LAW AND DENTISTRY

LAW AND DENTISTRY



 INTRODUCTION
Thou shalt be free from envy, not cause another’s death, and pray for the welfare of all creatures.

 DOCTOR PATIENT CONTRACT
Contract is defined as an agreement between two or more persons which creates an obligation to do or not to do a particular thing.

 AN IMPLIED CONTRACT
Is one inferred from conduct of parties and arises where one person renders services under circumstances indicating that he expects to be paid there for, and the other person knowing such circumstances, avails himself of the benefits of those services.
IMPLIED CONTRACT NOT ESTABLISHED
• The doctor renders first-aid in an emergency.
• He performs an examination for life insurance purpose.
• He is appointed by the trial court to examine the accused for any reson.

EMPLIED WARRANTIES (DUTIES OWNED BY THE DOCTOR:-
• Be properly licensed and registered and meet all other legal requirement to engage in the practice of dentistry.
• Employ competent personnel and provide for their proper supervision
• Maintain a level of knowledge in keeping with current advances in the profession.
• Maintain a level of knowledge in keeping with current advances in the profession.
• Not use experimental procedures.
• Obtain informed consent from the patient before instituting an examination or treatment.
• Ensure that care is available in emergency situations.
• Keep the patient informed of her or his progress.
• Maintain confidentiality of information.

 IMPLIED DUTIES OWED BY THE PATIENT:-
• He must disclose all information that may be necessary for proper diagnosis and treatment.
• He must co-operate with the doctor for any relevant investigations required to diagnose and treat him.
• He must carry out all the instructions as regards drugs, food, rest, exercise or any other relevant / necessary aspect.
• He should notify the dentist of a change in health status.
• In the case of a private medical practitioner he must compensate the doctor in terms of money.

 AN EXPRESS CONTRACT
Is an actual agreement of the parties, the terms of which are openly uttered or declared at the time of making it, being stated in distinct and explicit language, either orally (oral agreement) or in writing (written agreement)

 CONTINUE TO TREAT SUCH A PERSON
• The patient has recovered from the illness, for which treatment was initiated.
• The patient / attendant consult another doctor (of any branch of medicine) without the knowledge of the first attending doctor.
• The patient / attendants do not co-operate and follow the doctor’s instructions.

 WITH REASONABLE CARE
A doctor must use clean and proper instruments, and provide his patients with proper and suitable medicines if he dispenses them himself.
When the case is complicated.
In cases where there is suspicion of poisoning or other criminal act.

 REASONABLE SKILL
Medicine is not an exact science. I shall use my experience and best judgment and you take the risk that I may e wrong. I guarantee nothing.

 NOT UNDERSTAKE ANY PROCEDURE/ TREATMENT BEYOND HIS SKILL
This depends upon his qualifications, special training and experience. The doctor must always ensure that he is reasonably skilled before undertaking any special procedure/ treating a complicated case.

MUST NOT DIVULGE PROFESSIONAL SECRETS
A professional secret is one which a doctor comes to learn in confidence from his patients, an examination, investigations or which is noticed in the ordinary privacies of domestic.

THE DOCTOR – PATIENT RELATIONSHIP ENDS WHEN
• Both parties agree to end it.
• The patient ends it by act or statement.
• The patient is cured.
• The dentist unilaterally decides to terminate the care.

CONSENT
The term consent is defined as when two or more persons agree upon the some thing in the same sense they are said to on sent as per the definition of consent given in section 13 of the Indian contract act 1872

WHO CAN GIVE CONSENT
Consent can be given by any person who is conscious, mentally sound and is of and above twelve years of age as provided under section 88 and 90 of the Indian penal code (IIP) 1860.

WHEN CONSENT IS NOT VALID
Consent given under fear, fraud or misrepresentation of facts, or by a person who is ignorant of the implications of the consent, or who is under 12 years of age is invalid (Sec 90IPC)

TYPES OF CONSENT –
• IMPLIED CONSENT:- This is the most conmmon ariety of consent. The fact that a patient comes to a doctor for an alimen implies that he is grreable to medical examination in the general sense.

• EXPRESS CONSENT-
Anything other than the implied consent is express consent.

