emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


11th August, Wednesday, 2010

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Doctors, not hospitals, guilty in negligence deaths

If a patient dies due to medical negligence in a hospital then its management cannot be prosecuted and it is only the doctors who should be penalized, the Delhi High Court has ruled. However, the court held that the management of the hospital would be liable in case of administrative negligence and failure to provide basic infrastructure to patients.

Justice Shiv Narayan Dhingra passed the order on a petition filed by Indraprastha Medical Corporation Limited challenging a metropolitan magistrate’s order for registration of a first information report against it for alleged medical negligence resulting in the death of a patient in 2007. Setting aside the trial court order, Justice Dhingra said: "The hospital or company cannot be held liable for the personal negligence of the doctor in giving wrong treatment." "If there is an administrative negligence or a negligence of not providing basic infrastructure, which results into some harm to an aggrieved person or such negligence which is impersonal, the hospital can be held liable".

The court, said that it is the doctor who treats the patients and hospitals should not be punished due to error on part of its medical staff. "The offence of medical criminal negligence cannot be fastened on the company since the company can neither treat nor operate a patient of its own."

"It is the doctor working in the hospital who treats and performs operations. It is the doctors who examines the patients and prescribe medicines. If there is a deliberate or negligent act of the doctor working in the hospital, it is the liability of the doctor and not of the hospitals for criminal negligence," the court said.

In the present case, the company contended that the hospital could not be held responsible as the patient was being treated by three doctors from the Department of Cardiology a few years back.

Judgment

Present petition has been filed by the petitioner for quashing of order dated 19th December, 2007, passed by learned Metropolitan Magistrate in a complaint case under section 336/337/471 read with section 34 IPC qua the petitioner. It is submitted that petitioner Indraprastha Medical Corporation Limited was a company incorporated under Companies Act and the company being only a juristic person was incapable of committing a crime of medical negligence, because it involved personal negligent act.

A complaint was filed before the learned M.M. against the petitioner company and the Doctors involved in the treatment of deceased wherein it was alleged that deceased died due to gross medical negligence of the Doctors. It is also submitted that Doctors involved in treatment advised wrong/superfluous treatments in order to extract extra money. The petitioner’s counsel stated that petitioner is not assailing the order as against Doctors but is assailing it so far as company was concerned on the ground that the company running the hospital, could not have acted in the manner in which it is assailed by the complainant.

In Standard Chartered Bank Vs. Directorate of Enforcement, 2005 SCC (Cri.) 961, SC made following observations regarding criminal liability of the Corporation:

"6. There is no dispute that a company is liable to be prosecuted and punished for criminal offences. Although there are earlier authorities to the effect that corporations cannot commit a crime, the generally accepted modern rule is that except for such crimes as a corporation is held incapable of committing by reason of the fact that they involve personal malicious intent, a corporation may be subject to indictment or other criminal process, although the criminal act is committed through its agents.

8. In as much as all criminal and quasi-criminal offences are creatures of statute, the amenability of the corporation to prosecution necessarily depends upon the terminology employed in the statute. In the case of strict liability, the terminology employed by the legislature is such as to reveal an intent that guilt shall not be predicated upon the automatic breach of the statute but on the establishment of the actus reus, subject to the defence of due diligence. The law is primarily based on the terms of the statutes. In the case of absolute liability where the legislature by the clearest intendment establishes an offence where liability arises instantly upon the breach of the statutory prohibition, no particular state of mind is a prerequisite to guilt. Corporations and individual persons stand on the same footing in the face of such a statutory offence. It is a case of automatic primary responsibility. It is only in a case requiring mens rea, a question arises whether a corporation could be attributed with requisite mens rea to prove the guilt. But as we are not concerned with this question in these proceedings, we do not express any opinion on that issue." In Kalpnath Rai Vs. State, 1998 AIR (SC) 201, SC made following observations:

"The company is not a natural person. We are aware that in many recent penal statutes, companies or corporations are deemed to be offenders on the strength of the acts committed by persons responsible for the management of affairs of such company or corporations e.g. Essential Commodities Act, Prevention of Food Adulteration Act etc. But there is no such provision in TADA which makes the company liable for the acts of its officers. Hence, there is no scope whatsoever to prosecute a company for the offence under Section 3(4) of TADA. The corollary is that the conviction passed against A–12 is liable to be set aside." In Standard Chartered Bank Vs. Vinay Kumar Sood & Ors, 2009 (1) JCC 756, this court had observed as under:

