Emedinews: Insights on Medicolegal issues - Supreme Court of Mississippi affirmed a summary judgment in favor of physician

In 2002, the Supreme Court of Mississippi affirmed a summary judgment in favor of physician in the case of Martha K. Ekornes-Duncan v. Rankin Medical Center and Steven L. Chouteau

• The Rankin Country Circuit Court, Mississippi, gave the judgment in favor of physician and medical center, in  the case of the mother of a victim alleging medical negligence in the treatment of her son. The mother alleged that the trial court erred in granting summary judgment to the medical center and also found error with the trial court’s decisions to deny her motions for continuance, prohibit introduction of demonstrative evidence, allow the introduction of undisclosed business records, limit cross-examination of a medical expert and permit improper closing arguments.

•  The appellate court found that the mother failed to show any negligence on the part of the medical center by appropriate expert medical testimony. Even if the affidavits were allowed, the negligence assigned had already been provisionally diagnosed. There was nothing to substantiate the mother’s claim that she suffered injustice or prejudice from the denial of her motions for continuance.
  
  
• The mother’s claims that she was prejudiced by the trial court’s allowing the physician to use a log book were not properly before the appellate court. Defendant’s closing argument was not improper as an objection was made and sustained, the statement was rephrased, and counsel took the opportunity to further address the statement during his closing. Short jury deliberations did not automatically evidence bias or prejudice.
  
  
• The judgment was affirmed by the Supreme Court of Mississippi.

  

(Ref: American College of Legal Medicine, The Medical Malpractice Survival Handbook)
(Contributed by Dr Sudhir Gupta)

Emedinews - Insight on medicolegal issues: What is a Medical negligence Arbitration Agreement?

 In addition to expert testimony, include medical textbooks and other published medical data. The admissibility of such evidence as proof of the standard of care varies among jurisdictions. Medical texts or treatises may be effectively used to cross-examine the adverse medical expert

• A physician or an institution may privately, or pursuant to legislation enter into an agreement with a patient to arbitrate a medical malpractice claim. The purpose of the agreement is to avoid litigation, and not to avoid liability.

• Arbitration is merely an alternative to a full-blown litigation. An agreement to arbitrate a medical malpractice claim, particularly one that follows statutory procedure, is generally enforceable because it does not violate due process and is constitutional.

• If an agreement to arbitrate is accepted by the parties, basic requirements of due process must be met, and there must be a fair composition of the tribunal or arbiters.

(Ref: American College Of Legal Medicine, The Medical Malpractice Survival Handbook) 

(Contributed by Dr Sudhir Gupta)

Emedinews - Insight on medicolegal issues: What is the Continuing Treatment Rule?

In medical practice, when  a physician retires or moves and sells his or her practice to a succeeding health care provider, patients records are often sold as part of the transaction. However, physicians should be warned that many states have medical record retention acts, and these acts usually do not provide an exception for record-keeping requirements even in such a transfer. 

• When the patient treatment continues for a period of time, during which it is difficult to ascertain when the negligence occurred. Some jurisdictions have adopted a “continuing treatment” rule to determine the time of injury for purposes of the statute of limitations. 

• The continuing treatment rule provides another exception to the statute of limitations by extending the time allowed for the filing of a complaint. 

• The malpractice action would only accrue, thus activating the statute of limitations, when treatment of the medical condition ceases. 

(Ref: American College Of Legal Medicine, the Medical Malpractice Survival Handbook 2007)

(Contributed by Dr Sudhir Gupta)

Emedinews- Insight on medicolegal issues: Autopsy and reconstitution of the corpse

An important component of the autopsy is the reconstitution of the body such that it can be viewed, if desired, by relatives of the deceased following the autopsy procedure.

·         After the conduction of postmortem examination, the body has an open and empty chest cavity with chest flaps open on both sides, the top of the skull is missing, and the skull flaps are pulled over the face and neck.

·         All organs and tissue must be returned to the body unless permission is given by the family to retain any tissue for further investigation.

·         Normally the internal body cavity is lined with cotton wool or an appropriate material; the organs are then placed into a plastic bag to prevent leakage and returned to the body cavity.

·         The chest flaps are then closed and sewn back together and the skull cap is sewed back in place.

