Journal of Indian Medico Legal And Ethics Associationimlea-india.org/journal/Oct-dec18.pdfCriminal...

Journal of Indian Medico Legal And Ethics Association

Oct.-Dec.2018 103

EDITORIAL BOARDEditor-in- Chief Dr Asok Datta

Executive EditorsDr Anurag Tomar

Dr Alka KutheDr A S Jaggi

Managing EditorsDr Piyali Bhattacharya

Dr Manish Machwe

Associate editorsDr Vivekanshu

Dr T P Jayaraman

Legal IssuesDr Balraj Yadav

Dr J K Gupta

Ethical IssuesDr Ashish Jain

Dr Vishesh KumarExecutive Members

Dr B M SinghDr Anurag VermaDr C M Chhajer

Dr Santosh PandeDr Prabuddh Sheel Mittal

Dr Anuradha ToteyDr Kritika Malhotra

Dr Anil Lohar

Advisory BoardDr Neeraj Nagpal (Chandigarh)Dr Piyush Gupta (New Delhi)Dr Rajesh Shah (Ahmedabad)Dr Mukul Tiwari (Gwalior)

Dr Mahesh Baldwa (Mumbai)Dr Sushma Pande (Amravati)

Journal of Indian Medico Legal

And Ethics Association

Journal of Indian Medico Legal And Ethics

AssociationVol.06 I Issue : 04 I Oct.-Dec. 2018

CONTENTS

Address for correspondence :Dr. Asok Datta, ULHAS GRAV, 01, Post Joteram,Dist. Burdwan - 713104 (WB).Email:[email protected] Ph. 08170993104.

1. Editorial: ... 106

2. Review Article : ... 109

3. Perspective: ... 118

4. Medico-legal News ... 121Dr. Santosh Pande

5. Professional Assistance Scheme

6.

7. IMLEA Life Membership Form ... 134

8. Index ... 135

Violence against medical professionDr. J. K. Gupta

Video-conferencing - Do’s & Don’ts for Doctors and Lawyers Dr. Vivekanshu Verma,

Mr. Santosh Kumar Verma

Poisoning Management - Medicolegal issues Dr Rajesh VermaMr. Santosh Kumar VermaDr Devendra Richhariya,Dr Vivekanshu Verma

... 126

Instructions to authors for ... 129publication in JIMLEA

B To promote, support and conduct research related to medico-legal, ethical and quality care issues in the field of medicine.

B To help, guide, co-ordinate, co-operate and provide expert opinion to the government agencies, NGO, any semi-government, voluntary, legal bodies / institutions and judiciary in deciding settled or unsettled laws or application of laws / rules related to medico-legal or ethical issues.

B To train the medical professionals in doctor-patient relationship, communication skills, record maintenance and prevention of litigations.

B To promote and support the community members and individuals in amicable settlements of the disputes related to patient care, management and treatment.

B To provide specialized training in related issues during undergraduate or postgraduate education.

B To organize conferences, national meets, CME, updates, symposia etc related to these issues.

B To identify, establish, accreditate and promote organizations, hospitals, institutes, colleges and associations working on the related and allied issues.

B To promote goodwill, better care, quality care, professional conduct, ethical values.

B To establish and maintain educational institutes, hospitals, medical colleges, libraries, research centers, laboratories etc. for the promotion of its objects and to provide scholarships, fellowships, grants, endowments etc. in these fields.

B To print and publish the bulletins, books, official journal/newsletters or periodicals etc on related and allied subjects.

B To co-operate, co-ordinate, affiliate and work with other bodies, agencies or organizations to achieve the objects.

Aims & Objectives

Indian Medico Legal And Ethics Association


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Executive Board of IMLEA 2018-19

President : Dr B B Sahni

IPP : Dr Rishi Bhatia

Secretary : Dr Rohini Deshpande (Sholapur)

Jt.Secretary : Dr. Rajesh Shah (Ahmadabad)

Zonal Chairmans :North Zone : Dr Balraj Yadav (Gurgaon)East Zone : Dr Sudhir Mishra (Jamshedpur)West Zone : Dr Alka Kuthe (Amravati)South Zone : Dr Shobha Banapurmath (Davangere)Central Zone : Dr Mukul Tiwari (Gwalior)

Treasurer : Dr Rajesh Boob (Amravati)

Executive Member : Dr Anurag Verma (Kashipur)Dr Sushrut Das (Bhubaneshwar)Dr B P Karunakara (Bengaluru)

Advisory Board : Dr Neeraj Nagpal (Chandigarh)Dr U R Deshmukh (Amravati)Dr K K Aggarwal (New Delhi)Dr Mahesh Baldwa (Mumbai)

Indian Medico Legal And Ethics Association


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Violence against medical profession

Editorial :

Dr. J. K. Gupta

Consultant Pediatrician, Kanpur email : [email protected]

Received for publication : 11 Nov. 2018 Peer review : 30 Nov. 018 Accepted for publication : 15 Dec.2018


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Keywords : Violence in health care, Litigations, Professional indemnity, Mob mentality, Medicare protection, Security alert.

Medical profession has been tougher and tougher for last few years. Challenges are so many and very detrimental that young guys are very much hesitant to opt it. Medical professionals, who were grown with a dream of saving the lives of others, are now forced to think of saving only one life in true sense and that is none other than the life of oneself. Increasing litigations and incidences of violence have converted the medical profession into a curse. Charles Darwin has rightly said that 'It is not the strongest species that survives nor the most intelligent but the one most responsive to the change'. So we have to find out the solutions to the challenges which we are being forced to face. Answer to consumer cases is handsome professional indemnity insurance which all the medical professionals must possess along with professing utmost care not only while treating the patients but also in documentation and in record keeping. In view of immunity provided by honourable Supreme Court in various judgments, Criminal negligence cases are harder to be imposed and arrest of doctors has been prevented in broader sense. The least addressed and dreaded challenge is Violence against medical persons. India is not the only country facing violence against it's medical practitioners; today this is a global phenomenon. According to a study by the Indian Medical Association, over 75% of doctors have faced violence at work. A lady doctor in Tuticorin was killed by the husband of a pregnant woman who

was admitted in a serious condition. In 2014, in Mansa district of Punjab a doctor's clinic was burnt following death of a boy who was referred to a tertiary hospital but died. Innumerable incidents of violence against doctors are reported nearly on a daily basis across India, some resulting in grievous injuries. Even institutions such as the All India Institute of Medical Sciences, New Delhi, the premier medical institute of the country is not spared. Nineteen states of India have some kind of Medicare Protection Acts passed and notified in the past 10 years but these have failed to address the issue. But most cases of violence have not been registered and no case has been penalized so far under medicare protection act. There are many causes for the increase in violence against medical personnel. Poor images of doctors which has been contributed by some private business-mindedness persons in our profession and sensationalization of every news item in an incident of alleged medical negligence by media often ignoring information that would gloss over mundane details exonerating a doctor, is a big factor for increasing violence. Overcrowding, long waiting time to meet doctors, absence of a congenial environment, multiple visits to get investigations done as well as consult doctors, sharing of beds and poor hygiene and sanitation, dysfunctional equipment with shortage of staff have developed frustration with government hospitals. Poor infrastructure and no increase in the number of posts for government doctors over the past many decades, despite an increasing population, have put the public healthcare system on the verge of collapse and violence against the health service provider is only a symptom of this


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crippling underlying malady. Meagre government spending on healthcare resulting in poor infrastructure and human resource crunch in government hospitals has forced people to seek private healthcare. According to International Trade Administration, the US Department of Commerce, the Indian government's share in the healthcare delivery market is only 20%. The remaining healthcare providers are in the private sector. According to the WHO, just 33% of Indian healthcare expenditure is from government sources and the remaining is from out-of-pocket expenditure. This out-of pocket expense for healthcare in small and medium healthcare establishments pushes many households into poverty all over India. Many incidents of violence have occurred at the time of billing and with any decrease in the already pitiable budget for health the situation is likely to deteriorate further. Small and medium private healthcare establishments, which provide the bulk of healthcare services, are isolated, disorganized and vulnerable to violence. Lack of faith in the judicial process, Mob mentality, Mobocracy (small time leaders), Desire to achieve 2 minute of fame/notoriety, Low health literacy, Cost of healthcare, Poor communication, Lack of security, Insufficient security, Insufficient law- e.g. compared to attacking a policeman on duty are the other important causes for increasing violence. The rising cost of healthcare is the key reason for the breakdown of the bond between doctors and their patients. Poor communication too is an important cause of rising incidents of violence in India. There is an urgent need to make healthcare facilities a safe environment. Only then can healthcare professionals be expected to work with devotion and dedication. Sensational media coverage of the death of a patient due to a doctor's alleged negligence has only served to work against the patient's own interest. Healthcare professionals are now reluctant to handle serious cases. Time has come that Government must take immediate steps to prevent violence against medical persons. Having a Central law for prevention of violence against healthcare persons and institutions would also help but not as much as a change in the IPC to make such violence a cognizable offence with

stringent punishment. Any complaint filed by a patient or the relatives in any court of law, fora or commission, should be automatically infructuous and cancelled ab initio if proof of violence by the patients or the relatives can be provided by the hospital/doctor. This single change will stop all violence by the patient's attendants.

Doctors should also make some necessary changes in their routine practice. The cardinal principle 'Do not overreach 'i.e. remaining within one's capability and experience is very important in today's litiginous environment. Valid and informed consent is the second most important step in preventing violence. Proper documentation of the patient's course in hospital may not prevent violence but is important once violence occurs and the police are called and record is seized. Improving communication skills will be the most important tool in preventing doctors from facing violence in the long run. Doctors should remain alert and vigilant all the time and they need to evaluate each situation for potential violence when they enter a room or begin to relate with a belligerent patient or relative. It is important to be vigilant throughout the encounter and not isolate oneself with a potentially violent person or group. It is advisable to look for indicators of violent behaviour such as staring and eye contact, tone and volume of voice, anxiety, mumbling and pacing (STAMP).The most important step in preventing mob violence in a hospital is restricting entry of the public. A large number of relatives should not be allowed at the patient's bedside. Entry should be strictly by passes and this must be implemented through good security, preferably by deploying ex-army personnel. Security guards must be placed inside the hospital at sensitive areas such as intensive care units, operation theatres and casualty. CCTV must be installed in all clinical establishments. All clinical establishments should develop an SOP for violence. Mock drills need to be conducted and each member of the staff should be clear about his role if the situation of impending or actual violence does arise. If violence occurs then important tips are- Do not meet anger with anger, remain calm in the face of provocation and let

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things blow over; Depute someone (preferably beforehand) to take photographs and, even, audio/video records of the violence; Depute someone to immediately (preferably as part of the SOP) get the medical record of the patient photocopied, If the mob carries away the original record, the photocopies will be useful; Inform your lawyer; Inform the police immediately by phone, etc. and keep a record of such phone call; Identify the troublemakers/leaders in the mob; Get written, signed statements from the persons present (doctors, staff, patients, relatives, others) regarding the occurrence of violence; Do lodge a FIR with the police; When making a police complaint the doctor/hospital should make sure that a request is made to register a FIR under the relevant Act for protection of medical personnel; Do not try to 'settle' the issue by paying hush money (more often than not it is taken as admission of guilt). There is definite and important role of Indian Medical Association and other medical organizations including IAP in making strategy to combat violence. IMA should ensure timely release of periodic circulars from DGP office for implementation of Medical Protection Act and compliance of guidelines laid down in Honorable Supreme court judgements like Jacob Mathews Vs. State of Punjab 2005 and Martin F. D'Souza Vs. Mohd Ishfaq 2009. Framework of bouncers under Local IMA headship may be planned. Each big hospital should have bouncers of its own connected through IMA and these bouncers may reach timely at the time of violence. Local IMA should frame

Zonal committees Police Station area wise and these Zonal action committees should develop rapport with regional police stations by organizing health camps for their family members twice in a year under presence of IMA office bearer and Senior Police Officials. IMA must work on the line of 'No Treatment List' on pattern of Airlines. Hospitals should be instructed to allow entry of attendants by issuing visitor passes only after having Biometry-Photo caption. In case of violence photograph of offender may be tracked to whole identity with help of preregistered biometry data. IMA should collect data on culprit of violence from different hospitals and clinics and persons involved in any kind of violence against medical person or establishment must be refused for treatment in any hospital as per inclusion in 'No Treatment List' or be allowed in few instances only after getting NOC from Police Station. Violence against doctors behoves ill for society. It is important for all medical practitioners to be aware that this can occur and they need to take steps to prevent it. Doctors need to pressurize the government to equate assault on a doctor with assault on a public servant on duty. Necessary changes should be made urgently in the IPC and Criminal Procedure Code (CrPC) to have a deterrent effect and prevent future incidents of violence against doctors. However, for this to happen a coordinated effort is needed and IMA should take up the matter of Violence with utmost seriousness and responsibility unless it becomes too late.


