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JIAFM, 2007 - 29(4); ISSN: 0971-0973 Differential Diagnosis of Artefacts: 1. Differential diagnosis of bloating and distention of abdomen;- a. Putrefaction b. Ascites 2. Differential diagnosis of protrusion of tongue and reddish discharge from mouth;- a. Strangulation b. Hanging 3. Differential diagnosis of discolouration;- a. Traumatic asphyxia b. Bansdola c. Burking d. Opium poisoning 4. Differential diagnosis of Vesication a. In putrefaction b. Blisters in antemortem burns c. Blisters in barbiturate poisoning d. Poisoning by tricyclic antidepressants e. Carbon monoxide poisoning f. Meprobamate g. Mustard gas h. Lewisite i. Antimony 5. Differential diagnosis of purging a. Drowning b. Opium poisoning c. Barbiturate poisoning d. Tik 20 e. Endrin f. Kerosene poisoning 6. Differential diagnosis of non uniform decomposition;- Because of the pressure of gases of putrefaction, postmortem stains may be displaced in any direction. If hypostasis extends to the head, it may be mistaken for violence to the neck or smothering. The skin from the hands or feet may peel off like glove or stocking in 48 – 72 hrs. This peeling off is also seen in severely burnt bodies and in drowning where the body remains in water for 2 days or more. 7. Differential diagnosis of rupture of oesophagus and stomach;- a. Corrosive acid perforation b. Ulcer perforation 8. Differential diagnosis of autolysis of pancreas;- a. Acute haemorrhagic pancreatitis 9. Differential diagnosis of pendulous female genitals appear and discharge from genitalia;- a. Sexual assault b. Postmortem delivery in case of pregnant woman c. Criminal abortion Conclusion: Medicolegal Autopsy or Forensic Autopsy is learnt only through extensive practical experience and the doctor conducting the autopsy carries great responsibility over his shoulders. It is obvious that if he is unable to extract proper interpretation of the findings, the pangs of justice will be disturbed and therefore, it is imperative that all unusual findings must be meticulously examined and photographed and if need be, some experienced, better qualified colleague may be approached there and then. The doctor should learn to draw conclusions logically and rationally, instead of forming hasty judgment. Bibliography: 1. Pillay VV. Conflicts of Opinion in Forensic Work – Need for a Rational Outlook. J. Indian Academy For. Med. 1993;15:40-1 2. Muthiharan K, Patnaik A K. Modi’s Medical Jurisprudence and Toxicology. Postmortem Artefacts. 23 rd ed. New Delhi: Lexis Nexis Butterworths India; 2005. p. 463-69. 3. Parikh CK. Parikh’s Textbook of Medical Jurisprudence. Forensic Medicine and Toxicology. Postmortem Artefacts. 6th ed. New Delhi: CBS Publishers and Distributors; 2004. p. 2.82 – 2.89. 4. Reddy KSN. The Essential of Forensic Medicine and Toxicology. Artefacts. 26 th ed. Hyderabad: Om Sai Graphics; 2007. p. 422 – 26. 5. Dogra TD, Rudra A. Lyon’s Medical Jurisprudence and Toxicology. Postmortem Artefacts. 11 th ed. Delhi: Delhi Law House; 2005. p. 804 – 9. 6. Nandy A. Principles of Forensic Medicine. Medicolegal Autopsy and Artefacts in Postmortem Examination. 2nd ed. Calcutta: New Central Book Agency Pvt. Ltd; 2003. p.174- 90. 7. Camps FE. Gradwohl’s Legal Medicine. Hypoxia and Asphyxia. 3rd ed. Chicago: John Wright and Sons Ltd Publications; 1976. p. 326 - 37. 71
JIAFM, 2007 - 29(4); ISSN: 0971-0973 Doctor and Law * Dr. T.K.K. Naidu, MD, LLB. * Professor & Head, Department of Forensic Medicine, Medico legal consultant, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar – 505 417 (A.P.) E-mail: naidutkk@yahoo.com, naidutkk@rediffmail.com Abstract After the Consumer Protection Act, 1986, came into effect, a number of patients have filed cases against doctors. This article presents a summary of legal decisions related to medial negligence: what constitutes negligence in civil and criminal law, and what is required prove it. Public awareness of medical negligence in India is growing. Hospital managements are increasingly facing complaints regarding the facilities, standards of professional competence, and the appropriateness of their therapeutic and diagnostic methods. After the Consumer Protection Act, 1986, has come into force some patients have filed legal cases against doctors, have established that the doctors were negligent in their medical service, and have claimed and received compensation. As a result, a number of legal decisions have been made on what constitutes negligence and what is required to prove it. Civil law and negligence: Negligence is the breach of a legal duty to care. It means carelessness in a matter in which the law mandates carefulness. A breach of this duty gives a patient the right to initiate action against negligence. Persons who offer medical advice and treatment implicitly state that they have the skill and knowledge to do so, that they have the skill to decide whether to take a case, to decide the treatment, and to administer that treatment. This is known as an “implied undertaking” on the part of a medical professional. In the case of the State of Haryana Vs Smt. Santra, the Supreme Court held that every doctor “has a duty to act with a reasonable degree of care and skill” (1). Doctors in India may be held liable for their services individually or vicariously unless they come within the exceptions specified in the case of Indian Medical Assoication Vs V P Santha (2). Doctors are not liable for their services individually or vicariously if they do not charge fees. Thus free treatment at a non-government hospital, government hospital, health center, dispensary or nursing home would not be considered a “service” as defined in Section 2 (1) (0) of the Consumer Protection Act, 1986. However, no human being is perfect and even the most renowned specialist could make a mistake in detecting or diagnosing the true nature of a disease. A doctor can be held liable for negligence only if one can prove that she/he is guilty of a failure that no doctor with ordinary skills would be quality of if acting with reasonable care (3). An error of judgement constitutes negligence only if a reasonably competent professional with the standard skills that the defendant professes to have, and acting with ordinary care, would not have made the same error (4). In a key decision on this matter in the case of Dr. Laxman Balkrishna Joshi Vs Dr. Trimbak Bapu Godbole, the Supreme Court held that if a doctor has adopted a practice that is considered “proper” by a reasonable body of medical professionals who are skilled in that particular field, he or she will not be held negligent only because something went wrong. Doctors must exercise an ordinary degree of skill (5). However, they cannot give a warranty of the perfection of their skill or a guarantee of cure. If the doctor has adopted the right course of treatment, if she/he is skilled and has worked with a method and manner best suited to the patient, she/he cannot be blamed for negligence if the patient is not totally cured (6). Certain conditions must be satisfied before liability can be considered. The person who is accused must have committed an act of omission or commission, that act must have been in breach of the person’s duty; and this must have caused harm to the inured person. The complainant must prove the allegation against the doctor by citing the best evidence available in medical science and by presenting expert opinion (7). In some situations the complainant can invoke the principle of res ispa loquitur or “the thing speaks for itself”. In certain circumstances no proof of negligence is required beyond the accident itself. The National Consumer Disputes Redressal Commission applied this principle in Dr. Janak Kantimathi Nathan Vs Murlidhar Eknath Masane (8). The principle of res ipsa loquiture comes into operation only when there is proof that the occurrence was unexpected, that the accident could 72
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