MEDICO LEGAL ISSUES

INTRODUCTION

A medico-legal case is one where besides the medical treatment; investigations by law enforcing agencies,
are essential to fix the responsibility regarding the present condition of the patient. The case therefore has both
medical and legal implications. Registering MLC is a MUST.

DEFINITION

A medico-legal case can be defined as a case of injury or ailment etc, in which investigations by
the law-enforcing agencies are essential to fix the responsibility regarding the causation of the
injury or ailment .

TERMINOLGY
MLC-Medico legal cases :-Malpractice-a dereliction of professional duty or a failure to exercise an ordinary
degree of professional skill or learning by one (such as a physician) rendering professional services which
results in injury, loss, or damage .

Assault and battery-The action of threatening a person together with the action of making physical contact
with them.

Consent- Concent is your agreement for a doctor or healthcare professional to provide you with treatment ,
including any medical or surgical management , care , therapy , test or procedure .

Abortion-Abortion is the ending of a pregnancy by removal or expulsion of an embryo or fetus.

IVF - In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the
body, in vitro ("in glass")

Surrogacy-The process of giving birth as a surrogate mother or of arranging such a birth.

A. LEGAL ISSUES SPECIFIC TO NURSING

Nurses face legal issues daily. Those issues may be in connection to negligence, administering
medication and advocating for the patient. The Nurse Practice Act lists all of the duties and role of a
nurse, except the legal and ethical issues. If these duties and regulations are not followed, the nurse
is at risk of losing his license and facing a malpractice suit.

 Duty to seek Medical Care for the patient

It is the legal duty of the nurse to ensure that every patient receives safe and competent care. The
nurse cannot guarantee the patient will receive medical care that the nurse be a strong advocate for
the patient and use every resource to ensure medical care is received. If you determine that a patient
in any setting needs medical care and you do not do everything within your power to obtain that
care for the patient, you have breached your duty as a nurse.

 Confidentiality

 It is a privilege to care for other people. At times, your patients will relate to you in a personal
way. One of the outcomes of your relationship is that you may be told information of a personal
nature in addition to what a patient may share with you, you have access to the person‘s
hospital records.

 The law requires you to treat all such information with strict confidentiality. This is also an
ethical issue. Unless a patient has told you something that indicates danger to self or others, you
are bound by legal and ethical principles to keep that information confidential.
 Permission to treat

 When people are admitted to hospitals, nursing homes and home health services, they sign a
document that gives the personnel in the organization permission to treat them. Every time the
nurse provides nursing care to person, however, permission must be obtained.

 The courts have ruled that people are expected to have some understanding of basic care, which
means the nurse should explain briefly what he or she is about to do.

 When you are giving medication, you may say, ―Here are your pills, Here is the new
medication the doctor ordered for you.‖ If the patient takes the medication, he or she has given
you permission to treat.

 Informed consent

 The concept of permission to treat is closely tied to the concept of informed consent. The law

states the persons receiving health care must give permission to treat based on informed consent.

The principle of informed consent states that the person receiving the treatment fully understands

the possible outcomes, alternatives to treatment and all possible consequences.

 The physician is responsible for obtaining informed consent for medical procedures, such as

surgery, whereas the nurse is responsible for obtaining informed consent for nursing procedures.

Each institution has forms for informed consent for complex or serious procedures, such as

surgery, chemotherapy, electroconvulsive therapy.

 Surgical procedures commonly require informed consent. Although the law states that either

verbal or written consent is acceptable, most institutions require written consent because it is the

most legally binding. It is the physician‘s responsibility to give the surgical patient the

information necessary to meet the requirements for informed consent. It often is the

responsibility of the nurse to get the surgical consent from signed .

 Advance Directives

 Although the Patient Self – Determination Act was passed by the U.S. Congress in 1990, it was
not implemented until 1992. The act states that all the health care institutions are required to
give clients or patients an opportunity to determine what lifesaving measures or life-prolonging
actions they want implemented.