"Undisputedly, the petitioner is a bank incorporated in England with limited liability by Royal Charter, 1853 and, therefore, is a corporation/company. A company cannot be in any case held to have committed an offence under Section 500 IPC because; most essential ingredient of the said offence i.e. ‘mens rea’ would be missing as a company is a juristic entity or an artificial person, whereas a Director is not a company. The company may be made liable for offences, however, if there is anything in the definition or context of a particular Section or a particular statute which would prevent the application of the said section to a limited company, the limited company cannot be proceeded against. There are number of provisions of law in which it would be physically impossible by a limited company to commit the offence. A limited company, therefore, cannot generally be tried for offences where mens rea is essential. Similarly, a company cannot face the punishment of imprisonment for obvious reasons that company cannot be sent to prison by way of a sentence."

5. The offence of criminal negligence requires a specific state of mind in respect of the person committing the offence. The offence of medical criminal negligence cannot be fastened on the company since the company can neither treat nor operate a patient of its own. It is the Doctor working in the company who treats & performs operations. It is the Doctor who examines the patients and prescribes medicines. If there is a deliberate or negligent act of the Doctor working in the Corporation/Hospital, it is the liability of the Doctor and not of the Corporation for criminal negligence despite the fact that due to the act of the Doctor of treating patients the Corporation was getting some revenue. These days, all Doctors with big hospitals, are on panels where they have fixed fee for examination of patients and for conducting operations. Out of this fee, a percentage is paid to the hospital. The hospital/company cannot be held liable for the personal negligence of the Doctor in giving wrong treatment.

However, if there is an administrative negligence, or a negligence of not providing basic infrastructure, which results into some harm to an aggrieved person or such negligence which is impersonal, the hospital can be held liable. But, in the case of medical negligence, which is personal to the Doctor who gave treatment, the Corporation would not be liable and it is the Doctor who can be indicted for medial criminal negligence.

6. I therefore, allow this petition in respect of the petitioner. The order passed by learned M.M. qua the petitioner is hereby quashed.

AUGUST 02, 2010 SHIV NARAYAN DHINGRA, J

Comments

  1. This is an important judgment.
  2. Needs to be read in totality.
  3. Is applicable mainly for the criminal act and not for compensation purposes.
  4. A criminal negligence on the part of a resident will be the responsibility of the resident and not the hospital.
  5. But a fault of a resident where compensation is awarded will have to be paid by the hospital as he is the full time salaried staff of that hospital.
  6. The judgment lines "However, if there is an administrative negligence, or a negligence of not providing basic infrastructure, which results into some harm to an aggrieved person or such negligence which is impersonal, the hospital can be held liable" covers a lot of situations. A mistake by the nurse, resident, pathology services, radiology services etc all will come under the umbrella term "providing basic infrastructure services".

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature( From Net)

 

Weird X-Rays

Accidents come in all shapes and sizes

This X–ray shows a nail (upper centre) lodged in bones of the index and middle fingers of an adult male, having penetrated through the skin

(Contributed by Dr. Mukul Tiwari)

Dr k k Aggarwal

 

News and Views

Does chickenpox protect against skin condition?

Reuters Health: Kids who get chickenpox may be less likely to develop atopic dermatitis and asthma when they’re older than their peers who don’t get chickenpox – including those that are vaccinated against it. But one finding shouldn’t challenge the benefits of the chickenpox vaccine. (Dr. Jonathan Silverberg, from the State University of New York Downstate Medical Center in Brooklyn)

Oral Complications of Cancer Chemotherapy ( Dr G M Singh)

Oral Complications
• Mucositis
• Infection

• Bacterial Infections
• Fungal Infections
• Viral Infections

• Hemorrhage
• Xerostomia
• Neurological Problems
• Nutritional Problems

Combination weight loss drugs appear effective for obesity

According to research published online July 30 in The Lancet, treatment with two obesity drugs, naltrexone and bupropion, plus lifestyle modification appears effective in helping people lose 5 percent or more of their excess body weight.