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Video-conferencing - Do’s & Don’ts for Doctors and Lawyers

Review Article :

Received for publication : 9 Sept.2018 Peer review : 20 Oct.2018 Accepted for publication : 20 Nov.2018

* Dr. Vivekanshu Verma ** Mr. Santosh Kumar Verma

* Associate consultant, Emergency & Trauma care, Medanta-The Medicity, Gurugram. Email: [email protected]** Senior Advocate, Rajasthan High Court. Email: [email protected]

Keywords : Video-conferencing, evidence, Witness, Cross examination, Court point, Remote point.

Video-conferencing (VC) facilities provide Courts with the capacity to receive evidence and submissions from doctors involved in court proceedings in medicolegal cases of roadside trauma, assault, sexual assault, burn, poisoning, murder and alleged medical negligence, where it would be expensive, inconvenient or otherwise not desirable for a treating doctor to attend a court in person, to facilitate the recording of evidence of the Medical Experts through Video Conferencing, so that the Medical Experts are able to devote their time in the hospitals in attending patients rather than commuting to Court for recording of their evidence and to make optimum use of Video Conferencing facility. An over-riding factor is that, the use of video-conferencing in any particular case must be consistent with furthering the interests of justice and should cause minimal disadvantage to the parties. The Presiding Judge shall be very careful while following the procedure established by law since the force of judgment is derived from the recording of evidence. As such, the mode of taking and recording evidence is integral feature of trial. Higher Court (Appellate/ Revisional Court) looks at the evidence through the eyes of the trial Judge. Unless a Judge is well equipped with legal knowledge and also well trained in recording evidence, it will impact on Judgment. Even with the advancement of technology, there is a delay of milliseconds between video picture seen and sounds being heard. Allowances appropriate to this time gap need to be made to avoid one participant talking

over another. Microphones set up at the bench, the bar table and at the witness box are highly sensitive. Persons during a video conferencing should assume from the time the video conference is activated until the same is disconnected that microphones are "live" and as such all remarks are audible to the court.

First landmark Supreme Court Judgement accepting video conferencing of doctors legal and authentic in case of alleged medical negligence:

In State of Maharashtra Vs. Dr Praful B Desai (AIR 2003 SC 2053) The question involved was whether a witness can be examined by means of a video conference. The Hon'ble Supreme Court observed that video conferencing is an advancement of science and technology which permits seeing, hearing and talking with someone who is not physically present with the same facility and ease as if they were physically present. The legal requirement for the presence of the witness does not mean actual physical presence. The court allowed the examination of a witness through video conferencing and concluded that there is no reason why the examination of a witness by video conferencing should not be an essential part of electronic evidence. Supreme Court held that a trial judge could record evidence of doctor staying abroad through video conferencing in case of alleged medical negligence. Interpreting Section 273 of the Criminal Procedure Code in the light of technological advancements, a bench comprising Justice S N Variava and Justice B N Agrawal said recording of evidence through video conferencing would be perfectly legal.The judgment relates to a case in which a US-based doctor had opined against


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operation of a cancer patient through video conferencing. Ignoring the advice, two Indian doctors operated on the lady, who later passed away. The patient's family went to court against the doctors. However, the US-based doctor, Ernest Greenberg, refused to come to India, but expressed willingness to give evidence through video conferencing. But the Bombay high court did not allow the trial court to go ahead citing Section 273, which lays down the procedure for recording evidence. The husband of the deceased patient, and the Maharashtra government had appealed against the high court order in the Supreme Court. The prosecution has alleged that the two Indian doctors did not take good care of the patient after the operation as a result of which she suffered a lot before her death. In cases where the attendance of a witness cannot be procured without an amount of delay, expense or inconvenience, the court could consider issuing a commission to record evidence by way of video conferencing. Normally a commission would involve recording of evidence at the place where the witness is. However, advancement in science and technology has now made it possible to record such evidence by way of video conferencing in the town/city where the court is. Referring to the chances of witness abusing the trial judge during video conferencing, the apex court said, as a matter of prudence, evidence by video-conferencing in open court should be accepted only if the witness is in a country which has an extradition treaty and under whose laws contempt of court and perjury are punishable. The court then directed the Mumbai court to set up a commission and take help ofVSNL in recording Dr Greenberg's statement through video conferencing in the presence of the two accused doctors. It also allowed the two accused to cross-examine the US- based doctor. The court directed the Maharashtra government to bear the cost of video conferencing. Rejecting all arguments about inferior video quality, disruption of link and other technical problems, the bench said by now science and technology has progressed enough to not worry about video image/audio interruptions or disruptions. The counsel for the two doctors argued that the rights of the accused

under Article 21 could not be subjected to a procedure involving 'virtual reality'. Rejecting the argument, the bench said video conferencing has nothing to do with virtual reality and gave the example of the telecast of the cricket World Cup. It could not be said that those who watched the World Cup on television were witnessing virtual reality as they were not in the stadium where the match was taking place, the court pointed out. This is not virtual reality, it is actual reality. Video conferencing is an advancement of science and technology which permits one to see, hear and talk with someone far away with the same facility as if he is present before you, that is, in your presence,” the apex court said. Recording of evidence by video conferencing also satisfies the object of providing, in Section 273, that evidence be recorded in the presence of the accused [1].Video conferencing is regulated under the Indian Evidence Act & Information Technology (IT) Act:

All, relevant statutory provisions applicable to judicial proceedings including the provisions of the Information Technology Act, 2000 and the Indian Evidence Act, 1872 shall apply to the recording of evidence by video conference. In Indian law, to incorporate the provisions on the appreciation of digital evidence, the Information Technology (IT) Act 2000, is amended to allow for the admissibility of digital evidence. Sections 65-A and 65-B provide provisions for evidences relating to electronic records and admissibility of electronic records, and that definition of electronic records includes video conferencing.

Minimum requisites for video conference:-(i) A desktop or laptop with internet

connectivity and printer(ii) Device ensuring uninterrupted power supply,(iii) Video Camera(iv) Microphones and speakers(v) Display unit(vi) Document visualizer(vii) Comfortable sitting arrangements ensuring

privacy


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(viii) Adequate lighting(ix) Insulations as far as possible/proper acoustics(x) Digital signatures from licensed certifying

authorities for the coordinators at the court point and at the remote point.

Court permit recording of evidence through VC:-

Generally, all the courts have a liberal approach towards allowing recording of evidence through video conferencing. Unless there were special reasons to deny it, courts are always willing to adopt the technology for the betterment of all. By evaluating various cases where courts admitted and denied an application for recording evidence through video conferencing, we can say that, unless it is a mandatory condition of law or a written and valid contract among parties that parties must appear physically it must be allowed by the courts. In any other such circumstances where the court considers that if the recording of evidence through video conferencing is allowed, it will defeat the purpose of the law or procedure established by law, the court can deny it.

Doctor can appear in court by video conference:-

A Court may either “suo moto” or on application of a party or an expert medical witness, directed by a reasoned order, that any doctor shall appear before it or give evidence or make submissions to the Court through video conference. In criminal medicolegal cases, where the Doctor to be examined is a prosecution witness or court witness in medicolegal cases of roadside trauma or assault, the prosecution counsel and where doctor to be examined is a defence witness in alleged medical negligence, the defence counsel will confirm to the Court his location, willingness to be examined by video conferencing, place and facility of such video conferencing. In case person to be examined is an accused in medical negligence suit, prosecution will confirm his location at remote point.

Timings ofVC for doctors in medicolegal cases:-Video conference shall ordinarily take place

during the court hours. A time slot between “11.00

AM to 1.00 PM” on working days should be kept fixed for Video Conferencing. However, in case of witness living out of India with different time zone (USA, UK) the Court may pass suitable directions with regard to timings of the video conferencing as the circumstances may dictate.

Cost Bearing of video conferencing:-In criminal cases, the expenses of the video

conference facility including expenses of preparing soft copies/certified copies of the Court record for sending to the co-ordinator at the remote point and fee payable to translator/ interpreter/ special educator, as the case may be, and to the co-ordinator at the remote point shall be borne by such party as the Court directs taking into account the Delhi Criminal Courts (Payment of Expenses to Complainant and Witnesses) Rules, 2015.

In civil cases, as a general rule, the party making the request for recording evidence by video conference shall bear the expenses. In other cases, the court may make an order as to expenses as it considers appropriate taking into account rules/ instructions regarding payment of expenses to complainant and witnesses as may be prevalent from time to time.

High court Guidelines for lawyers conducting Video conferencing:-Delhi High Court issued the following directions for conducting Video conferencing: [2]1) The identity of the person to be examined shall

be confirmed by the court, with the assistance of the co-ordinator at remote point at the time of recording of the evidence.

2) Reference to the 'court point' means the Courtroom or other place where the Court is sitting or the place where Commissioner appointed by the Court to record the evidence by video conference is sitting and the 'remote, point' is the place where the person to be examined via video conference is located, for example, a prison.

3) Person to be examined includes a person whose deposition or statement is required to be recorded or in whose presence certain proceedings are to be recorded :


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I) Wherever possible, proceedings by way of video conference shall be conducted as judicial proceedings and the same courtesies and protocols will be observed.

ii) Where the person to be examined is in another State or Union Territory, a judicial Magistrate or any other responsible official as may be deputed by the District Judge concerned or Sub-Divisional Magistrate or any other responsible official as, may be deputed by the District Collector concerned,

iii) Where the person to be examined is in custody, the concerned Jail Superintendent or any other responsible official deputed by him,

iv) Where the person to be examined is in a hospital, public or private, whether run by the Central Government, the State Government, local bodies or any other person, the Medical Superintendent or In-charge of the said hospital or any other responsible official deputed by him,

v) Where the person to be examined is a juvenile or a child who is an inmate of an Observation Home/Special Home/Children's Home/ Shelter Home, the Superintendent/Officer In-charge of that Home or any other responsible official deputed by him,

(vi) Where the person to be examined is in Nirmal Chhaya, the Superintendent/Officer In-Charge of the Nirmal Chhaya or any other responsible official deputed by him.

4) Video conferencing facilities can be used in all matters including remands, bail applications and in civil and criminal trials where a witness is located intrastate, interstate, or overseas. However, these guidelines will not apply to proceedings under section 164 of Cr.P.C.

5) The guidelines applicable to a Court will mu ta t i s mu tand i s app ly t o a Loca l Commissioner appointed by the Court to record the evidence. “Mutatis mutandis” means making necessary alterations while not affecting the main point at issue.

6) Role of Interpreter/ translator : A translator can be appointed by court in case the person to be examined is not conversant with Court

language; an expert in sign language in case the person to be examined is speech and/or hearing impaired; for reading of documents in case the person to be examined is visually challenged; an interpreter or special educator, as the case may be, in case the person to be examined is temporarily or permanently mentally or physically disabled.

7) Privacy of witness: The court may, at the 'request of a person to' be examined, or on its own motion, taking into account the best interests of the person to be examined, direct appropriate measures to protect his privacy keeping in mind his age, gender and physical condition. Where a party or a lawyer requests that in the course of video-conferencing some privileged communication may have to take place, Court will pass appropriate directions in that regard.