 This requirement applies to all hospitals, long term care facilities, and home health agencies
and is to be done at the time of admission. The institution is required to give adequate
information to the person and assist in completing any forms.

 In most situations, the nurse is responsible for educating patients if there is not enough
information to make an informed decision.

 The purpose of advanced directives is to give the person an opportunity to make decisions
regarding healthcare before an illness or a need for treatment that would prohibit making such
critical decisions.

 Negligence

 The law requires nurses to provide safe and competent care. The measure of safe and
competent care is the standards of care. A standard of care is the level of care that would be
given by a comparable nurse in a similar situation.

 Negligence occurs when a person fails to perform according to the standards of care or as a
reasonably prudent person would perform in the same situation. It is the responsibility of the
nurse to monitor the patient.

 If a patient calls for a nurse to come and assist him in going to the restroom for example, the
nurse is to assist, or if she is busy with another patient, have another nurse assist the patient.
Ignoring the patient or responding after a lengthy delay could be considered negligence and if
the patient is hurt from trying to move himself, the nurse could face legal suits.

 Also, it could be considered negligence if a physician orders the nurse to administer a

prescription, and the nurse did not do so.

Requirements to establish Negligence

There are four legal requirements that must be met for negligence to be proved:-

 A standard of care exists.

 A breach of duty or failure to meet the standard of care has occurred.

 Damages or injury has resulted from the breach of duty. (This could be commission of an
inappropriate action or omission of a necessary or appropriate act).

 The injury or damage must result from the nurse‘s negligence. I have never met a nurse whose
goal was to be negligent, but it doesn‘t happen.

Examples of negligent acts are:-

 Leaving a patient‘s bed in high position with the side rails down and the patient gets confused
during the night and falls out of bed.

 Committing medications errors of either omission (not giving the drug) or commission (giving the
wrong drug).

 Breaking sterile technique when changing a dressing, with a resultant wound infection.

 Mistakenly ambulating a patient who is on bed rest.

Nurses are not supposed to make mistakes, yet the best educated and well intentioned nurse can. To
avoid neglect, you need to pay attention to the details of your assignment and focus on managing
your workload efficiently. It is important to practice such skills now while you are a student and
have an instructor to help you determine the most effective way to get your work done.

 Malpractice

Malpractice is a term used for negligence. Malpractice specifically refers to negligence by a

professional person with a license. You can be sued for malpractice once you have your LPN
license. If you are a nursing assistant right now, you may be negligent, but it wouldn‘t be
malpractice because you are not licensed.

 Fraud

Few cases of fraud exist in nursing, but it does need to be mentioned. Fraud is a deliberate
deception for the purpose of personal gain and usually is prosecuted as a crime. Most courts are
harder on cases of fraud compared with cases of negligence or malpractice because fraud is
deliberate and results in personal gain.

 Assault and Battery

 It is found that most nurses do not understand the definitions for assault and battery. It is
important to your practice that you do understand them.

 Assault is the threat of unlawful touching of another, the willful attempt to harm someone.

 Battery is the unlawful touching of another without consent, justification, or exercise. In legal
medicine battery occurs if a medical or surgical procedure is performed without patient
consent.

 In both situations, it is not necessary for harm to occur. The events simply need to happen. If
you understand and practice the caring and empowering concepts shared in this test, you should
never have to be concerned about assault and battery.

 Assault can be verbally threatening a patient. Rather than threaten a patient, you need to use
your creative tactics to assist the patient in whatever is his or her choice in the matter. You do
not have to hurt the person. If you practice transpersonal caring, however you should not have
to be concerned with these legal issues.

 False Imprisonment

 Preventing movement or making a person stay in a place without obtaining consent is false
imprisonment. This can be done through physical or non physical means.

 Physical means include using restraints or locking a person in a room.Insome unique situations,
restraints and locking patients in a room are acceptable behaviours.This is the case when a
prisoner comes to the hospital for treatment or when a patient is a danger to self or others.