NIH Genomic mapping study finds largest set of genes related to major risk factor for heart disease

Scanning the genomes of more than 100,000 people from all over the world, scientists report the largest set of genes discovered underlying high cholesterol and high triglycerides — the major risk factors for coronary heart disease, the nation’s number one killer. Taken together, the gene variants explain between a quarter and a third of the inherited portions of cholesterol and triglyceride measured in the blood. The research, representing scientists from 17 countries, appears in two papers in the Aug. 5 issue of Nature.

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

What is lust murder? Dead body do tell tales (Cont…)

Lust murder may be organized or disorganized depending on the psychopathology of the offender and the same is manifested in the crime scene of the killings. It is determined by very close observation/examination of the scene and corpse.

In a disorganized offender, the victim is immediately rendered unconscious or dead by a "blitz–style" of attack and there will be evidence of symbolic and postmortem sexual activities. In both instances, however, the cutting, mutilation and overkill type wound structures will be directed towards those parts of the body that the offender finds significant to him as per his fantasy and serve as a sexual stimulus. The disorganized offender usually depersonalizes his victim by facial destruction or overkill type of wounds, which becomes a signature forensic component for crime detection. Any sexually sadistic acts are performed postmortem. Mutilation to the genitalia, of females, neck, throat and buttocks are performed because these parts of the body contain a strong sexual significance to him. Most cases of lust murder usually involve male perpetrators. However, accounts of female lust murderers do exist also. A Criminal Investigative Analysis model was developed for investigators by Hazelwood of FBI, one of the top researchers in the field of lust murders. On the basis of various literature and my experience of two decades, I endorse the view that dead bodies do tell tales about the modus operandi. All that is required is a meticulous autopsy surgeon to hear/understand this language.

 

Experts’ Views

Interesting Tips in Hepatology & Gastroenterology

(Dr. Neelam Mohan – Director Pediatric Gastroenterology, Hepatology and Liver Transplantation Medanta Medicity)

Childhood Pancreatitis

Diagnosis: Radiology

  • Abdominal ultrasound is the most frequently used and useful imaging investigation performed in patients with suspected acute pancreatitis.

  • Abdominal computed tomography is usually reserved for situations where sonography is technically unsatisfactory or where better anatomic definition is required. Contrast–enhanced CT is the imaging method of choice in delineating the pancreas, evaluating the severity of and detecting the complications of acute pancreatitis.

  • Endoscopic Retrograde Cholangiopancreatography (ERCP): With the development of a smaller pediatric side–viewing endoscopy, ERCP examination can be successfully performed in small children for detection of anatomic abnormalities and its also used for therapeutic drainage of pseudocyst.

Question of the day

Does a positive ASO titer suggest acute rheumatic fever?
(Dr Sujata Sawhney)

No. A positive ASO titer does not suggest acute rheumatic fever on its
own. ASO is elevated in up to 85% of children who have a streptococcal sore
throat infection. In a vast majority of children, no complication occurs and can be prevented if the patient is given appropriate antibiotic within nine days of diagnosing a strep sore throat. Only in 3% of patients will there be an aberrant immune response and the occurrence of acute rheumatic fever. Acute rheumatic fever must have at least one major criterion and two minor criteria with preceding evidence of streptococcal infection as laid down in the Jones criteria, last modified in 2003.

Reference

  1. Sawhney S. Acute Rheumatic Fever. In: Pediatric Rheumatology edited by Surjit Singh. Ist Edn. 102–110. Publisher PEEPEE 2006.
 

Public Forum (Press Release for use by the newspapers)

BSNL Dil ka Darbar in September

Heart Care Foundation of India, which has successfully pioneered many replicable low cost health education modules like Perfect Health Mela and Perfect Health Parade, in its quest to further strengthen its bond with public on prevention of sudden death is organizing a one-day non stop public forum 'BSNL Dil Ka Durbar on 26th September' (8 am - 8 pm) at MAMC Auditorium, Maulana Azad Medical College, Delhi Gate, New Delhi 110002.

Addressing a press conference Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India, BSNL Dil Ka Darbar & MTNL Perfect Health Mela, Mr Sanjay Sinha Jt. DDG(PR) from BSNL and Acharya Dr Sadhvi Sadhnaji Maharaj, Chairperson, World Fellowship of Religions said that the theme for the Dil ka Darbar is Preventing Sudden Cardiac Death. The event is being organised to earmark the World Heart Day.

