LEGAL ASPECTS IN HOSPITAL

1. LEGAL ASPECTS IN HOSPITAL • Laws & regulations applicable to hospitals . • Enquiries & Disciplinary actions • Permits n& Licences.

2. Introduction Definition Objectives Gen. Acts/legislation applicable to Hosp. Law of torts. Bill of Rights Ethical & legal Responsibilities

3. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

4. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

5. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

6. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

7. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

8. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

9. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

10. Introduction • Society has laid down the laws of land prescribing normative behavior of Indls./Groups with provision of deterrent corrective punishment for any contravention by the society through various methods e.g. imprisonment/fine. • Law can be divided into i)civil law is concerned with relationship among people & the protection of persons right . Violation may causes harm to an indl. or property but no threat to society & ii) criminal law includes rules forbidding conduct that is injurious to public order & specifies punishment to indl who exhibits injurious conduct.

11. Criminal law is concerned with relationship between indls. & Govt. & acts that threatens the society & its order. • “Crime is an offense against a society that violates a law.” • Ignorance of law offers no protection from punishment. • Public is now becoming aware of its own rights, obligation of Drs. & also obligation of hospitals consequently MLC are on rise.

12. MLC : Any case of injury or ailment where some criminality is involved is called as MLC. Criminality in a case may be Non Cognizable(Police has no auth to arrest without warrant) or cognizable (police can arrest without warrant). • Dyeing Declaration: It is a statement of a person, written or oral, who is dying as a result of some unlawful act,relating to the material facts of cause of his death or bearing on the circumstances. • Magistrate,Doctor, Public personality/police.

13. Various Medico-legal issues

14. Objectives • Increasing number of MLC has made it necessary for hosp. Administrators to understand Medico Legal issues. • To understand Medico legal issues is necessary so as to do the right things and protect themselves & institutes from frivolous litigations & also do justice to patients.

15. DEFINITION • Law means body of rules to guide human action. • Law is a system of rights & obligations which the state enforces. • Law is the body of principles recognised by the state & the administration of justice.

16. Hospital Administration • Has an obligation to have clear understanding of Ethical & legal responsibilities. Mgt is responsible for policies, for maintaining a safe hosp., physical facilities & services, must ensure building conforms to local bye laws, safety regulations,sanitation arrangements. • Hosp. Being an integral part of the social system is subject to all laws of the land. • Hosp. Is responsible for safety from explosives & inflammatory gases,chemicals, machinery, steam damages from slippery floors etc.

17. Application of Law • There are no specific laws relating to hosp./staff/Equipment. • Application of Laws related to hosp working, of interest are the ones which are concerned with Consent, Professional secrecy, evidence, Medical negligence, law of torts, & organ transplant.

18. General Acts/Legislation applicable to hosp. • Industrial dispute act 1948: Where >50persons. • Minimum wages Act1948: Categories wise. • Employees Provident Fund Act: where >20 persons & is punishable by imprisonment. • Payment Of Bonus Act: Where >40 persons but not applicable to charitable/ Non profit hosp. • Payment of Gratuity act 1972:Where 10 or more persons work. • Payment of wages act 1936: within 7 days. • ESI act 1948: Hosp contributes 4% of total wage bill.

19. Industrial dispute Act 1948 considers strikes a breach of contract in public utility service, if without 6 weeks prior notice, or within 14 days of notice of a strike, or during reconciliation proceedings are on.The notice of strike has to be intimated within 5days to Govt. • Minimum Wages Act: States No.of hours of work/overtime/working days/holidays. • Workman’s compensation Act:loss of both hands/feet/one hand &one foot right/total disfigurement of face constitutes 100% loss.Act lays down the %age of loss of earning capacity.

20. Motor vehicle Act1988: Breath analyzer test/blood test. Police can detain a person for alcohol test for not more than 2 hrs. • Drug Act 1940:Regulates import,manufacture,distribution & sale of drugs in India.Insecticide,disinfectant & contraceptives & cosmetics are included in this Act. It lays down the drugs which can be sold over the counter& those e.g. schedule H &L normally would not be sold without prescription.

21. Medical / professional Acts • Indian Medical Council Act 1933. • Indian Nursing Council Act 1947. • The Pharmacy Act1948: Hosp has to acquire drug licence if it sells drug otc. • Births & Deaths & Marriages registration Act.Hosp is bound to inform all births/deaths taking place in a hosp.

22. Miscellaneous Acts Applicable to Hospitals • Societies registration Act,1860: It governs working & Mgt of institutions est. or owned by charitable trusts. • State Public charitable Trust Acts. • Acts in relation Establishment of Nursing homes.

23. Law of Torts • Tort is defined as “Any wrong,injury or damage is done to the person for which a civil suit can be brought” e.g. wrong operation, operating without consent, leaving instrument inside the body,invading the right of privacy, breach of professional secrecy, defamation,malicious prosecution, misrepresentation.

24. COPRA 1986 • This Act came into force w.e.f.1 Sep,1987. • Advantage Minimal cost is involved & matter is decided within 3 to 4 months. • Provides redressal for defective goods,deficient service, unfair trade practices. • Consumer A person who hires any services for any considerations, & any beneficiary of such services other than who hires, when such services are availed of with the approval of the first mentioned person.

25. Deficiency: Any fault,imperfection shortcoming or inadequacy in the qlty,nature & manner of performance of a contract,or otherwise in relation to the service. • Service means service of any description except free service & personal service. • A claim for compensation under COPRA must be filed within 3Yrs. • National Forum deals cases >10 lacs, state forum >5lacs & district forum upto 5lacs.

26. BILL OF RIGHTS • Respectful care • Complete information regarding diagnosis,tmt,&prognosis. • Pt. Has right to information from Dr before he gives consent. • Right to refuse tmt,to the extent permitted by law & to be informed of med. Consequences. • Right to privacy, all communication & records be treated as confidential. • Hosp must provide evaluation,service,&/or referral as indicated by the urgency of case.

27. Relationship of hosp to other hosp where one is being referred to. • Right to refuse to participate in research. • Right to know appointments/availability of DR, continuity of hlth care requirements after discharge. • Right to examine & receive explaination of bill. • Right to Hospital rules.

28. Offences & Professional Misconducts • Adultery/improper conduct/association with patient. • Issuing false certificates. • Conviction by court of law for offences involving moral factors. • Selling of schedule poisons • Performing an abortion or illegal operation/op without consent.Disclosing patients secrets. • Issuing certificates to unqualified persons. • Advertisement of services or the institutions run by the physicians. Use of agents.

29. Organ Transplant • There is no specific central legislation which permits sale/purchase of organs. Indian law is silent on trade in human organs. • Transplant of Human organs Bill1992 is under consideration deals with various aspects of organ transplantation.It deals with measure to curb malpractice,punishment for donors,doctors & even advertisement seeking donation of organs.

30. MTP ACT 1972 • Specifies conditions under which pregnancy can be terminated., the persons who can perform termination & places where such procedures can be performed. It can be performed either in Govt. hosp or other places approved by the Govt.

31. Current Ethical Issues • Aids • Abortions • Euthanasia • Sterilization • Adoption of children • Ethical issues & poor patients • Ethical Issue of Examination of females. • Use of new drugs on trial on patients.

32. ETHICAL ISSUES • We will have to treat every case on its merits, if we do our best in all honesty, we will make the decision right. Respect for a patient is fundamental to the Dr. pt relation ship & respect we show reflects what we think of the patient’s worth.