• INFORMED CONSENT:-
Informed consent has come to the fore in recent years. All information must be explained in comprehensible non-medical terms preferably in local language about the.
Diagnosis
Nature of treatment
Risks involved
Prospects of success.
Prognosis I the procedure is not performed, and
Alternative methods of treatment.

PROXY CONSENT ( SUBTITUTE CONSENT)
All the above of consent can take the shape of proxy consent. Parent for child, close relative or mentally unsound/ unconscious patient, etc.

PROFESSIONAL NEGLIGENCE (Malpractice, Malproxis)
Professional negligence is defined as the breach of duty caused by the omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct o human affairs would do or doing something which a prudent and reasonable man would not do.
Medical negligence or malpractice is defined as lock of reasonable core and skill or will full negligence on the part of a doctor in the treatment of a patient where by the health o life of a patient is endangered.
 CRIMINAL NEGLIGENCE:-
Not only has the doctor made a wrong diagnosis an treatment, but also that he has shown such gross ignorance, gross carelessness or gross neglect for the life and safety of the patient that a criminal charge is brought against him.
• Injection anesthetic in fatal dosage or in wrong tissues.
• Amputation of wrong finger, operation on wrong limb, removal of wrong organ/ tooth, or errors in ligation of ducts.
• Leaving instruments or sponges inside the part of body operated upon.
• Transfusing wrong blood.

 CONSUMER PROTECTION ACT (CPA/COPRA)
The consumer protection act, 1986, that came into force on 15th April 1987 is a milestone in the history of socio-economic egislation in the country.
The main objective of the act is to provide for the better protection of consumers.
The act is intended to provide simple, speedy and inexpensive redressed to the consumers grievances.

 WHO IS LIABLE?
• All medical/ dental practitioners doing independent medical / dental practice unless rendering only free service.
• Private hospitals charging all patients.
• All hospitals having free as well as paying patients and all the paying and free category patients receiving treatment in such hospitals.

 WHO IS NOT LIABLE?
It exempts only those hospitals and the medical/ dental practitioners of such
• Supreme court,
• National commission,
• State commission,
• District forum.

 OTHER LEGAL AVENUES AVAILABLE TO AGGRIEVED PATIENTS
• Medical council of India and dental council of India.
• Civil courts.
• MRTP (monopolies and Restrictive Trade Practices Commission)
• Public Interest litigation
• Sections of Indian Penal Code, 1860

 DO’S FOR DOCTORS
• Mention your qualifications / training/ experience/ designation on the prescription. Qualifications mean recognized degrees/ diplomas. Mention of scholarship/ membership/ awards which are not qualifications should be avoided.
• Always mention date and timing of the consultation.
• Mention age and sex o the patient. In a pediatric prescription, weight of the patient must also be mentioned.
• Listen attentively look carefully. Ask questions intelligently.
• If the patient/ attendants are erring on any count (history not realable, refusing investigations, refusing admission) make a note of it or seek written refusal preferably in local language with proper witness.
• Mention likely side-effects, and action to be taken if they occur.
• Mention whether prognosis is explained. If necessary take a signature of patient/ attendant, after explaining the prognosis in written local languages.

 WHIL ADMINISTERING AN INJECTION/ DRUG ALWAYS CHECK:
• Name of the Drug.
• Expiry Date.
• Rate of administration (fast, slow, in drip, etc.)
• That a disposable syringe and needle are used.

 DONTS FOR DOCTORS
• Don’t prescribe without examining the patient, even if he is a close friend or relative.
• Never examine a female patient without presence female nurse/ attendant.
• Do not permit considerations of religion, nationality, race, party, polictics, or social standing to intervene between you and your patient.
• Don’t smoke while examining a patient.
• Don’t adopt experimental method in treatment.
• Don’t refuse if the patient/ attendants want to leave organist medical advice. It is their right document this properly.
• Don’t leave at the moment of death. There is a tendency especially on the part of senior doctors to go away at this time when his presence and experience are most needed.
• Don’t deny medical care to a patient with HIV infection/ AIDS. Observe all necessary precautions.

 PREVENTIVE MEASURES- HOW TO AVOID LITIGATION
• True And MCI / DCI Approved Qualification
• Communication/ Interpersonal Behavior
• Academic & Technical Up gradation
• Medical /Dental Ethics And Laws
• Prevention By Professional Indemnity (Insurance Cover)






















LAW
AND
DENTISTRY