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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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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; Member 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


31st May, 2010 Monday

Guidelines for prosecuting medical professionals?

Dear Colleague

The Supreme Court of India in the Jacob Mathew case noted that "the cases of doctors (surgeons and physicians) being subjected to criminal prosecution are on an increase". Sometimes such prosecutions are filed by private complainants and sometimes by police on an FIR being lodged and cognizance taken.

The investigating officer and the private complainant cannot always be supposed to have knowledge of medical science so as to determine whether the act of the accused medical professional amounts to rash or negligent act within the domain of criminal law under Section 304-A of IPC. The criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment. He has to seek bail to escape arrest, which may or may not be granted to him. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

'We may not be understood as holding that doctors can never be prosecuted for an offence of which rashness or negligence is an essential ingredient. All that we are doing is to emphasize the need for care and caution in the interest of society; for, the service which the medical profession renders to human beings is probably the noblest of all, and hence there is a need for protecting doctors from frivolous or unjust prosecutions. Many a complainant prefers recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

Statutory Rules or Executive Instructions incorporating certain guidelines need to be framed and issued by the Government of India and/or the State Governments in consultation with the Medical Council of India. So long as it is not done, we propose to lay down certain guidelines for the future which should govern the prosecution of doctors for offences of which criminal rashness or criminal negligence is an ingredient.

A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.

The investigating officer should, before proceeding against the doctor accused of rash or negligent act or omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation.

A doctor accused of rashness or negligence, may not be arrested in a routine manner (simply because a charge has been levelled against him). Unless his arrest is necessary for furthering the investigation or for collecting evidence or unless the investigation officer feels satisfied that the doctor proceeded against would not make himself available to face the prosecution unless arrested, the arrest may be withheld."

Reference: Criminal Medical Negligence, Jacob Mathew's Case 2005 AIR 3180 SC, Appeal (crl.) 144-145 of 2004, CJI R.C. Lahoti, Justice G.P. Mathur & P.K.Balasubramanya.

Take Home Messages

  1. State Medical councils have judicial powers of that of civil courts. (DMC has)

  2. Council court is a court.

  3. A patient will file a case against the doctor under CPA if he or she needs compensation.

  4. Most of the times he will approach the respective State Medical Council for medical negligence (criminal negligence).

  5. Supreme court has given a procedure for the same.

  6. The investigating officer and the private complainant most likely will not have knowledge of medical science.

  7. The unnecessary criminal process once initiated subjects the medical professional to serious embarrassment and sometimes harassment.

  8. At the end he may be exonerated by acquittal or discharge but the loss which he has suffered in his reputation cannot be compensated by any standards.

  9. There is a need for protecting doctors from frivolous or unjust prosecutions.

  10. Many complainants prefer recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.

  11. A private complaint should not be entertained (also by state medical council) unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.

  12. The investigating officer should, before proceeding against the doctor accused of negligence/omission, obtain an independent and competent medical opinion preferably from a doctor in government service qualified in that branch of medical practice who can normally be expected to give an impartial and unbiased opinion applying Bolam's test to the facts collected in the investigation.

  13. Investigating officer can refer for the same to state council or appoint an independent board.

  14. Suspension of license is a prosecution.

  15. Prosecution is allowed only in the case of a professional misconduct in the MCI act.

  16. Professional medical deficiency is not a professional misconduct in the MCI act.

  17. Professional misconduct has been defined in the MCI Act . (see part 2 ans part 3 tomorrow and day after tomorrow)

Dr KK Aggarwal
Padma Shri & Dr B C Roy Awardee and Chief Editor

 

Photo Feature (From HCFI file)

Tobacco Effigy Taken Around the City in a Tableau

Heart Care Foundation of India (HCFI) has emphasized on the inevitability of death and destruction caused on account of smoking and consumption of tobacco related products. In one of the modules used by the foundation in the past, Mr. Tobacco representing the smoking society, an effigy was taken around the city in a tableau. Celebrities, Politicians, Health Minister, Govt. officials and concerned officials were involved in the campaign to assure the impact of the campaign. Pamphlets indicating the ill effects of tobacco were also distributed simultaneously. 