Star attractions of the press conference were Mr Ramesh Sharma, Guineas Book record holder for long nails and Mr Rinku Nigam, eminent Film Producer and President, Film Piracy Eradication Cell.

The Durbar is being organized jointly with World Fellowship of Religions, Health & Family Welfare Dept. Govt. of NCT, Delhi and other non govt. organizations.

The one-day Darbar is being held on the same lines as the Durbar used to be held in golden old days during Mughal Maharaja Rule. It will be a non-stop question answer session in which the top medical experts will answer the public questions (Fariyadis). Registration is free and more than 10000 persons are expected to participate in this event.

Besides Allopathy, Experts from other systems of medicine (Homeopathy, Ayerveda, Unani, Siddha, Naturopathy, Yoga, etc.) will also be present to answer questions raised by the public.

The subjects that would be discussed include preventing sudden cardiac death, reversal of heart and kidney diseases; angioplasty and bypass; preventing paralysis; non drug treatment of high B.P; prevention and management of diabetes, obesity & nutrition; osteoporosis; sex and diseases and medical emergencies and first aid.

Dr KK Aggarwal, said that it is easy to anticipate and identify people at risk of sudden cardiac death. The following people are at risk of sudden cardiac death.

 •  People who have survived a past cardiac arrest. 
 •  Heart patient with pumping action of the heart less than 30%
 •  ECG showing wide QRS conduction of more than 120 msec. 
 •  Inability to climb to flight of stairs without symptoms. 
 •  Inability to walk 2 kms on level ground without symptoms. 
 •  Inability to do exercise in the bed with the partner without symptoms. 
 •  Patient with uncontrolled blood pressure, diabetes, smoking and people who drink more than 5 pegs of alcohol in one hour or 6 pegs of alcohol in one day. 
 •  People who have uncontrolled snoring.

Other attractions of the event will be day-long free health checkups using all the systems of medical practice; exhibition on the latest medical aids available; distribution of public health education material; cultural show in the evening; certificates to all the participants and coverage of day's proceedings in CD format etc. In addition, the economically poor heart patients who have been advised special treatments will be provided subsidized pacemakers, stents, heart devises and other medical treatments. The selection of the patients for this medical benefit would be done by a screening committee to be set up for the purpose.

 

Conference Calendar

NABH – Chandigarh – Programme on Implementation of NABH Hospital Standards

Date: August 12 –14, 2010
Venue: Chandigarh.

ijcp
IJCP
IJCP
ijcpgroup
nuspera
Docconnect
IJCP
 

An Inspirational Story

(Dr. Sushma Chawla, Founder President Hope Ek A.S.H.A)

An old man lived alone in Minnesota, He wanted to spade his potato garden, but it was very hard work. His only son, who would have helped him, was in prison. The old man wrote a letter to his son and mentioned his situation: Dear Son, I am feeling pretty bad because it looks like I won’t be able to plant my potato garden this year. I hate to miss doing the garden because your mother always loved planting time. I’m just getting too old to be digging up a garden plot. If you were here, all my troubles would be over. I know you would dig the plot for me, if you weren’t in prison. Lover, Dad.

Shortly, the old man received this telegram: ‘For Heaven’s sake, Dad, don’t dig up the garden!! That’s where I buried the GUNS!!’

At 4 a. m. the next morning, a dozen FBI agents and local police officers showed up and dug up the entire garden without finding any guns.

Confused, the old man wrote another note to his son telling him what had happened, and asked him what to do next. His son’s reply was: 'Go ahead and plant your potatoes, Dad. It’s the best I could do for you, from here.’

MORAL: No mater where you are in the world, if you have decided to do something deep from your heart, you can do it. It is the thought that matters, not where you are or where the person is.

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with dyspepsia wanted to know if could eat Almonds.
Dr Bad: You can eat them raw.
Dr Good: You should eat almonds soaked in water.
Lesson: Soaking almonds in water reduces their gas producing qualities.

Make Sure

Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA.
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2, an ongoing trial suggest that this intervention is much better than thrombolytic therapy in such patients.

