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NEGLIGENCE

 -­‐  DEFINED  AS  CARELESS  


CONDUCT  OF  A  PERSON  LEADING  TO  
DAMAGES/INJURY  TO  A  PERSON  
 
 
THE  PERSON  WHO  CAUSED  THE  
DAMAGE/INJURY  IS  LIABLE  FOR  
DAMAGES  CAUSED  
 
MEDICAL  NEGLIGENCE  IS  WHEN    DUE  TO  
ABSENCE  OF  REASONABLE  SKILL  AND  CARE  OF  
A  DOCTOR  RESULTS  IN  BODILY  INJURY/DEATH  
OF  A  PATIENT  
 
MEDICAL  NEGLIGENCE  IS  CLASSIFIED  AS;  
 
   A)  CIVIL  MEDICAL  NEGLIGENCE    
 
   B)  CRIMINAL  MEDICAL  NEGLIGENCE    
 
           CIVIL  MEDICAL  NEGLIGENCE  
TO  PROVE  CIVIL  MEDICAL  
NEGLIGENCE  
1.  DOCTOR  OWED  A  DUTY  OF  CARE  
2.  THERE  WAS  A  BREACH  IN  THE  DUTY  OF  
CARE  
3.  PATIENT  SUFFERED  DAMAGE/DEATH  
4.  DAMAGE/DEATH  WAS  A  RESULT  OF  THE  
BREACH  OF  DUTY  (  Reasonable  
proximate  connec2on  between  conduct  
of  duty  and  damage)  
 •  BEGINS  WHEN  A  DOCTOR  ACCEPTS  
A  PATIENT  UNDER  HIS  CARE  

•  EVEN  IN  AN  EMERGENCY  SITUATION  

•  WITH  OR  WITHOUT  A  FEE  BEING  


PAID  
 • DOCTOR  SHOULD  EXERCISE  A  
REASONABLE  DEGREE  OF  SKILL  &  
CARE  

• DEGREE  OF  SKILL  AND  CARE  


DEPENDS  ON  THE  DOCTOR’S  
QUALIFICATIONS  (STANDING)  &  
EXPERIENCE  
 
1.  DOCTOR  OWED  A  DUTY  OF  CARE  
 
• A  paFent  is  seen  at  the  OPD,  Clinic  in  
a  state  or  private  hospital  
• A  paFent  is  seen  by  a  GP  
• A  paFent  at  the  A  &E,  ward,  OT  
• A  doctor  aWends  to  an  emergency  
situaFon  outside  hospital    
 
2.  THERE  WAS  A  BREACH  IN  THE          
         DUTY  OF  CARE  ?  
 
•  The  breach  in  the  duty  of  care  arises  
when  the  doctor  fails  to  exercise  
reasonable  degree  of  skill  and  care  

•  Degree  of  skill  and  care  to  be  given  


depends  on  the  qualificaFons  and  
experience  of  the  doctor    
THERE  WAS  A  BREACH  IN  THE          
 DUTY  OF  CARE  ?  
•  What  an  intern  medical  officer  could  
do  in  a  given  situaFon  is  different  to  
that  of  a  specialist    
 
•  Therefore  the  acFon  taken  by  the  
doctor  will  be  decided  by  his  
standing    
THERE  WAS  A  BREACH  IN  THE          
DUTY  OF  CARE  ?  Contd.  
•  STANDARD  OF  CARE  GIVEN  BY  THE  DOCTOR  
WILL  BE  COMPARED  WITH  THE  STANDARD  
OF  AN  AVERAGE  &  COMPETANT  DOCTOR  OF  
HIS  STATUS.  IF  THERE  IS  DEPARTURE  FROM  
STANDARD  PRACTICE  

•  IN  DECIDING  THE  CASE  WILL  TAKE  INTO  


ACCOUNT  AVAILABLE  RESOURCES;  
personnel,  equipment  etc.  and  physical  
surroundings  
 