Dr k k Aggarwal
Sri Yoganand Shastri, Health Minister of Delhi and others, a tableau carrying Mr. Tobacco effigy and health messages in the background.

International Medical Science Academy Update (IMSA): New FDA Drug Update

Bazedoxifene

In a three–year trial of bazedoxifene (BZA), raloxifene, or placebo, the incidence of new vertebral fractures was significantly lower in women randomly assigned to BZA or raloxifene; the rates of endometrial hyperplasia, cancer, and polyps; and changes in breast density (assessed by mammography) were low and similar among the groups 1–4 In a two–year randomized trial of raloxifene, varying combinations of BZA/conjugated estrogen (CE), or placebo in over 3,000 postmenopausal women with osteopenia, combinations with the lower doses (10 or 20 mg) of BZA with either 0.45 or 0.625 mg of CE significantly improved indices of vaginal atrophy and reduced the daily number of hot flushes .5 The incidence of venous thromboembolic events was low and similar among the groups. BZA is available in limited areas of Europe. Availability in US is pending FDA approval.

References:

  1. Silverman SL, Christiansen C, Genant HK, et al. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3–year, randomized, placebo–and active–controlled clinical trial. J Bone Miner Res 2008;23:1923.

  2. Archer DF, Pinkerton JV, Utian WH, et al. Bazedoxifene, a selective estrogen receptor modulator: effects on the endometrium, ovaries, and breast from a randomized controlled trial in osteoporotic postmenopausal women. Menopause 2009;16:1109.

  3. Pinkerton JV, Archer DF, Utian WH, et al. Bazedoxifene effects on the reproductive tract in postmenopausal women at risk for osteoporosis. Menopause 2009;16:1102.

  4. Harvey JA, Holm MK, Ranganath R, et al. The effects of bazedoxifene on mammographic breast density in postmenopausal women with osteoporosis. Menopause 2009;16:1193.

  5. Lobo RA, Pinkerton JV, Gass ML, et al. Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Fertil Steril 2009;92:1025.
 

DMA UPDATE

All DMA members are requested to contact the office at 23271726 or 9811542055 in case they are not receiving DMA News Bulletin. They can also contact at delhimedicalassociation@yahoo.com Dr Ashwini Dalmiya Hony Secretary.

  

Mnemonic of the Day (Dr Prachi Garg)

Hypervitaminosis A: signs and symptoms "Increased Vitamin A makes you HARD"

  • Headache/ Hepatomegaly
  • Anorexia/ Alopecia
  • Really painful bones
  • Dry skin/ Drowsiness

News and Views

An experimental drug for prostate cancer failed to show significant benefit in trial

Toremifene, an experimental drug for prostate cancer failed to show a significant benefit in a final–stage clinical trial. Compared with those on a placebo, the incidence of prostate cancer was not statistically significantly different in patients taking a 20–milligram dose of the drug.

A new oral tranexamic acid formulation beneficial for heavy menstrual bleeding

A study presented at the annual meeting of the American College of Obstetricians and Gynecologists in San Francisco reports that a novel, oral tranexamic acid formulation may improve quality of life in women with heavy menstrual bleeding. In the study, 294 women aged 18 to 49 with a mean menstrual blood loss of > 80 mL per cycle were randomly assigned to receive 1.95 or 3.9 grams per day of tranexamic acid, or placebo, for up to five days per menstrual cycle for three cycles.

Flibanserin effective for sexual desire disorder

Flibanserin appears to be an effective treatment in premenopausal women with generalized acquired hypoactive sexual desire disorder, as per a research presented this week at the annual meeting of the American College of Obstetrics and Gynecology in San Francisco.

Meta–Analysis Confirms Statins’ Anti–Thrombotic Effect

A study presented at the annual international conference of the American Thoracic Society, held in New Orleans May 14–19 states that a large number of evidence shows that statins do decrease the risk of venous thromboembolism. The study is published in the May issue of American Journal of Respiratory and Critical Care Medicine.

