Frequently Asked Questions
Is it legally mandatory to disclose the cost of surgery / treatment in consent form?
Disclosing the cost of a surgery / treatment in the consent form that is signed by the patient is not legally mandatory. However, being a poor nation, with most of the patients not having health insurance and healthcare becoming expensive with every passing day, there is no harm in disclosing and recording this fact in the consent form. In fact it is a good practice.
Disclosing the cost of a surgery / treatment in the consent form that is signed by the patient is not legally mandatory. However, being a poor nation, with most of the patients not having health insurance and healthcare becoming expensive with every passing day, there is no harm in disclosing and recording this fact in the consent form. In fact it is a good practice.
In case a pediatric patient is not willing for telemedicine consultations, but his/her parents are forcing for the same, will it be legally safe for the doctor to continue on telemedicine?
Avoid if the patient is above 12 years of age although there is no legal prohibition as a minor is legally incompetent to give or withhold consent for treatment or telemedicine
Avoid if the patient is above 12 years of age although there is no legal prohibition as a minor is legally incompetent to give or withhold consent for treatment or telemedicine
What should be done to remain legally safe when a distant relative wants patients health related information on phone?
Health related information of an adult, conscious and oriented patient should not be disclosed to anyone without patients’ positive assent or directions. In case the patient is legally incompetent, information can be shared with near relatives. Sharing information on telephone must be avoided as far as possible unless the patient has given express directions in this regard.
Health related information of an adult, conscious and oriented patient should not be disclosed to anyone without patients’ positive assent or directions. In case the patient is legally incompetent, information can be shared with near relatives. Sharing information on telephone must be avoided as far as possible unless the patient has given express directions in this regard.
What is the legally correct reaction when a person who was never a patient of the doctor, seeks only a 'fitness certificate' to resume work?
There are two options. Either refuse outrightly or examine the patient properly, get the requisite investigations done and then issue an appropriate certificate.
There are two options. Either refuse outrightly or examine the patient properly, get the requisite investigations done and then issue an appropriate certificate.
How long is it legally permissible for a patient to seek tele-consultations for regular follow up from the doctor without physically meeting the doctor, especially if the patient is well maintained on his/her medication?
There is no bar on the length of time for which tele-consultations can be done for follow-up or even otherwise. One simply has to be careful in prescribing medicines, as some medicines can be prescribed only in case of ‘follow up consult’ and not ‘first consult’. A new patient, a patient coming after 6 months of physical consultations or a patient coming for a different condition / symptom is considered as ‘first consult’. Rest all are ‘follow up’ consult.
There is no bar on the length of time for which tele-consultations can be done for follow-up or even otherwise. One simply has to be careful in prescribing medicines, as some medicines can be prescribed only in case of ‘follow up consult’ and not ‘first consult’. A new patient, a patient coming after 6 months of physical consultations or a patient coming for a different condition / symptom is considered as ‘first consult’. Rest all are ‘follow up’ consult.
Will the senior consultant be legally liable if the junior doctor fails to write correctly what was dictated by the senior consultant?
Yes. Rather in India, it is only the senior consultant who will be legally liable. Checking the notes taken by juniors, residents and/or nurses and then putting initials is a legally and therapeutically safer option
Yes. Rather in India, it is only the senior consultant who will be legally liable. Checking the notes taken by juniors, residents and/or nurses and then putting initials is a legally and therapeutically safer option
Is DNI (Do not Intubate) / DNR (Do not Resuscitate) currently legal in India?
Currently, none of these concepts are legally acceptable in India. Only ‘Advance Medical Directive’ of the patient is legally valid although the procedure prescribed by the Hon’ble Supreme Court for making one and acting / executing the same is very cumbersome, nearly impossible.
Currently, none of these concepts are legally acceptable in India. Only ‘Advance Medical Directive’ of the patient is legally valid although the procedure prescribed by the Hon’ble Supreme Court for making one and acting / executing the same is very cumbersome, nearly impossible.
What is the legally correct protocol that should be followed if the patient informs the surgeon that he/she is not in a position to afford ICU / ICCU after an elective surgery, in case such a need arises?
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
What is the current legal status for consulting new psychiatric patients online?
There is no prohibition or special provisions for psychiatric patients, new or old, in the Telemedicine Practice Guidelines. But examining and interacting with such patients physically is always advisable, moreover in case of new patients.
There is no prohibition or special provisions for psychiatric patients, new or old, in the Telemedicine Practice Guidelines. But examining and interacting with such patients physically is always advisable, moreover in case of new patients.