8) Reviewing recorded audiovisual of VC: The audio-visual shall be recorded at the court point. An encrypted master copy with hash value shall be retained in the court as part of the record. Another copy shall also be stored at any other safe location for backup in the event of any emergency Transcript of the evidence recorded by the Court shall be given to the parties as per applicable rules. A party may be allowed to view the master copy of the audio video recording retained in the court on application which shall be decided by-the Court consistent with furthering the interests of justice.

9) Marking of exhibits : Exhibits admitted in evidence during VC shall be marked as follows:-

(i) if filed by the prosecution with the capital letter 'P' followed by a numeral, P1, P2,P3 and the like;

(ii) if filed by defence with the capital letter 'D' followed by a numeral, D1, D2, D3 and the like;

(iii) in case of Court exhibits with the capital letter 'C' followed by a numeral C1, C2, C3 and the like.


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Video conferencing : Is it oral evidence or is it documentary evidence ? All statements which the court require and permit to be made before it by the witnesses, regarding the matter of fact under inquiry are oral evidence. In video conferencing, if the court is just permitting to make these statements through electronic means, it is not covered in the definition of documentary evidence. It is purely oral evidence in electronic form. But, if any documents are being admitted as evidence then they may be treated as documentary evidence depending on the facts and circumstances and discretion of the court.

Guidelines which a trial court must keep in mind while recording evidence through video conferencing :- Kolkata High court gave some guidelines, which a trial court must keep in mind while recording evidence through video conferencing:[3].1. The court must satisfy itself regarding the

identity of the witness.2. The oath must be administered to witness

before recording his evidence.3. The witness can only be examined during the

working hours of Indian courts.4. Copies of the documents to be proved must be

provided to witnesses well in advance.5. It must be ensured by the court that the witness

is alone in the room of Indian embassy from where he is giving evidence through video conferencing.

6. The demeanor of the witness must be recorded by the court which is relevant for the purpose of evaluation of the evidence.

7. Once the recording of the evidence is started through video conferencing, it must be continued on day by day basis till evidence of such witness is recorded completely.

8. Other conditions can be imposed by the court to ensure smooth recording of evidence through VC.

High court Guidelines for Doctors attendingcourt evidence via Video conferencing:- Punjab & Haryana High Court issued the following directions in exercise of the inherent powers conferred on this Court under Section 482 Cr.P.C. and/ or Section 151 CPC and Under Article 226 of the Constitution:[4] (i) The State Government shall set up Video Conferencing Rooms in the Civil Hospitals, if not already available, to facilitate recording of evidence of medical experts through Video Conferencing. The Court shall satisfy itself that the doctor to be examined at the remote point can be seen and heard clearly and similarly that the doctor to be examined at the remote point can clearly see and hear the Court. (ii) The Public Prosecutor in criminal cases or Advocate for the claimant in accident cases or any other Advocate representing any party, who wishes to examine a Medical Expert is required to disclose the place of posting of the concerned Doctor along with his e-mail address and/or the contact phone number. (iii) The photocopies/ soft copies of the documents to be proved by examining the Medical Expert, shall be forwarded to the concerned Expert by either the Public Prosecutor in criminal cases or Advocate for the Claimant in accident cases or any other Advocate representing any party requiring evidence of the medical experts. The Court will allow the Public Prosecutor or Advocates for preparation of the photocopies of the relevant documents, if the same are not available with them as per rules. (iv) If the documents to be proved by the Medical expert are in possession of a third person or party, a simultaneous direction would be issued by the Court requiring that person to make available the documents in the Court at the time of recording of evidence of the medical expert through Video Conferencing. (v) The concerned Court will fix a date, before which the examination-in-chief will be furnished by the Medical Expert concerned to the Court. (vi) The concerned Court will also fix a date for the purposes of cross-examination giving tentative


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time slot for Video Conferencing until mechanism of booking of slots is put in place. The Doctor will confirm his availability in the said slot along with his statement to be sent to the Court.

(vii) On the given time, the Court will organize two way or three-way Video Conferencing i.e. between Court , Medical Expert and the Central/District Jail, if the accused is in custody and not in Court to facilitate recording of the statement of the medical experts.

(viii) The Registrar (Computerization) of this Court will be coordinator to facilitate the mechanism of recording of such evidence including development of module for fixation of time slot. In case of any difficulty in implementing the directions, the State Governments and/or the Officers including Medical Experts and the Judicial Officers may give their suggestions, which shall be given effect to as far as possible.

(ix) Until rooms/studios are established in Civil Hospitals, the medical experts may go to such rooms/studios available in the District Court, DC office or the NIC office. In-charge Officers of such institutions would facilitate recording of evidence of medical experts by permitting them access to the VC rooms/studios. The State Government shall issue appropriate directions in this regard.

(x) The above directions will be applicable to the Medical Experts posted outside the District of the place of Court sitting and shall not preclude the Court in appropriate cases to record evidence of the Medical Experts in Court.

(xi) The record of proceedings including transcription of statement shall be prepared at the court point under supervision of the Court and accordingly authenticated. The soft copy of the transcript digitally signed by the co-ordinator at the court point shall be sent by e-mail through NIC or any other Indian service provider to the remote point where printout of the same will be taken and signed by the deponent. A scanned copy of the statement digitally signed by co-ordinator at the remote point would be sent by e-mail through NlC or any other Indian service provider to the court point. The hard copy would also be sent

subsequently, preferably within three days of the recording, by the co-ordinator at the remote point to the court point by courier/mail. (xii) Putting Medical Records (MR)/ Medico Legal Record (MLR)/ Post Mortam Record (PMR)/ documents to a doctor at remote point: If in the course of examination of a doctor at a remote point by video conference, it is necessity to put a document to him, the Court may permit the document to be put in the following manner :

(a) if the document is at the court point, by transmitting a copy of it to the remote point electronically including through a document visualizer and the copy so transmitted being then put to the person.

(b) if the document is at the remote point, by putting it to the person and transmitting a copy of it to the court point electronically including through a document visualizer. The hard copy would also be sent subsequently to the court point by courier/mail.Affidavit is required from doctor submitting his evidence in medicolegal cases:- A Division Bench of Punjab & Haryana Court, While deciding Murder case Reference No.8 of 2007 titled "State of Punjab Vs. Mohinder Singh", noticing spelling mistakes in the medical evidence given by the Doctors, gave the following directions: "In view of the aforesaid, in order to ensure that medical evidence is placed on Court records in correct and clear terms and also that Presiding Officers of Courts do not take it lightly, we direct the Registrar (Judicial) to issue instructions to Secretaries (Health) and Director General/Directors (Health Services) and Presiding Officers of Courts in Punjab, Haryana and Chandigarh, that at the time of recording of evidence of Doctors, who are produced as expert witnesses, Courts shall ask them (Medical Doctors etc.) to submit medical reports on affidavit in clear terms with correct spelling[3]. In pursuance of above directions, the Registrar (Rules) has issued a communication dated 28.08.2008 to the effect that requisite affidavits are required to be prepared by the Doctors, who appear as expert witnesses, as the


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original records always remain with them, which they can use/refer to, while preparing their affidavits.

In some medicolegal cases doctor's VC is not preferred by courts. Courts still prefer doctors (who have prepared medicolegal reports of the victim/accused) to visit the court in criminal cases of sexual assault of minors under POCSO (Protection of child against sexual offences) act. The courts, to protect child's privacy, keeping in mind his/her tender age, gender and physical condition. In these cases, in the course of video-conferencing, some privileged communication may take place during internet transmission, so Courts avoid VC and summons the doctors to visit personally.Can evidence be recorded in legal cases through VC ? :-

By amendment in Cr.P.C in 2009, a proviso was added to subsection (1) of section 275 Cr.P.C. which states as follows:

“Provided that evidence of a witness under this subsection may also be recorded by audio-video electronic means in the presence of the advocate of the person accused of the offense”.

By analyzing this provision, we can say that taking evidence of a witness through video conferencing is permissible. By observing various guidelines of various High Courts and Supreme Court (2 & 3) also, it is clear that evidence can be taken through video conferencing.

Here it is worth mentioning that as per Section 273 Cr.P.C., evidence must be recorded in the presence of the accused. But, here presence does not mean the actual physical presence of the accused. Evidence may also be taken in presence of the pleader of accused if attendance of accused is dispensed with. Presence of pleader is deemed to be the presence of accused as provided by section 273 and 275 (1) proviso.

In case of State of Maharashtra Vs Dr. Praful B. Desai and Another: AIR 2003 SC 2053, the Apex Court interpreted the meaning of the term 'presence of the accused' in the aforesaid manner.

Apex Court and various other Court allowed record ing o f ev idence through v ideo conferencing in following cases:-

In State of Maharashtra Vs Praful B Desai (Dr.) Supreme Court permitted recording of evidence of witnesses staying abroad through video conferencing.

In Md.Ajmal Md.Amir Kasab @Abu ... Vs State of Maharashtra: The court permitted Kasab to appear through video conferencing.

Delhi High Court in International Planned Parenthood Federation (IPPF) Vs Madhu Bala Nath directed courts to have a liberal and pragmatic approach in allowing the witnesses to depose through Video conferencing.

Gujarat High Court Ketan @ Arcit Pravinbhai Patel Vs State of Gujarat gave directions to the State to consider the production of undertrial person in concerned courts through video conferencing.

The Bombay High Court taking suo-moto cognizance of a letter written by Shaikh Abdul Naeem, who was one of the accused in the Aurangabad Arms Haul case has directed the Maharashtra government to install video conferencing facilities in all courts in the state by the end of March 2017.

Recently in February 2018, it was reported that Jammu bench of Jammu and Kashmir High court for the first time heard 11 cases listed before Srinagar wing of High court through video conferencing. The Chief Justice of J & K High court, Justice Badar Durrez Ahmed had himself heard these cases.

Apex court in Asha Ranjan Vs State of Bihar and others, transferred Mohammad Shahabuddin from Siwan Jail, district Siwan in Bihar, to Tihar Jail, Delhi directing that pending trials shall be conducted by video conferencing by the trial court. The Division Bench of Madras High Court created history when it conducted the court proceedings over Skype from Chennai for the first time in a case related to 89 inmates of an unauthorized private children's Home for girls run by Mose Ministries in Turuchi. In this case, girls


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rescued from the brothels in Delhi were repatriated and rehabilitated in their hometowns in several parts of India. To avoid any discomfort to them the court decided to take evidence through video conferencing. SIL Import, USA Vs Exim Aides Exporters, Bangalore (1999) [4] SCC 567: In this decision also use of available technology was given a boost. But, it was also held that technologies like internet, email etc were being used swiftly even before the bill was discussed in Parliament. So, if Parliament has decided that notice is to be given in writing, the court cannot ignore this fact. The court assumes that Parliament was well aware of the modern technology available. Grid Corpn. of Orissa Ltd. Vs AES Corpn. 2002 AIR (SC) 3435. Here Supreme Court held that it is not necessary for two parties to sit together at one place where an effective consultation can be done through electronic means and remote conferencing, unless, law or any condition specifically mentioned in the contract has binding on them to do so. Hon'ble Karnataka High court in Twentieth Century Fox Film Corporation Vs NRI Film Production Associates (P) Ltd. (AIR 2003 KANT 148) held that a witness must file an affidavit or undertaking duly verified by a notary or a judge before he is examined, that the person who is going to depose on screen is the same person who is s h o w n a s t h e w i t n e s s o n t h e r e c o r d s .Apex court denied recording of evidence through video conferencing: In Santhini Vs Vijaya Venketesh, the apex court held that Evidence via video conference not permissible in matrimonial cases. If both parties are not present in court, then there less possibility of emotional bond. It can create a dent in the process of settlement. Family court judge should never be the slave of the concept of a speedy trial. Reconciliation requires the presence of both parties at the same time and same place. This if permitted, can defeat the purpose of the whole act.

