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Medicolegal Aspects in Obstetrics and Gynecology
Federation of Obstetric and Gynaecological Societies of India
Disclaimer The editors do not take any responsibility for the opinion expressed in the chapters as they are individual and personal opinion of the respective authors
Medicolegal Aspects in Obstetrics and Gynecology Second Edition Editors
Gita Ganguly Mukherjee
DGO MD FICOG FRCOG
Senior Consultant Gynecologist, Kolkata Former Professor and Head Department of Obstetrics and Gynecology RG Kar Medical College, Kolkata, India
Narendra Malhotra
MD FICOG
Consultant and Director MNMH (P) Ltd. Agra Apollo Pankaj Hospital (P) Ltd, Agra, India President Federation of Obstetric and Gynaecological Societies of India-2008 Co-Editors
Bhasker Pal
DGO MD DNB MRCOG
Senior Consultant Gynecologist Apollo Gleneagles Hospital, Kolkata, India
Basab Mukherjee
MD MRCOG
Visiting Consultant Obstetrics and Gynecology Calcutta Medical Research Institute and Anandalok Hospital, Kolkata, India
A FOGSI Publication ®
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Medicolegal Aspects in Obstetrics and Gynecology © 2008, Federation of Obstetric and Gynaecological Societies of India All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher. This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 1997 Second Edition: 2008 ISBN 978-81-8448-321-5 Typeset at
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Dedicated to The women of our country and to All the Obstetricians and Gynecologists Who work tirelessly to put an imperfect science to perfection, so that Women’s health can improve
Contributors A Rudra MD FAMS Hon Consultant Department of Anesthesiology Perioperative Medicine and Pain Apollo Gleneagles Hospital, Kolkata Abinash Chandra Ray DGO MD FICS FICOG
Consultant Gynecologist SN Pandit Hospital, Kolkata Ajit De DGO MD Gynecologist Malda Sadar Hosital, Malda, West Bengal Ajit Kumar Sarkar Ex Professor and Head Department of Obstetrics and Gynecology Medical College and Eden Hospital Kolkata Alaka Goswami MS Ex-Professor and Head Department of Obstetrics and Gynecology Guwahati Medical College, Guwahati Alakananda MD FICOG Associate Professor Department of Obstetrics and Gynecology Guwahati Medical College, Guwahati Amol P Pawar MD DGO FCPS Lecturer Department of Obstetrics and Gynecology TNMC and BYL Nair Hospital, Mumbai Anima Biswas DGO PhD FRCOG Former Professor and Head, Department of Obstetrics and Gynecology R G Kar Medical College, Kolkata
Arati Ghosh DGO DRCOG FRCOG Ex-Professor Department of Obstetrics and Gynecology RG Kar Medical College and Hospital Kolkata Ex-Professor Department of Obstetrics and Gynecology MGM Medical College and Hospital Kishangunj, Bihar Arijit Biswas MD(AIIMS) MD (Sing) FRCOG FAMS
Associate Professor and Clinical Director Department of Obstetrics and Gynecology YLL School of Medicine National University of Singapore Arup Kumar Majhi MD DNB Associate Professor Department of Obstetrics and Gynecology R G Kar Medical College, Kolkata Ashis Kumar Mukhopadhyay Associate Professor Department of Obstetrics and Gynaecology Eden Hospital Medical College, Kolkata Basab Mukherjee MD MRCOG Visiting Consultant Obstetrics and Gynecology Calcutta Medical Research Institute and Anandalok Hospital, Kolkata Bejoylakshmi Goswami DGO MD FICOG FIMSA
Arati Basu Sengupta Consultant Gynecologist Kolkata
Ex-Professor and Head Department of Obstetrics and Gynecology Chittaranjan Seva Sadan College of Gynecology Obstetrics and Child Health Kolkata
Arati Biswas DGO PhD FRCOG Ex Professor and Head Department of Obstetrics and Gynecology RG Kar Medical College, Kolkata
Bhasker Pal DGO MD DNB MRCOG Senior Consultant Gynecologist Apollo Gleneagles Hospital Kolkata
viii Medicolegal Aspects in Obstetrics and Gynecology Biswapati Mukherjee MD Consultant Gynecologist, Lohia Maternity Seva Sadan, Kolkata BK Goswami DGO MS FICS FICOG FIMSA FICMCH
