1

Student Name: Mohamed Rifas Course: MBA HCS

Registration Number: 1302018756 LC Code: 00205
Subject Name: Legal Aspects in Healthcare Administration Subject Code: MH0058


Question 1- What is professional secrecy? Discuss the exceptions to the rule of confidentiality.


Answer1- Professional secrecy is an implied term of contract between the medical practitioner
and his patient. Its disclosure would be a breach of trust and confidence and would render the
medical attendant liable to damages. One of the most basic medical values is the sanctity of the
doctor-patient relationship and the confidentiality of the communication between the physician
and the patient. It must, however, be remembered that a medical witness is bound to reveal
them in a judicial proceedings, if ordered by the court. Patients in health care settings have a
legal and moral right to privacy, which includes confidentiality of all information related to the
patient. Although patient's confidentiality has been a fundamental ethical principle since the
Hippocratic Oath, it is under increasing threat in the changing health and social scenarios.
Emergence of new diseases like AIDS, increased cognizance of criminal acts like child abuse,
technological sophistication like DNA testing, modern data storage like electronic technology in
medical records are some examples of these changing scenarios. Such threats to patient's
confidentiality have to be addressed after due inter professional interactions.

Patient's secrets are theirs and theirs alone. Generally a doctor can divulge these only with the
patient's permission. Some common situations involving patient's confidentiality arise in the
following circumstances.

1. Management of the patient:
2. Medical research:
3. Medical education:
4. Disclosure of sensitive information:
5. Medical Records:



Exceptions to confidentiality

Even if confidentiality and the obligation of professional secrecy are extensive, there are some
cases when confidentiality can be broken without the consent of the patient. Those are

When a court, prosecutor, police, law enforcement, or tax authority demands to know if a
certain person is being treated at a health care institution.
When the National Board of Health and Welfare requires the information for their
activities.
When the Agency needs the information to review someone's suitability for having a
driver's license, a tractor license or a taxi driver's licence.
2

When the information is needed for reviewing if a student should be suspended from
studying at university.
When the information is needed in a forensic investigation.

Regarding suspicion of a crime that is severe enough to warrant at least one year in prison,
health care professionals have the right to break confidentiality by reporting the crime to the
police, and answer the questions made by the police and prosecuting authorities. Examples of
such crimes are murder, rape, and aggravated assault. There some traffic offences with milder
penalties, like driving under the influence, which health care professionals are entitled to report.

Special exceptions for children
Exceptions to the obligation of professional secrecy are made when it comes to children, if
health care professionals suspect that the child is being subjected to a crime, like assault or
sexual abuse.

If health care professionals suspect that a child is being harmed, they should report their
suspicions to social services, who then conduct an investigation and later report to the police if
necessary. The same thing applies if there is an investigation under way regarding a minor's
need of protection. Then, healthcare professionals are obligated to give out information that can
be of value to the investigation.


Thus Professional Secrecy is an important commitment for the society in the Medical profession
and has to be handled in the best way so that no ones rights are beings hindered.



Question 2 - Explain the following concepts:
a. Accountability to patients
b. Vicarious liability

Answer 2(a Accountability to patients)-
Comprising physicians from around the state and numerous specialties, and including legal
experts and patient safety advocates from the consumer and hospital arenas, the Workgroup
has crafted a long-term strategy to achieve these ends.

Put simply, accountability is about taking responsibility for your actions.

What it means in practice is that whatever you do in your work as a health care assistant, you
should be able to justify it as a sensible course of action. This means that whatever you do:

You should know why youre doing it.
You should have been properly trained and assessed as being competent to do it.
You should be doing it as part of an agreed plan of care for the patient/client.
Even though youll always be working under the supervision of a registered member of
staff whos accountable for the overall care given by the team, youre still accountable for
what you do as part of the team.
3


Youre accountable to your patients/clients, to whom you owe what is called a duty of care. In
health care, there will be times when your actions could cause harm to a patient/client if not
carried out in a careful and competent way. There are also times where your failure to do
something that a health care assistant would normally be expected to do what is called an
omission could also cause a patient/client harm. Health care assistants are legally
accountable to patients/clients for any errors they make, or any acts they fail to take, that cause
the patient/client harm, and the patient/client is entitled to pursue the case through the civil law.
In very extreme cases, where a patient/client has died due to an error or omission, the case
might be pursued through the criminal courts.

Youre also accountable to your employer, who must set out in your contract of employment the
duties youll be expected to perform. You then become accountable to the employer for safely
and effectively carrying out those duties, and failure to do so can result in disciplinary action.
Your employer has accountability to you as well, however, and the RCN has suggested that
employers must support you to carry out your duties safely and effectively by:

Making your duties clear and ensuring you have the right training to carry them out safely
and effectively.
Making the boundaries of your role very clear.
Providing agreed protocols to guide care delivery (protocols are discussed more details in
the Protocols section).
Ensuring you have adequate support and supervision in your role.
Offering you opportunities to develop in your role.
Making issues around delegation clear.