 In these situations, be sure you know the standards of care and the institution‘s policies
regarding physical restraints. To restrain a person is a serious decision. It requires a physician‘s
order and permission of the patient or the patient‘s family members.

 It is used to be common practice to use restraints on nursing home residents who wandered or
had other behaviours that were difficult to manage. This is no longer an acceptable standard of
care. The best approach to avoiding a charge of false imprisonment is to work closely with
patients who seem at risk for confinement.

 Talk to them, do an ongoing assessment, assign extra staff to assist the person, or implement
some other creative way to manage the problem. To resolve such complex issues is truly
practicing the art of nursing.

 Invasion of privacy
Clients have claims for invasion of privacy‘, e.g. their private affairs, with which the public has no
concern, have been publicized. Clients are entitled to confidential health care. All aspects of care
should be free from unwanted publicity or exposure to public scrutiny. The precaution should be
taken sometimes an individual right to privacy may conflict with public‘s right to information for
e.g. in case of poison case.

 Nurse Practice Act

 Each state has what is called a Nurse Practice Act. The guidelines and laws outlined in the act
pertain to all nurses who are licensed in that particular state. Nurse limitation is one of those
laws. Each nurse has a limitation on what he is allowed and trained to do.

 He must follow the chain of command, especially with the care of a patient. If he does not have
the authority or knowledge to give a prescription, analyze a lab report, or advise the patient on
treatment, he may not legally do so.

 Any wrong information or practice he commits is punishable by the law and the patient or
family may file a suit against him and the health agency or hospital he works for.

 Patient's Advocate

A nurse has a legal obligation to act as the patient's advocate in case of emergency. The nurse is to
act as the liaison between the patient and the health care provider, such as a physician. The nurse
will monitor the patient, ensuring that if any complications or abnormalities arise, a physician
notified immediately. The nurse is legally obligated to keep the personal data and information of the
patient private; not doing so is a violation of the code of ethics for nurses.

 Administering Medication

Nurses are responsible for administering the correct doses and medications to patients. If the nurse
gives a fatal dosage amount, she may face legal malpractice suits. It is also the responsibility to
research the patient's records, or ask the patient and family members if there are any allergies or
complications that may pose a risk if a certain medication is administered.

 Report It or Tort It

Allegations of abuse are serious matters. It is the duty of the nurse to report to the proper authority
when any allegations are made in regards to abuse (emotional, sexual, physical, and mental)
towards a vulnerable population (children, elderly, ). If no report is made, the nurse is liable for
negligence or wrongdoing towards the victimized patient.

Examples of legal torts

 Invasion of Privacy example: a nursing student observing a procedure without the client's

consent or taking photos of the client.

 False imprisonment example is telling the client that he/she may not leave the hospital or the
use of restraints.

 Battery example: performing procedure without consent such as resuscitation.

 Rights to Privacy
The nurse is responsible for keeping all patient records and personal information private and only
accessible to the immediate care providers, according to the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). If records get out or a patient's privacy is breached, the
liability usually lies on the nurse because the nurse has immediate access to the chart.

 Document

It is the nurse's responsibility to make sure everything that is done in regards to a patient's care
(vital signs, specimen collections, medication administration, etc.), is documented in the chart. If it
is not documented with the proper time and what was done, the nurse can be held liable for negative
outcomes. A note of caution: if there was an error made on the chart, cross it out with one line (so it
is still legible) and note the correction and the cause of the error.

B. LEGAL ISSUES IN SPECIALITY AND PRACTICE AREA

MATERNAL AND INFANT NURSING

Many legal issues are involved in the care of mother and her infant. Generally the causes of lawsuits
for malpractice in this area may be divided into two categories who handling the mother and child.
Lawsuits brought against physicians/ doctors and nurses differ, reflecting the wellrecognized
differences between these professions and their responsibilities. A likely against a doctor who is in
charge of looking after mother and infant might be one of the following:-

 Failure to diagnose a high risk pregnancy.

 Delay in performing a caesarean section.

 Improper vaginal delivery or failure to perform a caesarean section.

 Improper use of forceps.