Technical difficulties faced by doctors, lawyers and judges during VC:1. Lack of infrastructure : Still, in many parts of the country, courts do not

have basic infrastructure like computer systems, uninterrupted supply of electricity and high-speed internet connections to facilitate recording of evidence through video conferencing.

2. Lack of technical knowledge required for video conferencing among judges, doctors, lawyers and no availability of technical assistance to them.

3. No mechanism to compel witnesses in countries other than India, to be present at the time of the conference.

4. People are still not as acquainted with the technology, as required, and hence, they are reluctant to adopt it. They still prefer the conventional methods.

5. Judges do not have enough time to record evidence through video conferencing and they have to appoint commissioners for this purpose. But commissioners are not well acquainted with technology and guidelines for recording evidence through video conferencing.

6. The speed of the internet is not world class.7. The government has not supported the efforts of

courts and has not provided with the appropriate funds required for making this possible.

8. Advocates have a tendency to linger on the cases by taking adjournments during the trials. Parties in default also want to take advantage of the loopholes in the legal system as delays irritate opposite parties and sometimes may even change the fate of matter in their favor. Generally, only one party to the suit is interested in it. Party in default and his counsels do not agree to adopt this procedure as it may result in early disposal of a matter which will probably be decided against them.

Conclusion: The courts have generally observed that, for speedy and effective disposal of cases, there is a requirement to avail technologies and innovations in the justice delivery system by

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2. Video Conferencing Guidelines issued by Delhi High Court.http://www.nja.nic.in/CJ- CM Resolution/Delhi_ HC/Video Conferencing Guidelines issued by DHC.PDF Last accessed on 9/9/18.

3. Video Conferencing Guidelines issued by Kolkata High Court in case of Sujay Mitra Vs State of West Bengal CRR No.1285 of2015.

4. Video Conferencing Guidelines issued by Punjab & Haryana High Court in State of Punjab Vs. Mohinder Singh in MRC No.8 of 2007, CRM No.18934 of 2013. https:// indiankanoon .org/ doc/ 138702728/ Last accessed on 9/9/18.

including video conferencing, but, with necessary safeguards and precautions. In our technological age justice can be awarded by recognizing latest discoveries promoting forensic efficiency by liberal use of scientific aids of audiovisual aids to prove guilt of the accused by conducting timely court evidence of treating doctors from their Hospitals, in medicolegal cases pending in trial courts, because justice delayed is justice denied for the victim.References:-1. Video Conferencing Guidelines issued by

Supreme court in State of Maharashtra Vs. Dr Praful B Desai (AIR 2003 SC 2053) https:// indiankanoon. org/doc/560467/ Last accessed on 9/9/18.

Contribution in JIMLEA

All the readers of this issue and the members of IMLEA are invited for contributing

articles, original research work / paper, recent court judgement or case laws in the forth

coming issues of JIMLEA. This is a peer-reviewed journal with ISSN registration.

Please send your articles to Dr. Asok Datta, email : [email protected]

Poisoning Management - Medicolegal issues *Dr Rajesh Verma

**Mr. Santosh Kumar Verma***Dr Devendra Richhariya,

****Dr Vivekanshu VermaReceived for publication : 3 July2018 Peer review : 30 July 2018 Accepted for publication : 5 Oct.2018

* Associate Professor, Dept. of Forensic Medicine and Toxicology, SMS Medical College, Jaipur. Email: [email protected]**Senior Advocate, Rajasthan High Court. Email: [email protected]

***Associate Director, Emergency and Trauma care, Medanta-The Medicity, Gurugram. Email: [email protected] ****Associate Consultant, Emergency and Trauma care, Medanta-The Medicity, Gurugram. Email: vivekanshu @ yahoo.co.in


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Perspective :

Keywords- Consent, Medicolegal Reports, Sampling for forensic lab, Chain of custody, Drunk, In toxica ted , Negl igence dur ing postmortem.

M e d i c o l e g a l R e p o r t s ( M L R ) a r e documents prepared by a government and private doctors, pertaining to injury, sexual offence, suspected poisoning or unexplained death [1]. It contains all the facts, observed by the doctor and his opinion drawn there-from. Doctor's opinion must be based upon the clinical observations made by him, and not on hearsay evidence [2].

Doctor's dilemma includes what to do first; MLR documentation or treatment. In the Hospital, while attending to an emergency, the doctor should understand that his first priority is to save the life of the patient. He should do everything possible to resuscitate the patient and ensure that he is out of danger. All legal formalities stand suspended till this is achieved. This has been clearly exemplified by the Hon'ble Supreme Court of India in Parmananda Katara Vs Union of India [3].MLC Writing comprises of 3 parts [2]:a) Preamble - includes the date, time and place of

examination, name of the patient, his residential address, occupation; informed consent of the person being examined, two marks of identification, thumb impression, etc, wherever applicable.

b) Clinical Findings/Observations -includes a complete description of the injuries/any other vital findings present; any investigations/ referrals, etc, asked for.

c) Opinion -includes the Nature of the injury-whether simple or grievous.

- Poison consumed-whether fatal/ dangerous to life.

- Duration of the poisoning. Easy recall in MLR for suspected drugoverdose, poisoning and intoxication includes:-• Who is victim ? (Name, Age, gender, address)• Which occupation? (college students, banker,

policeman, journalist, politician, lawyer, doctor)

• What poison consumed? (then call poison control centre)

• What quantity consumed? (fatal dose)• When consumed ?(fatal period)• What is route of poisoning? (ingestion/

inha la t ion / i n j ec t ion - subcu taneous , intramuscular, intravenous)

• Where consumed? (place of crime)- to collect evidence by police

• Whether any associated injuries visible? (physical injury- bruise, abrasion, laceration), (chemical injuries- burns, blisters, erosions, red line of demarcation)

• What number of victims? (mass casualty)• Who gave poison? - only in dying declaration

(suicidal/ homicidal/ accidental)• Why? (intentional, non-intentional, suicidal,

homicidal, accidental)

Do's and Don'ts of MLR writing [2]:-• Always intimate the police about MLC

promptly. Not informing police to screen offender under S.201 IPC is punishable.

• MLC reports should be prepared in duplicate preferably with ball pen.


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• No overwriting in MLR (if any word corrected) it should be initiated by signature of doctor. Any tempering or altercation in entries will amount to fabricating false evidence under S.191 IPC and is punishable.

• MLR reports are confidential legal document hence, don't issue to anyone in right to information except the patient.

• Don't miss the court date on summons. Arrest warrant may be issued for Contempt of Court under S.228 IPC which is also punishable.

If patient is not fit for consent for examination: -Any medical procedure without consent of

patient is assault (battery) on patient, which may be punishable offence. Eg., examining intoxicated young females may face allegation of indecent assault under 354-B IPC for assault or use of criminal force to woman with intent to disrobe. So, always examine in presence of female nursing staff. Life-saving procedures in emergency can be done without consent, if patient is not fit for consent, if procedure done by qualified professional, in good faith for the patient (S. 92 IPC) [4].

Sampling in a case of suspected poisoning: It is mandatory to send blood, urine, clothes or gastric lavage for chemical analysis in patients with suspected poisoning, or unconscious patients with suspected foul play. Containers with toxicology samples must be well labeled; the name of suspected poisoning communicated and signed by the doctor, after sealing the sample.Chain of custody : Samples should be handed over to Police investigating officer, to be sent to Forensic Science Lab (FSL)[1].Is Suicide attempt by poisoning is MLC or not? : Recently, Mental Health Act 2017 amendment [5] decriminalizes Section 309 IPC. No offence for the patient as it is due to mental illness. But abatement of suicide is crime, if the patient has consumed the poison under the pressure by patient's husband or in-laws. Many times, homicidal attempt is projected as suicidal attempt/ accident to prevent police case. So suicide attempt is still MLC.

What is minimum qualification to treatpoisoning cases:�There was alleged history of snakebite, MBBS doctor in emergency, gave Antisnake venom and referred the patient to nearby medical college. Patient recovered and discharged home. The patient later alleged that emergency doctor was just an MBBS and was not qualified to administer the antidote. The court held that MBBS doctor was competent to handle a poisoning patient [6].Patient being "drunk" and "having a drink": Defence lawyer claimed that the witness (PW-1) to crime was drunk at the time of quarrel between accused and victim, so his evidence as eye witness is not reliable. Supreme Court observed that there is a distinction between being "drunk" and "having a drink". The accused took up a bottle lying on the table, broke it by hitting it on the table and stabbed victim on his neck. When PW.1 intervened he too was caused injuries in that process PW.1 and his friends and the deceased were having a drink in the restaurant but to say that PW.1 was drunk at that time is not forthcoming from the evidence. There is not even a suggestion put to him that he was completely drunk at the time of the incident. We also find that no question had been put to the investigating officer or to the treating Doctor (who treated PW.1) as to the condition of PW.1 at the time when he had been brought to the hospital or at the time when his statement had been recorded for the registration of the FIR. In the absence of any evidence the suggestion that PW.1 was drunk, is completely baseless [7].In case of death of a patient of suspected poisoning :

• Recording date and time of death

• Information to the police

• Death certificate not to be issued

• Body to be sent for medicolegal autopsy

• Post mortem certificate issued after autopsy may be issued in place of death certificate towards registration of death.

• Postmortem Sampling of patient's clothes and body fluids, stomach contents, blood, urine etc to be sent for detection of residual poison, if any.

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recorded their view that it was a case of poisoning, which has been duly supported by witnesses. According to post-mortem report and the statement of doctor who conducted post mortem, it is a clear case of murder as the cause of death is strangulation. Hyoid bone was found fractured. Allahabad High court observed that the injuries were caused on neck though according to their extra-judicial confession before the informant when altercation took place, the accused and co-accused caught hold the neck of deceased and throttled him to death. None of the witnesses stated that injury was caused to the deceased by any outsider. Hence, considering the facts and circumstances and evidence in the present case, the trial court has convicted and sentenced the appellant under Section 302/34 IPC. [8]

References:-1) Haryana Medicolegal Manual, 1st Ed. 2012.2) Richhariya Devendra. Medicolegal issues in

Emergency. Textbook of Emergency and Trauma Care. 1st Edition. Jaypee Publishers; Delhi 2018. (7) 35-71.

3) Parmananda Katara Vs Union of India(1989) 4 SCC 286.

4) Indian Penal Code, 18605) Mental Health Act amendment 2017.6) Dr. P. V. Nair v/s. Allettutty Jose on 25 June,

2012 - by Kerala State Consumer Disputes Redressal Commission, Thiruvananthapuram.

7) Supreme Court decision in case of Subramani Vs. SHO 14 SCC 454 : 2011.

8) Supreme Court decision in case of Dev kanya Tiwari Vs state of Uttar Pradesh. Criminal Appeal No. - 2894 of 2014 decided in March 2018.

Doctor's Negligence in Poison Sampling during Postmortem leads to acquitting the accused on charges of murder on benefit of doubt. In a case of alleged murder of man by his mother in-law and wife- High court held the accused guilty for strangulation based on postmortem findings of doctor. There was strangulation ligature mark with hyoid bone fracture. But Supreme Court acquitted the accused based on the negligence of postmortem doctor in failure to preserve viscera for identifying poisoning as submitted in panchnaama by Investigation Officer (IO). The Supreme Court has acquitted a lady accused of murdering her son-in- law by setting aside concurrent findings of the trial court and the high court. Wife and mother-in-law of deceased were accused of killing him while he paid a visit to their house. During the pendency of the trial, the accused wife died. The trial court found the mother-in-law guilty and sentenced her to life imprisonment. The conviction was later upheld by the high court. It was urged before the apex court that the death was due to poisoning and the deceased had committed suicide by consuming poison. It was also contended that the factum of deceased committing suicide by consuming poison has been sidelined and therefore viscera was not preserved by the doctors. The SC observed: “Primarily when there existed a complaint lodged by the wife of deceased pointing out that the deceased committed suicide by consuming poison, generally it is expected that the Doctor will preserve viscera for chemical analysis. On this point, prosecution has failed in its duty as no steps have been taken to preserve viscera. Merely a statement by doctor that viscera was not preserved as there is no presence of poison would not suffice in the peculiar circumstances of this case, particularly when the independent panch witnesses together as well as the Investigating Officer

Practicing anesthetist & President IMLEA, Amravati Branch E mail:[email protected]

Compiled by : Dr. Santosh Pande

Medicolegal News:


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Sion Hospital Oncologist ordered to pay Rs 6 Lakh compensat ion for wrong blood transfusionMumbai: The State Consumer Disputes Redressal Commission ordered the BMC run Sion hospital and its surgical oncologist to pay Rs. 6 lakh for the transfusion of wrong group blood to a patient's body who had been undergoing treatment for gallbladder cancer. The patient had died soon after the wrong transfusion.