There may be a code of conduct that applies to you in your country or, indeed, your organisation
ask your manager or supervisor to advise you on what codes apply to you, then study them to
make sure you comply. This makes accountability more clear.

Answer 2(b Vicarious liability)-

Hospitals in India may be held liable for their services individually or vicariously. They can be
charged with negligence and sued either in criminal/ civil courts or Consumer Courts. As
litigations usually take a long time to reach their logical end in civil courts, medical services have
been brought under the purview of Consumer Protection Act,1986 wherein the complainant can
be granted compensation for deficiency in services within a stipulated time of 90 -150 days.

Hospitals liability with respect to medical negligence can be direct liability or vicarious liability.
Direct liability refers to the deficiency of the hospital itself in providing safe and suitable
environment for treatment as promised. Vicarious liability means the liability of an employer for
the negligent act of its employees. An employer is responsible not only for his own acts of
commission and omission but also for the negligence of its employees, so long as the act occurs
within the course and scope of their employment.

Vicarious liability
A hospital can be held vicariously liable on numerous grounds on different occasions.
4


The hospital authorities are not only responsible for their nursing and other staff, doctors, etc.
but also for the anesthetists and surgeons, who practice independently but admit/ operate a
case. It does not matter whether they are permanent or temporary, resident or visiting
consultants, whole or part time. The hospital authorities are usually held liable for the negligence
occurring at the level of any of such personnel. Where an operation is being performed in a
hospital by a consultant surgeon who was not in employment of the hospital and negligence
occurred, it has been held that it was the hospital that was offering medical services. The terms
under which the defendant hospital employs the doctors and surgeons are between them but
because of this it cannot be stated that the hospital cannot be held liable so far as third party
patients are concerned. The patients go and get themselves admitted in the hospital relying on
the hospital to provide them the medical service for which they pay the necessary fee. It is
expected from the hospital, to provide such medical service and in case where there is
deficiency of service or in cases like this, where the operation has been done negligently without
bestowing normal care and caution, the hospital also must be held liable and it cannot be
allowed to escape from the liability due to reason of non-existing master-servant relationship
between the hospital and the surgeon.


In many cases of negligence against government hospitals, it has been held that the State is
vicariously liable for negligence of its doctors or staff or even primarily liable where there is lack
of proper equipment or staff. In few cases, court has passed orders to the effect that the
compensation paid to the complainant may be recovered from the government doctors whose
negligence has been established.


Compensation can be awarded to an injured person for not being provided treatment in a
Government hospital or for death or injury caused therein because of negligence. Appointing
practitioners of Alternative Systems of Medicine [Ayurveda/ Unani/ Sidha] or Homeopaths in
hospitals giving services in allopathy too amounts to negligence.

The hospitals must keep their services and staffs better so that they can serve their patients
better without letting them go on for a Vicarious liability case.




Question 3- Which are the 3 types of inquests in India? Explain

Answer 3- An inquest is a judicial inquiry in common law jurisdictions, particularly one held to
determine the cause of a person's death. Inquests are only conducted when deaths are sudden
or unexplained.

An inquest uses witnesses, but suspects are not permitted to defend themselves. The verdict
can be, for example, natural death, accidental death, misadventure, suicide, or murder. If the
verdict is murder or culpable accident, criminal prosecution may follow, and suspects are able to
defend themselves there.
5


There are 3 types of Inquests. They are:

1) Police Inquest:
In India, normally the inquest is mannered through a police officer, not below the rank of a
head constable. A police officer conducting an inquest is recognized as an investigating
officer. Whenever a suspicious death occurs anywhere, the information reaches the local
police officer first of all. He immediately informs the Executive Magistrate of the area and
then proceeds to the place where the body is lying.

The usual papers that the report contains are:-(i) Brief facts of the case (ii) statements and
opinions of two or more relatives or neighbors or friends of the deceased (iii) a sketch of the
scene where the body is lying (iv) a form filled up through the police officer himself, giving
details of injuries as visualized through him (v) any treatment records, if the person had been
getting some treatment for some disease or injury prior to his death (vi) a copy of the MLC, if
this was made at the time the patient was brought to the hospital (vii) statement of the
deceased prior to his death concerning his cause of death(viii) suicide note of the deceased
if this was found (ix) a copy of the First Information Report (FIR), if this had been lodged with
the police (x) any other relevant paper (for instance, the railway ticket found in the
deceased's wallet, if the body was found on a platform. It may indicate where he was
traveling from and where to). After preparing the inquest report, the police Officer may come
to one of the two conclusions; either there has been a foul play or there has been none. In
either case, his subsequent action would be different..