Is an anesthetist always held liable for medical negligence along with the surgeon?
The legal liability of surgeons and anesthetists is distinct. An anesthetist will be held liable only if there is any negligence in administering anesthesia or failure to perform a pre-anesthesia check-up. All other responsibilities are on the surgeon performing the surgery.
The legal liability of surgeons and anesthetists is distinct. An anesthetist will be held liable only if there is any negligence in administering anesthesia or failure to perform a pre-anesthesia check-up. All other responsibilities are on the surgeon performing the surgery.
Can a small hospital / nursing home not appropriately equipped write on its entrance "Emergency services are not available"?
Any qualified doctor, even a simple MBBS, is bound to accept and manage a patient who is in need of emergency care. Every hospital / nursing home irrespective of its size can provide first aid, try to stabilize the patient and then shift to another facility. Writing "Emergency services are not available" or not accepting any emergency patient is illegal and unethical.
Any qualified doctor, even a simple MBBS, is bound to accept and manage a patient who is in need of emergency care. Every hospital / nursing home irrespective of its size can provide first aid, try to stabilize the patient and then shift to another facility. Writing "Emergency services are not available" or not accepting any emergency patient is illegal and unethical.
If an electronic equipment suddenly malfunctions will the doctor or the hospital be held negligent?
Doctors / hospitals are expected to take the requisite precautions in servicing the equipment at the indicated intervals and using them appropriately. Failure to do so could be construed as negligence. But inspite of all precautions if the equipment suddenly fails to work properly, the doctor / hospital is not negligent. The requisite evidence will have to be produced before the court.
Doctors / hospitals are expected to take the requisite precautions in servicing the equipment at the indicated intervals and using them appropriately. Failure to do so could be construed as negligence. But inspite of all precautions if the equipment suddenly fails to work properly, the doctor / hospital is not negligent. The requisite evidence will have to be produced before the court.
What are the legal consequences if the consultant gives proper advice but the nurse does not execute it properly or at all?
The hospital and/or nurse only will be held legally liable. The consultant will not be held negligent. But proving this aspect in court is a Herculean task. There are other practical difficulties also.
The hospital and/or nurse only will be held legally liable. The consultant will not be held negligent. But proving this aspect in court is a Herculean task. There are other practical difficulties also.
Will doctors be liable towards patients if the data is leaked by companies such as the ones providing online medical records / cloud-based software / cloud storage options, and so on?
As far as telemedicine is concerned, the law is absolutely clear. If the doctor has performed due diligence before engaging these services and has no role to play in data leakage, the doctor is not liable. But the law is not clearly set out in other areas of operations..
As far as telemedicine is concerned, the law is absolutely clear. If the doctor has performed due diligence before engaging these services and has no role to play in data leakage, the doctor is not liable. But the law is not clearly set out in other areas of operations..
What name should be written on the prescription – the common name or the name registered with NMC?
Legally speaking, it should be the name registered with NMC. A middle way could be writing both names, especially if the doctor is known by some other name (common name) in the society.
Legally speaking, it should be the name registered with NMC. A middle way could be writing both names, especially if the doctor is known by some other name (common name) in the society.
Why does the legal system think that hospitals / doctors in India are working in an ideal situation with all resources in place?
Indian courts are aware of the handicaps that doctors / hospitals face in providing healthcare services. This is clearly reflected in their judgments although aberrations do happen.
Indian courts are aware of the handicaps that doctors / hospitals face in providing healthcare services. This is clearly reflected in their judgments although aberrations do happen.
Is it legally necessary to get the consent forms vetted by lawyers?
No. However, doing so is always advisable in view of the rising numbers of medical negligence cases.
No. However, doing so is always advisable in view of the rising numbers of medical negligence cases.
Is it safe to use the Apps that are available today for online patient counselling?
Telemedicine Practice Guidelines 2020 to a certain extent protects doctors if there is any breach of confidentiality or data if the doctor is not directly involved. Nevertheless, it also mandates that the doctor must perform due diligence before opting for any such service..
Telemedicine Practice Guidelines 2020 to a certain extent protects doctors if there is any breach of confidentiality or data if the doctor is not directly involved. Nevertheless, it also mandates that the doctor must perform due diligence before opting for any such service..
Can smaller hospitals / nursing homes display "Emergency services are not available"? Especially if they do not have requisite equipment?
No. This is legally not permitted. Furthermore, every hospital / nursing home run by a qualified doctor is competent to provide first aid and can facilitate a patient in need of emergency care in reaching the right hospital..