The case concerns Asha Singh (deceased) who was suffering with gallbladder cancer and was being treated at the Lokmanya Tilak Municipal Medical College and General Hospital Sion, Mumbai in the year 2010-11.

The patient was diagnosed with cancerous lump in her gallbladder in the year 2010. Since then she was taking treatment for the same with the hospital under the supervision of Dr.K.S.Sethna. She received chemotherapy treatment and was responding well as per the complainant. On 27 September 2011 during routine examination of blood, it was revealed that her haemoglobin dropped to 6.3 gm% for which as per the advice of Dr Sethna, she got admitted to the hospital on 8 October 2011 at 7:30 pm.

Working on the condition of the patient, duty officer, Dr. Bhushan Vispute, arranged for blood transfusion by sending the patient's blood sample to the blood bank for grouping and cross matching. On duty technician in the blood bank Smt. Jaya Anand Wakode received the blood sample, conducted grouping and cross matching tests on the blood sample. She found the blood group to be “A positive” and so issued two units of “A positive” blood for transfusion.

The condit ion of complainant 's wife deteriorated on 9th of October 2011 soon after the transfusion and she died in the early hours of 10th October 2011. According to the complainant, he raised concern over non acceptance of the blood by his wife, the assistant doctor and the nurse on duty dismissed his concern. As per the complainant, his wife blood group was “B positive” and previously she had received the blood of same group without any complication. Alleging the wrong blood transfusion responsible for the death of his wife, the complainant approached this Commission for claiming relief under Section 17 of the Consumer Protection Act 1986.

The complainant prayed for the total compensation of Rs. 49, 06,900/- under various headings. In their written response before the forum, the surgical oncologist, Dr Sethna as well as the hospital represented by the dean, Lokmanya Tilak Municipal Medical College and General Hospital, denied the claims stating that the complainant's wife died due to the terminal cancer and not due to the wrong blood transfusion. Explaining their case, the doctors stated that on the day of 8th October 2011, late in the evening, deceased was admitted with severe anaemia for blood transfusion. That day being Saturday, indoor case records were not available and hence the blood group of the patient was not known, so “A positive” blood was accepted and transfused to the deceased by the on duty hospital staff. The reaction to the wrong blood transfusion was not observed and the patient was passing clear urine which was indicative of no transfusion reaction. The opposite parties explained this on the basis of the change of blood group due to the suppression of immunity in


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the terminal cancer patient. The complainant's wife died due to the terminal cancer and not due to the wrong blood transfusion. Hence the opposite parties denied the allegations of medical negligence and deficiency in service.

The court noted as per the reports available under Right to Information act 2005, there was deficiency in collecting blood sample, labelling the blood sample correctly and transporting the same to the blood bank for grouping and cross matching adding that the subject patient had been admitted and transfused thrice prior to this blood transfusion and death incident, but the hospital has not maintained records pertaining to the correct blood group (medical history) of the patient.

The report also mentions that, "The medical certification of cause of death is mentioned as Disseminated Intravascular Coagulation (DIC) which is relevant to wrongly transfused blood unit and no primary investigation has been carried out by hospital administration to reveal the facts”. The court also noted the lack of post-mortem.

A RTI further revealed that a departmental inquiry was conducted and the Professor and Head of Surgery from Department of Surgery reported that as per the records deceased Mrs. Asha received two units of "A positive" blood on 8 October 2011, who on previous occasion; on 23rd of February 2011 received "B positive" blood unit. The court also noted that after the Departmental enquiry of the lab technician, she was given punishment by stopping the next increment and warning was given to the house officer.

After going through the literature on blood transfusion including its complications, the court also dismissed the contention of the learned advocate for the opponents that the blood group changes from B to A as the medical literature does not support this contention and only says that due to the change in the antigenicity of surface antigens, they are neutralized and as per the literature no blood group should surface as altered one. The court then held the hospital and its doctors guilty of deficiency in service asking them to pay a compesation of Rs 6 lakh to the patient plus interest.

Decision - After considering the submissions made before us, documents submitted and evidence affidavits; we are of the opinion that there was deficiency in service while treating deceased Mrs Asha. The reports of enquiry of the on duty doctor and the blood bank technician, clearly established that there was rashness and negligence in the way the blood sample was sent to the blood bank and the Grouping and Cross matching that was done, or unlabelled or wrongly labelled that sample resulting into a wrong blood group A instead of B Blood Group and hence the blood bags with wrong blood group were issued and transfused by the staff in the ward. Non availability of previous medical record on Saturday evening is also negligence on the part of hospital system.Ref. : https://medicaldialogues.in/sion-hospital- o n c o l o g i s t - o r d e r e d - t o - p a y - r s - 6 - l a k h - compensation- for-wrong-blood-transfusion/ Accessed on 7/11/2018

Failed surrogacy procedure: Consumer forum orders IVF clinic to pay 3 lakh Compensation Bengaluru: A consumer cour t o rdered Hyderabad- based fertility clinic to pay compensation of Rs 3 lakh on account of not providing service of promised surrogacy and also for following unfair trade practices.

The case concerns a 41-year old, Martin Sujay and his family who came for the services of Dr.Rama's Fertility IVF Centre, Bengaluru on August 19,2016 after getting to know about the clinic via a newspaper advertisement. The first conversation happened over phone where the attendants from the clinic assured Sujay to provide baby through surrogacy. The clinic attendants informed that total cost incurred for the process would be around 7 lakh for one child and another extra 1.5 lakh for twin pregnancy. During the first visit to the IVF centre on 19.08.16, Sujay paid Rs.2,25,000 along with the sperm for the process and on the next visit on 25.04.17 paid Rs Rs.2,50,000. He made multiple rounds to the clinic to give his sperm but the surrogacy case never took place. Each time the clinic gave him a new story of why things are


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getting delayed regarding getting the surrogate including once that surrogates are not available, once that there are chances of surrogate getting the half money and running away from the clinic etc., and that they are waiting for good surrogate.

He al leged that on asking about the development in the process of surrogacy, the IVF centre would give different excuses on the matter. After three months the clinic stated it is not possible for them to give baby for single parent ( on account of the fact that he was a divorcee). The issues with the clinic continued and in the meanwhile complaint was filed by the man in the IV Additional District Consumer Disputes Redressal Forum, Bengaluru, against Dr. Rama's Fertility IVF Centre, Bengaluru seeking issuance of direction to pay the fees paid of Rs 4,75,000; cost of Rs 50,000 and damages ofRs 14,75,000.

Before the court, the opponents (doctor and the clinic) in their response submitted, they explained that the Complainants regarding the charges paid and to be payable to the surrogate is well within the knowledge of Complainants. The complainant had given sperms only once and in spite of that the IVF centre made several 7 phone calls to give sperms once again after taking necessary medicine for increase the counts in the sperm. It was explained regarding motility of sperms was inadequate hence the fact was made known to the Complainants. The main facts of the complaint were not explained in the complaint instead of the true facts all non- believable facts are given in the complaint to spoil the 27 year reputation of the clinic and thereby demand money in an illegal way by filing false cases like this.

The IVF centre submitted that, it was discussed and agreed between the Complainants and the IVF centre to settle the issue in the table of the clinic and the clinic were ready to return after deducting the first cycle expenditure and payments made to surrogate mother. The Complainants were non-cooperative from the beginning till filing of this complaint. The complainant knows each and every facts and expenditure to be made on getting a baby through surrogate mother. The clinic further submit that, both the Complainants from day one were

keen to record both audio and video of discussion taken place between OPs and the Complainants and misuse the private recording made by the Complainants and sharing the same with the competitors of clinic and to make unlawful money through shortcut methods of selling the recorded material and spoiling the 27 year old reputation of the clinic and damaging the public views which are shared by different beneficiaries through this clinic. Hence, opponents prayed to dismiss the complaint and impose heavy cost on Complainants for filing false complaint and for non-payment of full charges to the clinic and also non-cooperating without giving sperms as and when required by the clinic.

The court took into record all the audio conversations between the clinic and the patient.On hearing the grievances of both the sides, the court observed the lack of preliminary testing done by the clinic, in response to the argument about inadequate sperms of the complainant.

Looking to the entire contents of the version and also the written arguments filed by them, nothing is pleaded with regard to the preliminary examination conducted on Complainant no.1, as to know, whether his sperm is quite sufficient having qualifed counts to insert in the womb of the surrogate mother for pregnancy. When the preliminary test was not conducted, certainly there was laxity on the part of OPs.

The court also noted unfair trade practices by the clinic.

Further, the issue regarding, not possible to give baby for single parent is concerned, OPs never informed either to Complainant no.1 or Complainant no.2. If the said problem would have been informed to Complainant no.1 & 2, they never opted for surrogacy to get the child. Without informing with regard to not providing surrogacy to the single parent is concerned which itself is unfair trade practice on the part of OP.no.1 to 3. Hence the court held the IVF clinic liable for compensation. After going through the matter and further discussing over it the IV Additional District Consumer Disputes Redressal Forum


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comprising president SL Patil and member T N Roopa gave the following orders to Dr.Rama's Fertility IVF Centre, Bengaluru:-1. The IVF centre directed to pay jointly and

severally an amount of Rs.4,75,000/- to the Complainants, being paid by them to get child through surrogacy along with interest at the rate of 10% p.a. from the date of periodical payment to till the date of realization.

2. The IVF centre was also directed to pay compensation of Rs.3,00,000/- and cost of litigation of Rs.5,000/- to the Complainants.

3. IVF centre was also directed to realise the said amounts within six weeks from the date of receipt of this order, failing which the Complainants are at liberty to have the redress as per law.

Ref. :ht tps : / /medicaldia logues . in / fa i led- surrogacy-procedure-consumer-forum-orders-ivf- clinic-to-pay-3-lakh-compensation/ Accessed on 10/11/2018

Maharashtra Paediatrician Arrested in Fake CPS Certificate SCAMMumbai: A paediatrician, Dr Snehal Nyati, who was identified as the key players in the organized scam of allegedly helping doctors procure fake certificates of PG diplomas and fellowships offered by the College of Physicians and Surgeons (CPS), has been arrested by Agripada Police recently.

The arrested doctor has been booked under various Indian Penal Code sections of cheating, forgery, breach of trust and using fake documents as genuine. Medical dialogues had extensively reported about the scam since months. The Maharashtra Medical Council (MMC) stumbled upon the scam over a year ago, while scrutinizing documents of a candidate, who had submitted a fake certificate for registration. This prompted the medical council to launch a statewide probe into the matter. The MMC investigations revealed that around 77 doctors had failed the College of Physicians and Surgeons examinations, but managed to procure passing certificates and had been practising based on those specialists' degrees since.

Most fake degrees were of sought-after courses such as diploma in gynaecology and obstetrics, diplomas in ophthalmic medicine, general surgery and cardiology, fellowships in surgery, medicine. The state medical council began taking action and in the first go- 20 of these doctors were suspended in the month of April 2018. The 20 doctors had confessed that they paid lakhs of rupees in order to procure fake PG degrees and they also named a middleman who is paediatrician by profession. Later, the MMC summoned 53 specialists for questioning.

