|Year : 2016 | Volume
| Issue : 3 | Page : 141-143
Medicolegal aspects of road side accident victims
Anil K Aggrawal
Department of Forensic Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||7-Oct-2016|
Prof. Anil K Aggrawal
Maulana Azad Medical College, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
Medical professionals are often unsure of the course of action in medico-legal cases. Thus they are rather reluctant to attend to cases of accident for fear of being involved in unnecessary litigation later on. Even in cases of serious accidents, medical professionals hesitate to offer help, sometimes resulting in patient's death. This paper highlights some important legal precautions to be taken care of in cases of road side vehicular accidents. These simple steps, if observed by medical practitioners, will prevent unnecessary litigation.
Keywords: Accident, medico-legal, roadside
|How to cite this article:|
Aggrawal AK. Medicolegal aspects of road side accident victims. MAMC J Med Sci 2016;2:141-3
Many general practitioners are rather reluctant to attend to cases of accident for fear of being involved in unnecessary litigation later on. It has been seen that even if a serious accident has occurred just in front of a doctor's clinic and he knows he can save the life of the patient by giving emergency treatment, yet generally he advises the relatives to take the patient to a hospital. More often than not, the patient dies on the way. This happens because most doctors have a "fear of the unknown." They are generally not very well versed with the medicolegal issues involved and fear that if they treat the patient, they would be "legally involved." Nothing of this is true as we shall see here.
The first question that arises in such cases is whether any medical man can be forced to accept an accident victim. The answer to this till some time back was very clear. The doctor could choose patients according to his own will. But now according to a recent Supreme Court verdict, no doctor can refuse treatment in case of emergency.  Hence, if now a doctor refuses treatment, in case of emergency, he/she could be sued under the law. Once the doctor accepts the case and starts treatment, then the doctor-patient relationship is established. Now at this stage, suppose the doctor shows some gross carelessness (say, he fails to administer injection Tetanus Toxoid (TT) despite multiple abrasions and lacerations) and the patient dies as a result of this carelessness, the doctor may be sued for negligence. Even a doctor working in a charity hospital or a private practitioner working on a charitable basis can be sued for negligence. The doctor cannot take the defense that he/she was treating the patient free of charge. 
This is not as gloomy a picture as it appears. By and large, a doctor is not sued until and unless his neglect is of a very gross nature. No one can legally sue a doctor for wrong diagnosis. Suppose you admit a case of an accident with multiple fractures and the patient is unconscious. You find that the pulse is weak and thready, and the blood pressure (B.P.) is low. Naturally, you conclude that the patient is in shock because of multiple fractures. You start proper treatment such as blood transfusion. Later, the patient dies and is found to have a ruptured liver. In this case, had a proper diagnosis been made, the patient could have been saved. Yet, no one can sue a doctor in this case. In the same case, the doctor could have been sued, had he not started blood transfusion even after finding the collapsing vitals because not administering blood in such cases is a gross neglect.
The next question arises: What is that degree of carelessness which amounts to gross neglect? This is a very subjective question. The law prescribes that the doctor should apply reasonable skill and care. What is this reasonable skill? Generally speaking, it is the average degree of skill possessed by a practicing doctor. As we can see, this is a very vague definition. There are however certain things which all doctors would do in an accident case. Failure to do these things will make the doctor liable to be used for negligence. Some of these things are:
- Inject TT immediately - many times the doctor may forget to inject TT in view of patient's other more serious injuries. If the patient develops tetanus subsequently, the doctor will be sued for negligence.
- Take X-rays - when the dilemma is "to do or not to do" the answer is "to do." Take X-ray of all possible parts to exclude fractures. Even if you have the slightest doubt of fracture, take X-ray.
- Bleeding points - bleeding points, internal or external, are surprisingly prone to be missed. Do not feel ashamed to uncover the patient completely. Maintain a vitals chart. Any unexplained fall in B.P. could be due to an internal bleeding.
- Ophthalmoscopic examination - many doctors would not routinely do this examination and would thus miss early signs of intracranial damage. With the increasing use of ophthalmoscopes in general practice, the courts now include this examination within an average degree of skill and care. One must remember that about 60% of roadside vehicular accident deaths are due to a head injury. In view of this fact, ophthalmoscopic examination is a must in every accident case.
