eMedinewS 17th July 2013, Wednesday

Dr K K Aggarwal Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); 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);
For updates follow at
www.twitter.com/DrKKAggarwal
www.facebook.com/Dr KKAggarwal

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In Bihar 9 students die 50 sick of mid-day meal poisoning

Food poisoning occurring within few hours is always due to pre formed toxins and presents with predominant vomiting. It looks like it was a case of severe staph preformed toxin poisoning.

Facts about non meat common food poisoning

  1. Foodborne illness is suspected when a patient presents with gastrointestinal symptoms including nausea, vomiting, abdominal pain, diarrhea and fever.
  2. Some patients with foodborne illness may present initially with other complaints such as neurologic symptoms (eg, headaches, paralysis or tingling), hepatitis, and renal failure.
  3. There are three important elements of the history that the physician should consider: Presenting symptoms; exposure to a particular type of food associated with foodborne disease and the time interval between exposure to the suspect food and the onset of symptoms.
  4. Organisms that make a toxin in the food before the food is consumed. Consumption of the toxin-contaminated food will usually lead to the rapid onset of symptoms (6 to 12 hours) that are predominantly upper intestinal. Examples of this are Staphylococcus aureus, Bacillus cereus emetic toxin and botulism.
  5. Pathogens that make toxin once they have been ingested. This usually takes longer (approximately 24 hours or longer), causes diarrhea that may be watery (eg, Vibrio cholerae or Enterotoxigenic Escherichia coli) or bloody (eg, Shiga toxin-producing E. coli).
  6. Microbes that cause pathology by either damaging the epithelial cell surface or by actually invading across the intestinal epithelial cell barrier. This group of pathogens can produce a wide spectrum of clinical presentations from watery diarrhea (eg, Cryptosporidium parvum, enteric viruses) to inflammatory diarrhea (eg, Salmonella, Campylobacter, Shigella) or systemic disease (eg, L. monocytogenes).
  7. VOMITING AS THE MAJOR PRESENTING SYMPTOM — A sudden onset of nausea and vomiting is likely due to the ingestion of a preformed toxin, such as S. aureus enterotoxin or B. cereus emetic toxin, or a chemical irritant. Because these are preformed toxins, there is no risk of person-to-person spread.
    a. Staphylococcus aureus: symptoms usually begin within one to six hours of ingestion with nausea, vomiting and abdominal cramps. S. aureus toxin is heat-stable and is often associated with the consumption of foods prepared by a food handler such as dairy, produce, meats, eggs, and salads. The food handler usually contaminates the product; after the food is left at room temperature, the organisms multiply and can produce a substantial quantity of toxin.
    b. Bacillus cereus — B. cereus is also capable of producing a heat-stable emetic enterotoxin, typically in starchy foods such as rice.
  8. WATERY DIARRHEA AS THE MAJOR PRESENTING SYMPTOM: In contrast to the preformed toxin-mediated illnesses, which occur only hours after ingestion, and the organisms that produce toxins once ingested typically have an incubation period of 24 to 48 hours.
  9. Clostridium perfringens is an important cause of watery diarrhea. The spores of C. perfringens can germinate in foods such as meats, poultry or gravy. Following ingestion of a large quantity of organisms with the food; C. perfringens toxin is produced in the host GI tract. The simultaneous ingestion of sweet potatoes, which contain trypsin inhibitors preventing the intestinal degradation of the toxin, may be a potentiating factor.
  10. Botulism — Botulism (due to Clostridium botulinum toxin) is one of the most important of this group because of its life-threatening consequences. Typical foods associated with botulism are those canned at home, fermented fish, herb-infused oils, and foods held warm for extended periods of time
  11. Brucellosis: Brucellosis is acquired from consuming unpasteurized dairy products or from undercooked meat from animals that are infected with Brucella. Read More

cpr10 Mantra The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”


VIP's on CPR 10 Mantra Video
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Ringtone - CPR 10 Mantra Hindi

Ringtone - CPR 10 Mantra English

sprritual blog Why do we do Namaste or Namaskar?

Yesterday one of my critics put a query about my views on Namaste and Namaskar.