Ex-Professor Department of Obstetrics and Gynecology NRS Medical College, Kolkata BN Chakravarty FRCS FRCOG Institute of Reproductive Medicine Salt Lake, Kolkata Bulbul Raichaudhuri MD DGO FICOG Consultant Gynecologist and ObstetricianVisiting Gynecologist Association of Medical Women in India Mission Hospital, Kolkata Ex Senior Specialist in Gynae and Obst, SAIL Chaitali Datta Roy MD Assistant Professor Department of Obstetrics and Gynecology Institute of Postgraduate Medical Education and Research, Kolkata CN Purandare MD MAO (IRL) DO (DUB) DGO DFP FICOG FICMCH
Consultant Obstetrician and Gynecologist St. Elizabeth Hospital and BSES Hospital Mumbai Ex Hon Professor Department of Obstetrics and Gynecology Grant Medical College and JJ Hospital Mumbai Debashis Mukherjee DGO MD FICOG Consultant Gynecologist ESI Hospital, Kamarhati West Bengal Debdut Ghosh Thakur Chief Reporter Ananda Bazar Patrika, Kolkata Dilip Walke MD Director Medipoint Hospital Pune
Duru Shah MD FCPS FICS FICOG DGO DFP FICMCH
Program Director, Assisted Fertility Unit, Gynaecworld Medical Director Gynaecworld, Consultant Obstetrician and Gynecologist Breach Candy Hospital Jaslok Hospital and Research Centre Sir HN Hospital and Research Centre Mumbai Edwin Chandraharan MS (Obs and Gyn) DFFP MRCOG
Consultant Obstetrician and Gynecologist Lead Clinician for Labour Ward and Clinical Governance in O and G St. George’s Health care NHS Trust London Gita Ganguly Mukherjee DGO MD FICOG FRCOG
Senior Consultant Gynecologist, Kolkata Former Professor and Head Department of Obstetrics and Gynecology R G Kar Medical College, Kolkata Gokul Chandra Das MD FICOG Associate Professor Department of Obstetrics and Gynecology Guwahati Medical College, Guwahati Harshad Parasnis MD DNB FCPS DGO Consultant Gynecologic Oncologist Pune Associate Professor Bharati Medical College, Pune Hema Divakar DGO MD PGDMLE CEO and Consultant Divakars Speciality Hospital, Bangalore Hema Purandarey MS FICMH Founder Centre for Genetic Health Care Director, Wellspring Hiralal Konar MD DNB MNAMS FACS FRCOG
Associate Professor Department of Obstetrics and Gynecology NRS Medical College and Hospital Kolkata
Contributors ix Jagdishwari Mishra DGO MD MS FRCOG FICOG
Ex-Professor and Head Department of Obstetrics and Gynecology PMCH, Patna Chief Consultant JM Maternity and Child Welfare Clinic Patna Jaideep Malhotra Malhotra Nursing and Maternity Home Agra Jayanta Ray DGO MD Consultant Gynecologist Kolkata Jaydeep Tank MD DNB DGO FCPS MICOG K J Somaiya Medical College Hospital and Research Center Ashwini Maternity and Surgical Hospital Center for Endoscopy and IVF Kakali Sinha Karmakar DGO MD Assistant Professor Department of Obstetrics and Gynecology Kalidas Bakshi DGO MS Consultant Gynecologist and Obstetrician Kolkata Kalpana Sarkar Ex-Professor and Head Department of Obstetrics and Gynecology Chittaranjan Seva Sadan College of Gynecology Obstetrics and Child Health, Kolkata Kamal Buckshee FRCOG MD Consultant Gynecologist, New Delhi Ex Professor and Head Department of Obstetrics and Gynecology All India Institute of Medical Sciences New Delhi Kamini A Rao DGO DORCP DCH FRCOG MCh FICOG PGDMLE (Law) FNAMS
Medical Director Bangalore Assisted Conception Centre, Bangalore
Khyati Arvind Patel MBBS Resident in Obstetrics and Gynecology LTMG and Sion Hospital Mumbai Krishnendu Gupta Professor Department of Obstetrics and Gynecology Vivekananda Institute of Medical Sciences Ramakrishna Mission Seva Pratishthan Kolkata Kuldeep Singh Malhotra Nursing and Maternity Home Agra M M Samsuzzoha DGO MD MRCOG Assistant Professor Department of Obstetrics and Gynecology Vivekananda Institute of Medical Sciences Ramakrishna Mission Seva Pratishthan Kolkata Madhuri A Patel MD DGO Consultant Obstetrician and Gynecologist Ex Associate Professor Department of Obstetrics and Gynecology GMC, Hon. Consultant Nagpada Police Hospital Mumbai Mahesh Baldwa MD DCH LLB LLM Medicolegal Advisor to Insurance Companies AICL NIACL UIICL NICL Visiting Faculty and Professor of Law, University of Mumbai, Mumbai Visiting Faculty, National Insurance Academy, Baner, Pune Visiting Faculty, Symbiosis Institute, Pune Formerly Assistant Professor, Department of Pediatrics TN Medical College and Nair Hospital, Mumbai Chairman and Director Baldwa Hospital Mumbai Manish Banker MD Gynecologist and Infertility Specialist Director, Pulse Women’s Hospital Ahmedabad
