In Covid pandemic, you do not have the right to refuse the patient in an emergency. In routine practice, each patient should be given a mask, sanitiser on hands and requested to keep a physical distance of 2 meters. Keep distance while examining and wash your hands after each examination.
Look for flu-like symptoms. On suspicion of covid, refer to Covid hospital for testing. If you are above the age of 55 years, you are exempted from treating patients having Covid like symptoms. You are not allowed not to close your clinics without any written information sent and approved by the authorities. You should not consider yourself immune to litigation arising during a period of pandemic. Though you are working in a difficult scenario, still don’t skip any sort of documentation.
Following legal provisions are applicable….
Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
1.9 Evasion of Legal Restrictions: The physician shall observe the laws of the country in regulating the practice of medicine and shall also not assist others to evade such laws. He should be cooperative in observance and enforcement of sanitary laws and regulations in the interest of public health. A physician should observe the provisions of the State Acts like ……… and such other Acts, Rules, Regulations made by the Central/State Governments or local Administrative Bodies or any other relevant Act relating to the protection and promotion of public health.
2.1.2 Medical practitioner having any incapacity detrimental to the patient or which can affect his performance vis-à-vis the patient is not permitted to practice his profession 5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a.
Dr. Dinesh Thakare MBBS, D.P.B., LLB., MA, MBA, BA
physician should not abandon his duty for fear of contracting the disease himself.
7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –i)in a court of law under orders of the Presiding Judge; ii)in circumstances where there is a serious and identified risk to a specific person and / or community; and iii)notifiable diseases. In case of communicable / notifiable diseases, concerned public health authorities should be informed immediately.
The Epidemic Diseases Act, 1897
2(A). Powers of Central Government.—When the Central Government is satisfied that India or any part thereof is visited by, or threatened with, an outbreak of any dangerous epidemic disease and that the ordinary provisions of the law for the time being in force are insufficient to prevent the outbreak of such disease or the spread thereof, the Central Government may take measures and prescribe regulations for the inspection of any ship or vessel leaving or arriving at any port, in the territories to which this Act extends, and for such detention thereof, or of any person intending to sail therein, or arriving thereby, as may be necessary.
- Penalty.—(1)Any person disobeying any regulation or order made under this Act shall be deemed to have committed an offence punishable under Section 188 of the Indian Penal Code (45 of 1860).
(2)Whoever – (i)commits or abets the commission of an act of violence against a healthcare service personnel; or (ii)abets or causes damage or loss to any property, shall be punished with imprisonment for a term which shall not be less than three months, but which may extend to five years, and with fine, which shall not be less than fifty thousand rupees, but which may extend to two lakh rupees.
(3)Whoever, while committing an act of violence against a healthcare service personnel, causes grievous hurt as defined in section 320 of the Indian Penal Code to such person, shall be punished with imprisonment for a term which shall not be less than six months, but which may extend to seven years and with fine, which shall not be less than one lakh rupees, but which may extend to five lakh rupees.
- Protection to persons acting under Act.—No suit or other legal proceeding shall lie against any person for anything done or in good faith intended to be done under this act. The Indian Penal Code 1860 IPC 188. Disobedience to order duly promulgated by public servant
Whoever, knowing that, by an order promulgated by a public servant lawfully empowered to promulgate such order, he is directed to abstain from a certain act, or to take certain order with certain property in his possession or under his management, disobeys such direction, shall, if such disobedience causes or tends to cause obstruction, annoyance or injury, or risk of obstruction, annoyance or injury, to any person lawfully employed, be punished with simple imprisonment for a term which may extend to one month or with fine which may extend to two hundred rupees, or with both; and if such disobedience causes or trends to cause danger to human life, health or safety, or causes or tends to cause a riot or affray, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine which may extend to one thousand rupees, or with both.
Explanation :- It is not necessary that the offender should intend to produce harm or contemplate his disobedience as likely to produce harm. It is sufficient, that he knows of the order which he disobeys, and that his disobedience produces, or is likely to produce, harm.
IPC. 269. Negligent act likely to spread infection of disease dangerous to life.
Whoever unlawfully or negligently does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.
IPC. 270. Malignant act likely to spread infection of disease dangerous to life.
Whoever malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either registered description for a term which may extend to two years, or with fine, or with both.
About tele consultation in short…
All Registered Medical practitioners meaning to offer online consultation got to complete a compulsory on-line course among three years of its notification. Till that point, you’ll tele-consult, provided you follow the Telemedicine observe tips notified beneath IMC Act, 1956. The same moral and skilled standards ought to be observed as in routine practice. Do not give telecom Consultation,
Telemedicine and on-line Consultations, unless it is proven to be the simplest possibility out there within the given state of affairs.
Ensure that correct security measures are in situ to guard confidentiality of knowledge shared with you by the patient. Be extremely clear & well documented thereon. Maintain quality of instruments used. Keep copy. Be out there for follow-up procedures whenever necessary. Maintain all records as well as the way to determine the patient.
You may prescribe medicines via telemedicine only if you are confident about the data gathered being adequate and relevant to the patient’s medical condition and prescribed medicines are within the best interest of the patient.
Patient consent is critical for any telemedicine consultation. The consent is tacit or express betting on the subsequent situations:
- If the patient initiates the telemedicine consultation, then the consent is tacit.
- An Explicit patient consent is required if: A medical examiner, RMP or a Caregiver initiates a Telemedicine consultation.
- An Explicit consent is recorded in any kind. The patient will send associate degree email, text or audio/ video message.
If a Medical condition needs a specific protocol to diagnose and impose as during a case of in-person consult then a similar prevailing principle are going to be applicable to a telemedicine consult .
You cannot impose medicines that have a high potential of abuse and will damage the patient or the society at giant if used improperly like medicines listed in Schedule X of Drug and Cosmetic Act and Rules or any Narcotic and mind-blowing substance listed within the Narcotic medication and mind-blowing Substances, Act, 1985
Emergency consultations should be limited to directing the patient or caregiver to the appropriate site for physical care and advice about first aid until reaching such a site. Prescriptions should be provided in standard format. Medications are classified as per the mode of consultation, practicableness and safety of telemedicine.
List O includes medication that are out there over the counter like paracetamol, oral rehydration solutions, etc. they’ll be suggested by any mode of consultation.
List A includes medication that may be prescribed solely when video consultation like eye drops for inflammation.
List B includes of these medication that ar prescribed for a similar condition as add-ons (E.g.: ondansetron for severe nausea in physiological condition that isn’t eased by initial line agents like doxylamine).
You have to keep up the subsequent records/ documents for the amount as prescribed from time to time: Log or record of Telemedicine interaction (e.g. Phone logs, email records, chat/ text record, video interaction logs etc.). Patient records, reports, documents, images, nosology, data etc. (Digital or non-Digital)used within the telemedicine consultation ought to be maintained by you.
Specifically, just in case a prescription is shared with the patient, you’re needed to keep up the prescription records pro re nata for in-person consultations.