 Incidence surrounding including labour and the use of oxytocin.

 Delay in arriving at the hospital.

 Non attendance at the delivery.

The common causes for lawsuits against nurses will include the following:-

 Problems of medication

Nurses are authorized to administration of medication. So many allegations against nurses with
regard to medication dosage, route or time, and failure to monitor side effects, for e.g. nurses are
often involved in the administration of oxytocin for the augmentation of labour.

 Failure in adequate client monitoring.

Nurses are expected to monitor their clients at appropriate time intervals that depend upon the
client‘s condition. Labour and delivery pose a unique monitoring challenge, in that there are two
clients to monitor, the mother and baby. The delivering mother must be adequately monitored to
prevent any maternal complications during prenatal period. Nurses have legal responsibilities
regarding fetal monitoring during labour. And prompt monitoring will be continued during natal
period, postnatal period to prevent complication related to mother and child in respective periods.

 Failure to adequately assess the client.

Every nurse regardless of the area of practice is expected by virtue of his or her licensure to be
capable of performing assessment. The nurse is an important member of the health care team who is
the client constantly, and responsible for the minute by minute evaluation of the client progress.
Nurses in all specialty areas must maintain the higher level of assessment skills.

 Failure to report changes in the patient

 Whenever the nurses‘ assessment indicates that the client‘s condition has changed, the nurse
must notify the concerned physician. For example the nurses failure in reporting changes in the
child, denied the physician the opportunity to intervene and possibly save the child‘s life.

 When a nurse reports a client‘s changed condition to the physician, the nurse feels that the
physician has not responded in a manner that is in the client‘s best interest, the nurse must
proceed up the chain of command until proper medical care is given to the client.

 As a patient advocate, nurses must understand that failing to notify a doctor of a problem often
leads to a delay in appropriate medical care being implemented. This in turn can lead to an
injury to the client and a lawsuit.

 Abortions

Abortion is one of the emotionally charged issues confronting nurses. Nurses cannot be forced to
participate in procedures they find morally offensive. Nurses have right to refuse to assist with
abortions. However, nurses cannot attempt to stop an abortion being performed. She can assist with
abortion if it is performed under Medical Treatment of pregnancy Act.

 Nursing care of new born.

There are certain legal requirements in providing nursing care for newborns, such as properly
identifying the infant- mother pair as soon as possible with finger prints, foot prints and wrist bands.
Standards of practice include providing a clear airway, clamping the umbilical cord, applying
antibiotics or silver nitrate to the edges and keeping infant warm. Resuscitation equipment must be
in the delivery room. When a still born infant is delivered, the nurse must record all events about the
delivery. Although the atmosphere in a delivery room is disquieting, the nurse must complete legal
requirement by careful documentation .

 Informed Consent

 Before treatment, diagnostic procedures, or experimental therapy, a patient must be informed of

the reasons for the treatment as well as possible adverse effects and alternative treatments.

 The physician must obtain signed consent.

 The nurse must ensure that signed consent is in the patient‘s chart before the procedure is
performed.

 Prenatal Screening

 Can detect inherited and congenital abnormalities long before birth.

 Early diagnosis may allow repair of an abnormality in utero.

 May force a patient to choose between having an abortion and assuming the emotional and
financial burden of raising a severly disabled child.
 Helps the patient fully understand the procedure.

 Pretest and post test counseling are essential parts of an ethical prenatal- screening program.

 In vitro fertilization (IVF)

 With IVF, the ovum is fertilized outside the body and then implanted into the uterus. Between 15
and 20 embryos may result from a single fertilization effort.

 Only 3 to 5 of these embryos are implanted in the women‘s uterus.

 Ethical questions arise as to what to do with remaining embryos.

 Although the procedure has allowed infertile couples to have children, some are concerned that it
is unnatural.

 Surrogacy

 A surrogate mother carries a fetus for another couple, with the expectation that the couple will
adopt the neonate after he is born.

 Questions have evolved over the surrogate mother‘s legal rights to the infant.

