During his professional career, every general medical practitioner comes across many cases of poisoning. In our country, a majority of the cases of poisoning are suicidal/ accidental in nature. Rarely do we come across a case of homicidal poisoning.
Whenever a victim of poisoning is brought to a medical practitioner, even though it is a medico-legal case, medical responsibilities of the doctor assume first importance i.e. saving the life of the patient. Legal duties, i.e. informing the legal authorities and other related procedures always take a back seat in such instances.
Therefore the legal duties of the medical practitioner are likely to be missed during the management of the poisoned patient.
* As soon as the doctor agrees to treat a patient, the doctor-patient relationship is established. It then becomes the duty of a doctor to treat the patient.
*A doctor working in a government hospital can never refuse treatment to a patient of poisoning. *On the other hand, a private practitioner has the right to choose a patient and hence, can refuse to treat a case of poisoning.
*Though every doctor has a right to choose a patient (i.e. he can refuse to treat any patient), as per the Supreme Court Ruling (Parmananda Katara Vs Union of India), no doctor shall refuse to treat a patient in emergency. In the same case, the MCI filed an affidavit stating that “the MCI expects that all registered medical practitioners must attend to the sick and the injured immediately and it is the duty of the medical practitioner to make immediate and timely medical care available to every injured person, whether he is injured in an accident or otherwise…..Life of a person is far more important than the legal formalities.” However, in such cases, the doctor-patient relationship is not established till the patient has been given first-aid treatment and is in a position to give consent for further treatment or medico-legal examination. All legal formalities stand suspended till the patient’s life is out of danger. The duty of the doctor to provide medical aid, even in MLCs, has been extended to the private doctors also as exemplified by the High Court of Andhra Pradesh in Pattipati Venkaiah Vs State of AP. Therefore, it is unethical to refuse any case of emergency like poisoning.
*A medical practitioner must remember that he is protected against any harm done in good faith to a patient in an emergency situation ethically as well as legally as per Section 92 IPC.
*In order to avoid any legal or medical complications, it is always advisable to consult a senior colleague in cases of doubt or otherwise.
*In the absence of tell-tale signs and symptoms of poisoning, observation of the patient for at least 24 hours is a good practice and can help medical practitioners avoid a lot of suits of negligence being filed against them.
*If working in a government hospital, a doctor is bound to inform the legal authorities of all the cases of poisoning regardless of their manner, either suicidal/accidental/homicidal.
*A private medical practitioner, on the other hand, is not legally bound to inform the legal authorities of all the cases of poisoning. He only has a legal obligation to inform in homicidal cases of poisoning as per Section 39 CrPC. He is not bound to inform the legal authorities if he is sure the case is suicidal/ accidental in nature. However, as doctor is not an investigating officer and can never be sure about the manner of poisoning, to be on the safer side, he should always inform the legal authorities about any case of poisoning.
*Failure to inform the police in a case of homicidal poisoning makes the doctor liable for prosecution under Section 176 IPC [punishment is simple imprisonment of 1 month or fine of Rs. 500/- or both].
*In circumstance of death in a case of poisoning (irrespective of whether the police was informed of the case or not due to any reason), death certificate should not be issued and the body should be handed over to the legal authorities for a medico-legal postmortem examination.
*If an investigating officer inquires about a case of poisoning, regardless of its nature, the medical practitioner is expected to report all details to him (without taking excuse of professional secrecy) failing which he can be penalized under Sections 193 IPC [punishment is imprisonment of either description upto 7 years with fine] and 202 IPC [punishment is imprisonment of either description upto 6 months or fine or both].
*If the doctor provides false information, then he is liable to be punished under Section 177 IPC [punishment is of simple imprisonment for 6 months or fine of Rs. 1000 or both].
It is the duty of a medical practitioner to collect and preserve any evidence suggestive of or confirmatory to poisoning. Failure to do so attracts penalization under Section 201 IPC [punishment is imprisonment of either description upto 7 years depending upon the nature of offence tried to shield]. In this case, the onus of proving a non-deliberate omission to collect and preserve the samples would lie on the medical practitioner.
*Materials like vomitus, the first returning fluid of stomach wash, feces, blood, urine etc. should be collected and preserved for chemical analysis and dispatched to the nearest forensic science laboratory at the earliest. In case of any delay, they should be properly preserved.
*In case of an imminent death, doctor should arrange for recording of a dying declaration.
*In case a doctor comes across a case of poisoning arising out of a public eating place or where further exposure to other people is anticipated, as his duty towards the State, he must inform the authorities concerned.
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1 comments:
Dr.Pravir Bodkha
Prof. & Head
Dept. Of Forensic Medicine & Toxicology
SAIMS, Indore
Ph: 0731-2555565, 9300729950
Email: pbodkha@yahoo.com
I went through the article of Dr.Ajay Kumar Ex.
President IMA, published in Economic Times pg 4, May 8 2008, regarding :Doctors havethe right to promote". In this article Dr. Ajay KumarMentioned that the deal with Pepsi is non commercialone where Pepsi Co. will help IMA in sponsoring eventsand other public flora.
Question is if Indian Medical Association is
promoting any health product for getting sponsorship,
is it ehical??? In legal terms will it not amount to
consideration to be given to IMA in form of
sponsorship??
In this regard please refer the following CHAPTER 6
on UNETHICAL ACTS :As published in Code of Ethics
Regulations, 2002 (Published in Part III, Section 4 of
the Gazette of India, dated 6th April,2002)
MEDICAL COUNCIL OF INDIA, NOTIFICATION New Delhi,
dated 11th March, 2002
It states that:6.4 Rebates and Commission:
6.4.1 A physician shall not give, solicit, or receive
nor shall he offer to give solicit or receive, any
gift, gratuity, commission or bonus in consideration
of or return for the referring, recommending or
procuring of any patient for medical, surgical or
other treatment. A physician shall not directly or
indirectly, participate in or be a party to act of
division, transference, assignment, subordination,
rebating, splitting or refunding of any fee for
medical, surgical or other treatment.
6.4.2 Provisions of para 6.4.1 shall apply with equal
force to the referring, recommending or procuring by a
physician or any person, specimen or material for
diagnostic purposes or other study / work.
If the governing council of all the doctors in India
i.e. MCI is considering such an act by a physician as
an unethical act how the Indian Medical Association
can take consideration in form of sponsorship by
promoting Pepsi fruit juice (Tropicana Juice and Quaker Oats).
Such an act of IMA will promote unethical practice
among doctors and MCI should strictly prohibit such an
act. If such unethical practice is not checked at this level then medical associations at state level and city level will start promoting a brand or a product. If it continues then days are not far off when some renowned Doctor’s of reputation at national / state /city level start endorsing the products like film stars and cricketers are doing.
As a large chunk of consumer in India are not aware about their rights and if professional association of doctors start endorsing products then it will further deprive the consumer of their right to decide. The decision to purchase a product in some sense be dictated by authority figures. Hence, such unethical practice should not only be discouraged but totally banned.
Since, this issue is of National Importance and in the Public Interest, as a citizen to safeguard interest of the society a PIL public interest litigation should be filed against IMA and also against MCI if they don't take any strict action against IMA
.
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Publication:Economic Times Mumbai; Date:May 8, 2008; Section:Business Of Brands; Page Number:4
Publication:Economic Times Mumbai; Date:May 8, 2008; Section:Business Of Brands; Page Number:4
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