Dean Rajiv Gandhi Medical College Kalwa, Thane, Maharashtra, India

Satish Tiwari MD (Peds) LLB FIAP

Founder President Indian Medicolegal and Ethics Association

Associate Professor Department of Oral and Maxillofacial Pathology MPCD and Research Center Gwalior, Madhya Pradesh, India

Smriti Upadhyay BHMS

Consulting Homeopath and Medical Officer Indore, Madhya Pradesh, India

Subhash Behere MS (Gen Surg) LLB

Honorary Faculty, Medicolegal Wing INS Law College Pune, Maharashtra, India

Sudhir Mishra MD (Pediatrics)

Head, Pediatrics and In-Charge, PICU Tata Main Hospital Jamshedpur, Jharkhand, India

Sushila Baldwa MBBS DGO MD

Consultant Gynecologist Apollo Clinic Mumbai, Maharashtra, India

Tapas Koley MD (Internal Medicine)

Medical Director Modern Clinic Wai (Satara), Maharashtra, India

Specialist Physician Guest Faculty, National Institute of Health and Family Welfare Guest Faculty, West Bengal National University of Judicial Sciences International Author of Oxford University Press and Mcgraw Hill

Shashi Mohan Sardana

TBS Buxi

Shantanu Abhyankar MD (Obs and Gyn) FICOG

MD (Pediatrics)

PGDHHM (Health and Hospital Management) MBA Consultant Pediatrician Roopnagar, Punjab, India

Sheikh Minhaj Ahmed MD (Peds)

Consultant PICU NICU Lilavati Hospital and Research Center Mumbai, Maharashtra, India

MBBS MD (Radiology)

Chairman, Department of CT and MRI Sir Gangaram Hospital New Delhi, India

VP Singh MD LLB

Medicolegal Consultant Editor Legal Issues in Medical Practice Medicolegal Guidelines for Safe Practice

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Varsha Baldwa

Vishesh Kumar

MBBS MD

MD (Peds)

Department of Pathology Bhagawati Hospital Mumbai, Maharashtra, India

Vijay Kuthe MBBS D Ortho

Consultant Orthopedic Surgeon Founder Member Amravati Orthopedic Association Kuthe Hospital Amravati, Maharashtra, India

National Professional Officer Regional Team Leader WHO-NPSP Bihar Region WCO India

Vivekanshu Verma MBBS DFM

Emergency Consultant Department of Emergency and Trauma Care Medanta – The Medicity Gurugram, Haryana, India

Preface to the Second Edition “deZ.;sokf/kdkjLrs ek Qys”kq dnkpu” [One should always perform righteous conduct (Satkarma) without expecting its result.] —From: Bhagvad Gita, an ancient Hindu epic The practice of medicine has seen drastic changes in the twenty first century, some with positive and some with negative implications. Overall, the changing trends do not bode well for the future of the medical professionals, especially for the doctors who want to practice honestly, ethically and without the fear of litigations and violence from patients’ huge number. With so many changes happening to the profession, the good old doctor–patient relationship has taken a back seat. Commercialization is in; corporate houses and insurance companies have jumped in to join the bandwagon. The concept of privatization has added fuel to the fire; it has escalated expectations of the patients. Doctors are not only affected by medicolegal cases but also many other legal problems arising out of other related issues of staff, instruments and infrastructure also. The Government is introducing newer and newer laws and restrictions on medical fraternity and hospitals. The legal system wants medical practitioners to follow standard practices. Setting standards is, however a difficult task. Medicine is vast and ever changing field. It is also equally important to take into account the needs of the individual patient, available infrastructure, resources and the regional limitations. In our profession, there is often no second chance. It is a very risky profession and most of us have no protective umbrella. For example, if a group of miscreants enter our clinic/ nursing home and manhandle the staff or doctors, we are defenseless and vulnerable. By the time the help comes, the physical and psychological damage is already done. It would be wrong to say that it is only the society which is at fault and responsible for this situation. It takes two hands to clap, doesn’t it? If we want to change the present scenario, then we must think and find solutions. Assuming a “we versus them” attitude will help nobody. Irresponsible media is adding to our difficulties. There are exaggerated and twisted reports in the media about misdeeds of the doctors, many of which are baseless but have the effect of creating distrust and hatred for doctors among the common men. Media is also highlighting reports of lawsuits and violence against doctors, which encourages masses to follow suit. Society is also changing; conflicts and tensions have increased in general. Mob violence and lynching behavior are becoming common. People have become edgy and are ready to fight at the smallest pretext. There are a lot of doctors now than there were in the past and there is lack of unity amongst them. Patients know that if they misbehave with one doctor and go to another doctor, they will be readily accepted. Medicine is a service which will always require human touch and cannot be governed by “cold” science alone. Most of the doctors have poor communication skills. They should try to make

