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Journal of the Academy of Hospital Administration

Attendance of Doctors in Courts - Supreme Court Ruling

Author(s): Editors

Vol. 16, No. 2 (2004-07 - 2004-12)

(1989) 4 Supreme Court cases 286 (before Raghunath Misra and G L Oza, JJ .)
Pt . Parmanand Katara......petitioner Versus Union of India and others .....
Respondents Writ petition ( Criminal) No 270 of 1988, Decided on August 28, 1989

In this issue we reproduce salient features of the Hon'ble Supreme Court guidelines regarding attendance of doctors in courts. We feel that this will be of value to doctors and administrators in day to day course of their medicolegal practice. (Editors)

Constitution of India Article 21 & 32.

Immediate medical aid to injured person. State's obligation to preserve life. Professional obligation of all doctors, of government Hospitals, or private, to extend medical aid to the injured immediately . Statutory procedural requirement of observance of police formalities or Zoning of the hospitals or formalities of evidence of doctors cannot delay avoid rendering of immediate medical relief. In not waiting for completion of legal formalities doctors would not be violating and law. Lawyers, police and courts exhorted not to call the doctors for evidence or interrogation unless absolutely necessary and when called to treat them with respect and not be made to wait for long or suffer harassment. The 1985 decision of Committee chaired by the Director General Health Services (Quoted below). Held, will become operative immediately. Government of states and UT's can seek amendment in directions upto three months. Government, Media, registry, Law reports and Medical Council of India directed to inform all concerned, the courts, Medical Colleges, Practicing doctors, and to give high publicity to this Ruling.

Keywords/Issues

Medical Ethics, Medico-legal case - Criminal Procedure Code 1973. Section 154, 156, 157, 159, 160, 161. Evidence Act 1872, Section 45. Public Interest litigation.

Article 21 of the Constitution casts the obligation on the state to preserve life. The patient whether he be an innocent person or be a criminal is liable to be punished under the laws of the society. It is the obligation of those who are in charge of the health of the community to preserve life so that the innocent may be protected and the guilty may be punished. Social laws do not contemplate death by negligence to tentamount to legal punishment. Every doctor whether at a Government Hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. The obligation being total absolute and paramount. law of procedure whether in statues or otherwise which would interfere with the discharge of this obligation cannot be sustained and must , therefore , give under Article 32 of the constitution of India way. The matter is extremely urgent and brooks no delay to remind every doctor of his total obligation and assure him of the position that he does not contravene the law of the land by processing to treat the

injured victim on this appearance before him either by himself or being carried by others. Zonal regulations and classification cannot also operate as fetters in the process of discharge of the obligations and irrespective of the fact whether under instruction or rules. The victim has to be sent elsewhere or how the police shall be contacted, the guidelines indicated in the 1985 decision of the committee, is to become operative. (Para 7 and 8)

Guidelines:

The committee under the chairmanship of the Director- General of Health Services referred above had taken the following decisions:

1. Whenever any medico-legal case attends the hospital, the medical officer on duty should inform the duty constable, name, age, sex of the patient and place and time of occurrence of the incident, and should start the required treatment of the patient. It will be the duty of the constable on duty to inform the concerned police station or higher police functionaries for further action. Full medical report should be prepared and given to the police, as soon as examination and treatment of the patient is over. The treatment of patient would not wait for the arrival the police or completing the legal formalities.

2. Zonalisation as has been worked out for the hospitals to deal with medico-legal case will only apply to those cases brought by the police. The medico-legal cases coming to hospital on their own (even if the incident has occurred in the zone of other hospital) will not be denied the treatment by the hospital where the case reports, nor the case will be referred to other hospital because the incident has occurred in the area, which belongs to the zone of any other hospital. Same police formalities as given in para-1 above will be followed in these cases.

3. All government hospitals, medical institutes should be asked to provide the immediate medical aid to all the cases irrespective of the fact whether they are medico legal cases or otherwise. The practice of certain Government institution to refuse even the primary medical aid to the patient and referring them to other hospitals simply because they are medico legal cases is not desirable. However after providing the primary medical aid to the patient, patient can be referred to other hospital if the expertise facilities required for the treatment are not available in the institution.

