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Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective
Abstract
A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief to his medical problem. The relationship takes the shape of a contract retaining the essential elements of tort. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. The doctor has a duty to obtain prior informed consent from the patient before carrying out diagnostic tests and therapeutic management. The services of the doctors are covered under the provisions of the Consumer Protection Act, 1986 and a patient can seek redressal of grievances from the Consumer Courts. Case laws are an important source of law in adjudicating various issues of negligence arising out of medical treatment.
... It is possible that these may have just been simple error, it is also possible that DNR orders were counted in false positive cases when patients received a consultation with palliative care or hospice teams, which they might have interpreted as having a DNR order. Another potential explanation is that coders may have observed evidence of a DNR order for a prior hospitalization and assumed (correctly or incorrectly) that the DNR order would apply to the current hospital admission [6,24]. ...
... This may occur if the clinical team is unaware of the DNR order or if the patient's family overrides the DNR order. Family members' desire for heroic measures may be given preference to patient's wishes, particularly in hospital environments where lawsuits are more prevalent and if the medical care ends in death for the patient [24]. The greater the extent of these occurrences, the more the estimates of association between DNR orders and outcomes will be biased toward the null. ...
Background:
Observational research on the advance care planning (ACP) process is limited by a lack of easily accessible ACP variables in many large datasets. The objective of this study was to determine whether International Classification of Disease (ICD) codes for do-not-resuscitate (DNR) orders are valid proxies for the presence of a DNR recorded in the electronic medical record (EMR).
Methods:
We studied 5,016 patients over the age of 65 who were admitted to a large, mid-Atlantic medical center with a primary diagnosis of heart failure. DNR orders were identified in billing records from ICD-9 and ICD-10 codes. DNR orders were also identified in the EMR by a manual search of physician notes. Sensitivity, specificity, positive predictive value and negative predictive value were calculated as well as measures of agreement and disagreement. In addition, estimates of associations with mortality and costs were calculated using the DNR documented in EMR and the DNR proxy identified in ICD codes.
Results:
Relative to the gold standard of the EMR, DNR orders identified in ICD codes had an estimated sensitivity of 84.6%, specificity of 96.6%, positive predictive value of 90.5%, and negative predictive value of 94.3%. The estimated kappa statistic was 0.83, although McNemar's test suggested there was some systematic disagreement between the DNR from ICD codes and the EMR.
Conclusions:
ICD codes appear to provide a reasonable proxy for DNR orders among hospitalized older adults with heart failure. Further research is necessary to determine if billing codes can identify DNR orders in other populations.
... 5 This steady rise has several reasons, including population increase, people's awareness of their rights, complex technologies used in medicine, lack of proper justification for possible side effects of remedies, patients' increased expectations of treatment outcomes, lack of disciplinary actions, and so on. 4,6,7 Today, laser devices ('Laser' is the abbreviation of Light Amplification by Stimulated Emission Radiation) have brought about a revolution in health care systems and are an integral part of medicine. 8 Laser surgery has increased enormously with regard to various applications in medical or paramedical procedures in the past 2 decades, including general surgeries (e.g. ...
Introduction: The purpose of the present study is to investigate the common causes of injuries, claims, and decisions related to laser therapy medical malpractice during a nine-year survey. Methods: The legal documents in the Coroner’s Office of Forensic Medicine were investigated in a national database from 2012 to 2020 in Tehran, Iran. The frequency and nature of the cases, including the year of litigation, the location and certificate of the provider, the injury sustained, and the cause of legal action and judgment were collected. Results: Three hundred and eighty-three cases related to injury from laser therapy were registered in the coroner’s Office of Forensic Medicine during the study period. The incidence of litigation related to laser surgery showed an increasing trend, with a peak occurrence in 2020. Laser hair removal was the most common (51.2%) litigated procedure. General practice operators (48%) recorded the highest rate of laser-related medical complaints. Lack of skill was the most common reason for failure. Among 383 cases with public decisions, 62.4% of them were fault liability in paid judgment. Conclusion: Medical claims related to laser application are increasing. However, as it is clear, the growth of laser technology and the increasing demand for lasers in medical science require more surveillance to avoid probable injuries and improve patient safety, especially surveillance of the physicians who work outside the scope of their specialty.