Vedic knowledge has two components: Shruti and Smriti. While Shruti is original knowledge, Smriti is interpretation. The Upanishads are the interpretations of the Vedic texts by people.

When I write on Vedic text, it is my interpretation based on my understanding of the literature.

I have written KK Aggarwal ki Ramayana or KK Aggarwal ki Hanuman Chalisa. These are not intended to offend anyone but are my interpretations, which people may or may not agree with.

Understanding spirituality is not everyone’s cup of tea. It has taken me 30 years of reading to understand what consciousness means in the Vedic sense. The Bhagavad Gita says that only in many thousands will hear, listen, know and practice it.

Understanding spirituality cannot be done simply by translating the written Sanskrit phrase as there is much more to it. If spirituality could be interpreted only by translating from Sanskrit into literal terms, then none of the Upanishads would have come into existence. I write on all religions including Christianity, Islam, Sikhism and Jainism apart from Hinduism.

Just to recapitulate, why do Indians greet each other with Namaste?

The two palms are placed together in front of the chest and the head is bowed whilst speaking aloud the word Namaste. So the steps involve two hands, folded and placed in front of chest, head bowed.

But, there is much more to it than meets the eye.

  • Literal meaning: In Sanskrit, namah + te = Namaste. It means – I bow to you – my greetings, salutations or prostration to you. Here ‘you’ is not the body but the consciousness. You have the same consciousness as that of mine. In Vedic terminology, ‘I” represents ego, ‘HE’ represents consciousness, ‘You” represents that it’s the same consciousness in you and me.
  • Mythological meaning: Namaha is also interpreted as "na ma" (not mine). It has a spiritual significance of negating or reducing one’s ego in the presence of another. This interpretation has nothing to do with the Sanskrit translation.
  • Spiritual meaning: The real meeting between people is the meeting of their minds. When we greet another, we do so with Namaste, which means, "may our minds meet," indicated by the folded palms placed before the chest.
  • Namaste also has to be read with the word Namaskar: NAMASKAR (NAMAH + OM + KAR). Namah means we bow to you, OM signifies consciousness and KAR means shape or form. OMKAR therefore signifies manifestation of OM, the UNIVERSE or the cosmos. In Namaskar there is no mention of “te” as in Namaste. Namaskar signifies I bow to the consciousness present in you, which has the same interpretation as the mythological meaning of the word Namaste.

With Namaste we also bow down and often close our eyes. The bowing down of the head is a gracious form of extending friendship in love and humility.

The spiritual meaning is even deeper. The life force, the divinity, the Self or the consciousness in me is the same in all. Recognizing this oneness with the meeting of the palms, we salute with head bowed, the Divinity or the consciousness in the person we meet.

That is why sometimes, we close our eyes as we do Namaste to a revered person or the Lord – as if to look within. The gesture is often accompanied by words like "Ram Ram", "Jai Shri Krishna", "Namo Narayana", "Jai Siya Ram", "Om Shanti" etc. indicating the recognition of this divinity.

When we know this significance, our greeting does not remain just a superficial gesture or word but paves the way for a deeper communion with another in an atmosphere of love and respect.

When you bow to say Namaskar and if you try to get angry at this time, you cannot. The body posture does not allow you to do so. For an angry posture you must have expansion of the chest wall and not the flexion of the chest wall....Read More

cardiology news

Sitting on your talent

There was a man who played the piano in a bar. He was a good piano player. People came out just to hear him play. But one night, a patron told him he didn't want to hear him just play anymore. He wanted him to sing a song.

The man said, "I don't sing."

But the customer was persistent. He told the bartender, "I'm tired of listening to the piano. I want that guy to sing!"

The bartender shouted across the room, "Hey buddy! If you want to get paid, sing a song. The patrons are asking you to sing!"

So he did. He sang a song. A piano player who had never sung in public did so for the very first time. And nobody had ever heard the song Mona, Mona Lisa sung the way it was sung that night by Nat King Cole!

He had talent he was sitting on! He may have lived the rest of his life as a no-name piano player in a no-name bar, but because he had to sing, he went on to become one of the best-known entertainers in America.