 Fetal tissue research

 Fetal tissue has facilitated scientific research for Parkinson‘s disease, Alzheimer‘s disease,
diabetes, and other degenerative disorders.

 Transplanted fetal nerve cells help to generate new cells in the patient that somehow reduce
symptoms.

 Immaturity of the fetal immune system reduces the chances of the recipient rejecting the tissue.

 Some are concerned whether the number of abortions will increase in response to the need for
tissue and whether this is an ethical use of human tissue.

 Preterm and high risk neonate treatment

 Medical advances have improved survival rates for high risk neonates.

 Some are concerned about the physical, psychosocial and economic costs.

 The nurse must present all available options in a compassionate, unbiased manner using simple
terms.

 The nurse must help family members consider the pros and cons both initiating and withholding
treatment.

PEDIATRIC NURSING

 As in all areas of nursing practice, negligence involving pediatric clients is possible. Paediatric
nurses are responsible for preventing children, in their care, from accidentally harming
themselves.
 Cribs which sometimes have a restraining device over the top are designed to keep infants and
toddlers from climbing out of bed and injuring themselves. All poisonous substances and sharp
objects should be kept out of the reach of children.

 Children should be kept under constant surveillance to minimize opportunities for accidental
harm. It is advisable that the health care professional including nurses should report to the
concerned authority if they come across the suspected cases may be liable for civil or criminal
legal action.

 Every state and province with child abuse legislation requires that suspected child abuse or
neglect be reported. Health Care professionals such as nurses are mandated to report suspected
cases. Healthcare professionals who don‘t report suspected child abuse or neglect may be liable
for civil or criminal legal action.

MEDICAL SURGICAL NURSING

As in the case of paediatric clients, disoriented adults may require form of restraints to prevent
accidental self injury. Standard care, laws and regulations about the use of restraints and supervision
apply to nursing practice with medical surgical patient. Side rails are available on hospital beds for
adult patients. Some disoriented older patients may also require belt restraints to prevent them
falling of the bed. If patients fall off bed and injure themselves, they may bring a lawsuit against the
nurses and hospital. Nurses are responsible for performing all procedures correctly and exercising
professional judgement. A nurse who does not meet the accepted standards of practice or who
perform duties in a careless fashion runs a risk of being found negligence.

Some common acts of negligence in medical surgical nursing are as follows:-

 Over looked sponges, instruments needles

In the operation theatre, it is a responsibility of the nurse to count the sponges, instruments, needles
before the closure of the abdomen or any cavity. The nurse may be liable if she makes an error in
their court.

 Burns

The professional nurse is required to know the cause and effect of any heat application so as to
avoid burns. Some of the common heat applications are applications, of hot water bags, heating
pads, double sitz bath etc. The nurse could be held liable if she/he neglects to take proper safety
measure prior to application of such measures.

 Falls

The nurse could be held liable if a patient falls from the bed or due to improper securing of patient
on examination table or improper application of restraint or provision of a proper bed for an
unconscious patient or a child.

 Injury due to the use of defective apparatus or supplies

The defective bed pans infect patients. The nurse could be held liable if she uses equipment or
supplies them which she or he knows to be faulty, e.g. the use of unsterilized gauze of surgical
dressings.

 Injury due to administration of wrong medicine, wrong dosage and wrong concentration.
Administration of medicine without prescription by the concerned authority, mixing up of
poisonous and non poisonous drug in cupboards leading to errors, and failing to identify right
medication for right patient, in right dosage, at right time, considered as negligent act can be liable
to be used.

 Assault and battery

Failure to take the informed consent of the patient prior to any procedure, treatment, investigation
or operation, the nurse be held liable.

 Failure to report accidents

The nurse has a moral and legal responsibility to report to the concerned authority any accidents,
losses or unusual occurrences. Failure to do this is an act of negligence.