2) Magistrate's inquest
The magistrate's inquest is held under section 176 of the Cr.P.C. This means an inquiry
mannered through a magistrate to ascertain certain matters of fact. The law (i.e. section 176 of
Cr.P.C.), specifically directs the Magistrate to hold an inquest in following types of cases:-

Death occurring in police custody
Suicide of a woman within seven years of marriage
Death of a woman within seven years of marriage in any circumstances raising a
reasonable suspicion that some other person committed an offence in relation to such
woman.

In addition to the above 3 cases in which a magistrate is legally bound to hold an inquest, the
magistrate reserves the right to hold an inquest in any other case of death which he deems fit.
On receipt of information of death through the police officer, he may choose to hold an inquest
himself.

3) Coroner's inquest
This means an inquiry mannered through a coroner into the cause and manner of death. In
India, the Coroner's inquest is no more done now. It was actually a legacy of the English Raj that
we had for over 200 years. The Coroners inquest is of historical importance only.

The Coroner: As already stated, in India, the coroners inquest is no more held. The following
discussion is meant for people interested in Coroner's inquest for historical research. Coroner
6

used to be a special officer appointed through the government to inquire into causes of unnatural
deaths. The Coroner was required to have a legal qualification and is usually an advocate,
attorney, pleader, or first class magistrate, or a transferred metropolitan magistrate (all of whom
necessity have a minimum of five years experience in the legal field). He held the rank of a First
Class Judicial Magistrate.

These are the 3 types of Inquests In India



Question 4- Define abortion. Explain medical termination of pregnancy act in detail.

Answer 4- Abortion is the termination of pregnancy by the removal or expulsion from the uterus
of a fetus or embryo before viability. An abortion can occur spontaneously, in which case it is
often called a miscarriage, or it can be purposely induced. The term abortion most commonly
refers to the induced abortion of a human pregnancy. After viability, the relevant procedure is
referred to as a "late termination of pregnancy". Modern medicine utilizes medications and
surgical procedures for induced abortion.

Abortion, when induced in the developed world in accordance with local law, is among the safest
procedures in medicine. Uncomplicated abortions do not cause either long term psychological or
physical problems. Unsafe abortions, however, result in approximately 47,000 maternal deaths
and 5 million hospital admissions per year globally.

Termination of Pregnancy and Abortion in India

Abortion has been legal in India since 1971, when the Medical Termination of Pregnancy Act
was passed. The law is quite liberal, as it aims to reduce illegal abortion and maternal mortality.

An abortion can be performed in India until the 20th week of pregnancy. The opinion of a second
doctor is required if the pregnancy is past its 12th week.

The Medical Termination of Pregnancy Act was amended in 2002 and 2003 to allow doctors to
provide mifepristone and misoprostol (also known as the morning-after pill) on prescription up
until the seventh week of pregnancy.

An abortion is permitted in the following cases according to MTP Act:

A woman has a serious disease and the pregnancy could endanger her life
A womans physical or mental health is endangered by the pregnancy
The foetus has a substantial risk of physical or mental handicap
A woman contracts rubella (German measles) during the first three months of pregnancy
Any of a womans previous children had congenital abnormalities
The foetus is suffering from RH disease
The foetus has been exposed to irradiation
The pregnancy is the result of rape
7

A womans socio-economic status may hamper a healthy pregnancy
A contraceptive device failed

Permissions required

If a woman is married, her own written consent is sufficient. Her husbands consent is not
required
If a woman is unmarried and over 18, she can provide her own written consent
If a woman is unmarried and under 18, she must provide written consent from her
guardian
If a woman is mentally unstable, she must provide written consent from her guardian

Procedure of performing an abortion

Abortions can be performed in any medical institution that is licensed by the government to
perform medically assisted terminations of pregnancy. Such institutions must display a certificate
issued by the government.

Abortions must be performed by a doctor with one of the following qualifications:

A registered medical practitioner who has performed at least 25 medically assisted
terminations of pregnancy
A surgeon who has six months experience in obstetrics and gynaecology
A person who has a diploma or degree in obstetrics and gynaecology
A doctor who was registered before the 1971 Medical Termination of Pregnancy Act and
who has three years experience in obstetrics and gynaecology
A doctor who registered after 1971 and has been practising in obstetrics and
gynaecology for at least a year

Thus is described the MTP Act.


Question 5- Explain medical negligence. List the various rights and responsibilities of the
patient.

Answer 5-
Any negligence by an act or omission of a medical practitioner in performing his/her duty is
known as medical negligence. Medical negligence happens when the medical practitioner fails to
provide the care which is expected in each case thus resulting in injury or death of the patient.