You, too, have skills and abilities. You may not feel as if your "talent" is particularly great, but it may be better than you think! And with persistence, most skills can be improved. Besides, you may as well have no ability at all if you sit on whatever talent you possess! The better question is not "What ability do I have that is useful?" It is rather "How will I use whatever ability I have?" ...Read More

News Around The Globe

  1. Children who were punished physically during their childhood are at higher risk of heart diseases, arthritis and obesity and in adulthood, as per a Canadian Report published in the Journal Pediatrics.
  2. A new study published in Environmental Health Perspective has shown that short term exposure to high levels of ozone increases the risk of perforated appendicitis.
  3. As per a study published in May 30 edition of New England Journal of Medicine, very few in-flight medical emergencies result in diversion of aircraft or death. The most common in-flight emergencies are syncope, pre-syncope, respiratory symptoms, nausea or vomiting. In 75% of the cases, patients were treated by some type of healthcare provider including paramedics.
  4. As per Harvard Newsletter, the best way to manage insomnia is avoiding caffeine and stick to a regular sleep schedule. Also get thyroid problems, anemia, sleep apnea, menopausal hot flashed, heart burn, depression ruled out. Other tips
    • If you cannot fall asleep in 15 minutes, leave the bed room, sit somewhere and read a book for 15-20 minutes until you feel sleepy and then go back to the bed.
    • Turn off your TV, computer, cell phone and tablet devices at least 30 minutes before sleep. They stimulate the brain.
    • Read a book but not on the tablet.
    • Always cover your alarm clock so that you cannot see the time if you wake up in the middle of the night.
    • Eat your food 3 hours before sleep.

5.BMC statistics received by the public health department

Mumbai has seen an alarming 61 % rise in the number of abortion cases over the past three years, according to the BMC statistics received by the public health department, reports TOI. The city recorded 27,256 abortions in 2012-13 against 16,977 abortions registered in 2010-11. But government officials find nothing suspicious in this sudden rise in the numbers. They say it's an indication of a better working system.

Infertility News (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is ICSI?

Before a man’s sperm can fertilize a woman’s egg, the head of the sperm has to attach to the outside of the egg. Then it pushes through the outer layer of the egg to the inside of the egg (cytoplasm). Sometimes the sperm cannot penetrate the outer layer. A procedure called intracytoplasmic sperm injection (ICSI) can help fertilize the egg by injecting the sperm directly into the egg.

Rabies News (Dr. A K Gupta)

Do antibodies from rabies vaccination cross an intact blood-brain barrier?

No. Antibodies from vaccination do not cross an intact blood-brain barrier.

cardiology news

Pre-PCI factors predict return trip

A new 30-day readmission risk prediction model for patients undergoing percutaneous coronary intervention (PCI) showed it's possible to predict risk using only variables known before PCI, according to a study published online in Circulation: Cardiovascular Quality and Outcomes.

After multivariable adjustment, the 10 pre-PCI variables that predicted 30-day readmission were older age (mean age 68 in this study), female sex, insurance type (Medicare, state, or unknown), GFR category (less than 30 and 30-60 mL/min per 1.73m2), current or history of heart failure, chronic lung disease, peripheral vascular disease, cardiogenic shock at presentation, admit source (acute and non-acute care facility or emergency department), and previous coronary artery bypass graft surgery.

Additional significant variables post-discharge that predicted 30-day readmission were beta-blocker prescribed at discharge, post-PCI vascular or bleeding complications, discharge location, African American race, diabetes status and modality of treatment, any drug-eluting stent during the index procedure, and extended length of stay.

A risk score calculator using the pre-PCI variables will be available online soon, according to Robert W. Yeh, MD, MSc, of Massachusetts General Hospital in Boston, and colleagues.

Two BP drugs for diabetes stand out

Two drugs, telmisartan (Micardis) and valsartan (Diovan), which are used to reduce blood pressure in people with diabetes, are associated with a lower risk of hospitalization for heart attack, stroke, or heart failure, according to a retrospective study comprising more than 54,000 patients (median age 73, a majority of women).