Quote of the day (Paramjeet Chadha)

Heart tells the eyes see less, because you see and I suffer a lot.
Eyes replied, feel less because when you feel I cry a lot.

Question of the Day

What is the Treatment of community–acquired pneumonia in adults with COPD in the outpatient setting?

The presence of significant comorbidities (i.e. chronic obstructive pulmonary disease (COPD), liver or renal disease, cancer, diabetes, chronic heart disease, alcoholism, asplenia or immunosuppression), and/or use of antibiotics within the prior three months, increases the risk of infection with more resistant pathogens. Recommended regimens

1. A respiratory fluoroquinolone (levofloxacin 750 mg daily, gemifloxacin 320 mg daily or moxifloxacin 400 mg daily) for a minimum of five days.

2. Combination therapy with a b–lactam effective against S. pneumoniae
— Cefpodoxime 200 mg twice daily high–dose amoxicillin, 1 g three times daily — Amoxicillin–clavulanate 2 g twice daily
— Cefuroxime 500 mg twice daily
Plus
— Azithromycin 500 mg on day one followed by four days of 250 mg a day
— Clarithromycin 250 mg twice daily
— Clarithromycin XL 1,000 mg once daily)
— Doxycycline (100 mg twice daily)
Treatment should be continued for a minimum of five days. These regimens are also appropriate where there is a high prevalence of "high–level" macrolide&ndashresistant S. pneumoniae, even in the absence of co&ndashmorbidity or recent antimicrobial use.

Liver Fact

In NASH, SGOT and SGPT never rises more than 4 times the normal value.

Women Safety Tips

If a robber asks for your wallet and/or purse, DO NOT HAND IT TO HIM. Toss it away from you. Chances are that he is more interested in your wallet and/or purse than you, and he will go for the wallet/purse. Run like mad in the other direction!

Today i World No Tobacco Day 

Tobacco consumption is contraindicated in Islam teachings.

Invitation

World No Tobacoo Day (WNTD) is being commemorated today at 3 PM in the Auditorium Delhi Government Secretariat, I P Estate, New Delhi. Smt. Sheila Dikshit Hon’ble Chief Minister Delhi will be the chief guest. Prof Kiran Walia Hon'ble Health Minister Delhi will preside over. A community based integrated pilot project on tobacco cessation will be launched. A comprehensive web site www.smokefreedelhi.org will also be launched Dr S. Bhattacharji, Director Health Services.


eMedinewS Try this it Works

A new twist on Pap smears

Rotate the cytobrush in the opposite direction of that used to brush across the slide plate. For example, if you move the brush across the plate from left to right, you rotate the brush counterclockwise. You will not end up with inadequate samples.


Dr Good Dr Bad

Situation: A diabetic patient, who was recently hospitalized, came for a vaccine consult.
Dr Good: You need a redoes of pneumonia vaccine.
Dr Bad: No further vaccine is needed.
Lesson: Individuals with diabetes who are or have been recently hospitalized and other immuno–compromised states, such as after transplantation are candidates for repeat pneumococcal vaccination. ADA Standards of Care 2009


Make Sure

Situation: A patient with large intestinal diarrhea developed sepsis after he was given anti–motility drugs.
Reaction: Why was antibiotic not given?
Lesson: Make sure that if anti–motility drug is given in a large intestinal diarrhea, it is always given with an antibiotic.


IMANDB Joke of the Day

CARELESSNESS

The housemaid, tidying the stairs the morning after a reception, found one of the solid silver teaspoons lying there.

"My goodness gracious!" she exclaimed, as she retrieved the piece of silver. "Someone of the company had a hole in his pocket."


Formulae in Clinical Practice

Arterio Venous Oxygen Difference (CaO2– CvO2)
Formula: (CaO2 – CvO2) = 1.39 (SaO2 – SvO2) + 0.0031 (PaO2 – PvO2) Normal value: 3.5 – 5.5 ml/100 ml blood.