No. This is legally not permitted. Furthermore, every hospital / nursing home run by a qualified doctor is competent to provide first aid and can facilitate a patient in need of emergency care in reaching the right hospital..
In Canada psychiatrists do psychotherapy sessions via telemedicine? Is it permitted in India?
There is no legal bar in India to do so.
There is no legal bar in India to do so.
Should advance consent be taken for subsequent ‘tailoring’?
Advance consent can be taken for those surgeries / interventions that are commonly performed along with or are an extension of the main surgery / procedure.
Advance consent can be taken for those surgeries / interventions that are commonly performed along with or are an extension of the main surgery / procedure.
A patient's relatives take me to their home and then force me to give a Death Certificate to my old patient? What should I do – legally and pragmatically?
Legally, you must refuse to give a Death Certificate, if you are not aware of the cause of death. On the practical side if you are unable to withstand force, give the Death Certificate but at the first opportunity lodge a complaint with the police.
Legally, you must refuse to give a Death Certificate, if you are not aware of the cause of death. On the practical side if you are unable to withstand force, give the Death Certificate but at the first opportunity lodge a complaint with the police.
What should be done when the patient refuses to sign 'refusal consent'?
This fact must be specifically recorded in the medical records of the patient.
This fact must be specifically recorded in the medical records of the patient.
Can a doctor stop a patient from recording a telemedicine session?
Yes. And if the patient refuses to do so the doctor can very well stop the telemedicine session midway.
Yes. And if the patient refuses to do so the doctor can very well stop the telemedicine session midway.
Do Indian courts take into consideration the situation under which doctors are working in government hospitals?
Yes. In fact, they are very accommodating with government doctors / hospitals.
Yes. In fact, they are very accommodating with government doctors / hospitals.
Is malfunctioning of equipment considered negligence / deficiency of service by courts?
Malfunctioning is not per se negligence. But when a patient is admitted or taken for an intervention knowing well that the equipment is not functioning properly, courts draw adverse inferences.
Malfunctioning is not per se negligence. But when a patient is admitted or taken for an intervention knowing well that the equipment is not functioning properly, courts draw adverse inferences.
I am a senior anesthesiologist, I don’t need physician clearance before administering anesthesia. I do it myself. Am I legally correct?
Generally, a fitness certificate from a physician is advisable and rather mandatory in critical / complicated cases. It would all depend on the patient’s condition and what medical science and medical practice permits.
Generally, a fitness certificate from a physician is advisable and rather mandatory in critical / complicated cases. It would all depend on the patient’s condition and what medical science and medical practice permits.
What should be done in emergencies when there is no time to explain / take consent?
All efforts must be done to take consent even in emergencies. But if it is interfering with patient management in anyway, proceeding without consent is acceptable to courts.
All efforts must be done to take consent even in emergencies. But if it is interfering with patient management in anyway, proceeding without consent is acceptable to courts.
The Discharge Card was admittedly having a mistake. The patient comes after a year and requests a new Discharge Card. What is the legally correct protocol to follow?
There is a possibility of misuse. The best way to deal with this situation is to give a clarification letter rather than changing the Discharge Card.
There is a possibility of misuse. The best way to deal with this situation is to give a clarification letter rather than changing the Discharge Card.
What is the current legal status of accepting / consulting new psychiatric patients online?
There is no prohibition on doing so. The law laid down in the Telemedicine Practice Guidelines 2020 must be followed.
There is no prohibition on doing so. The law laid down in the Telemedicine Practice Guidelines 2020 must be followed.
If a doctor prescribes recently banned medicine due to sheer ignorance, will the doctor be legally liable?
Yes certainly. Ignorance of law is no defence in a court of law.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
Is consent required even for day care / IV Canula / oral chemotherapy?
It is advisable to obtain consent whenever there is a dilemma about whether to do so. There is no legally reliable resource in India that can be referred to while obtaining consent..
It is advisable to obtain consent whenever there is a dilemma about whether to do so. There is no legally reliable resource in India that can be referred to while obtaining consent..
Will the treating doctor or hospital be legally liable for hospitalizing a patient at their request or insistence, especially in a small town?
The ‘locality rule’ applies in such situations in favour of doctors / hospitals. However, the communication with the patient / attendants regarding shortcomings must be clear and appropriately documented.
The ‘locality rule’ applies in such situations in favour of doctors / hospitals. However, the communication with the patient / attendants regarding shortcomings must be clear and appropriately documented.
Does insurance cover telemedicine?
Yes. IRDAI has issued clear instructions to insurance companies in this regard.