 Maintenance of records and reports

Failure to maintain accurate record and reports or removing a position of record may also make the
nurse liable. Nurses working in critical care units are also legally accountable for performing their
duties. Critical care nurses require additional training and ongoing intensive education to provide
them with information about advances in care methods to handle high- techmachines and electric
and electronic apparatus in addition to other critical care nursing measures. The possible legal
problems for critical care nurses are associated with use of electronic monitoring devices. No
monitor can be considered totally reliable and nurse must not completely depend on it. These may
be electrical hazards. The equipment should be checked routinely by engineers to ensure that a
patient will not receive any electrical shock .

 Critical care units

Nurses working in critical care settings are legally accountable for performing their duties. Critical
care nurses require additional training and ongoing in service education to provide them with
information about advances in methods of patient care. Possible legal problems for critical care
nurses are associated with the use of electronic monitoring devices. No monitor can be considered
totally reliable, and the nurse must not completely depend on it. There may also be electrical
hazards. The equipments should be checked routinely.

PSYCHIATRIC NURSING

The practice of psychiatric nursing is influenced by the law, particularly in concern for the rights of
patients and the quality of care they are receiving. A psychiatric nurse should be sufficiently
acquainted with the legal aspects of psychiatry so that she/he can be aware of the patient‘s rights
and can avoid giving poor advice or innocently involving herself/himself in a legal entanglement.

 Informal Admission

This type of admission to the psychiatric hospital occurs in the same way as a person is admitted to
a general medical hospital, i.e. without formal or written application. The individual is then free to
leave at any time, as he would be in a general medical hospital.

 Restraints

 Discharge

COMMUNITY HEALTH NURSING

In older days nurses were working under the control and supervision of doctors. But in modern
practice nurses are able to assess, diagnose, plan, implement and evaluate nursing care
independently. As we begin professional practice, it is essential to understand the law that defines
the nurse‘s responsibility and duties. Especially the community health nurse must be very careful
while doing services in the community. Because there is team of people working in the hospital.
Whereas in the community the community health nurses are alone and most of the time she is in a
position to implement the services at home. So, she must be more careful and she should have
enough knowledge on legal issues.

a. Intentional Torts

 Assault: It is a threat or an attempt to make bodily contact with another person without that
person‘s consent.

 Battery: It is an assault that is carried out with willful angry and violent or negligent touching
of another person‘s body or clothes.

Examples:-

 Forcibly removing patient‘s cloth.

 Injection with force or when refused by patient.

 Pushing a patient in floor or the chair.

 Defamation: It is an intentional tort makes derogatory remarks about another .

Slander: oral defamation of character.

Libel: Written defamation (petition)

E.g. About patient or co workers.

 Invasion of Privacy

 All information should be confidential.

 Interacting with the family members.

 Avoid unnecessary exposure.

 Checking of all machines.

 Carryout research activities.

 False Imprisonment: A person cannot be legally forced to remain in health centers or hospital.
(Unjustified intension)

 Fraud: Willful and purposeful interpretation or misinterpreting the outcome of procedure or a

treatment. (License may be prosecuted under the Nurse Practice Act ) .

b. Unintentional Torts

 Negligence: An act of negligence may be enacting of omission or commission.

 Malpractice or Negligence
 Liability: It involves four elements that must be established to prove that malpractice or
negligence has occurred.

 Duty: Execution of safety measures.

 Breach of Duty: Failure to note and report to the higher authority about the seriousness.

 Causation: Failure to use appropriate safety measures.

 Damages: Lengthened hospital stay and need for rehabilitation (Injection abscess)

Nurses Responsibilities

 Practice within the scope of nurse practice act.

 Observe agency policies and procedures.

 Establish standards by using evidence based practice.

 Always prefer patient‘s welfare.

 Be aware of relevant law and understand the limits.

 Practice within the area of individual competence.

 Upgrade technical skills by attending continuing nursing education (CNE) and seeking
certification.

 Following the standards of care and referral services.

 Proper action for needs and problems and appropriate treatment.

 Monitor the programme and proper reporting.

 Verify the medication errors and reactions.

Legal Safe Guards of Community Health Nurses

 Informed consent: Granted freedom, written or oral form (procedures, expected outcome,
Complication, side effects, and alternative treatment) .

