Dr. Kamini A Rao, Medical Director, Bangalore Assisted Conception Centre Pvt. Ltd.

Bangalore-based Pegasus Health Law Consultants, which is India's first exclusive health law consultant firm that caters exclusively to the healthcare sector is in the process of seeking an affiliation with the Rajiv Gandhi University of Health Sciences (RGUHS) to start medico legal courses. The decision follows in the wake of the fact that India's Obstetrics and Gynaecologists have to pay the highest premium for legal cover as they face the highest law suits, followed by cosmetologists and anaesthesiologists.

In the Consumer Courts, one of the highest number of medico-legal cases in India are against obstetrics-gynaecologists. In Karnataka, three out 10 medical-legal cases are against Obstetrics and Gynaecologists. The Pegasus Health Law Consultants is currently dealing with medico-legal cases in different specialities.

The main reason for law suits against Obstetrics and Gynaecologists is the lack of communication with the patient and her family on the health condition and poorly written records to justify the condition of the case in the event of a mishap, Dr. Kamini A Rao, Medical Director, Bangalore Assisted Conception Centre Pvt. Ltd. and former president, Federation of Obstetrics & Gynaecological Societies of India (FOGSI), told Pharmabiz.com

“Litigations are due to lack of trust and openness. Patients are suspicious about the doctor who does not communicate. If health records are maintained and made known it clears misunderstandings, she added.

The Obstetrics and Gynaecologists need to deal with two lives – mother and child where the health of both cannot be left to chance. For instance, if condition of the mother and foetus could be in conflict when there are maternal conditions that would aggravate if pregnancy is continued like high blood pressure (PET) and if the baby is still premature in the womb, then the 'Sword of Damocles' is before the doctor who is in a tricky situation. These sort of problems occur very often in Obstetrics and Gynaecologists practice, explained Dr. Kamini Rao.

There are instances where babies born normally showing delayed milestones have been blamed to have been caused by Obstetrics and Gynaecologists who have not recognised 'Hypoxia' during labour. Hence, the baby would have been better had it been delivered by caesarean. The use of mid-cavity forceps has been questioned as it could damage the brain. Doctors are apprehensive as to whether it is worthwhile opting for forceps delivery or take recourse to caesarean section, informed Dr. Kamini Rao.

Obstetrics have no protection when a case is filed and even their own colleagues blame them on the decision when they opt for a particular procedure. Such judgements could go in favour of either and depends on the competence of the lawyers dealing with the case.

According to Dr. Kamini Rao, the solution to bring down the number of medico litigations would be to introduce Continuing System of Medical Education Learning (CMEL) programme that highlights the responsibilities of the doctor towards the patient and vice versa. Sometimes, medical advice is not followed by the patient and her condition deteriorates. In such cases only if a written record of diagnosis, treatment and precautionary measures to be taken by the patient is made available, then the doctor could protect himself against negligence.

To sue a doctor in the Consumer Forum Court, the patient need not keep a deposit. Consumer Courts have to dispose cases within two years. With an increase in medico-legal cases, it takes a minimum two-three years for the final verdict. Some cases like the 'failure of sterilisation' had been placed before the Supreme Court, said Dr. Kamini Rao.

The cases pending in Karnataka are those related to the Obstetrics surgery, caesarean section, damage of the baby's brain, presence of foreign body (swab) in the abdomen after surgery and unexplained maternal deaths, besides dissatisfaction on the quality of service. “The patient must prove that the doctor is guilty of neglect before any judgement is passed,” she said.

According to Dr. Kamini Rao, most of the final judgements have gone in favour of the doctors. But it would be important to have doctors from the related speciality giving expert advice so that both the parties can have a fair trail. Hence specialists' bodies like the FOGSI and Society for Surgeons & Physicians could have representation in the Consumer Forum Court which would make the proceedings even more transparent, she noted.