These two angiotensin-receptor blockers (ARBs) beat out other ARBs such as candesartan (Altacan), irbesartan (Avapro), and losartan (Coazaar), wrote Tony Antoniou, MD, of St. Michael's Hospital in Toronto, and co-authors in the study published online CMAJ.

"Our findings suggest that statistically important differences exist in the effectiveness of angiotensin-receptor blockers when used for the prevention of diabetes-related macrovascular disease, and that a class effect for these agents may not be assumed when used for this purpose in clinical practice," they wrote. Randomized controlled trials and large observational studies are needed to further this area of research, they said.

Valvular Heart Disease News

Should surgery be done in elderly patients with aortic stenosis?

Elderly patients have poorer preoperative status and higher operative mortality with aortic valve replacement. However, those who survive the perioperative period often do well and have marked improvement in quality of life. When aortic valve replacement is indicated, a bioprosthetic valve is generally preferred to a mechanical valve in elderly patients in whom life expectancy is shorter than the expected function life of the bioprosthesis.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

cardiology news

Spanking in childhood tied to adult obesity and heart disease

Children who were punished physically had higher risks for cardiovascular disease, arthritis, and obesity in adulthood, researchers found. (Source: Medpage Today)

FDA bans BPA in infant formula packaging

The FDA had decided to ban bisphenol A (BPA)-based epoxy resins as coatings in infant formula packaging, saying Thursday in a Federal Register announcement the use has largely been abandoned by manufacturers anyway. (Source: Medpage Today)

cardiology news

High fat diet prostate cancer prone

Diets high in saturated fat increases the risk of prostate cancer, according to a report from University of Texas M. D. Anderson Cancer Center in Houston published in the International Journal of Cancer.

  • Men who consume high saturated animal fat diet are two times more likely to experience disease progression after prostate cancer surgery than men with lower saturated fat intake.
  • There is also shorter "disease-free" survival time among obese men who eat high saturated fat diet compared with non-obese men consuming diets low in saturated fat.
  • Men with a high saturated fat intake had the shortest survival time free of prostate cancer (19 months)
  • Non-obese men with low fat intake survived the longest time free of the disease (46 months).
  • Non-obese men with high intake and obese men with low intake had "disease-free" survival of 29 and 42 months, respectively.

Take home messages

  • High saturated fat diet has been linked to cancer of the prostate
  • Reducing saturated fat in the diet after prostate cancer surgery can help reduce the cancer progression.
  • Cancer prostate has the same risk factors as that of heart blockages and both are linked to high saturated fat intake.
  • With the increase of heart patients, a corresponding increase in prostate cancer patients is also seen in the society. ...Read More
cardiology news

Victims of intimate partner violence are found among people of all ages, socioeconomic classes, ethnicities, gender identities, and sexual preferences.

Risk factors: Younger age, female gender, lower socioeconomic status, family history or personal history of violence.

Certain aspects of the history or observations made during the clinical encounter that should heighten the clinician's suspicion of IPV include:

  • An inconsistent explanation of injuries.
  • Delay in seeking treatment.
  • Frequent emergency department or urgent visits.
  • Missed appointments.
  • For pregnant women, late initiation of prenatal care.
  • Repeated abortions.
  • Medication nonadherence.
  • Inappropriate affect. Victims may appear jumpy, fearful, or cry readily. They may avoid eye contact and seem evasive or hostile.
  • Overly attentive or verbally abusive partner.
  • Apparent social isolation.
  • Reluctance to undress, have a genital or rectal examination, or difficulty with these examinations.