Further inquiry led to 50 more doctors coming out and pleading guilty to the fraud and submitting written apologies. These doctors were handed a one-year suspension by the council. Another 7, who did not show for the final hearing were handed over a 5-year ban. The whole case of fake certificates was linked to a larger scam and is alleged to have been involving more medical practitioners, who were assisting these doctors get their “Pass certificates.” Doctors allegedly paid between Rs 3 lakh and Rs 6 lakh for the certificates after fai l ing the CPS examination. The paediatrician, Dr Nyati's name figured as the kingpin of the scam. After a confirmed identification that he was the one allegedly helping doctors procure fake certificates, the MMC permanently revoked Nyati's registration to practice. The Bhoiwada police filed a charge sheet against Dr Nyati, but he managed to get out on bail.

“Most of the students are not even aware that the certificates are fake. They thought they were real. We suspect that nobody from College of Physicians and Surgeons is involved in the case,” a police official from Agripada police station informed . The police officials said they will be discussing with seniors about the course of action against the doctors. The police informed that more arrests will follow as the number of people involved in the scam is more than 100, including 58 MBBS medicos who procured the fake degrees for their post-graduation courses from College of Physicians and Surgeons.Ref. : https://medicaldialogues.in/maharashtra- paediatrician-arrested-in-fake-cps-certificate- scam/Accessed on 15/11/2018

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Court slams Doctor family, slaps Rs 4 lakh fine for Promising Complete Diabetes Cure in AdvertisementNagpur: A family of doctors has been directed by the Additional District Consumer Disputes Redressal Forum, Nagpur to pay up an amount of Rs 5.05 lakh on account of unfair trade practices a n d m i s l e a d i n g p a t i e n t s t h r o u g h f a l s e advertisements for providing complete cure to diabetes. This includes Rs 4 lakh fine that has to be deposited with the Consumer Legal Aid Fund. The case primarily concerns a senior patient Manohar Khorgade, who came across an advertisement that claimed to provide a complete cure for diabetes without any use of medicine and insulin. It mentioned that Jay Kumar Dixit was a Mumbai based doctor who was the only doctor specializing in acupuncture for curing diabetes and was recognised by the Government of India.He visits Congress Nagar based clinic run by his son and daughter-in-law. The advertisement detailed about the acupuncture therapy that it is done by piercing only two needles above ears and is completely harmless. As per his plea, Khargode went to the city based clinic of these doctors in 2010. The complainant started receiving the treatment for next 23 months. He was charged Rs 2,000 per needle. He was asked to pay Rs 46,000 as treatment cost for which he was not provided any receipt. When no progress in the treatment was observed, the doctors provided free treatment for the next 41 months. Still, no improvement was noticed, the sugar level rose to an alarming level. The doctors then asked him to take allopathic medicines but his condition kept deteriorating. He was eventually forced to move to the court to get justice. The court found that respondents were indulging into “unethical acts” as per Indian Medical Council (Professional conduct, etiquette and Ethics) Regulations, 2002, by publishing a misleading advertisement of curing diabetes through acupuncture, without any concrete medical evidence. The court also flayed the trio for not

keeping medical records of the patients as per 2002 regulations, where it was made mandatory for medicos to keep all such records for at least three years. The court also pointed out that as per the Medical Ethics regulations, It is unethical to enter into a contract of “no cure no payment”.A bench comprising president Shekhar Muley and members—Avinash Prabhune and Dipti Bobde — observed that the Dr Jay Kumar Dixit, his son Dr Swarnim and daughter-in-law Punam adopted “unfair trade practices” by misleading hundreds of patients through false advertisements, promising a complete cure for diabetes without medicines or insulin. The judges pointed out that they were indulged in “unethical practices” of entering into a contract of “no cure no payment” with the patient where he was provided free treatment for 41 months. The doctors also came under attack of judges for trying to mislead judiciary over advertisement published in media claiming that their adversaries had floated them. The bench directed the doctors to publish a c o r r i g e n d u m a b o u t t h e i r m i s l e a d i n g advertisements in the newspaper with a view to neutralizing its effect. “It should be published for three days in a row so that the gullible patients would be saved from falling into their trap in future.” The respondents are warned against continuing their unethical and unfair trade practices and asked to comply with forum's directives within a month. The Additional District Consumer Disputes Redressal Forum finally directed to pay Rs 4 lakh fine towards 'Consumer Legal Aid Fund' and Rs. 1 lakh to complainant towards financial losses and mental and physical harassment along with Rs 5,000 for litigation cost.Ref.: https://medicaldialogues.in/court-slams- doctor-family-slaps-rs-4-lakh-fine-for-promising- complete-diabetes-cure-in-adv/ Accessed on 18/11/2018

1) The scheme shall be known as PAS “Professional Assistance Scheme”.2) ONLY the life member of IMLEA & IAP shall be the beneficiary of this scheme on yearly basis.

The member can renew to remain continuous beneficiary of this scheme by paying renewal fees every year. The scheme shall assist the member ONLY as far as the medical negligence is concerned.

3) This scheme shall be assisting the members by:i) Medico-legal guidance in hours of crisis. A committee of subject experts shall be formed

which will guide the members in the hours of crisis.ii) Expert opinion if there are cases in court of law. iii) Guidance of legal experts. A team of Legal & med-legal experts shall be formed which will

help in guiding the involved members in the hours of crisis.iv) Support of crisis management committee at the city / district level. v) Financial assistance as per the terms of agreement.

4) The fund contribution towards the scheme shall be decided in consultation with the indemnity experts. The same will depend on the type & extent of practice, number of bed in case of indoor facilities & depending upon the other liabilities.

5) The financial contribution towards the scheme shall be as follows:

Admission Fee (One Time, non-refundable)

Physician with Bachelor degree Rs. 1000

Physician with Post graduate diploma Rs. 2000

Physician with Post graduate degree Rs. 3000

Super specialist Rs. 4000

Surgeons, Anesthetist etc Rs. 5000

Surgeons with Super specialist qualification Rs. 6000

S. no Qualification/ Specialty Ten Twenty Forty Fifty One Lakhs Lakhs Lakhs Lakhs Crore

1 Physician / doctors with 450 900 1800 2200 4000 Bachelor degree and/or (625) (1250) (2500) (3125) (6250)OPD Practice

2 Physician / doctors with 950 1900 3700 4500 8500 PG degree &/ or Indoor (1250) (2500) (5000) (6250) (12500)Practice

3 Physician / doctors with 1900 3800 7300 8500 16000Practice of Surgery (2500) (5000) (10000) (12500) (25000)

4 Plastic Surgeons, 2800 5600 10000 12000 22000Anesthetist etc (3750) (7500) (15000) (18625) (37250)

Figure in (bracket) indicates amount if you directly go to Insurance Company.

Indian Medico- Legal Ethics AssociationProfessional Assistance / Welfare Scheme


Oct.-Dec.2018126

B The amount includes the charges of New India Assurance company charges as well as the charges of Human Medico-Legal Consultants Company.

B This scheme is for single case; amount shall be calculated on individual to individual basis for extra assistance.

B 5% concession on payment for three years & 10% concession for payment for five years on individual to individual basis.

B Physician / doctors visiting other hospitals shall have to pay 5% extraB The additional charges 15 % for those working with radioactive treatment. B The additional charges can be included for other benefits like OPD/ indoor attendance,

instruments, fire, personnel injuries etc

PAS for Hospital Establishments:

Annual Fee for Hospitals Establishment

Rs/- 300 per lakh + 1 rupee/OPD Patient (total OPD in one calendar year)+ 5 rupee per IPD patient (total admissions in one calendar year) + GST 18 % + 7.5 % of basic premium for Unqualified Staff.

The exact calculations will depend upon number of OPD & Indoor patients as per the actual number given by the hospital.Medical colleges/ Corporate hospitals after discussing with hospital administration.

This scheme is for AOY (Any one year Limit); amount shall be calculated on individual to individual basis for extra AOA (Any one Accident limit) assistance.

5% concession on payment for three years & 10% concession for payment for five years on individual to individual basis.


Oct.-Dec.2018 127

6) The hospital can become the member of this scheme only if all the members associated with the hospital have their personal professional indemnity under the scheme.

7) A trust / committee / company/ society shall look after the management of the collected fund. The scheme shall initially be run in collaboration with the New India Assurance or National Insurance Company.

8) The Financial assistance will be like Medical Indemnity welfare scheme, where indemnity part shall be covered by government / IRDA approved companies or any other private company.

9) The amount shall be deposited in the Central Indemnity Reserve Fund (CIRF) of the association. The associa t ion shal l be responsible only for the financial ass is tance. Any compensation/cost/damages awarded by judicial trial shall be looked after by government / IRDA approved insurance companies or any other similar private company.

10) Experts will be involved so that we have better vision & outcome of the scheme.11) The payment to the experts, Legal & med-legal experts shall be done as per the pre-decided

remuneration. Payment issues discussed, agreed and processes shall be laid down by the members of these scheme.

12) If legal notice / case are received by member he should forward the necessary documents to the concerned person.

13) Reply to the notice/case should be made only after discussing with the expert committee.14) A discontinued member if he wants to j oin the scheme again will be treated as a new member.15) Most of the negligence litigations related to medical practice cases shall be covered under this

scheme. The scheme will NOT COVER the damages arising out of fire, malicious intension, out of fire, malicious intension, natural calamity or similar incidences.


Oct.-Dec.2018128

16) All the doctors working in the hospital (Junior, Senior, Temporary,�Permanent�etc) shall � be the members of the IMLEA, if the hospital wants to avail the benefits of this scheme.

17) The scheme can cover untrained hospital staff by paying extra amount as per the decision of expert committee.

18) A district/ State/ Regional level committee can be established for the scheme.19) There will be involvement of electronic group of IMLEA for electronic data protection.20) Flow Chart shall be established on what happens when a member approaches with a complaint

made against him or her [Doctors in Distress (DnD) processes].21) Telephone Help Line: setting up and manning will be done.22) Planning will be done to start the Certificate / Diploma / Fellowship� Course on�med-leg issues to

create a pool of experts.23) Efforts will be made to spread preventive medico-legal aspects with respect to record keeping,

consent and patient communication and this shall be integral and continuous process under taken for beneficiary of scheme by suitable medium.

-----------

- Chief Editor, JIMLEA

Instructions to authors for publication in JIMLEA


Oct.-Dec.2018 129

JIMLEA is online peer reviewed journal with ISSN registration. You can contribute articles, original research work / paper, recent court judgement or case laws related to medico-legal issues, ethical issues, professionalism, doctor - patient relationship, communication skills, medical negligence etc in JIMLEA. The content of the journal is freely available on-line to all interested readers.

Please read the following instructions carefully and follow them strictly. Submissions not complying with these instructions may not be considered for publication.

Communications for publication should be sent to the Chief Editor, Journal of Indian Medico-legal and Ethics Association (JIMLEA) and only on line submission is accepted and will be mandatory. In the selection of papers and in regard to priority of publication, the opinion of the Editorial Board will be final. The Editor in chief shall have the right to edit, condense, alter, rearrange or rewrite approved articles, before publication without reference to the authors concerned.Authorship :

All persons designated as authors should qualify for authorship. Authors may include explanation of each author's contribution separately if required. Articles are considered for publication on condition that these are contributed solely to JIMLEA, that they have not been published previously in print and are not under consideration by another publication. A statement to this effect, signed by all authors must be submitted along with manuscript.Manuscript :

Manuscripts must be submitted in precise, unambiguous, concise and easy to read English.Manuscripts should be submitted in MS Office

Word. Use Font type Times New Roman, 12-point for text. Scripts of articles should be double-spaced with at least 2.5 cm margin at the top and on left hand side of the sheet. Italics may be used for emphasis. Use tab stops or other commands for indents, not the space bar. Use the table function, not spread-sheets, to make tables.