x Medicolegal Aspects in Obstetrics and Gynecology Manju Gita Mishra DGO MS FICS FICOG FIAMS FICMCH
Ex-Professor Department of Obstetrics and Gynecology PMCH, Patna Chief Consultant, MGM Hospital, Patna Manju Puri MD MNAMS FICOG Professor Department of Obstetrics and Gynecology Lady Hardinge Medical College and SSK Hospital, New Delhi
Neelima Gupta DGO DNB Consultant Obstetrician and Gynecologist Bangalore Assisted Conception Centre Bangalore Nikhil Datar MD DNB FCPS LLB DGO DHA Gynecologist and Medicolegal Consultant Nanavati Hospital Assistant Honorary Cooper Hospital, Mumbai Nikhil Purandare MD MRCP(Ob/Gyn, IRL) DGO MCPS
Mausumi Banerjee DGO DNB MNAMS Consultant Gynecologist ESI Hospital, Baltikuri Howrah, West Bengal
Registrar Obstetrics and Gynecology Rotunda Hospital Dublin, Republic of Ireland
Maya Padhi Associate Professor Department of Obstetrics and Gynecology SCB Medical College, Cuttack
Nimisha Pandya MD Fulltime Gynaecologist Pulse Women’s Hospital, Ahmedabad
Monika Madaan MD Senior Resident Department of Obstetrics and Gynecology Lady Hardinge Medical College and SSK Hospital, New Delhi Mridul Gehlot MS MICOG FICMCH Fellowship in Gynae-Oncology Professor and Head of Gynae-Oncology Unit Department of Obstetrics and Gynecology SMS. Medical College, Jaipur Mumtaz Sanghamita Ex Professor and Head Department of Obstetrics and Gynecology Medical College and Eden Hospital Kolkata Narayan Jana MD DNB FRCOG MFFP MAMS FIMSA FICOG
Associate Professor Department of Obstetrics and Gynecology Institute of Postgraduate Medical Education and Research, Kolkata Narendra Malhotra Malhotra Nursing and Maternity Home Agra
Nirmala Saxena MS FRCOG Ex Professor and Head Department of Obstetrics and Gynecology Nalanda Medical College, Patna Nozer Sheriar MD DNBE FICOG FCPS DGO Consultant Obstetrician and Gynecologist Holy Family Masina and Parsee General Hospitals Gynecological Endoscopist Bhatia and BARC Hospitals Nupur Hooja MS MICOG FICMCH PGDMLS PGDHHM
Assistant Professor Department of Obstetrics and Gynecology SMS Medical College, Jaipur Pakhee Aggarwal Postgraduate student Maulana Azad Medical College New Delhi Pankaj Desai MD FICOG FICMCH Consultant Obstetrician and Gynecologist Janani Maternity Hospital, Baroda Parag Biniwale Consultant Obstetrician and Gynecologist, Pune
Contributors xi PK Shah MD FICOG FCPS FICMU FICMCH DGO DFP
Professor and Head of Unit Department of Obstetrics and Gynecology LTM Medical College and LTMG Hospital, Sion, Mumbai Prakash V Pawar MD DGO DFP FICOG Associate Professor, Terna Medical College, Navi Mumbai Pranati Sinha DGO MD Ex Professor and Head Department of Obstetrics and Gynecology Chittaranjan Seva Sadan, Kolkata Pranay Phukan MD FICOG Assistant Professor Department of Obstetrics and Gynecology Assam Medical College, Dibrugarh Pravin Patel MD DGO Gynecologist and Infertility Specialist Director Pulse Women’s Hospital, Ahmedabad Preeti Nitsure MD Registrar, Department of Obstetrics and Gynecology LTMG Hospital, Sion, Mumbai Rajiv Dhall DGO DNB MD FRCOG Visiting Consultant Obstetrics and Gynecology Peerless Hospital and BK Roy Research Centre, Kolkata Ram Prasad Dey SSKM Hospital Kolkata Runa Bal MD Assistant Professor Department of Obstetrics and Gynecology Calcutta National Medical College Kolkata Sabaratnam Arulkumaran MD PhD FRCOG
Professor and Head Division of Obstetrics and Gynecology St. George’s Hospital Medical School London
Saikat Sengupta MD DNB Consultant Department of Anesthesiology Perioperative Medicine and Pain Apollo Gleneagles Hospitals, Kolkata Sajal Datta MD DNB Professor of Obstetrics and Gynecology Vivekananda Institute of Medical Sciences Ramakrishna Mission Seva Pratisthan Kolkata Sanjay Gupte Hon Secretary, ICOG Hon Asso Prof of Obstetrics and Gynecology BJ Medical College, Pune Sanjeev Khurd MD FICOG Infertility Specialist and Director Dr Khurd’s Infertility and IVF Centre Pune Seetha Ramamurthy (Pal) DGO MD MRCOG