...Read More

cardiology news
  1. 9th July: HCFI Executive Meeting

EBook

CPR 10 Training Camp, EPFO, 30th May 2013

CPR 10 Camp - Police Training Center Najafgarh

Camps

CPR Classes: Persons trained (52)

CPR VIP Sensitization

Total CPR since 1st November 2012 – 54572 trained

6th July: Zoonosis Conference: 52

Video Chats and uploads

Symposium on Prayer, Faith, Meditation and healing Part 9

Symposium on Prayer, Faith, Meditation and healing Part 8

Symposium on Prayer, Faith, Meditation and healing Part 7

Symposium on Prayer, Faith, Meditation and healing Part 6

Symposium on Prayer, Faith, Meditation and healing Part 5

Symposium on Prayer, Faith, Meditation and healing Part 3

Symposium on Prayer, Faith, Meditation and healing Part 2

Symposium on Prayer, Faith, Meditation and healing Part 1

CPR 10 training was given to 1001 students learnt CPR at Bal Bharti Public School, Dwarka

Seven Steps to Patient Safety

What patient expect on doctor – A survey

MTNL Perfect Health Mela to focus on Disaster Management & Doctor patient relationship

Dr AK Aggarwal Speaks on Workshop on Patient Safety

Dr RN Makroo on Blood Safety

Prof (Dr) Usha Gupta on Medication Safety

Dr N V Kamath DHS on Patient Care

East and West, the Combination is the Best

The very fact our body has a receptor for each and every drug means that the body has the capacity to produce that drug, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

He said that western modern science has no match in diagnosis, acute management and surgical procedures but when it come to prevention and lifestyle management one needs to adopt a holistic approach.

Holistic medicine is founded on three pillars of timeless wisdom: Meditation, Ayurveda and Yoga.

Meditation demonstrates a reduction in stress, anxiety, emotional turbulence, chronic pain, depression, insomnia, and confusion in only a few days. The result is a calmer, more relaxed, happier, more centered, and more fulfilled person. Stress is today considered as the number one killer and is responsible for the causation of most diseases.

All doctors should incorporate stress management in their practice. The aim should be to bring a patient back into a stage of harmony between physical health and mental health. Anger; hostility and aggression are the newly discovered established risk factors for heart disease. Yoga is not just doing asanas. It is the union of mind with the body.

Most people believe that aging is universal but there are biological organisms that never age. Most people believe that aging is painful and we know that pain is from diseases that are preventable, not from aging. By consciously using our awareness, we can influence the way we age biologically. One can tell his body not to age.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 54572 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.” ...Read More

today emedipics

Doctor Day Celebration

On the occasion of Doctors Day, a CME was organized by IMANDB, eMedinewS and Heart Care Foundation of India on 29th June 2013 at IIC, New Delhi

press release

Exercise impact on the knee

today video of the dayDr KK Aggarwal on Danger of Epidemics (Uttarakhand Disaster)

Symposium on Prayer, Faith, Meditation and healing Part 9

CPR Utsav 6th April 11543 Male Female Trained in 1 day

eMedi Quiz

Read this…………………

Nurse Rose is caring for a neonate with congenital clubfoot. The child has a cast to correct the defect. Before discharge, what should the nurse tell the parents?

a. The cast will be removed in 6 weeks
b. A new cast is needed every 1 to 2 weeks
c. A short leg cast is applied when the baby is ready to walk
d. The cast will be removed when the baby begins to crawl

Yesterday’s Mind Teaser: A male client with acute pyelonephritis receives a prescription for co-trimoxazole P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?

a. Urine output increases to 2,000 ml/day.
b. Flank and abdominal discomfort decrease.
c. Bacteria are absent on urine culture.
d. The red blood cell (RBC) count is normal.

Answer for yesterday’s Mind Teaser: c. Bacteria are absent on urine culture.

Correct answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr Prakash Khalap,
Dr B K Agarwal, Dr Abbas Vakil, Dr Avtar Krishan, Pushpa Otiv, Dr P K Sahu, Dr Thakor Hitendrsinh G, Dr PC Das, Rajeev Ardey, Dr RK Mehta, Dr VP Thakral, Daivadheenam Jella,
Dr Pankaj Agarwal, Dr (Brig) C H Gidvani, Dr (Maj. Gen.) Anil Bairaria, Dr Arpan Gandhi,
Dr Vishal D Wahane, Dr K Raju, Dr Jainendra Upadhyay, Muthumperumal Thirumalpillai,
Dr A J Dabawala.