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improvements in this field and should strive to develop good rapport with the patients/ relatives. Patients want to remain informed at all times and the doctor should not seem to be hiding facts from them. Doctors can learn to use some humor: good-hearted humor always befriends a doctor to patients. Despite all positive attitudes of the doctors problems may still arise. Mistakes do happen. Patients may at times be very unreasonable. Hence, it is advisable that every doctor be covered with medical indemnity insurance. But many doctors are negligent about their indemnity insurances. During the last few years, the consumer forum has given judgments on a number of cases of medical negligence. Consumer Protection lawsuits are a global trend, hence rather than trying for abolition of this act, we should try to avoid the situations which result in patients going to court. Doctors should not avoid responding to a case. He should send reply as early as possible. The explanation should address misunderstandings, misrepresentation and other discrepancies made out in written statement of the litigant. Doctors should not show antagonistic or negative attitude towards judges or presume that they are on the side of the litigant, even if their attitude or body language seems unfavorable. They should not ignore or disrespect court. CPA has really not proved beneficial to the patients. Rather, the Patient has been the ultimate loser. Doctors have started declining treatment to high risk cases in their private set-ups. These cases are referred to government hospitals where the doctor to patient ratio is very low or to corporate hospitals where the patients have to pay exorbitant charges. The term “Medicolegal” incorporates the basics of two professions, i.e. medicine and law. Although doctors meet the law at every turn during the practice of their profession they frequently have insufficient knowledge of it. In the last few years we have found various problems, which, as medical consultants/medicolegal experts, we are trying to solve single handedly. It was then, that we realized the need of a fleet of experts to work in co-ordination. The aim of this book is to create a pool of sensitized and motivated consultants who can guide their colleagues in the hour of crisis. The response to the first edition of this book has been exceptional and phenomenal; paving the path for this second edition. Ten new chapters have been added and the most of the previous chapters have been revamped and updated. We hope this book will succeed in achieving our aims and objectives of guiding the medical practitioners in their difficult times. Editors also hope the book will offer constructive suggestions and solve most of the medicolegal queries and dilemmas in day-to-day practice for doctors. The editors gratefully acknowledge contribution of the authors who have responded positively to our pressing demands and sincerely contributed their expertise in this endeavor. Lastly, we welcome feedback and suggestions from the esteemed readers that will make this book even more relevant and useful in the times to follow .…. Satish Tiwari Mahesh Baldwa Mukul Tiwari Alka Kuthe