Type of article must be specified in heading of the manuscript i.e. 1. Review article, 2. Original paper, 3. Case scenario / case report / case discussion, 4. Guest article, 5. Reader's ask and Experts answer, 6. Letter to editor. The contents of the articles and the views expressed therein are the sole responsibility of the authors, and the Editorial Board will not be held responsible for the same. Title page :

The title page should include the title of the article which should be concise but informative, Full names (beginning with underlined surname) and designations of all authors. with his/her (their) academic qualification(s) and complete postal address including pin code of the institution(s) to which the work should be attributed, along with mobile and telephone number, fax number and e-mail address and a list of 3 to 5 key words for indexing and retrieval.Text :

The text of Original articles and Papers should conform to the conventional division of abstract, introduction, material and method, observations, discussion and references. Other types of articles are likely to need other formats and can be considered accordingly. Abbreviations— Standard abbreviations should be used and be spelt out when first used in the text. Abbreviations should not be used in the title or abstract. Use only American spell check for English. Please use only generic names of drugs in any article/ paper.


Oct.-Dec.2018130

Length of manuscripts :No strict word or page limit will be demanded

but lengthy manuscript may be shortened during edi t ing wi thout omit t ing the important information. Tables :

Tables should be simple, self-explanatory and should supplement and not duplicate the information given in the text. Place explanatory matter in footnotes and not in the heading. Explain in footnotes all non-standard abbreviations that are used in each table. The tables along with their number should be cited at the relevant place in the text.Case scenario / case report / case discussion: Only exclusive case scenario / case report / case discussion of practical interest and a useful message will be considered. While giving details of cases please ensure privacy of individuals involved unless the case is related to a judgment already given by a court of law where relevant details are already available in public domain.Letter to the Editor :

These should be short and decis ive observations which should preferably be related to articles previously published in the j ournal or views expressed in the journal. They should not be preliminary observations that need a later paper for validation.Illustrations :

Good quality scanned photographs and drawings only will be accepted.References : Use the Vancouver style of referencing, as the example given below which is based on the formats used in the U.S. National Library of Medicine 'Index Medicus'. Mention authors' surnames and initials, title of the paper, abbreviation of the Journal, year, volume number, and first and last page numbers. Please give surnames and initials of first 3 authors followed by et al. The titles of journals should be abbreviated according to the style used in Index Medicus. Any manuscript not following Vancouver system will immediately be sent back to author for revision. Authors are solely responsible for the accuracy of references. Only verified references against the original documents should be cited. Authors are

responsible for the accuracy and completeness of their references and for correct text citation. References should be numbered in the order in which they are first mentioned in the text.

Books should be quoted as Authors (surnames followed by initials) of chapter / section, and its title, followed by Editors—(names followed by initials), title of the book, number of the edition, city of publication, name of the publisher, year of publication and number of the first and the last page referred to.Examples of reference style :Reference from journal : 1) Cogo A, Lensing AWA, Koopman MMW et al —Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 1998; 316: 17-20.Reference from book : 2) Handin RI— Bleeding and thrombosis. In: Wilson JD, Braunwald E, Isselbacher KJ, Petersdorf RG, Martin JB, Fauci AS, et al editors—Harrison's Principles of Internal Medicine. Vol 1. 12th ed. New York: Mc Graw Hill Inc, 1991: 348-53.Reference from electronic media: 3) National Statistics Online—Trends in suicide by method in England and Wales, 1979-2001. www.statistics. gov.uk/ downloads/ theme_health/HSQ 20.pdf (accessed Jan 24, 2005): 7-18.The Editorial Process

All manuscripts received will be duly acknowledged. On submission, editors review all submitted manuscripts initially for suitability for formal review. Manuscripts with insufficient originality, serious scientific or technical flaws, or lack of a significant message are rejected before proceeding for formal peer review. Manuscripts that are unlikely to be of interest to the Journal readers are also liable to be rejected at this stage itself. Manuscripts that are found suitable for publication in the Journal will be sent to one or two reviewers. Manuscripts accepted for publication will be copy edited for grammar, punctuation, print style and format. Upon acceptance of your article you will receive an intimation of acceptance for publication.

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Oct.-Dec.2018 131

Proof readingThe purpose of the proof reading is to check

for typesetting, grammatical errors and the completeness and accuracy of the text, substantial changes in content are not done. Manuscripts will not be preserved.

Protection of Patients' Rights to Privacy: Identifying information should not be published in written descriptions, photographs, sonograms, CT scan etc., and pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian, wherever applicable) gives written informed consent for publication. Authors should remove patients' names from text unless they have obtained written informed consent from the patients. When informed consent has been obtained, it should be indicated in the article and copy of the consent should be attached with the covering letter.

Please ensure compliance with the following check-list■ Forwarding letter : The covering letter accompanying the article should contain the name and complete postal address of one author as correspondent and must be signed by all authors. The correspondent author should notify change of address, if any, in time.■ Declaration/ Warranty : A declaration should be submitted stating that the manuscript represents valid work and that neither this manuscript nor one with substantially similar content under the present authorship has been published or is being considered for publication elsewhere and the authorship of this article will not be contested by anyone whose name (s) is/are not listed here, and that the order of authorship as placed in the manuscript is final and accepted by the co-authors. Declarations should be signed by

all the authors in the order in which they are mentioned in the original manuscript. Matters appearing in the Journal are covered by copyright but no objection will be made to their reproduction provided permission is obtained from the Editor prior to publication and due acknowledgment of the source is made.■ Dual publication : If material in a submitted article has been published previously or is to appear in part or whole in another publication, the Editor must be informed. Designation and Institute of all authors, specify name, address and e-mail of corresponding author.Specify Type of paper, Number of tables, Number of figures, Number of references,Original article :Capsule : 50 wordsRunning title of upto five wordsStructured abstract : 150 wordsManuscript : up to 2500 wordsKey words : 3 to 5 wordsTables : not more than 5Figures with legends : 8 x 13 cm in sizeReference list : Vancouver style

Case scenario / case report / case discussion &letter to editor - 500 words without abstract with 2-3 references in Vancouver style, & 3-5 key words

Review article : 4000 words, unstructured abstract of 150 words with up to 30 references in Vancouver style & 3-5 keywords.