Answer for 15th July Mind Teaser: b. Elevating the neonate’s head and giving nothing by mouth

Correct answers received from: Kavita Dhingra, Dr Bitaan Sen & Dr Jayashree Sen.

Send your answer to ijcp12@gmail.com




eMedi Apps



medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Chairman Legal Cell Indian Academy of Echocardiography; Chairman Ethical Committee Delhi Medical Council; Editor eMedinewS and President Heart Care Foundation of India)

When can hospitals be liable for medical 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 S N 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 examine 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. Inasmuch 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 S N Dhingra, J

Comments

  • This is an important judgment.
  • Needs to be read in totality.
  • It is applicable mainly for the criminal act and not for compensation purposes
  • A criminal negligence on the part of a resident will be the responsibility of the resident and not the hospital.
  • 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.
  • 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. will come under the “providing basic infrastructure services”.

Read More

medicolegal update

I recently picked a new primary care physician. After two visits and exhaustive lab tests, he said I was doing "fairly well" for my age. A little concerned about that comment, I couldn't resist asking him, "Do you think I'll live to be 90?"

He asked, do you smoke tobacco or drink beer/wine?" "Oh no," I replied. "I'm not doing either."

Then he asked, "Do you eat rib-eye steaks and barbecued ribs?" I said, "No, my other Doctor said that all red meat is very unhealthy!"

"Do you spend a lot of time in the sun, like playing golf, sailing, hiking, or bicycling?"

No, I don't," I said.

He asked, "Do you gamble, drive fast cars, or have a lot of sex?"

"No," I said. "I don't do any of those things."

He looked at me and said, "Then why do you care if you live to be 90? Read More

medicolegal update
medicolegal update

Situation: A young patient came with mild hypertension
Dr. Bad: Start reserpine.
Dr. Good: Start ACE inhibitor.
Lesson: An ACE inhibitor or ARB may be more effective in younger patients, and a dihydropyridine calcium channel blocker may be more effective in the elderly in mild hypertension with no compelling indications. Read More

medicolegal update

Situation: A patient with acute rheumatic fever was directly put on penicillin prophylaxis.
Reaction: Oh my God! Why was the full initial course of penicillin not given?
Lesson: Make sure that patients with acute rheumatic fever are initiated on antibiotic therapy as delineated for eradication of streptococcal pharyngitis, whether or not pharyngitis is present at the time of diagnosis.

medicolegal update

Mediocrity knows nothing higher than itself, but talent instantly recognizes genius. Arthur Conan Doyle, Sr.

medicolegal update

Dr KK Aggarwal: Beware of Monsoon Disorders By Dr K K Aggarwal
http://bit.ly/132xLOW #Health

Dr Deepak Chopra: Neurons that fire together wire together. You can rewire your brain for higher consciousness by focusing on love.

medicolegal update

Dear Sir, Emedinews is very useful to us.. Regards: Dr Sapna

Forthcoming Events

2nd annual Ped Neuro Conclave

Sunday, 25th August 2013.
This is an annual event hosted jointly by Fortis Escorts Hospital and IAP Jaipur. This conference is held every year and is attended by more than 200 delegates, which include Neurologists, Pediatricians, GPs and resident doctors from all over Rajasthan. Senior faculty from different institutes all over India and abroad participates and shares their knowledge and experience with the audience.

The eminent faculty includes
Dr. Pratibha Singhi, Head Pediatric Neurology, PGI – Chandigarh
Dr R K Sabharwal, Head Pediatric Neurology, Sir Ganga Ram Hospital, New Delhi
Dr. Vineet Bhushan Gupta, Sr Consultant Pediatric Neurologist, Apollo Hospital, New Delhi;
Dr Deepak Gupta, Sr Consultant Paediatric Psychiatrist, Sir Ganga Ram Hospital, New Delhi.
Venue: Jaipur Marriott Hotel
Date: Sunday, 25 August 2013 (0900-1700)
Organizing Secretary: Dr Sharad Sharma, MD (PGI), MRCPCH (UK), Fellow Pediatric Neurology (London)
Senior Consultant Pediatric Neurology, Fortis Hospital, Jaipur, Rajasthan

eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

medicolegal update



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