MCI defines Professional Incompetence, issues Guidelines

In recent times, professional incompetence has become one of the growing reasons for medical negligence. However,there still exist various ambiguities regarding the issues of professional incompetence and how these issues are to be addressed by the medical fraternity.

Recently, a special committee headed by Dr Ved Prakash Mishra, Chairman, Academic Committee, Medical Council of India has proposed a set of guidelines, to fill in the void of having specific definitions of the various issues involving adjudication of medical incompetence as well as to specify guidelines for  peer assessment to ascertain the professional incompetence of a professional

It is reported that a Study group was constituted by MCI President after it was found that no guidelines have been prescribed by the Medical Council of India as contemplated under section 8.6 of the Code of Medical Ethics Regulation 2002 to address the issues of professional incompetence.

In particular, Section 8.6 of the Code of Medical Ethics Regulation 2002 reads,

"Professional incompetence shall be judged by peer group as per guidelines prescribed by Medical Council of India"

With no guidelines to this effect, the Study group was specifically formed to address the lacunae in the Code of Medical Ethics and prescribe guidelines with respect to judgment by a peer group. With due efforts, the group has now created the draft guidelines on the issue and submitted to the council for further action.

Speaking to Medical Dialogues about the issue, Dr Ved Prakash Mishra said,"  

professional incompetence, professional misconduct and professional incapacitation by and large are used interchangeably in a colloquial as well as operational sense on practically more occasions than not primarily because all the three within their fold include failure on part of the professional to take reasonable steps to safeguard the life and health of the person under his care. It is for this reason it is imperative that the distinction between the three needs to be taken note of."

Addressing this lacunae, the study group has specified following definitions

• Adverse event means an unintended injury to patient that results from healthcare management and results in measurable disability, prolonged hospitalization or both.


• Bolam Test means the test evolved out of the judgment in the case of Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 used to assess standard of care when deciding medical negligence.


• Clinical Establishment means establishment as defined in the Clinical Establishment Act, notified by the Government of India.


• Institution means a medical college permitted / approved / recognized  by the Medical Council of India / Non-Teaching Hospitals.


• Medical accident means an unforeseen or unexpected medical event causing loss or physical damage or injury, brought about unintentionally, as a result of treatment or failure to treat appropriately due to ignorance or lack of knowledge.


• Medical error The failure of a planned action to be completed as intended or use of  a wrong inappropriate, or incorrect plan to achieve an aim.


• Medical malpractice means negligent or improper or unreasonable lack of skill in the treatment of a patient, on the part of a health care professional or health care facility that causes harm, injury, or death to a patient or any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient. Or  improper, unskilled, or negligent treatment of a patient by a health care professional. Or  Medical malpractice is the failure of a medical professional to follow the accepted standards of practice of his or her profession, resulting in harm to the patient.


• Medical mishap means an unfortunate accident


• Peer means a person who is equal in ability, standing, or rank with another


• Professional incapacity means inability to carry out professional activities and responsibilities/obligations due to a physical or mental condition/illness that may limit the capacity of a professional person to fulfill his/her professional responsibilities/obligations temporarily or permanently.


• Professional incompetence means failure to exercise due care and diligence in professional responsibilities due to lack of knowledge, skill.


• Professional misconduct means unacceptable/dishonorable and unethical behavior by a professional person or non compliance with the applicable laws and regulations.


• Professional negligence means an act or omission (failure to act when there is a duty to act) which a reasonable man in the circumstances would do or an act of commission (wrong doing) by a medical professional, which a reasonable man in the circumstances would not do.


• Untoward event means an unfavorable or adverse event.

GUIDELINES

 Guidelines have been now framed to specify assessment by a duly constituted peer group to judge professional / medical incompetence of a registered medical practitioner . This shall be applicable for any medical trial jurisdiction at the institutional or at any council level. However, they shall not cover criminal aspect of professional negligence

 Composition of the peer group :

a)     Peer Group shall be constituted at Institutional / Clinical Establishment / State Medical Council / Medical Council of India level to judge the professional incompetency of a registered medical practitioner in a time-bound manner.

b)    The peer group shall be a three-member committee with a chairman, one IMA nominee and one professional subject expert.

c)     The peer group on receipt of any complaint shall examine the allegation in a time-bound manner, preferably within two weeks and forward its reasoned-out speaking order following the principle of natural justice and based on "Bolams Test" to the Institutional Head, Clinical Establishment Head / Chairman of the Ethics Committee of the State Medical Council / Chairman of the Ethics Committee of the Medical Council of India as the case may be.

The above guidelines have been submitted by the study group to the Council for approval and shall come into the force from date of its Notification by the Medical Council of India.