Dr KK on the net

TOI––Calcium supplements news

Calcium supplements increase heart risk in women – GEO.tv
President of Heart Care Foundation of India and cardiologist Dr K K Agarwal, who is also attached to Moolchand Hospital, said, "Around 1500 mg of calcium …
geo.tv/8–1–2010/69304.htm

Good Slogans

THE BEST ONE

It’s God’s responsibility to forgive the terrorist organizations. It’s our responsibility to arrange the meeting between them and God.

(Contributed by Dr. Chandresh Jardosh)

SMS of the Day

A lovely star dropped on earth last night and asked me, "You want a million dollar or a good friend." I chose million dollars because I have already you.

(Contributed by Dr.Prachi Garg)

Are you fit to fly?

Deep Vein Thrombosis

  1. Blood thinners for high risk patients can decrease risk.

  2. There are a number of maneuvers that travelers can use that may be beneficial during extended travel times (ie, flights of greater than six to eight hours duration). These include:
    • Moving about every hour or two
    • Request bulkhead seating
    • Refraining from smoking
    • Avoidance of constrictive clothing
    • Flexing and extended the ankles and knees periodically; avoidance of leg crossing; frequent changes of position while seated
    • Adequate consumption of fluids to avoid dehydration
    • Avoidance of agents favoring immobility (eg, sedative drugs, alcoholic beverages)
    • Use of below-knee stockings
 

International Medical Science Academy Update (IMSA)

Urinary tract infection

Antibiotic prophylaxis with trimethoprim sulfamethoxazole (TMP–SMX) was associated with a 6 percent reduction in the number of recurrent urinary tract infections (UTI) in a multicenter randomized trial. Give antimicrobial prophylaxis with TMP–SMX or nitrofurantoin for 6 to 12 months in children with recurrent febrile UTI in whom other treatment options have been ineffective.

Reference

  1. Food and Drug Administration. Current drug shortages. http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050792. (Accessed January 20, 2010).
 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Pregabalin SR 75/150/300mg + Methylcobalamin 1500mcg tablets

For the treatment of adult patients with peripheral neuropathy

9–Feb–10

 

Medi Finance

Q. Income of a trust which is created for the benefit of any particular religious community or caste, will it be allowed as exemption?

Ans. Any income of a trust which is created for benefit of any particular religious community or caste isn’t allowed as exemption.

 

Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Anti–Smooth Muscle Antibody (ASMA):To help diagnose chronic active autoimmune hepatitis and distinguish it from other causes of liver injury.

 

Lateral thinking

Read this………………

LE/
VEL

The answer for yesterday’s puzzle "seven c (seas)"

Correct answers received from: Dr Ashok Wasan, Dr GP Adman Abhan, Dr Simran Singh, Dr Praveen Sablok

Correct answer received for 9th August Puzzle: Dr Anurag Jain

Said your answer to: ijcp12@gmail.com

 

Humor Section

Jokes

Why do we cut size of the capsule before taking it?

Dr. Jhatka : To avoid the side effects.

Funny One Liners

Matka falls in luv with a nurse… After much thinking, he finally writes a love letter to her: "I luv u sister."

 

 Readers Responses

  1. Dr R.S.Bajaj: Sector 13, Rohini: Dear Dr. Aggarwal, The recent judgement by Delhi High Court "Only docs, not hospitals liable for medical negligence"( TOI dated 9.8.10) is a cause of concern for medical community. We all need to wake up. This has done away with vicarious liability of hospital. As we all know that inspite of best efforts, things may go wrong at any time while treating a serious patient. Doctors/ consultant always work as team. There are nurses on rotation basis and other paramedical staff and then resident doctors. The oversight by any one of them can lead to mishap.So why hold only the doctor responsible? The hospital has equal role to play. Consultant has no role to play in the recruitment of these paramedics and resident doctors. Nor does he know about the competency of his team members.
    Even after a good surgery, things may go wrong in post operative period. Even in case of Bhopal Gas– The responsibility of company was also fixed and that is the acceptable norm till now. There is a need to appeal against this judgement now. The hospitals which are being run now by big corporates will earn the profit and the consultant will pay the price if anything goes wrong. There was another judgement by another bench of high court – Which fixed the equal responsibility of doctor and hospital.
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at at C 599 Defence Colony Acharya Sushil Ashram in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: Sunday- BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Delhi Gate.

17th MTNL Perfect Health Mela 2010 Events
Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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