 Collective bargaining: Policies, legal procedures, up to date knowledge.

 Competent practice: It is most important and best legal safeguard.

Respecting Legal Boundaries

 Institutional policies/ procedures should be adopted.

 Respecting individual rights.

 Developing rapport and working relationship with the community.

 Keeping careful documentation for all activities.

C. Legal, Ethical, Professional Issues in Nursing

These three main duties are generally considered to respect a patient's confidentiality and
autonomy , to recognise the duty of care .

 The Nursing and Midwifery Council

The NMC contains guidelines regarding the expectations of particular duties such as confidentiality,
medical research obligations, consent rights and autonomy. The nursing practice is expected to
comply at an individual level with these guidelines on a daily basis. The NMC’s ‘Code of
Professional Conduct: Standards for conduct, performance and ethics’ is widely adhered to in the
profession. To be registered, it is a general rule that nurses must undergo education in addition to
personally indicating through performance and training that they intend to follow ethical standards
to retain a licence for nursing .

 Respecting Confidentiality

 Its stipulates that Patients have a right to expect that information about them will be held in
confidence by their doctors & nurses . Confidentiality is central to trust between health
professionals and patients. Without assurances about confidentiality, patients may be reluctant
to give doctors & nurses the information they need in order to provide good care.

 In addition to the civil requirement to maintain confidentiality there is a professional

requirement for to maintain the patient's confidentiality and failure to do so is a breach of good
medical practice and will attract sanctions. There are also professional guidelines on how a
nurse must deal with a situation should she make a mistake.

 Respecting Autonomy

 The right to determine what happens to ones own body is the right to autonomy. The words
autonomy and autonomous are used in respect of a capacity, a condition and a right. Successful
relationships between doctors and patients depend on trust.

 To establish that trust you must respect patients' autonomy - their right to decide whether or not
to undergo any medical intervention even where a refusal may result in harm to themselves or
in their own death.

 Patients must be given sufficient information, in a way that they can understand, to enable them
to exercise their right to make informed decisions about their care. Any adult, mentally
competent person has the right in law to consent to any touching of the person.

 If he is touched without consent or other lawful justification, then the person has the right of
action in the civil courts . Battery where the person it actually touched, assault where he fears
that he will be touched .

List of do‟s and don‟ts as guidelines for safe practice

Do‟s

 Documention of all unusual incidences.

 Report all unusual incidences.

 Know your job description.

 Follow policies and procedures as established by your employing agency.

 Keep your registration updated.

 Perform procedures that you have been taught and that are within the standard scope of your
practice.

 Protect patients from injuring themselves.

 Remain alert and focused.

 Establish and maintain rapport with patients and family.

 Seek and clarify orders when the patient‘s medical condition changes.

 Practise safety with physician‘s verbal orders.

Don‟ts

 Remove side rails from patient‘s bed unless there is an order or hospital policy to do so.

 Allow patients to leave the hospital or nursing home unless there is an order or a signed release.

 Accept money or gifts from patients.

 Give advice that is opposite to physician orders or the nursing care plan.

 Give medical advice to friends and neighbours.

 Attempt to practice medicine.

 Witness a patient‘s will.

 Take medications that belong to patients.

 Worked as a licensed practical/vocational nurse in a state in which you are not licensed.

Roles and Functions of Nurse Manager in Legal Issues

The following are the leadership roles and managerial functions of a nurse manager in legal and
legislative issues:-

a. Serve as a role model by providing nursing care that meets or exceeds accepted standards of care.

b. Seeks professional certification to increase expertise in a specific field.

c. Reports substandard nursing care appropriate authorities.

d. Maintain nurse/ patients relationships that are respectful, caring and honest, thus reducing the
possibility of future lawsuits.

e. Practices nursing within the area of the individual competence.

f. Prioritizes patient‘s rights and welfare first in decision- making.

g. Demonstrates vision, risk taking and energy in determining appropriate legal boundaries for
nursing practices thus defining what nursing is and should be in the future.

h. Delegates to subordinates wisely, looking at the managers scope of practice and that of those
they supervise.

i. Understands and adheres to institutional policies and procedures.

j. Practices nursing with scope of state nursing within the scope of the state nurse practice act.

k. Monitors subordinates to ensure that they have a valid, current and appropriate license to practice
nursing.