Milestones in Diabetes

1675: Thomas Willis was an English doctor who added the word ‘mellitus’, from the Latin meaning ‘honey’ a reference to the sweet taste of urine.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Critical value

A critical value is defined as a value that represents a pathophysiological state at such variance with normal (expected values) as to be life–threatening unless something is done promptly and for which some corrective action could be taken. Note: The critical values do not necessarily correspond with normal reference ranges, toxic ranges, or therapeutic ranges.


List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name

Indication

 Approval Date

Sertaconazole Nitrate Powder 2% w/w & Lotion 2% w/v

For the topical treatment of the superficial fungal infections of the skin

02.05.2009

 MCI Update

Extend time to decide on medical colleges recognition
The six-member Board of Governors of MCI that replaced the MCI has sought more time, till July 15, from the Health Ministry to decide on recognition and related issues of 87 medical colleges pending with it. The original date is June 12.The cases include recognition of three colleges, renewal of 24 government and 37 private colleges and other issues related to 13 new government and 10 private colleges. This has been kept as the last date in the previous years also. The new inspection team will be a five member team with non medical and accounts experts also.

In the mena time CBI has also procured search warrants against most medical colleges to interogate about their past recognitions. They are meeting the heads of the medical colleges with the details of the  phone conversations with the MCI in the past. One of the inspector Dr S Shah has already become CBI approver. They are booking cases against the colleges under section 120 and 420.

Section 120. Concealing design to commit offence punishable with imprisonment.


Whoever, intending to facilitate or knowing it to be likely that be will thereby facilitate the commission of an offence punishable with imprisonment,

Voluntarily conceals, by any act or illegal omission, the existence of a design to commit such offence, or makes any representation which he knows to be false respecting such design,

If offence be committed-if offence be not committed: - shall, if the offence be committed, be punished with imprisonment of the description provided for the offence, for a term which may extend to one-fourth, and, if the offence be not committed, to one-eighth, of the longest term of such imprisonment, or with such fine as is provided for the offence, or with both.

Section 420. Cheating and dishonestly inducing delivery of property
Whoever cheats and thereby dishonestly induces the person deceived any property to any person, or to make, alter or destroy the whole or any part of a valuable security, or anything which is signed or sealed, and which is capable of being converted into a valuable security, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine.

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eMedinewS–Padma Con 2010

Will be organized at
Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

 
 

eMedinewS–revisiting 2010

The second 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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Public Forum (Press Release for use by the newspapers)

Omega–3 fatty acids beneficial for heart

Fish oil pills, diet rich in omega–3 fatty acids, fish, canola oil, soybean oil, flaxseeds and walnuts all lower the blood pressure. This was stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Quoting a study of middle-aged adults in China, Japan, Great Britain and the U.S. and published in the journal Hypertension, Dr Aggarwal said that there are heart benefits of omega–3 fatty acids. Oily fish, such as salmon, mackerel and sardines, contain two types of omega–3 fats –– DHA and EPA –– that have been shown to reduce blood fats called triglycerides and possibly prevent dangerous heart–rhythm disturbances.

American Heart Association recommends that adults eat fatty fish twice a week, and that people with heart disease consider taking fish oil pills to get extra DHA and EPA. Plant sources contain an omega–3 known as ALA, a precursor to DHA and EPA.  The new study shows that both fish and vegetable sources of omega–3 do offer a modest blood pressure benefit.

In the study, blood pressure levels tended to dip as participants’ omega–3 intake climbed.
The benefit was most clear among people without high blood pressure and those who were not taking medication or following a special diet to control their elevated blood pressure.
The bottom line is eat omega–3 fats as part of an overall diet, limit salt, alcohol and saturated fat, get enough vegetable protein and nutrients such as potassium and calcium. With blood pressure, every millimeter counts. The effect of each nutrient is apparently small but independent, so together they can add up to a substantial impact on blood pressure.


Readers Responses

  1. Comment on Liver Fact: SGOT can be more than SGPT in NASH, Hepatitis C cirrhosis, dengue, acute muscle injury, H1N1 and Wilson's disease. Alcoholic Liver disease is in fact the most common cause of SGOT>SGP: Dr. Varesh Nagrath.