Preface to the First Edition Hani-Labh, Jivan-Maran, Jas-Apjas Bidhi Hath (Loss-Profit, Life-Death, Fame-Defame is in the hands of destiny) — Tulsidas’s Ramcharitmanas No person on this earth is immortal. It is important to understand that doctors can never predict the future of any patient as the dynamic human body does not obey the linear laws of deterministic predictability. A very sick patient may stand long hours of surgery and recover completely while relatively healthy patient may succumb to minor stress or allergic reactions. The term “Medicolegal” incorporates the basics of two professions, i.e. Medicine and Law. Although doctors encounter the law at every turn during the practice of their profession, they frequently have insufficient knowledge of it. A doctor confronts it when, as the treating doctor, he is summoned to a court of law in a personal injury lawsuit; he meets it when he is called as an expert in connection with a claim against a colleague and when he is faced in his office or clinic by unforeseen situations, like sudden unexpected death, patient-generated violence, etc. It will be better to accept the change and brace ourselves with the knowledge to cope with the change. With passing time, the standards of medical care are rising as also the patients’ expectations. This race may convert medical practice into a battleground between the doctors and patients. In India, medical law is yet to crystallize. Nothing can be said with absolute certainty on many issues as the final word is yet to come. The legal system wants medical practitioners to follow standard practices; setting standards is, however, a difficult task. Medicine is a vast and ever-changing field. It is also equally important to take into account the needs of the individual patient, available infrastructure, resources and the regional limitations. Therefore, a lot of information, documentation and knowhow is needed. In the last few years, the medicolegal scenario has changed further. Every relationship is a dynamic process and doctor–patient relationship is no different. It has gone a sea-change since its beginning thousands of years back. It will be a futile exercise to look back and remember the good old days when the doctor was all powerful, a Semi-God. With the change in medicosocial dynamics, cases against doctors are witnessing a phenomenal rise, constant upgradation of the practicing doctor vis-á-vis the fast-changing laws of the country. Medical professionals fumble when they confront a court case against them with allegations of negligence or deficiency in medical service. It will be quite useful for today’s doctors to be wellequipped with medicolegal knowledge if they want to practice their profession safely, without the hassle of too many cases slapped on them. Doctors in the West have been quicker to respond to the need for such knowledge. There is ample literature generated from the West, which analyzes the issues of legal aspects of medical practice and doctor-patient relationship thoroughly. There is scanty literature on this subject in India where the volume of patients is many times more than that of most of the Western countries. We should have our literature, studies and observations

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suited to our milieu. With the phenomenal increase in the patient volumes in India, the need for indigenous literature is going to be even greater in the future. Each branch of medicine has its own medicolegal issues. There are different books on medicolegal issues pertaining to different branches of medicine, but no single book which comprehensively deals with medicolegal issues in most of the vulnerable branches together is available. This book was envisioned with the same objective in mind. The editors sincerely hope that this book will serve to fill the void effectively. The book looks beyond the problems and moves on to solutions. The editors hope that doctors from different specialities will find in this book constructive suggestions and solutions towards many of the issues which plague them. An endeavor has been made to include the information related to almost all the branches in allopathic medical science and to create a perfect blend of clinical practice and various laws applicable to its varied aspects. It covers major issues which a doctor is likely to face during his/her professional career with case laws and important Supreme Court judgments in simple language, so that a doctor can easily understand its legal implication and apply it. A section on the Acts and certain important tips in the form of algorithms for Safe Practice while managing the patient, have been added, which would help the doctors to follow uniform standards, which, in turn, will help in better patient care. Lastly, we welcome feedback and suggestions from the esteemed readers that will make the book more useful. Human mind is like a parachute, it works best when it is open 

Satish Tiwari Mahesh Baldwa Mukul Tiwari Alka Kuthe

Contents Section 1:  Basic Issues 1. Introduction......................................................................................................... 3 Rishi Bhatia

2. Ethical Issues in Medical Practice..................................................................... 7 Pukhraj Bafna

3. Rights/Duties of Patients and Doctors.......................................................... 17 Samyr Dalwai

4. Legal Hurdles in Medical Practice.................................................................. 25 Ajay Gambhir, Anju Gambhir

5. Communication Skills...................................................................................... 29 Sandhya Khadse

6. Doctor–Patient Relationship.......................................................................... 38 Mukul Tiwari

Section 2:  Documentation and Liabilities 7. Record Maintenance........................................................................................ 55 Nilofer Mujawar

8. Consent............................................................................................................... 60 Alka Kuthe

9. Medical Negligence.......................................................................................... 73 VP Singh, Vivekanshu Verma

10. Errors in Medical Practice................................................................................ 78 Shashi Mohan Sardana

11. Criminal Liability ............................................................................................102 Charu Mittal

12. Difficult Situations in Practice......................................................................110 Girish Kumthekar

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