When a man is in a miserable state hanging between life and death reaches the medical practitioner either in a hospital (run or managed by the state) public authority or a private person or a medical professional doing only practice he is always called upon to rush to help such an injured person and to do all that is within power to save life. It is a duty coupled with human instinct, which needs no decision nor any code of ethics nor any rule of law. Per Oza, J ( Concurring)

There is no legal impediment for a medical professional when he is Called upon or requested to attend to an injured person needing his medical assistance immediately. The apprehension regarding the law of procedure and the police regulation and the priorities in such a situation are based on misunderstanding. The effort to save the person should be the top priority not only of medical professions but even of the police or any other citizen who happened to be connected with the matter or who happened to notice such an incident or a situation. Apprehension that the doctor will have to face police interrogation and stand as witness in court and face all the harassment even if they have some foundation should not prevent them for discharging their duty as a medical professional to save a human life and to do all that is necessary but at the same time it is hoped that the police, the members of the legal profession, law courts and every one concerned will also keep in mind that a man in medical profession should not be unnecessarily harassed for purposes of interrogation or for any other formality and should not be dragged during any investigation at the police station and it should be avoided as far as possible , it is also hoped that law of courts will not summon a medical profession to give evidence unless the evidence is necessary and even if he summoned, attempt should be made to see that the man in this profession are not made to wait and waster time unnecessarily , it is expected of the members of the legal profession to honor the persons in the medical profession , and see that they are not called to give evidence so long as it is not necessary , it is also expected that where the facts are so clear , unnecessary harassment of the members of the medical profession either by way of request for adjournments or by cross examination should be avoided. ( Para 16)

Whenever on such occasion a man of the medical profession is approached and if he finds that whatever assistance he could give is not sufficient really to save the life of the person but some better assistance is necessary it is also the duty of the man in the medical profession so approached to render all the help which he could and also see the person reaches the proper expert as early as possible. (Para 17) The secretary of medical council of India in his affidavit refer to clauses 10 and 13 of the code of medical Ethics drawn up with the approval of the Central Government under Section 33 of the Act by the council where it has been said,

10. Obligation to the sick : Though a physician bound to treat each and every one asking his services except in emergencies for the sake of humanity and the noble tradition of the profession he should not only be ever ready to respond to the cause of the sick and injured but he should be mindful of the high character of his mission and his responsibility he incur in the discharge of the ministrations. He should never forget that the health and the lives of those entrusted his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visit at the hour indicated to the patient.

13. The patient must not be neglected: A physician is free to choose whom he will serve. He should however, respond to any request for his assistance in an emergency or whenever temperate public opinion expects the service. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw his responsible friends sufficiently long in advance of his withdrawl to allow them to secure another medical attendent. No provisionally or fully registered medical practioner shall willfully commit an act of negligence that may deprive his patient or patient from necessary medical care.” Article 21 of the constitution cast the obligation on the state to preserve life. The provision as explained by this court in scores of decision has emphasized and reiterated with gradually increasing emphasis that position. A doctor at the Government hospital positioned to meet this state obligation is , therefore duty bound to extend medical assistance for preserving life . Every doctor whether at the Government hospital or otherwise has the professional obligation to extend his service with due expertise for protecting life. No law or state action can intervene to avoid /delay the discharge of the paramount obligation cast upon the member of the medical profession. The obligation being total, absolute and paramount. Law of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore give way. On this basis, we have not issued notices to the states and Union territories for affording them an opportunity of being heard before we accepted the statement made in the affidavit of the Union of India that there is no impediment in the law. The matter is extremely urgent and in our view , brooks no delay to remind every doctor of his total obligation and assure him of the position that he does not contravene the law of the land by proceeding to treat the injured victim on his appearance before him either by himself or being carried by others. We must make it clear that zonal regulation and classifications cannot also operate as fetters in the process of discharge of the obligation and irrespective of the fact whether under instruction or rules the victims has to be sent elsewhere or how the police shall be contacted, the guideline indicated in the 1985 decision of the committee, as extracted above , is to be operative. We order accordingly.

We are of the view that every doctor wherever he be within the territory of India should forthwith be aware of this position and, therefore, we direct that this decision of ours shall be published in all journals reporting decisions of this court and adequate publicity highlighting these aspects should be given by the national media as also through the Doordarshan and the All India radio. The registry shall forward adequate number of copes of this judgment to every high court so that without delay the respective High Courts can forward them to every sessions judges in their turn shall give due publicity to the same within their jurisdictions. The Medical council of Indian shall forward copies of this judgment to every medical college affiliated to it. Copies of the judgment shall be forwarded to every state Government with a direction that wide publicity should be given about the relevant aspects so that every practicing doctor would soon become aware of the position.

In cases the state Government and union territories which have not been heard file any representation against the direction, they shall have liberty to appear before this court and as for appropriate direction within three month from now. Application filed after that date shall not be entertained by the registry of this court. Until altered, this judgment shall be followed.