THERE  WAS  A  BREACH  IN  THE          
DUTY  OF  CARE  ?  Contd.  
• Negligence  can  result  from  doing  
something  which  an  average  doctor  
wouldn’t  have  done  ex.  giving  a  
wrong  drug  or  failure  to  do  
something  which  would  have  been  
done  by  an  average  doctor  in  a  given  
situaFon    
   ex.  Failure  to  take  X-­‐ray  and  missing          
   a  fracture  leading  to  a  deformity  
The  doctor  will  not  be  found  negligent  for  
failure  to  diagnose  a  disease/  failure  to  
cure/ended  up  in  a  complicaFon  if  he  has  
exercised  reasonable  degree  of  care  and  
skill  and  followed  accepted  pracFce  
 
There  are  complicaFons  and  risks  inherent  
in  certain  procedures.  Doctor  should  take  
appropriate  acFon  to  recFfy  it.  If  no  acFon  
is  taken  he  will  be  guilty  of  negligence    
When  a  doctor  goes  beyond  his  level  of  
competence  and    a  paFent  develops  a  
complicaFon  resulFng  in  injury/death  then  he  is  
liable  for  medical  negligence.  Ex.  A  house  officer  
decides  to  do  a  laparotomy  by  himself  without  
calling  the  surgeon    
 
When  a  doctor  knows  that  a  parFcular  condiFon  
should  be  handled  by  a  different  specialist  he  
should  refer  the  paFent  to  him  immediately  
•  Doctors  are  expected  to  keep  abreast  of  new  
developments  but  it  is  impossible  to  read  all  
new  literature  
•  But  specialist  doctor  is  expected  to  be  aware  
of  new  well  established  means  of  therapy  or  
operaFve  procedures  
•  Doctor  is  expected  to  take  a  detailed  history,  
complete  physical  examinaFon,  order  
relevant  invesFgaFons  and  arrive  at  a  
reasonable  diagnosis  
•  Failure  to  make  a  diagnosis  does  not  amount  
to  negligence  provided  he  has  used  
reasonable  degree  of  skill  and  care  
 
•  Failure  to  do  a  relevant  invesFgaFon  such  as  
X  -­‐ray    in  trauma  case  and  paFent  ends  up  
with  a  mal-­‐united  fracture  will  amount  to  
negligence,  not  doing  a  laparotomy  when  
there  is  obvious  signs  of  bowel  rupture,  
transfusing  HIV  or  HepaFFs  B  posiFve  blood  
•  Failure  or  delay  in  referring  a  paFent  to  
another  specialist  may  result  in  serious  injury  
or  death  ex.  When  EDH  or  ruptured  ectopic  
pregnancy  is  suspected  by  a  physician  he  
should  refer  to  neurosurgeon  or  gynaecologist      
 
3.  PATIENT  SUFFERED  DAMAGE  
 
• Damage  suffered  could  be;  
 A.  diminished  chances  of  recovery  
 B.  Prolonging  his  illness  
 C.  Increasing  his  suffering  
 D.  PaFent’s  death  
If  the  paFent  didn’t  suffer  a  damage  
then  the  doctor  cannot  be  guilty  of  
negligence  
Damages  suffered  by  patients  
include;  
• Physical  injury  or  mental  trauma  
• Loss  of  earning  
• Expenses  incurred  for  medical  treatment  
• ReducFon  of  expectaFon  of  life  
• Reduced  enjoyment  of  life    
• Pain  and  suffering  
• Death  
4.  DAMAGE  WAS  DUE  TO  MEDICAL          
           NEGLIGENCE  
• PATIENT  (PLAINTIFF)  MUST  PROVE  THAT  
DOCTOR  FAILED  TO  PROVIDE  
REASONABLE  DEGREE  OF  SKILL  AND  CARE  
• AND  IT  WAS  THE  CAUSE  OF  THE  DAMAGE  
SUFFERED  AND  NOT  ANY  OTHER  EVENT/
CAUSE  
DAMAGES  CAN  RESULT  FROM;  