·         Then the body must be properly sutured and reconstructed by the doctor conducting the autopsy with a cosmetic and parlor touch and then only it should be handed over to the relative of deceased as a regard of human corpse for ritual cremation

[Contributed by Dr Sudhir Gupta]

Emedinews - Insight on medicolegal issues: Autopsies are important in medicine for continuous improvement in medical practice

 A study that focused on heart attacks i.e. myocardial infarction as a cause of death found significant errors of omission and commission, i.e. a sizable number cases ascribed to myocardial infarctions were not MIs and a significant number of non-MIs were actually MIs.

·         A systematic review of studies of the autopsy calculated that in about 25% of autopsies a major diagnostic error will be revealed. However, this rate has decreased over time and the study projects that in a contemporary US institution, 8.4% to 24.4% of autopsies will detect major diagnostic errors.

·         An analysis suggested that approximately one-third of death certificates are incorrect and that half of the autopsies performed produced findings that were not suspected before the person died. Also, it is thought that over one-fifth of unexpected findings can only be diagnosed histological, i.e. by biopsy or autopsy, and that approximately one -quarter of unexpected findings, or 5% of all findings, are major and can similarly only be diagnosed from tissue.

·         One study found that "Autopsies revealed 171 missed diagnoses, including 21 cancers, 12 strokes, 11 myocardial infarctions, 10 pulmonary emboli, and 9 endocarditis, among others”.

·         Focusing on intubated patients, one study found "abdominal pathologic conditions--abscesses, bowel perforations, or infarction--were as frequent as pulmonary emboli as a cause of class I errors. While patients with abdominal pathologic conditions generally complained of abdominal pain, results of examination of the abdomen were considered unremarkable in most patients, and the symptom was not pursued". 

References

1.       Ravakhah K. Death certificates are not reliable: revivification of the autopsy. South Med J 2006;99(7):728-33.

2.      Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 2003;289(21): 2849-56.

[      (Contributed by Dr Sudhir Gupta)

Emedinews- Insight on medicolegal issues: False negative chemical analysis report of viscera-autopsy

False negative chemical analysis report of viscera-autopsy

The doctor who conducts an autopsy in case of death due to poisoning and after ruling out any other cause of death and based on clinical evidence, if he forms a conclusive opinion that the death is due to poisoning and even has clinical evidence, he has all the authority to inform the investigating officer. He must mention in his postmortem report his conclusive opinion and that he is preserving viscera for chemical analysis. A false negative test report may be received due to:

·         Delay in chemical analysis

·         Improper preservation

·         Use of wrong analytical technique

·         Early disintegration of poison

·         Complete metabolism

·         Lack of suitable test for certain poison

In accordance with a judicial pronouncement, the doctor who has conducted the postmortem examination, on the basis of his examination and findings suggestive of poisoning in postmortem can give his opinion regarding the cause of death to be due to poisoning in spite of negative viscera report. 

[Contributed by Dr Sudhir Gupta]

Emedinews- Insight on medicolegal issues: Section 324 IPC

What is the Section 324 of IPC in medical practice?

Section 324. Voluntarily causing hurt by dangerous weapons or means: "Whoever, except in the case provided for by section 334, voluntarily causes hurt by means of any instrument for shooting, stabbing or cutting, or any instrument which, used as weapon of offence, is likely to cause death, or by means of fire or any heated substance, or by means of any poison or any corrosive substance, or by means of any explosive substance or by means of any substance which it is deleterious to the human body to inhale, to swallow, or to receive into the blood, or by means of any animal, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both".

It is the duty of the attending doctor to record all injuries, their dimension as much as possible, and the body parts where the injuries are located; the nature of injury whether simple or grievous, whether caused by sharp/blunt object, age or duration of injury and vital parameters like blood pressure, pulse respiration along with the mental status of the patient.

When an investing officer comes to the hospital he needs some specific answers for his legal investigation and to book a case under the law of land.

Are the injuries present self–inflicted or fabricated? If yes, please mention the forensic justification.
Are there any signs/symptoms or smell of alcohol or any drug intoxication? If yes, please opine about the mental status due the influence of intoxication. Also, preserve the sample of blood.

Please opine if the injured or intoxicated patient is fit to give statement? If no, please give due reasons and an approximate time interval for medical re–evaluation for his/her fitness for statement.

Is the condition of patient critical, severe or serious? If so, the dying declaration must be recorded by attending doctor before one or two witnesses.

[Contributed by Dr Sudhir Gupta]