Before we part with the case. We place on record our appreciation of the services rendered by the petitioner by inviting the attention of the court to the problem raised in this case. We must also place on record our appreciation of the cooperation and understanding exhibited by the union of India in the relevant ministry, the medical council of India and the Indian medical Association. No order for costs

OZA, J. (concurring)- I entirely agree with what has been observed by my learned brother and also agree with the directions indicated in the order made by Hon'ble Shri Justice R.N. Misra but I would like add:

As has been quoted by my learned brother , a high power committee by the Government of India was appointed at a high level and this was long before and the proceedings of may 29. 1986 have been filed and have also been quoted. The medical council of India along with their affidavit have filed code of medical ethics which everyone in the medical profession is expected to follow but still the news item which is the starting point of this petition is of 1988. The code of medical ethics framed by the medical council was approved on October 23, 1970. This only revents on unfortunate state of affairs where the decisions are taken at the higher level good intentioned and for public good but unfortunately do not reach the common men and it only remains a test good to read and attract to quote. It could not be forgotten that seeing an injured man in a miserable condition the human instinct of every citizen moves him to rush for help and do all that can be done to save the life. It could not be disputed that inspite of development economical, political and cultural still citizen are human beings and all the more when a man is in such a miserable state hanging between life and death reaches the medical practitioner either in hospital ( run or managed by the state ) public authority or a private persons or medical professional doing only private practice he is always called upon to rush to help such an injured persons and to do all that is within his power to save life. So far as this duty of medical professional is concerned its duty coupled with human instinct, it needs no decision not any code of ethics nor any rule or law. Still in the code medical ethics framed by the medical council of India item - 13 specifically provides for it. Item - 13 ..... as under:

13. The patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond any request for his assistance in an emergency or whenever temperate public opinion expects the services. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving notice to patients, his relative or his responsible friends sufficiently long in advance of his withdrawal to allow them to secure another medical attendant. No provisionally or fully registered medical practitioner shall willfully commits an act of Negligence that may deprive his patient or patients from necessary medical care.

Medical profession is very respectable profession, doctor is looked upon by common man as the only hope when person is hanging between death and life but they avoid their duty to help a person when he is facing death , when they know that is a medico-legal case. To know the response of the medical profession the Medical Association when put to notice and were requested to put up their case.

Some apprehensions were expressed because of some misunderstanding about the law of prosecutor and the police regulations and the priorities in such situations. On the basis of the affidavit filed by the union of India and considering the matter it is clear that there is no legal impediment for a medical professional when he is called up on or requested to attend to an injured persons regarding his medical assistance immediately . There is also no doubt that the effort to save the person should be the top priority not only of the medical professional but even of the police or any other citizen who happen to be considered with the matter or who happens to notice such an incidents or a situations. But on behalf of a medical profession there is one more apprehension which sometime prevent a medical profession in spite of this desire to help the persons, as he apprehend that he will be a witness and may have to face the police interrogation which sometime may need going to the police station repeatedly and waiting and also to be a witness in a court of law where also he apprehend that he may have to go on numbers of days and may have to wait or a long time and may have to face some times long unnecessary cross-examination which some time may even be humiliating for a man in the medical profession and in our opinion it is this apprehensions which prevents a medical professional who is not interested with the duty of handling medico-legal case do the needful, he always try to avoid and even if approached direct the person concerned to a state hospital and particularly to person who is in charge of the medico-legal cases . We therefore have no hesitation in assuring the person in the medical profession that these apprehensions, even if they have some foundation, should not prevent them from discharging their duty as a medical professional to save a human life and to do all that is necessary but at the same time we hope and trust that with this expectation from the member of the medical profession , the police, the members of the legal profession, our law courts and every on concerned will also keep mind that a man in medical profession should not be unnecessarily harassed for purpose of interrogation or for any other formality and should not be dragged during investigation at the police station and it should be avoided as far as possible. We also hope and trust that our law courts will not summon a medical professional to give evidence unless the evidence is necessary and even if he is summoned, attempt should be made to see that the men in this profession are not made to wait and waste time unnecessarily and it is known that our law courts always have respect for the men in the medical profession and they are called to give evidence when necessary and attempts are made so that they may not have to wait for long. We have no hesitation in saying that it is expected of the members of the legal profession which is the other honourable profession to honor the person in the medical profession and see that they are not called to give evidence so long as it is not necessary. It is also expected that where the facts are so clear it is expected that unnecessary harassment of the member of the medical profession either by way of request for adjournments or by cross examination should be avoided so that apprehension that the men in the medical profession have which prevents them from discharging their duty to a suffering person who needs their assistance almost, is removed and a citizen needing the assistance of a man in the medical profession receives it.

We would also like to mention that whenever on such a situation a man of the medical profession is approached and if he finds that whatever assistance he could give is not sufficient really to save the life of the person but some better assistance is necessary it is also the duty of the man in the medical profession so approached to tender all the help which he could and also see that the person reaches the proper experts as earlier as possible.

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