•  Failure  to  adopt  standard  pracFce  


•  If  there  was  no  informed  consent  
•  Fails  to  aWend  on  a  paFent  in  Fme  
•  Fails  to  review  the  paFent  frequently  as  
required  by  his  condiFon  
•  If  he  fails  to  arrive  at  diagnosis  due  to  absence  
of  skill  and  care  
•  If  fails  to  give  proper  instrucFons  
•  If  the  paFent  is  discharged  prematurely  
CASE  OF  CIVIL  MEDICAL  
NEGLIGENCE      
• IS  FILED/HEARD  IN  A  CIVIL  COURT  
• BURDEN  OF  PROOF  IS  ON  PLAINTIFF/
PATIENT  
• NO  VIOLATION  OF  LAW  BUT  ABSENCE  OF  
SKILL  AND  CARE  
• DECIDED  ON  BALANCE  OF  PROBABILITIES  
• LIABLE  TO  PAY  COMPENSATION  TO  
PATIENT/NEXT  OF  KIN  
CASE  OF  CIVIL  MEDICAL  
NEGLIGENCE  WILL  REQUIRE  
• Hospital  documents  BHT/Diagnosis  cards/
Clinic  cards/prescrip7ons  

• Inves7ga7on  reports  CT  scan/X-­‐ray/


angiograms/laboratory  test  etc.  

• Opera7on  notes/charts/blood  transfusion  


records  
CASE  OF  CIVIL  MEDICAL  NEGLIGENCE  
WILL  REQUIRE  contd.  
• Evidence  from  doctors  who  treated  the  
pa7ent  
• Evidence  from  other  categories  of  staff  ex.  
Nurses    
• Plain7ff/defendant/courts  may  get  
independent  medical  experts  to  give  
evidence  
Therefore  every  ac2on/decision  taken  
during  treatment  should  be  recorded  in  
BHT  contemporaneously    
THE  AWARD  OF  COMPENSATION  

If  medical  negligence  is  proved,  the  paFent  


or  next  of  kin  is  compensated  monetarily  
for;  
• Loss  of  earnings  
• ReducFon  of  expectaFon  of  life  
• ReducFon  of  enjoyment  
• AddiFonal  expenditure  incurred  for  
hospital,  drugs,  equipment,  diet  etc.  
• Pain  and  suffering  (physical  &  mental)  
• Death    
CASES  OF  NEGLIGENCE  ON  THE  
RISE  DUE  TO    
• BREAKDOWN  IN  COMMUNICATION  
BETWEEN  DOCTOR  AND  PATIENT  
• GENERAL  PUBLIC  MORE  AWARE  OF  
MEDICAL  ISSUES  
• INCREASING/UNREAL  EXPECTATIONS  OF  
PATIENTS  
• GREATER  AWARENESS  OF  LITIGATION  
• INCREASING  COST  OF  MEDICAL  CARE  
• MORE  LAWYERS  ENGAGED  IN  LITIGATION  
DOCTOR’S  DEFENCE  IN  CASES  OF  
MEDICAL  NEGLIGENCE  
1.  “Volen7  non  fit  injuria”-­‐    TREATMENT  WAS  
CARRIED  OUT  BECAUSE  THE  PATIENT  GAVE  
INFORMED  CONSENT  
2.  DUTY  DISCHARGED  UNDER  LESS  THAN  IDEAL  
CONDITIONS  –  lack  of  staff/equipment/drugs  
3.  DOCTOR  MAY  BLAME  ANOTHER  DOCTOR/
NURSE  FOR  THE  FAILURE    ex.  Failure  to  inform  
the  condi7on  of  the  pa7ent  
4.  CONTRIBUTORY  NEGLIGENCE  –  there  was  lack  
of  coopera7on  from  pa7ent  &  complica7ons  
arose  
DOCTOR’S  DEFENCE  IN  CASES  OF  
MEDICAL  NEGLIGENCE  contd.  
5.  INEVITABLE  ACCIDENT/MISADVENTURE  –  no    
       fault  on  the  part  of  staff  ex.  anaphylac7c  reac7on      
       to  a  drug  
6.  VICARIOUS  LIABILITY  –  Doctor  claims  that  injury    
       was  due  unavailability  of  other  staff/instruments  
       /drug/blames  other  staff  
7.  DEFENCE  OF  PRODUCTS  LIABILITY  –  Doctor    
       acributes  injury  to  pa7ent  due  to  a  defec7ve    
         instrument  or  sub-­‐standard  drug  
8.  DENIAL  OF  NEGLIGENCE      
Doctrine  of  “Res  Ipsa  Loquitur”  
•  Means  facts  speak  for  themselves  
•  The  outcome  of  the  negligence  is  so  obvious  
there  is  hardly  anything  to  prove    
•  In  these  types  of  cases  there  is  presumpFon  of  
negligence  by  the  doctor/other  staff  
•  Damage  was  a  direct  result  of  a  negligent  act,  
defendant  had  exclusive  control  over  the  act  
and  there  was  no  contributory  negligence  
•  Ex.  Failure  to  remove  swabs  during  a  
laparotomy,  mismatched  blood  transfusions  
CRIMINAL  MEDICAL  NEGLIGENCE  
TO  PROVE  CRIMINAL  MEDICAL  
NEGLIGENCE  
1.  DOCTOR  OWED  A  DUTY  OF  CARE  
2.  THERE  WAS  A  BREACH  IN  THE  DUTY  OF  
CARE  
3.  PATIENT  SUFFERED  DAMAGE/DEATH  
4.  DAMAGE  WAS  A  RESULT  OF  THE  BREACH  
OF  DUTY  (  Reasonable  proximate  
connec2on  between  conduct  of  duty  and  
damage)  
5.   RASH  AND  NEGLIGENT  ACT  WITH  GROSS  
DISRESPECT  FOR  HUMAN  LIFE  
 
