Doctors submitting sketchy medical reports would be held guilty: Delhi HC warns of license cancellation

The High Court bench comprising of Justice Subramonium Prasad mentioned in an order dated 05.03.2021, "Sketchy, wishy-washy medical documents from any random private doctor with ambiguous, incomplete documentation in illegible handwriting will not be entertained in future, rather viewed seriously with suspicion."

"Advantage is being taken of the fact that Judges are not medical experts and are therefore unable to correctly appreciate the nature of the ailments. The accused try to get their bail extended even though they are not suffering from any serious ailments which require them to be released on interim bail," mentioned the Court order.

Also Read: Not Case Of Sex Assault: Delhi HC grants bail to rape accused Safdarjung Doctor

The HC bench was listening to a case a petition had been filed challenging a bail order on medical grounds granted to an accused booked under Sections 302, 207,201,120B and 34 IPC and Sections 25/27 Arms Act.

Even though the accused had been asked to surrender as directed by order dated 05.01.2021, the Court became constrained to dwell further in the matter due to the sketchy medical reports given by the jail authorities at the time of granting bail.

The Court found that the medical reports which were filed by the Jail Superintendents were not clear and the medical terms which were used were not easily decipherable by Judges. The Reports did not bring out the correct picture and sketchy and incomplete reports were given by hospitals/doctors which were being used for grant of bail or extension of bail.

Medical Report dated 04.11.2020 submitted by the Office of the Jail Superintendant mentioned that the accused was having gynecomastia (enlargement of breast tissue) and piles. A second Medical Report dated 23.11.2020 that the accused had got enlargement of male breasts and piles apart from diabetes and blood pressure.

However, the petitioner contended that the accused had been given an interim bail on 01.11.2018 which he jumped and remained absconding for 461 days till he was re-arrested on 09.07.2020. The petitioner also mentioned that the accused had been charged with several other cases as well.

From the perusal of the medical reports submitted by the Jail Superintendent, the Court understood that the accused was suffering from

(a) Hypertension and diabetes both of which had been termed 'uncontrolled' but later reports show that both have been brought under control.

(b) Right-sided gynecomastia which essentially just means male breast enlargement.

FNAC (Fine Needle Aspiration Cytology) had been conducted by the jail hospital and the report comes out as simple gynecomastia meaning there was no tumour, neither benign nor malignant as alleged by the patient. However, the accused had stated in the bail application that he had "a chest tumour, which is making his breathing difficult and which can turn into a cancer." This was apparently wrong and misleading.

The Court opined that when the FNAC in the jail hospital itself has ruled out any tumor, let alone any malignancy, and it had also ruled out any infection like TB, the medical report set to the same ought to have clarified that there was no tumour or malignancy as that operation was only for mere cosmetic purpose and not a medical emergency. "Absence of such a clarification in a medical report does not assist the Court, rather the report conceals vital information from the Court," observed the HC bench.

It was also held by the HC bench that conditions like diabetes and hypertension and haemorrhoids are very common among 70-80% of the jail inmates. "The term 'uncontrollable' has been used for the hypertension, but at no time was any of the Blood Pressure (BP) recording seems to be so. If so, why were these terms used?" questioned the Court.

"The Status Reports filed by the jail doctors should be explicit and explain not just in medical jargon but also in simple language the complex medical terms used. The doctors preparing the Status Reports must clearly give their final impression and opinion as to whether the condition warrants any urgency/emergency. Further, the Status Report must explicitly state if the condition of the patient is likely benign/malignant/infective and state clearly whether surgery is needed for that specific condition or not," mentioned the HC order.

The court also noted that the surgery of the accused had been done by a private doctor who also used sketchy operative details in the report and failed to explain why the surgery was done in the first place as the previous FNAC mentions only gynecomastia. In fact, even after the surgery, the report mentioned 'removal of tumor' when there had been none and did not even mention any biopsy anywhere and it only to quoted the previous jail FNAC which mentioned 'no malignancy'.

Noting that the surgery was only done for cosmetic purposed and was a ruse to get bail, the HC bench further stated,

"All this leads to a lot of suspicion of a foul play and of ambiguity and can lead to serious doubt as to whether any procedure was at all done in the private hospital in good faith. A serious note is taken of such skimpy, wishy-washy medical documentation and the license of such doctors should be canceled if found to be lacking/falsely done."

The court further observed that reports from several private hospitals are very veiled and do not disclose the correct diagnostic terms which can be appreciated by a Judge, who is not from the medical background. "Applications on medical grounds are now being made as a ruse to get interim bail and then prolong it for indefinite periods even though it is not required and thereby taking the Courts for a ride," mentioned the High Court order.

Mentioning that sketchy, wishy-washy medical documents from any private doctor would be regarded with suspicion the HC has further given a direction to the Jail Hospital to clearly state the history, examination findings and the clinical diagnosis, the interpretation of the diagnosis in simpler terms for the Judges to understand.

As per the HC order, the reports from the jail hospital should mention,

i. What is the diagnosis?

ii. Whether it can be simply treated by giving medical treatment in the Jail Hospital.

iii. If there is any urgency and if it is an emergency then the nature of emergency must be clearly mentioned.

In case, the Patient gets referred to a referral hospital then the medical report must state,

i. The diagnosis, its simpler interpretation.

ii. Whether the disease/ailment is treatable by conservative medical management or is surgical intervention required. If yes, will it be an emergency surgery.

iii. If any tumour or growth is found is it benign or malign and/or infective.

iv. If any investigations are to be done, then the nature of the investigation, when it can be performed, and can it be performed in Jail hospital.

Further the Court directed that the "Post treatment/surgery the medical report must clearly state the result of the surgery and the post-operative care that is required. The report must indicate as to how many days of hospitalization would be required before the patient is sent to the prison."

In case of ambiguity and suspicion regarding a medical report, "It ought to be sent for scrutiny by a Medical Board consisting of two-three specialists from a government hospital so that they can endorse or refute such document and if it is found that the reports are only made to prolong the period of bail then, such report should be viewed seriously by the Court, which must consider initiating appropriate proceedings."

However, as the accused had surrendered in the concerned case, the Court refrained from taking actions against the concerned doctors. But it also advised the doctors to be more cautious while giving medical certificates for the purposes of submitting them as evidence before a Court of law.

Thus, the Delhi Hc disposed of the petition by giving directions to send a copy of the order to all the Jail Superintendents to ensure that accurate medical reports are prepared to assist Judges while considering application for bail on medical grounds.

To view the original court order, click on the link below.

https://medicaldialogues.in/pdf_upload/delhi-hc-medico-legal-150982.pdf

Also Read: SC quashes Bail given to Kerala man accused of murdering woman doctor