Dr Hidayathulla Shaikh, Lecturer, College Of Dentistry, Majmaah University.

Introduction  In performing their duty medical personnel often come across situations of professional negligence.  Medical professionals should keep in mind certain high risk situations, which are common cause of medical negligence actions.  The consequences of negligence would be drastic for medical professionals.  The medical professionals are liable for punishment through law and court if found guilty of medical negligence.

Medical Negligence - Medical negligence or mal practice is defined as lack of reasonable care and skill or willful negligence on the part of the doctor in the treatment of the patient whereby the health or life of the patient is endangered.

The term ‘Damage’ means physical, mental or functional injury to the patient, while Damages are assessed in terms of money by the court on the basis of loss concurrent and future earnings, treatment costs, reduction in the quality of life etc.

In order to seek compensation the patient/consumer should have evidence regarding 1) The doctor was derelict and breached his duty 2) The patient suffered actual damage 3) The doctors conduct was the direct or proximate cause of damage

Criminal Negligence - Here the negligence is so great that the matter is beyond mere compensation. The doctor here not only made the wrong diagnosis and treatment, but also has shown gross ignorance, carelessness and neglect for the life of the patient, so as the criminal charge brought against him. For this doctor may be prosecuted in the criminal court for causing injury or death to the patient by rash or negligence act.

Some examples are - 1) Injecting anesthesia in fatal dosage or in wrong tissues 2) Amputation of the wrong finger, operation on wrong limb, removal of wrong organ/ tooth or errors in the ligation of the ducts. 3) Operation on the wrong patient. 4) Leaving instruments or sponges inside the part of the body operated upon.

5) Leaving tourniquets too long resulting in gangrene. 6) Transfusing wrong blood. 7) Applying too tight plaster or splints, which may cause gangrene or paralysis. 8) Performing a criminal abortion.

Examples related to dentistry - 1) Slipping instruments damaging other parts of the body. 2) Broken needles 3) Root left in the socket without the knowledge of the patient. 4) Fragments entering the respiratory passages. 5) Injury from fitting or ill fitting dentures.

6) Infection from the use of unsterile instruments. 7) Fracture and dislocation of the jaws occurring during dental procedures. 8) Extraction of the wrong tooth or lack of consent. 9) Failure to fulfill duty in advising patients about remnants present within their body or any instructions. 10) Death from anesthesia.

Situations requiring extra caution - Doctors should keep in mind certain high risk situations which are common cause of medical negligence actions. 1) Retention of objects in the operation site - swabs, packs, instruments or towels may be left behind in the field of operation. 2) Accident and emergency department – it is the most hazardous part of the hospital and senior staff must be readily available to supervise the work.

3) Amputation of the wrong limb, digit, eye or tooth is a common mishap, carelessness in hospital notes, errors in pre operative skin marking and failure to check notes of the patient are common reasons for the mishap. 4) Anesthesia – presents the common target for litigation for the mishaps occurring in transfusions, injections, I.V, catheters etc.

What you should do when there is a complaint against you - A ‘complaint’ is an allegation made preferably in writing against complainant. Inform your insurance company (if any) at the earliest. Make photocopies of complete records and keep originals at safe place Tell your staff about the complaint and instruct them not to talk about this to any one without his permission. Co operate and follow the rules, regulations and instruction given by the court and that particular country.

What you should not do - Getting upset. Altering patients record. Agree to offer settlement without consulting lawyer or your insurance company. Discuss the patients treatment with any one. Give your original treatment records to the patient or his relatives. Admit fault or guilt to anyone.

Guidelines to be adopted to avoid needless litigation - 1) Maintain proper clinical records, documents of the treatment and diagnosis of the patients. 2) Prescriptions given by the doctors should stick to the prescribed norms of the medical practice. 3) Whenever certificates are issued duplicated should be taken for future references. 4) Obtain professional indemnity.

5) Avoid any comments in front of the patient regarding the line of management. 6) Before any invasive/costly investigation or therapeutic procedure to be undertaken, informed consent should be taken. 7) Continuously update your knowledge in recent developments. 8) Be honest and treat your patients with dignity.

Thank you