Morning MEDtalks with Dr K K Aggarwal

New Delhi, July, 28 2018 :

Prescribing medicines without diagnosis is culpable negligence: Bombay HC

No telephonic consults please- You can go to Jail

Press Trust of India: Observing that prescribing medicines to patients without diagnosis amounted to culpable negligence, the Bombay High Court has turned down the anticipatory bail pleas of a doctor couple booked for the death of a woman patient. The doctors have been booked by the Ratnagiri Police under section 304 of Indian Penal Code (culpable homicide not amounting to murder) after the patient died earlier this year.

“The high court noted that there was no effort to refer the woman to another doctor in the absence of Deepa Pawaskar and she (Deepa) continued to prescribe medicines telephonically.” “There was no resident medical officer or any other doctor to look after the patient in the absence of Dr Deepa and Sanjeev Pawaskar even when the couple knew that they would not be available in the hospital,”

“Prescription without diagnosis would amount to culpable negligence. This amounts to gross negligence from the point of standard of care and recklessness and negligence, which is a tricky road to travel,”

The accused couple, in their pleas, argued that they could not be charged with culpable homicide not amounting to murder and should, at the most, be booked under section 304 (A) (causing death due to negligence).

The high court, however, said that in the present case, the applicants took the risk of doing something with recklessness and indifference to the consequences.

“An error in diagnosis could be negligence and covered under section 304 (A) of the Indian Penal Code. But this is a case of prescription without diagnosis and, therefore, culpable negligence,”

“When a doctor fails in his duty, is it not tantamount to criminal negligence ? The courts cannot ignore the ethical nature of the medical law by liberally extending the legal protection to the medical professionals…,”

“Segregation of reckless and negligent doctors in the profession will go a great way in restoring the honour and prestige of large number of doctors and hospitals who are devoted to their profession and scrupulously follow the ethics and principles of the noble profession,” (Excerpts from PTI News)

World Hepatitis Day: “Test. Treat. Hepatitis”

Today is World Hepatitis Day. The theme this year is “Test. Treat. Hepatitis” Timely testing and treatment of hepatitis B and C can save lives and ultimately eliminate viral hepatitis. Let’s revise some key points about viral hepatitis:

Hepatitis B is the most infectious of the three blood-borne viruses: Hepatitis B, hepatitis C and HIV.
Absence of jaundice does not rule out acute hepatitis infection, which can present sometimes only with constitutional symptoms such as fever, vomiting, poor appetite, lethargy with high liver enzymes.
People at risk for HIV infection are also at risk for Hepatitis B and C infections due to their shared routes of transmission.
All people with HIV infection should be tested for hepatitis B and C infections.
Progression of liver disease is faster in viral hepatitis.
HIV coinfection increases the risk of serious, potentially fatal complications.
Hepatitis B can also be transmitted by fomites such as such as finger-stick devices used to obtain blood for glucose measurements, multi-dose medication vials, jet gun injectors, and endoscopes.
Hepatitis B virus is 10 times more infectious than hepatitis C virus and 50-100 times more infectious than HIV.
The Hepatitis B virus can survive in dried blood for up to 7 days and remains capable of causing infection. This makes hepatitis B a more dangerous infection than HIV.
Any blood spills from a person with hepatitis B should be cleaned up with appropriate infection control procedures e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water.
Any scratch, cut and wound should be cleaned with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood-borne infection.
Hepatitis B is preventable; hepatitis B vaccination is recommended for high-risk people or those living with HIV who have tested negative for hepatitis B virus.
All unvaccinated persons should be administered hepatitis B vaccine after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immunoglobulin is recommended.
Hepatitis C virus can survive on environmental surfaces for up to 16 hours. It can also spread from infected fluid splashes to the conjunctiva.