The Members of Professional Assistance Scheme

S.No. Name Place Speciality

1 Dr. Dinesh B Thakare Amravati Pathologist

2 Dr. Neelima M Ardak Amravati Ob.&Gyn.

3 Dr. Rajendra W. Baitule Amravati Orthopedic

4 Dr. Yogesh R Zanwar Amravati Dermatologist

5 Dr. Ramawatar R. Soni Amravati Pathologist

6 Dr. Rajendra R. Borkar Wardha Pediatrician

7 Dr. Satish K Tiwari Amravati Pediatrician

8 Dr. Usha S Tiwari Amravati Hospi/ N Home

9 Dr. Vinita B Yadav Gurgaon Ob.&Gyn.

10 Dr. Balraj Yadav Gurgaon Pediatrician

11 Dr. Dinakara P Bengaluru Pediatrician

12 Dr. Shriniket Tidke Amravati Pediatrician

13 Dr. Gajanan Patil Morshi Pediatrician

14 Dr. Madhuri Patil Morshi Obs & Gyn

15 Dr. Vijay M Kuthe Amravati Orthopedic

16 Dr. Alka V. Kuthe Amravati Ob.&Gyn.

17 Dr. Anita Chandna Secunderabad Pediatrician

18 Dr. Sanket Pandey Amravati Pediatrician

19 Dr. Ashani Sharma Ludhiana Pediatrician

20 Dr. Pitabas Rautray Bhubneshwar Pediatrician

21 Dr. Jagdish Sahoo Bhubneshwar Pediatrician

22 Dr. Menka Jha (Sahoo) Bhubneshwar Neurology

23 Dr. Sitanshu Kumar Meher Bhubneshwar Pediatrician

24 Dr. B. B Sahani Bhubneshwar Pediatrician

25 Dr. Poonam Belokar(Kherde) Amravati Obs & Gyn

26 Dr. Sandeep Dankhade Amravati Pediatrician

27 Dr. Ashish Dagwar Amravati Surgeon

28 Dr. Mallikarjun H B Bengaluru Pediatrician

29 Dr. Hemant Chandravanshi Raipur Obs & Gyn

30 Dr. Ashish Varma Wardha Pediatrician

31 Dr. Anuj Varma Wardha Physician

32 Dr. Neha Varma Wardha Ob & Gyn

33 Dr. Ramesh Varma Wardha Gen Practitioner

34 Dr. Ravindra Dighe Navi Mumbai Pediatrician

35 Dr. Jyoti Dighe Navi Mumbai Ob & Gyn

36 Dr. Madan Mohan Rao Hyderabad Pediatrician

37 Dr. Pramod Gulati Jhansi Pediatrician

38 Dr. Sanjay Wazir Gurgaon Pediatrician

39 Dr. Anurag Pangrikar Beed Pediatrician

40 Dr. Shubhada Pangrikar Beed Pathologist

41 Dr. Abhijit Thete Beed Pediatrician

42 Dr. Kiran Borkar Wardha Ob & Gyn

43 Dr. Prabhat Goel Gurgaon Physician

44 Dr. Sunil Mahajan Wardha Pathologist

45 Dr. Ashish Jain Gurgaon Pediatrician

46 Dr. Neetu Jain Gurgaon Pulmonologist

47 Dr. Bhupesh Bhond Amravati Pediatrician

48 Dr. R K Maheshwari Barmer Pediatrician

49 Dr. Jayant Shah Nandurbar Pediatrician

50 Dr. Kesavulu Hindupur AP Pediatrician

51 Dr. Ashim Kr Ghosh Burdwan WB Pediatrician

52 Dr. Archana Tiwari Gwalior Ob & Gyn

53 Dr. Mukul Tiwari Gwalior Pediatrician

54 Dr. Chandravanti Hariyani Nagpur Pediatrician

55 Dr. Gorava Ujjinaiah Kurnool(A.P) Pediatrician


56 Dr. Pankaj Agrawal Barmer Pediatrician

57 Dr. Prashant Bhutada Nagpur Pediatrician

58 Dr. Sharad Lakhotiya Mehkar Pediatrician

59 Dr. Kamalakanta Swain Bhadrak(Orissa) Pediatrician

60 Dr. Manjit Singh Patiala Pediatrician

61 Dr. Harpreet Singh Ludhiana Pediatrician

62 Dr. Mrinmoy Sinha Nadia (W.B) Pediatrician

63 Dr. Ravi Shankar Akhare Chandrapur Pediatrician

64 Dr. Lalit Meshram Chandrapur Pediatrician

65 Dr. Vivek Shivhare Nagpur Pediatrician

66 Dr. Ravishankara M Banglore Pediatrician

67 Dr. Bhooshan Holey Nagpur Pediatrician

68 Dr. Amol Rajguru Akot Ob & Gyn

69 Dr. Rujuda Rajguru Akot Ob & Gyn

70 Dr. V P Goswami Indore Pediatrician

71 Dr. Sudhir Mishra Jamshedpur Pediatrician

72 Dr. Shoumyodhriti Ghosh Jamshedpur Pediatric Surgeon

73 Dr. Banashree Majumdar Jamshedpur Dermatologist

74 Dr. Lalchand Charan Udaipur Pediatrician

75 Dr. Sunil Sakarkar Amravati Dermatologist

76 Dr. Mrutunjay Dash Bhubaneshwar Pediatrician

77 Dr. J Bikrant K Prusty Bhubaneshwar Pediatrician

78 Dr. Ashish Satav Dharni Physician

79 Dr. Kavita Satav Dharni Opthalmologist

80 Dr. D P Gosavi Amravati Pediatrician

81 Dr. Narendra Gandhi Rajnandgaon Pediatrician

82 Dr. Chetak K B Mysore Pediatrician

83 Dr. Shashikiran Patil Mysore Pediatrician

84 Dr. Bharat Shah Amravati Plastic Surgeon

85 Dr. Jagruti Shah Amravati Ob & Gyn

86 Dr. C P Ravikumar Banglore Ped Neurologist

87 Dr. Apurva Kale Amravati Pediatrician

88 Dr. Prashant Gahukar Amravati Pathologist

89 Dr. Asit Guin Jabalpur Physician

90 Dr. Sanjeev Borade Amravati Ob & Gyn

91 Dr. Usha Gajbhiye Amravati Pediatric Surgeon

92 Dr. Kush Jhunjhunwala Nagpur Pediatrician

93 Dr. Anil Nandedkar Nanded Pediatrician

94 Dr. Amit Toshniwal Nanded Pediatrician

95 Dr. Shrikant Kokadwar Nanded Pediatrician

96 Dr. Shreyas Borkar Wardha Pediatrician

97 Dr. Vivek Morey Buldhana Ortho. Surgeon

98 Dr. Arti Murkey Amravati Ob & Gyn

99 Dr. Nitin Bardiya Amravati Pediatrician

100 Dr. Kamini Kaushal Gurgaon Ob & Gyn

101 Dr. Pallavi Pimpale Mumbai Pediatrician

102 Dr. Susruta Das Bhubneshwar Pediatrician

103 Dr. Sudheer K A Banglore Pediatrician

104 Dr. Bhusahn Murkey Amravati Ob & Gyn

105 Dr. Jagruti Murkey Amravati Ob & Gyn

106 Dr. Sneha Rathi Amravati Ob & Gyn

107 Dr. Satish Agrawal Amravati Pediatrician

108 Dr. Ravi Motwani Gadchiroli Pediatrician

109 Dr. Ashwin Deshmukh Amravati Ob & Gyn

110 Dr. Anupama Deshmukh Amravati Ob & Gyn


Oct.-Dec.2018132

The Members of Professional Assistance Scheme


111 Dr. Aanand Kakani Amravati Neurosurgeon

112 Dr. Anuradha Kakani Amravati Ob & Gyn

113 Dr. Sikandar Adwani Amravati Neurophysician

114 Dr. Seema Gupta Amravati Pathologist

115 Dr. Pawan Agrawal Amravati Cardiologist

116 Dr. Madhuri Agrawal Amravati Pediatrician

117 Dr. Rupesh Kulwal Pune Pediatrician

118 Dr. Prashanth S N Davanagere Pediatrician

119 Dr. Jyoti Agrawal Amravati Pediatrician

120 Dr. Sonal Kale Amravati Ob & Gyn

121 Dr. Gopal Belokar Amravati ENT

122 Dr. Preeti Volvoikar Goa Dentistry

123 Dr. Sachin Kale Amravati Physician

124 Dr. Pradnya Kale Amravati Pathologist

125 Dr. Amit Kavimandan Amravati Gastroenterologist

126 Dr. Vinamra Malik Chhindwara Pediatrician

127 Dr. Shivanand Gauns Goa Pediatrician

128 Dr. Rishikesh Nagalkar Amravati Pediatrician

129 Dr. Rashmi Nagalkar Amravati Ob & Gyn

130 Dr. Vikram Deshmukh Amravati Urosurgeon

131 Dr. Raj Tilak Kanpur Pediatrician

132 Dr. Dhananjay Deshmukh Amravati Ortho. Surgeon

133 Dr. Ramesh Tannirwar Wardha Ob & Gyn

134 Dr. Sameer Agrawal Jabalpur Pediatrician

135 Dr. Sheojee Prasad Gwalior Pediatrician

136 Dr. V K Gandhi Satna Pediatrician

137 Dr. Sadachar Ujlambkar Nashik Pediatrician

138 Dr. Shyam Sidana Ranchi Pediatrician

139 Dr. Pradeep Kumar Ludhiana Pediatrician

140 Dr. Pankaj Agrawal Nagpur Pediatrician

141 Dr.Nishikant Dahiwale Nagpur Pediatrician

142 Dr. Vishal Mohant Nagpur Pediatrician

143 Dr. Pravin Bais Nagpur Pediatrician

144 Dr. Chetan Dixit Nagpur Pediatrician

145 Dr. Umesh Khanapurkar Bhusawal Pediatrician

146 Dr. Sushma Khanapurkar Bhusawal Gen Practitioner

147 Dr. Sameer Khanapurkar Bhusawal Pediatrician

148 Dr. Samir Bhide Nashik Pediatrician

149 Dr. Rajendra Vitalkar Warud Gen Practitioner

150 Dr. Kalpana Vitalkar Warud Ob & Gyn

Hospital Member`S.No. Name Place

1 Krishna Medicare Center Gurugram Multispecialty

2 Meva Chaudhary Memorial Hospital Jhansi Nursing Home

3 Usgaonker's Children Hospital Goa NICU


151 Dr. Shweta Bhide Nashik Opthalmologist

152 Dr. Pramod Wankhede Raigad Pediatrician

153 Dr. Shrikant Dahake Raigad Gen Practitioner

154 Dr. Rahul Salve Chandrapur Pediatrician

155 Dr. Devdeep Mukherjee Aasansol WB Pediatrician

156 Dr. Santosh Usgaonkar Goa Pediatrician

157 Dr. Ameet Kaisare Goa Opthalmologist

158 Dr. Sushma Kirtani Goa Pediatrician

159 Dr. Madhav Wagle Goa Pediatrician

160 Dr. Preeti Kaisare Goa Pediatrician

161 Dr. Varsha Amonkar Goa Pediatrician

162 Dr. Varsha Kamat Goa Pediatrician

163 Dr. Harshad Kamat Goa Pediatrician

164 Dr. Siddhi Nevrekar Goa Pediatrician

165 Dr. Dhanesh Volvoiker Goa Pediatrician

166 Dr. Pramod Shete Paratwada Pediatrician

167 Dr. Bharat Shete Paratwada Surgeon

168 Dr. Poonam Sambhaji Goa Pediatrician

169 Dr. Bhakti Salelkar Goa Pediatrician

170 Dr. Kausthubh Deshmukh Amravati Pediatrician

171 Dr. Pratibha Kale Amravati Pediatrician

172 Dr. Milind Jagtap Amravati Pathologist

173 Dr. Varsha Jagtap Amravati Pathologist

174 Dr. Rajendra Dhore Amravati Physician

175 Dr. Veena Dhore Amravati Dentistry

176 Dr. Satish Godse Solapur Physician

177 Dr. Pinky Paliencar Goa Pediatrician

178 Dr. Ashok Saxena Jhansi Pediatrician

179 Dr. Neeta Saxena Jhansi Ob & Gyn

180 Dr. Nilesh Toshniwal Washim Orthopedic

181 Dr. Swati Toshniwal Washim Dentistry

182 Dr. Subhendu Dey Purulia Pediatrician

183 Dr. Laxmi Bhond Amravati Pediatrician

184 Dr. Sangeeta Bhamburkar Akola Dermatologist

185 Dr. Aniruddh Bhamburkar Akola Physician

186 Dr. Nilesh Dayama Akola Pediatrician

187 Dr. Paridhi Dayama Akola Pediatrician


Oct.-Dec.2018 133


Oct.-Dec.2018134

Subject Index Abortion 19

Accidental Poisoning 49

AETCOM module 70

Appropriate 19

ATCOM Module 04,70

Authority 19

Bailable 19

BOLAM test 85

Cesarean section 14

Chain of custody 118

Charter 70

Clinical Establishment 37

Cobalt toxicity 75

Cognizable 19

Compensation 75

Confidentiality 41

Consent 118

Consumer 75

Court point 109

CPA 85

Cross examination 109

Data Security 37

drunk, intoxicated 118

Empathy 70

Ethics 04

Evidence 109

Faulty implant 75

Female feticide 19

Female fetus 19

Genetic counseling 19

Good Faith 19

Health data 37

Hospital Administration 06

Hospital statistics 06

Litigation 14 ,106

Medical Device Rules75

Medical Education 04,70

Medical errors 85

Medical Humanities 04

Medical Negligence 85

Medical records 06

Medicare protection 106

Medication bottles 49

Medico-Legal issues 85

Medico-legal Reports 118

Medico-legal 14

Mob mentality 106

National Digital Health Authority 37

Negligence 14

Negligence during postmortem.118

Pill Container 49

Product liability 75

Profession indemnity 106

Protection75

Quality care 41

Remote point 109

Safe environment 49

Safe kids 49

Sampling for forensic lab 118

Security alert 106

Sex selection 19

Telemedicine 41

Tort 75

Video Conferencing 41

Video-conferencing 109

Violence in health care 106

Witness 109


Oct.-Dec.2018135

AUTHOR INDEXAlka A Mukherjee 14,85

Apurva Mukherjee 14

Apurva Mukherjee 85

B. ShantharamBaliga 70

Brij Bhushan Sahni 36

Devendra Richhariya 75,118

Donna Ropmay 04

J. K. Gupta 106

Rajan Singh 06

Rajesh Verma 118

Santosh Pande 24,58, 94, 121

Santoshkumar Verma 75,109, 118

Soundarya Mahalingam 70

Sudhir Mishra 06

Vivekanshu Verma 19,41,49,75,109,118

Yash Paul 57

List of Reviewers

Satish Tiwari

Sudhir Mishra

Mahesh Baldwa

Alka Kuthe

Nilofer Mujawar

Rishi Bhatia

AS Jaggi

V P Singh

Prabudhh Mittal

Vivekanshu Verma

Balraj Yadav

Vishesh Kumar

Ashish Jain

Charu Mittal

Mukul Tiwari

Sushma Pande

Asok Datta

Gadadhar Sarangi

Kanya Mukhopadhyay

Pankaj Vaidya

Anjan Bhattacharya

Pramod Jog

Ashutosh Apte

INDIAN MEDICO-LEGAL & ETHICS ASSOCIATION[Reg. No. - E - 598 (Amravati)]

Website - www.imlea-india.org , e mail - [email protected]

LIFE MEMBERSHIP FORM

Name of the applicant : ____ __________________________________________________________

(Surname) (First name) (Middle name)

Date of Birth : __________________________________ Sex : ____________________________

Address for Correspondence: _____________________________________________________________________________

__________________________________________________________________________________________________

Telephone No.s : Resi. : ________________ Hosp. : ______________________ Other : ___________________________________

Mobile : ______________ Fax : ________________________ E-mail :___________________________________

Name of the Council (MCI/Dental/Homeopathy/Ayurved /BAR/Other) : _________________________________________________________

Registration No.: ____________________________________________ Date of Reg. : ______________________________________________

Medical / Legal Qualication University Year of Passing

____________________________________________ _____________________________________________

Name, membership No. & signature of proposer Name, membership No. & signature of seconder :

__________________

A) Experience in legal eld (if any) : _____________________________________________________________________________________

B) Was / Is there any med-legal case against you /your Hospital : (Yes / No) : ___________________________

If, Yes (Give details) _________________________________________________________________ (Attach separate sheet if required)

C) Do you have a Professional Indemnity Policy (Yes / No) : ___________________________

Name of the Company: _____________________________________________________________ Amount : ________________________

D) Do you have Hospital Insurance (Yes / No) : ________________________


E) Do you have Risk Management Policy (Yes / No) : ________________________


F) Is your relative / friend practicing Law ( Yes / No) : _________________________

If Yes, Name : ________________________________________________________________________________________________________

Qualication : _________________________________________ Place of Practice : _________________________________________

Specialized eld of practice (Civil/ Criminal/ Consumer / I-Tax, etc) : ______________________________________________________

G) Any other information you would like to share (Yes / No) ____________________________ If Yes, please attach the details

_____________________________________________________________________________________________________________________

I hereby declare that above information is correct. I shall be responsible for any incorrect / fraudulent declarations.

Place: __________________ ____________________________________

Date: __________________ (signature of applicant)

Enclosures: True Copy of Degree, Council Registration Certicate & photograph.

Life Membership fee (individual Rs.3500/-, couple Rs.6000/-) by CBS (At Par, Multicity Cheque) in the name of Indian Medico-legal & Ethics Association (IMLEA) payable at Amravati. Send to Dr.Satish Tiwari, Yashodanagar No.2, Amravati-444606, Maharashtra.


Oct.-Dec.2018136

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