1. Abstract

Gynaecologists, like other healthcare professionals, have a legal obligation to adhere to a reasonable standard
of care while acting in their professional capacity (the ‘duty of care’) . A breach of this duty, whether due to
an individual’s actions such as poor decision-making or corporate causes such as destitute safety culture in
the organisation, could lead to litigation. This review discusses the burden and causes of litigation in
gynaecology and outlines the process taken by a medico-legal claim. Failure to diagnose, intra-operative
complications, unnecessary surgery, consent issues, poor supervision and retention of foreign bodies are
common causes. An illustrative case study is presented and some ways of reducing the risk of litigation are
recommended .

2 . ABSTRACT

Abusive head trauma (AHT) is a medicolegal diagnosis based on medical information presented by
healthcare providers and determined by the judgment of legal professionals and jurors. The diagnosis not
only indicatesmechanism of action but also intention. As such, it is a unique diagnosis that presents the
neurosurgeon with many unfamiliar challenges. It is unfortunately common in the pediatric population, with
an incidence between 13 and 40.5 per 100,000 per year in infants younger than 1 year of age, and nearly a
quarter of those cases result in the death of the child.Thus, a diagnosis of AHT may progress to a legal
definition of homicide in select cases. The purpose of this article is to familiarize the pediatric neurosurgeon
with some of the more common medicolegal issues surrounding AHT as well as to discuss legal
commitments and ethical obligations of the neurosurgeon .

CONCLUSION

Medico-legal issues center mainly on the issue of consent, duty of care and rules of professional ethics. If the
clinicians properly obtained consent before starting medical procedure & treatment medical procedure or
treatment and also exercise care to the patient as well as observance of the rule of professional ethics, by so
doing the clinician can easily release himself from any charge or allegation arising from medico-legal cases .

Reference :
BOOKS
 Vati jogindra , principles and practice of nursing management and administration , Jaypee brothers
medical publishers , 2nd edition , page no - 54 .

 K. Deepak , C. Sarath Chandran , B.P. Mithun kumar , A comprehensive Text book on nursing
management , EMMESS Medical Publishers , Page no - 524-536 .

JOURNAL

 Bernstam VA. CRC Handbook of Gene Level Diagnostics in Clinical Practice. CRC Press; 1992 Aug 11 .

 Thomas J. Medical records and issues in negligence. Indian journal of urology: IJU: journal of the
Urological Society of India. 2009 Jul;25(3):384.
 Raveesh BN, Nayak RB, Kumbar SF. Preventing medico-legal issues in clinical practice. Annals of
Indian Academy of Neurology. 2016 Oct;19(Suppl 1):S15.

 Sinai Talaulikar V, Arulkumaran S. Medico-legal issues with CTG interpretation. Current Women's
Health Reviews. 2013 Aug 1;9(3):145-57.

 Edozien LC. Medico-legal issues in gynaecology. Obstetrics, Gynaecology & Reproductive Medicine.
2012 Oct 1;22(10):273-8.

WEBSITE

 Mr Rubin Migron, Medico Legal & ethical issues in nursing- issues in india, Published on Apr 24, 2017
at : https://www.slideshare.net/MigronRubin/legal-ethical-issues-in-nursing-issues-in-india .

 Dr sharma chetan , Medico-legal issues in casualty and Hosptial , Published on Nov 1, 2015 , Published
in: Health & Medicine at : https://www.slideshare.net/drchetansamra/medico-legal-issues .

 Dr Das N.C , Medico legal case, Published on Feb 27, 2012 , Published in: Health & Medicine, Business
at : https://www.slideshare.net/NcDas/medico-legal-case .