- Beware the patient who says there is nothing wrong with him-many patients, after a serious roadside vehicular accident assert that there is nothing wrong with them. The doctor charges fees for his examination, writes some prescription, and allows him to go. Later on, the patient may be readmitted for a serious extradural hematoma or multiple fractures of ribs, or ruptured spleen or some other similar things like that. If death occurs in such cases, the doctor may be sued for negligence. Hence, in all such cases keep the patient under observation for at least 24 h.
These simple precautions will enable the doctor to keep him away from subsequent litigation.
When to stop treatment?
If you have admitted an accident case and the case takes on a sudden and unexpected turn so that you feel that the case is beyond your means and skill, what should you do? In such cases, do not simply ask the relatives to take away the patient to a specialist or to a Government Hospital. This is a bad practice both morally and legally. Once a patient is under your care, you bear full moral responsibility. You must consult a specialist yourself, tell him what has happened, and ask if he could come over to have a look at the patient. In case the specialist cannot come over to your clinic or nursing home, arrange for the patient to be sent over to his specialty clinic, with a qualified doctor in charge of him. Once the specialist begins the treatment, your legal responsibility is over but not before that.
In any case you can stop treatment only under following conditions.
- When the patient is under some other responsible care as in the above case.
- When the patient himself has signified his intention of changing the doctor.
- When the patient is not cooperative and is not following your instructions. In such cases, you may first discreetly warn him and if he continues to disobey your instructions you may discontinue treatment.
- If the patient does not pay your fees.
- If the patient consults another doctor without your knowledge.
There are a few other conditions under which you can stop treatment, but they are not related to roadside vehicular accidents.
About reasonable care, a point which law recognizes is that the expectation from a doctor should be at par with his qualifications. Consider a roadside vehicular accident case, having severe head injury who is brought to a MBBS doctor and a similar case to a specialist holding an M.Ch. degree in neurosurgery. Naturally, the degree of care which can be expected from both doctors is different. Hence, if you hold a MBBS degree, do not be afraid to give primary care to the patient. This will help both you and your patient. You will get reasonably good fees for attending to a patient in an emergency and would earn good name while the patient would get primary care. Once you are through with him, you can arrange for him to be sent over to a specialty clinic. If the patient expires meanwhile, it will not put you in any legally embarrassing position because you did your best according to your qualifications and the resources at your disposal.
If on the other hand you hold a degree in neurosurgery and fail to diagnose middle cranial fossa fracture when the patient was bleeding through ears, you might in all probability be sued for negligence.
In all cases of the accident which you accept, you must make detailed entries in a separate register. The entries should include name, age, sex, address, occupation, and telephone number of the patient, as well as of the person who brought him and a detailed history.
This detailed document becomes the medio-legal report and is commonly referred to as the Medico-Legal Case (MLC). There is much misconception among the doctors regarding MLC. Many private practitioners are seen to refuse an accident case with the remarks that it is a MLC and thus can be attended to by a Government Hospital only. This is a very wrong notion. Many private practitioners also think that they cannot make a medicolegal report. They think that only a government doctor can do so. This is also wrong. Any recognized private practitioner (for that matter even a homeopathic or Ayurvedic physician) can make a medicolegal report. A medicolegal report is nothing but a detailed document meant for the guidance of the investigating authority. You are also not legally bound to inform the police regarding any accident.
Whenever you undertake a surgery on an accident victim, take care to get a proper consent form filled, otherwise you may be in trouble later. There are many cases when the patient is unconscious, and no relatives are traceable. Suppose his/her leg is badly crushed and it needs immediate amputation. Under such circumstances, you may have to do the amputation or any other surgery which is necessary to save the life of the patient. Section 92 of I.P.C. says that nothing is an offense which is done in good faith for the benefit of a person when the circumstances are such that his or his relatives' consent cannot be obtained.
These are thus a few relevant medicolegal points to be remembered in cases of roadside vehicular accidents. If these precautions are followed, the practitioner would find that he remains free of legal embarrassment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pandit MS, Pandit S. Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense - A legal perspective. Indian J Urol 2009;25:372.