RCOG/RCR Diploma in Advanced Fetal Ultrasonography Consultant Obstetrician and Gynecologist Apollo Gleneagles Hospital, Kolkata Shobha Chakraborty MS FICS FICOG Ex Professor and Head Department of Obstetrics and Gynecology RMCH (RIMS), Ranchi Shubha Sagar Trivedi MS FICOG FIMSA Director Professor and Head Department of Obstetrics and Gynecology Lady Hardinge Medical College and S S K Hospital, New Delhi SN Tripathy MD FICOG Ex Professor and Head Department of Obstetrics and Gynecology SC B Medical College, Cuttack Soma Datta MS Senior Resident Department of Obstetrics and Gynecology Employees State Insurance Corporation Joka, Kolkata Soumen Sen Advocate High Court, Calcutta
xii Medicolegal Aspects in Obstetrics and Gynecology Su Lin Lin MRCOG MMed (O and G) Assistant Professor Department of Obstetrics and Gynecology YLL School of Medicine National University of Singapore Subhash Chandra Biswas Associate Professor and Ex-Head Department of Obstetrics and Gynecology Institute of Postgraduate Medical Education and Research, Kolkata Subhra Ghosh Jr Consultant Bhagirathi Neotia Woman and Child Care Centre, Kolkata Subir Kumar Bhattacharyya DGO MS Assistant Professor Department of Obstetrics and Gynecology R G Kar Medical College, Kolkata Sudhir Adhikary Associate Professor Department of Obstetrics and Gynecology Eden Hospital, Medical College, Kolkata Sudip Chakravarti FRCS FRCOG Professor of Obstetrics and Gynecology Vivekananda Institute of Medical Sciences Ramakrishna Mission Seva Pratisthan, Kolkata Sujal Munshi MD DNB Consultant Obstetrician and Gynecologist Munshi Hospital and Pulse Women’s Hospital, Ahmedabad Ex-Faculty, PS Medical College S K Hospitals, Anand Ex-Hon Sonologist and Faculty VS General Municipal Medical College and Hospital Sujata Mohanty Ex-Professor and Head Department of Obstetrics and Gynecology SCB Medical College, Cuttack Sukhpreet Patel MD DNB FCPS DGO PGDMLS
Program Director Assisted Fertility Unit Gynaecworld Associate Consultant, Gynaecworld Consultant Obstetrician and Gynecologist Bombay Hospital and Medical Research Centre, Mumbai
Sukumar Barik MD DNB FRCOG MFFP MAMS FICOG
Consultant Obstetrician and Gynecologist and Academic Director Westbank Hospital, Andul Road Howrah West Bengal Suneeta Mittal Professor and Head Department of Obstetrics and Gynecology All India Institute of Medical Sciences New Delhi Suranjan Chakraborty DGO MD Senior Gynecologist Ramrikhdas Haralalka Hospital Kolkata Sushila Baldwa MD DGO Consultant Gynecologist Baldwa Hospital Mumbai Swapna Majhi MD Consultant Obstetrician and Gynecologist Kolkata Swaraj Kumar Bhattacharya MS FRCS Senior Surgeon Sambhunath Pandit Hospital, Kolkata Tanya B Rohatgi MRCOG MD DNB MNAMS New Delhi Tejas Dave MD DGO Consultant Endoscopic Surgeon Pulse Women’s Hospital and Pooja Hospital, Ahmedabad Ujjal Kumar Roy MD MNAMS FIAMS FICOG Consultant Gynecologist SN Pandit Hospital, Kolkata Member, West Bengal State Medical Council Usha Sharma FRCOG Consultant Obstetrician and Gynecologist SK Memorial and AK Memorial Hospital, Patna Vimla P Pawar MD DGO FICOG Consultant Obstetrician and Gynecologist, Thane Vishnu Kumar Poddar DGO MD Consultant Obstetrician and Gynecologist AMRI and Matri Mangal Hospital Kolkata
Preface to the Second Edition Medicine is an imperfect science and our discipline is no exception. The current buzzword is evidence-based medicine, but good evidence is lacking in most areas. In many a situation, the clinician has to depend on experience and instinct. Needless to say, the outcome for a patient sometimes, is not satisfactory. Adverse events result from inadequacies in the science of medicine, errors of judgment, and sometimes negligence. However, whenever there is an adverse event or outcome, the relatives are dissatisfied and more often than not, tend to hold the healthcare providers guilty of some wrongdoing which must have led to the adverse outcome. No doubt the rapid technological advances, much changing values and melancholic attitude of the society has led to a feeling of discontent with eventual straining of the doctor-patient relationship. Healthcare is now under the purview of the consumer laws. The doctor is now a service provider and the patient a consumer. It is now easier for patients to seek legal redressal in the consumer