It can be any tort or breach of contract of health care or professional services rendered by a
health care provider to a patient. The standard of skill and care required of every health care
provider in rendering professional services or health care to a patient shall be that degree of skill
and care ordinarily employed in the same or similar field of medicine as defendant, and the use
of reasonable care and diligence.
8



In medical negligence cases it is the duty of the patient or his/her relatives to establish that:

1. there was a duty which the medical practitioner owed to the patient;
2. there was a breach of duty;
3. the breach resulted in injury to the patient;
4. the injury resulted in causing damages.


RIGHTS OF THE PATIENT
Patients rights emanate from human rights, constitutional rights, civil rights, consumer rights,
codes of ethics of medical and nursing profession. The Indian Constitution bestows certain rights
on the citizens. One of them is Right to life. Right to a healthy life is an integral part of the Right
to life. WHOs definition of health includes physical, mental, social, environmental and spiritual
aspects of health. Any threat to health care must be considered as denial of the Right to Life.
Basic optimal health care is the right of every Indian citizen and it is the responsibility of the state
to provide it. The Government in the country has legislated certain laws to protect the citizens.
Some of these are, The Drugs and Cosmetics Act, The Medical Council Act and The Consumer
Protection Act. The codes of ethics of medical and nursing councils define the duties of the
doctors and nurses towards the patients. Thus these duties form the basis of patients rights.

Right to considerate and respectful care.
Right to information on diagnosis, treatment and medicines.
Right to obtain all the relevant information about the professionals involved in the patient
care.
Right to expect that all the communications and records pertaining to his/her case be
treated as confidential
Right to every consideration of his/her privacy concerning his/her medical care
programme.
Right to expect prompt treatment in an emergency
Right to refuse to participate in human experimentation, research, project affecting his/her
care or treatment.
Right to get copies of medical records
Right to know what hospital rules and regulations apply to him/her as a patient and the
facilities obtainable to the patient.
Right to get details of the bill.
Right to seek second opinion about his/her disease, treatment,etc.


RESPONSIBILITIES OF PATIENTS:

To faithfully undergo the agreed therapy.
To follow the doctors instructions diligently.
To take necessary preventive measures in case of infectious diseases as per the doctors
instructions.
9

To be aware that doctors and nurses are also human beings and are amenable to
mistakes and lapses.
To make the payment for the treatment, wherever applicable, to the doctors/hospital
promptly.
To respect the autonomy of the doctors and nurses.
To treat doctors and nurses with respect.
To be punctual to attend the clinics/hospital/dispensary for the treatment at the given
time.
To preserve all the records of ones illness.
To keep the doctor informed if the patient wants to change the hospital/doctor.

These are the rights and responsibilities of a Patient.




Question 6- Discuss the important documents and ethical codes in medical ethics

Answer 6- Practice of medicine is a profession and not a business. The Doctor-Patient
relationship is sacred and the practice of medicine is guided by a code of Ethics.

The oldest code of medical ethics is the Hippocratic oath. It has been reconstructed by the World
Medical Association and known as Declaration of Geneva and is adopted by the Medical Council
of India as the code of ethics for Medical Personnel.

Duties and obligations of doctors are enlisted in ordinary laws of the land and various Codes of
Medical Ethics and Declarations - Indian and International, which are :
(i) Code of Medical Ethics of Medical Council of India
(ii) Hippocratic Oath
(iii) Declaration of Geneva
(iv) Declaration of Helsinki
(v) International Code of Medical Ethics
(vi) Government of India Guidelines for Sterilization

The Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and physician assistants. It is
one of the most widely known of Greek medical texts. It requires a new physician to swear, upon
a number of healing gods, to uphold specific ethical standards. Of historic and traditional value,
the oath is considered a rite of passage for practitioners of medicine in many countries, although
nowadays the modernized version of the text varies among them.

Scholars widely believe that Hippocrates, often called the father of medicine in Western culture,
or one of his students wrote the oath. The oath is written in Ionic Greek (late 5th century BC), It
is usually included in the Hippocratic Corpus.

Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, an idea
that others questioned for lack of evidence for a school of Pythagorean medicine.
10



The Declaration of Geneva
The Declaration of Geneva (Physician's Oath) was adopted by the General Assembly of the
World Medical Association at Geneva in 1948, amended in 1968, 1983, 1994 and editorially
revised in 2005 and 2006. It is a declaration of a physician's dedication to the humanitarian
goals of medicine, a declaration that was especially important in view of the medical crimes
which had just been committed in Nazi Germany. The Declaration of Geneva was intended as a
revision of the Hippocratic Oath to a formulation of that oath's moral truths that could be
comprehended and acknowledged in a modern way.

These must be kept in mind for those who makes their profession in the medical field.