CRIMINAL  MEDICAL  NEGLIGENCE  
 
• CRIMINAL  NEGLIGENCE  IS  WHEN  THERE  IS  
GROSS  DISRESPECT  FOR  THE  PATIENT’S  
SAFETY/LIFE  WITH  LACK  OF  COMPETENCY  
AND  RESORTING  TO  RASH  AND  
NEGLIGENT  ACT  
• INVOLVES  SUCH  A  DEGREE  OF  
RECKLESSNESS  EVEN  EXPOSING  THE  
PATIENT  TO  EXTREME  DANGER  OR  DEATH    
CRIMINAL  MEDICAL  NEGLIGENCE  
contd.  
• Would  include  following  situa7ons;  

•  A  doctor  not  answering  a  call  to  acend  on  a  


bleeding  pa7ent  who  subsequently  dies  
•  A  surgeon  operates  under  the  influence  of  
alcohol  and  punctures  major  blood  vessel  
and  results  in  death  due  to  bleeding  
•  Amputa7on  of  a  wrong  limb  
•  Administra7on  of  a  wrong  dose  of  
anaesthe7c  drug  by  the  anaesthe7st  
causing  death  
•  Criminal  negligence  is  much  more  serious  
than  civil  negligence  
•  ProsecuFon  will  be  by  the  state  
•  Doctor  can  be  charged  under  criminal  law  
secFons  298,  327-­‐329  of  the  Penal  Code  in  a  
criminal  court  
•  Level  of  proof  required  is  “proof  beyond  
reasonable  doubt”  
•  Punishment  could  be  fine/imprisonment  or  
both  
•  Prosecuted  in  a  criminal  court  
NO  DUTY  OF  CARE  WHEN;  
• DOCTOR  EXAMINES  PATIENTS  FOR  
MEDICO-­‐LEGAL  PURPOSES  

• DOCTOR  EXAMINES  INDIVIDUALS  FOR  


INSURANCE  PURPOSES  

• WHEN  EXAMINATIONS  ARE  DONE  FOR  


MEDICAL  FITNESS