forum and over the past few years doctors find themselves more frequently in the dock. Frivolous complaints have also increased and the situation is likely to get worse. The doctors in turn tend to get defensive which may lead to increased healthcare costs and refusal to attend complicated cases in smaller establishments. The current generation of doctors need to have good communication skills, proper documentation and a sound knowledge of medicolegal issues apart from expertise in the specialty. This will enable them to take preventive measures in their relevant expertise. A doctor also needs to know what constitutes negligence. This is the second edition of the book—Medicolegal Aspects in Obstetrics and Gynecology, which has been updated. As with the previous edition, the present edition highlights those areas of professional endeavor in our speciality that constitute potential pitfalls and problems of a legal nature. This book aims to improve the awareness about medicolegal problems in obstetric and gynecology. Ethical issues of a few important aspects have also been included. It is our honour and privilege to extend our deep appreciation, thanks and gratitude to all the contributors and a special thanks to the coeditors Dr Bhasker Pal and Dr Basab Mukherjee. We would also like to thank Prof Sudip Chakraborty and Prof Kalpana Sarkar for their valuable assistance in the preparation of the book.
xiv Medicolegal Aspects in Obstetrics and Gynecology
We are grateful to the Federation of Obstetric and Gynecological Societies of India for allowing us to publish this book. We also thank Jaypee Brothers Medical Publishers for publishing the book. We have all worked hard to compile the book. Our efforts will be successful if the readers find the book useful. Gita Ganguly Mukherjee Narendra Malhotra
Preface to the First Edition A new Horizon has dawned in the medical practice in India. The rapid technological advancement, changing values and materialistic attitude of the society has lead to a feeling of discontent with eventual straining of doctor-patients relation and trust. With the inclusion of Medical Profession within the perview of Consumer Protection Act, there was a lot of controversy and confusion amongst the doctors. Accountability in Medical Practice has existed since ancient time. The legalisation is the reflection of the changing norms and values of the society to eradicate the feeling of so-called immunity against accountability of the doctors. The law provides protection of the interest of the persons who may have suffered on account of negligence or deficiencies in the service rendered by the medical profession. It does not usually imply a warranty that a doctor will achieve the desired result, but only envisages that he will use reasonable care and skill. It strives to inculcate the spirit of inquiry to discern what is ethical and what is not, in the light of moral, ethical, medical and legal considerations of our society. Necessary relevant information on these aspects has been gathered in the text and presented in a form which would be easily understood by the medical professionals and this would certainly help in allaying their fears and confusions. Many important topics related to Obstetrics and Gynaecology have been covered. Chapters include important information like: — Potential areas of litigations in Obstetrics and Gynaecology — What constitutes medical negligence — What is medical ethics — Preventive steps to be taken against litigation — Importance of obtaining consent — Queries commonly arising in the minds of doctors have been discussed. The book contains the opinions of the members of medical and legal profession who have contributed different chapters concerned in the medico-legal field in relation to Obstetrics and Gynaecology. The views expressed does not necessarily reflect or represent that of the medicolegal committee of FOGSI. However, the readers will find this book as a highly reliable comprehensive resource.The language used in the text is lucid, simple and makes an easy reading.
ISBN 81-8448-321-X
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