Yes. IRDAI has issued clear instructions to insurance companies in this regard.
What are the legal consequences of failure to record the time of admission of a patient needing emergency care, a common error?
Courts generally overlook procedural deficiencies in emergencies. However, diligence and following procedures are necessary even in emergencies.
Courts generally overlook procedural deficiencies in emergencies. However, diligence and following procedures are necessary even in emergencies.
Do the doctor and patient have to sign the consent form at the same time?
No. India has no such legal mandate, although this is best practice.
No. India has no such legal mandate, although this is best practice.
Can a minor consent for telemedicine if the parent initiates the consultation? Will it be legal?
Parents / guardians have the legal right to consent on behalf of minors and not the minors. Law is fairly well settled in this regard.
Parents / guardians have the legal right to consent on behalf of minors and not the minors. Law is fairly well settled in this regard.
Who will be held liable in cases where the junior doctor fails to write the correct dictation given by the senior consultant?
Generally, the senior doctor alone would be held liable. But nowadays, courts are even holding junior doctors liable.
Generally, the senior doctor alone would be held liable. But nowadays, courts are even holding junior doctors liable.
In case of interventions with multiple cycles / procedures - will a single consent suffice?
It is advisable to take consent for each cycle rather than taking a single consent for all the cycles / sessions.
It is advisable to take consent for each cycle rather than taking a single consent for all the cycles / sessions.
Is it legally mandatory for hospitals managing foreign patients to engage the services of an interpreter?
There is no written law or guideline mandating that hospitals accepting and managing foreign patients must employ interpreters. But then, how is one going to communicate with a patient who does not know English or the local language?
There is no written law or guideline mandating that hospitals accepting and managing foreign patients must employ interpreters. But then, how is one going to communicate with a patient who does not know English or the local language?
What kind of medicines should not be prescribed by doctors during online consultation?
This aspect is regulated by the Telemedicine Practice Guidelines, which provide a comprehensive list of medicines that can be and cannot be prescribed.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
What is the medicolegal risk if a doctor makes a wrong diagnosis because of incomplete information during telemedicine?
If the information provided by the patient is incomplete and within the doctor's knowledge, the doctor must refrain from proceeding further.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
In an elective surgery if post-surgery ICU is indicated, the doctor/hospital may have to continue care even without fees. But providing optimum care to such a patient beyond a particular period of time may not be possible. Referring such patients to government / charitable hospitals for surgery at the outset is a better option for both, the patient as well as the doctor.
If a patient dies immediately after taking medicines prescribed by the doctor for some other reasons, is the doctor negligent?
Merely because the patient has not responded favorably or has died the doctor cannot be held as negligent.
How much does pre-operative signatures from the patient and their relatives on consent safeguard doctors legally?
Consent safeguards the doctor from patients / attendants’ allegations about non-disclosure of relevant information. However, there are other misdemeanours for which the doctor can still be held legally liable.
What do the Telemedicine Guidelines say about consulting fees?
A doctor can charge fees for giving teleconsultations. It is permissible.
On one hand law wants doctors to give medical certificates to patients but on the other hand law punishes doctors for giving medical certificates. Why?
If any right, privilege, or authority is misused, the law is bound to punish. This law applies to one and all. Giving a medical certificate is a privilege given to doctors by law for obvious reasons. But misusing this privilege is bound to invite legal trouble.
Can psychotropic drugs be prescribed via telemedicine?
Except for the drugs whose prescription is banned under the Telemedicine Practice Guidelines 2020, all other medicines, including psychotropic medications, can be prescribed by telemedicine.
Does the law protect doctors who provide time-sensitive treatment to an incompetent patient in emergencies?
The law is very accommodating toward doctors / hospitals that provide emergency care. However, greater care and caution are required if the patient is legally incompetent.
Are DNI (Do Not Intubate) and DNR (Do Not Resuscitate) currently legal in India?
Advance Medical Directives are now legally recognized in India thanks to the Supreme Court’s judgment in the Common Cause case. However, other end-of-life care instructions, such as DNI / DNR, are unclear.
What are the legal implications of endorsement on OPD papers "Not valid for Medico-legal purposes”?
Such noting / endorsement has no legal sanctity nor provides any legal defence.
Is there any special protection for doctors in the Disaster Management Act?
No there are no specific provisions to protect doctors who provide healthcare services during a disaster. Nevertheless, general protection operates.
Without an MLC / Police report, can a doctor treat a patient whose life is in danger?