... A patient is almost totally vulnerable and dependent upon his doctor for therapeutic treatments, privacy, the right decision regarding treatment, financial aspect of the ailment and a lot of matters associated with it. This profession encompasses in it a lot of privileges and social recognition but also good deal of expectation, remonstrance, and resentment (Pandit, 2009). Doctors like every human are prone to make mistake, however, the quantum, causes and intensity of the mistake in discharge of their duties varies from one situation to another. ...
This paper aims to explicate that despite of legislative frameworks why medical malpractice is still rampant. The object of the study is to determine the question of jurisdiction of tribunals and courts pertaining to this felony and explains how effective mechanisms can be evolved for the proper enforcement of laws. The rationale of the study is to suggest that an exclusive and viable law on the subject must be enacted which shall conclusively lays down the parameter for determining the rights obligation and liabilities of all the stakeholders including healthcare providers and patients to uphold and implement the hopes trust and confidence associated with medical profession. The Research methodology involving qualitative, descriptive, analytical empirical and applied methods based on the rationale of the study. This research has highlighted some grey areas in the legislative and implementation mechanisms which are condition precedent for opulent implementation of laws.
... Healthcare professionals should respect patient decisions without influencing or interrupting. 4 Beneficence is the obligation of healthcare professionals to act for the benefit of the patient and to remove conditions that cause harm, 5 and to enhance patient health and well-being. In addition to these two principles, non-maleficence should also be considered. ...
... These directives or actions by the medical practitioner may in some cases yield undesired results that may cause bodily damage to the unsuspecting patient and in other adverse cases, the action may result in the death of the patient. Thus, the expectations of a patient are two-fold: the medical practitioners and the hospitals are expected to provide medical treatment with all the knowledge and skill at their command and secondly they will not do anything to harm the patient in any manner either because of their negligence, carelessness, or reckless attitude of their staff [5] . Under the code of ethics applicable in Nigeria, [6] a medial practitioner must see and attend to all patients on admission under his care as frequently as their conditions demand. ...
Under the Common Law and the Nigerian Evidence Act, a patient who alleges that he/she has suffered any form of bodily damage or harm due to the negligence or error of a medical practitioner or someone under the directive of the medical practitioner is expected to prove and show amongst other things, the particulars of the alleged negligence or error on the part of the medical practitioner. In most cases, the patient who has no knowledge of the nitty-gritty of medical practice and one who also possess shallow account of the complained act (s) of the medical practitioner that resulted to the alleged harm may find it difficult to discharge this evidential burden placed on him by Common Law and the Evidence Act. In other cases, perhaps, surgery, the patient may be unconscious throughout the surgical period when the act that resulted to the harm occurred and thus the patient will be apparently bereft of any fact as to the cause of the harm. It is against this backdrop that this work appraises the onerous evidential burden placed on these naïve and credulous patients which said burden may even be difficult to be discharged in cases where the services of an expert is secured by the aggrieved patient. As a panacea to this onerous evidential burden placed on the Nigerian patient, this paper advocates for a reliance on the doctrine of res ipsa loquitur most especially when it is manifestly clear that the alleged harm occurred as a result of the medical practitioner's act and that there is no possible explanation as to how the alleged harm occurred. This work also carried out a comparative analysis of the extent of the applicability of the doctrine.
Medical negligence is any harm caused due to negligent behaviour by any of the medical fraternity. Medical negligence can be either due to the doctor or the patient - doctors in hurry to treat many patients might miss some questions important for a diagnosis while patients may not reveal some important aspects regarding their health thinking those aspects may be less important. There-fore, a detailed history, thorough physical examination and getting investigations done when necessary may help in decreasing medical negligence. Few important points which all the doctors should keep in mind in day to day lives are given at the end.