Yes. The Supreme Court laid down the law in this regard way back in 1989. Doctors' / hospitals' first priority should be managing the patient, and the procedural protocols can be completed later.
When patients intentionally hide their history, and something goes wrong, does the law protect doctors?
A doctor can never be held liable for the consequences arising from patients' / attendants' failure to disclose the correct and complete history, intentionally or unintentionally.
Is the Telemedicine law permanent in nature?
Yes. It is permanent and is applicable with the same force even after the COVID-19 pandemic.
Is it necessary for a prescription to be handwritten on a physical prescription? Can it be typed in an online format and sent over mail or linked to?
No. Writing or giving a physical prescription is not mandatory. A prescription can be typed and even sent in digital format. While giving digital prescriptions the legal stipulations laid down in the Telemedicine Practice Guidelines 2020 must be followed.
In an emergency case, if a doctor refers a patient to another city, but the patient passes away in transit, then what are the possibilities of a court case?
Every decision and action of a doctor must be in accordance with medical science and without delay. Death is not a barometer for negligence in law.
Is the seniority of doctors and their clinical experience taken into account by courts, especially the consumer courts?
Yes. The seniority and clinical experience of the doctors are considered when deciding a case of medical negligence.
Can the National Medical Commission (NMC) advice the consumer courts in cases of medical negligence?
No. Courts are judicial bodies, while the NMC is a regulatory and statutory body. However, the orders issued by the NMC on complaints filed by patients against doctors are sometimes considered by the courts when determining cases of medical negligence.
Is an intraoperative change of consent to do a radical surgery legally acceptable?
Making intraoperative changes and extending the surgery beyond what was agreed upon in the consent is not legally permissible under ordinary circumstances. It is permitted only when the life or limb of the patient is at stake, and postponing the extended action may cause permanent harm to the patient.
If a patient dies immediately after being brought to casualty and before the final diagnosis, who is held legally liable?
It will all depend on the facts and circumstances of the case. If the hospital or doctors have acted in accordance with accepted medical practice without any delay, then they are not negligent, regardless of whether they were successful in reaching a final diagnosis.
How to deal with suspected or evident alcohol poisoning or intoxication cases?
The legally safest way is to inform the police in case of poisoning, although it may not always be possible or pragmatic.
Do we need to keep records of all the drugs and medicine prescribed to patients and how long to maintain the records?
Medical records for inpatient (IPD) patients must be preserved by law “for a period of 3 years from the date of commencement of the treatment.” There is no legal requirement to keep medical records for outpatient (OPD) patients, although it is recommended to do so.
In the case of infants, the anxious mother shares symptoms with the doctor that are actually absent in the infant, making diagnosis difficult. What should be done?
Documenting the complaints, symptoms, and history provided by the infant’s mother serves as a full defense in a court of law if something goes awry.
What is the current legal status of obtaining consent from OPD patients in India?
It does not matter whether the patient is an inpatient (IPD) or outpatient (OPD) when it comes to obtaining consent. In India, written informed consent from the patient is essential for all invasive interventions.
If an unconscious patient is brought to the emergency room, who will cover the patient's expenses?
In some states of India, laws provide fixed reimbursement for hospitals and doctors who treat emergency patients.
Is a doctor legally obligated to accept and treat all patients who approach the doctor?
No. The doctor has the right to accept or refuse a patient without providing a reason. It is a contract between two consenting adults. However, the doctor is obligated to accept every patient who is in need of emergency care.
Can time be limited for teleconsultation by the doctor?
Why not? But the patient attendants must be informed of the time allotted in advance.
What if the patient is intoxicated while joining the telemedicine consultation?
The doctor has the right and the discretion to stop the telemedicine consultation midway.
Can doctors be forced by government to practice telemedicine?
Not in ordinary situation. But in a pandemic or a disaster the government does have the power to do so.
Is it legally mandatory that the treating doctor or the ICU in-charge should accompany the patient in the ambulance?
If the patient who has taken DAMA, insists that the hospital should provide an ambulance for transfer to another hospital, what should be done?
Once the patient / attendants have taken DAMA / LAMA, the legal relationship between the hospital and the patient comes to an end. The hospital cannot be forced to provide an ambulance for transfer.
Can medical records be withheld if the patients / attendants have indulged in violence?
Yes. Even in such cases, the patient has the right to get medical records. The doctors / hospitals who are targeted in the violence have the legal remedy of filing police complaints.
What are the minimum equipment required in an ICU?
The minimum requirements of equipments in ICU are prescribed in the Rules made under the Clinical Establishment Act. Only some States have accepted and implemented this law.<