The aim of this paper is to analyze the evolution of medical litigation cases, from the first such case up to present time, and their importance in our current approach on clinical negligence cases, especially about their involvement in spine litigation cases. The authors present the outcome of the three famous cases of clinical litigation recognized in literature. The very first such case of litigation was represented by Mr. Bolam's accusation of clinical negligence, in 1957. The conclusion of this case was what became the "Bolam test", describing the clinical negligence of a doctor if three principles can be proven: doctor has a duty of care to the claimant, the doctor breached his duty by falling below the reasonable standard of care or foreseeable harm to occur. In another relatable case of clinical negligence emerged as the Bolitho case (1996). The judge rulled in favour of the doctors which were accused of clinical negligence. Bolitho case represents a departure from the Bolam case, mostly because the doctors' arguments must be sustained by a logical analysis in order to have an impact on the lawsuit. Moreover, another important aspect about clinical negligence is represented by the absence of informed consent of the patient, the most representative such case was the Montgomery case (2015). Spine surgery is considered the medical specialty with the highest risk of a malpractice claim, one in five neurosurgeons facing a lawsuit annually. Therefore, neurosurgeon should be aware of the up to date medical legislation and reasonable standard of care.
Drug industry, controlling medical publishers and large media promote flawed medicine for their revenues by systematically laundering medical knowledge in decades. They maintain and promote flawed research models and suppress disruptive discoveries, thereby precluding reform of medicine. In this study, I will deeply explore how the wrong life model, population-based research model, misused clinical trials, flawed statistical models, the symptom-based research methods, binary disease classification, failure to address the massive vital organ capacities, failure to correct biased caused by expected delay in realizing side effects, and failure to address the interference effects of non-controllable factors affect the conclusions of “effectiveness and safety” for mRNA vaccines. I will directly analyze three studies that have been relied upon by FDA in approving mNRA use authorizations: one BNT162b2 effectiveness study published in NEJM, one booster shot study published in NEJM and a Seven Integrated Health Care Organizations study published by CDC. I will expose fatal flaws in the frequency risk concept, effectiveness rate, and hazard reduction ratios, and show why 3% death rate, 95% effectiveness rate and 90% mortality reduction are all meaningless and misleading, and should never have been used as treatment guidance. I will also examine common biases that can be easily practiced by sponsors’ researchers to alter conclusions in favor of approval. By relying on laundered medical “knowledge”, FDA has consistently failed to predict latent drug side effects for any drugs and vaccines in its history. FDA approved disastrous DES in 1941, Swine Flu vaccine in 1976, and mRNA vaccines in 2020. The vaccines are used to deliver short-term benefits on a small percent of persons at the costs of damaging health, causing deaths that would be avoided, and shortening lifespans for all people in the population. I thus urge FDA to reevaluate all mRNA vaccines and revoke their use authorizations.
Despite existing interventions that have shown some promise for people with alcohol use disorder (AUD), there is a sizable number of patients that fail to respond to or complete treatment. In the current study, we analyzed data from the Treatment Episode Data Set (TEDS) to create profiles that indicate who may be more likely to resist treatment-as-usual. For the analysis, chi-square and logistic regression were used to associate personal characteristics with being at high and low risk of treatment resistance. Characteristics that put someone at higher risk of resisting treatment-as-usual include being unemployed, homelessness (or a dependent living arrangement), using daily, being male, and co-occurring mental and substance abuse disorders. The results suggest that general demographic information at patients’ admission can be used to identify population groups where conventional strategies for standard AUD treatment may be insufficient. As such, the findings can help to inform, shape, and personalize treatment, leading to successful outcomes for the subgroup of individuals who will not benefit from typical AUD interventions.
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