This article is written by Sarthak Kulshrestha, from the Jagran Lakecity University. This article deals with the problems of the use of medical jargon by doctors making it difficult for the judges to decide the bail application filed on medical grounds.
Table of Contents
Medical jargon is often used by doctors in the reports of patients. It is needed to set up a common code of terminologies to indicate specific disorders or conditions in a medical report. It is useful as it helps the doctors interpret the concerned patient’s ailment in any corner of the world. For example, if a patient had been treated with cancer in India and moved to England, then the medical authorities of England would be able to understand the patient’s current condition by interpreting his report formed in India by their ability to decipher the medical jargon other terminologies used. So, it is used to prevent unnecessary delays in the treatment as well as to avoid any kind of confusion.
But, the large-scale bottlenecks of medical jargon have been noticed. The doctors intentionally or unintentionally use medical terms while talking to the patients without considering the unfamiliarity of the patients or their family members about the disease or a particular medical concept. For example, if a patient is classified as “inpatient” (which means the patient needs to be admitted to the hospital), then it may be misinterpreted by the patient’s side in some other form as he or his family members might not be familiar with the term “inpatient”. So, it must be the responsibility of the doctor to inform all the necessary conditions to the patient not only by using medical jargon but also in simple language.
In Himanshu Dabas v. State, Govt. of NCT of Delhi & Anr (2021), the petitioner challenged the bail of respondent No.2 on medical grounds and it is found that the reports filed by the Jail Superintendent are ambiguous and sketchy. Also, it lacks simple terminologies rather contains medical jargon which is undecipherable by the judges. This article further deals with the responsibility of doctors regarding the same with respect to the present case.
Need for the doctors to be cautious while issuing the medical certificate for bail
Medical certificates are the legal documents issued by doctors or medical practitioners and they are supposed to bear legal responsibility for the facts mentioned in the certificate. It is believed that all the facts mentioned in it are based on the doctor’s knowledge and observations and are deemed to be true by the doctor. Since it is a legal document, any casual or fake issuance of the same may attract civil or criminal liability of the doctor if it is not found in consonance with the actual condition of the patient. In such cases, the authenticity of the medical certificate is doubted and may even result in the cancellation of the license of the concerned medical practitioner.
Doctors need to be cautious while issuing the medical certificate for bail. The Delhi High Court has clearly stated that the submission of questionable documents by the doctors, makes them guilty of the offence of fabricating false evidence, under Section 192 of the Indian Penal Code, 1860 while giving medical certificates to furnish them as evidence in a criminal case or for securing bail. It has been said in the case that the jail doctors are responsible for filing explicit and clear-cut status reports. It is their responsibility to mention the degree of the illness of the patient so that it can be inferred whether his/her condition warrants any emergency. The Court has strictly remarked that sketchy and spineless medical documents to get bail will not be considered in the future. The present case is fit for the exercise of powers under Section 340 of Cr.P.C (Code of Criminal Procedure) against the concerned doctors, this Court is refraining from doing so, only because the accused has surrendered and is back in custody. Doctors are advised to be more cautious while giving medical certificates to submit them as evidence before a court.
An analysis of the case of Himanshu Dabas v. State
Respondent No.2 approached the Additional Sessions Judge to secure interim bail on medical grounds as allegedly he was suffering from several ailments along with breathing difficulty and especially a serious tumor in the chest area. In the bail application, it was stated that his medical condition may deteriorate more if he fails to get the required treatment.
The petition was filed by the petitioner in the Delhi High Court, which challenged the bail granted to respondent No.2 on medical grounds. Respondent No.2 is said to have serious disorders as stated under the medical reports given by the jail authorities at the time of granting the bail. The nature of these medical reports is sketchy and indecisive with complex medical terms used in it making it tough for the judges to decipher the same.
The medical report submitted by the Jail Superintendents stated that the Fine Needle Aspiration Cytology (FNAC) test of the inmate took place on Aug. 4, 2020, which suggested right-sided gynaecomastia in the inmate’s chest. Between August and November, the inmate came to the jail dispensary with complaints of several physical disorders such as bleeding per rectum while defecation, manual push-back of excretory substances, and constipation. On examination, it was found that he was having Grade-III internal hemorrhoids at 3,7 and 11 o’clock position. So, he was provided with some laxative syrups, an ointment, and was advised to take a high fiber diet. The inmate is said to have a known case of systemic hypertension, diabetes mellitus type-II, kidney stones, and gynecomastia, which means swelling of breast tissues. He is being treated by the jail dispensary but his symptoms are persistent.
So, the two medical reports, one submitted on Nov. 04, 2020, and another one on Nov. 23, 2020, in simple terms, show that respondent No. 2 was suffering from the non-serious enlargement of breast tissue and piles along with diabetes and blood pressure. The medical report shows that the FNAC test which was conducted by the jail hospital suggested simple right-sided gynecomastia, which is nothing else than enlargement of the male breast. This means that there was no tumor in the chest of the inmate. Respondent No. 2 alleged the apprehension that such a tumor can turn into cancer if not treated on time. This allegation is misleading as gynecomastia does not mean the development of any kind of tumor. It is medical jargon used in the report with no clarification made. And such a sketchy report makes the Court take decisions considering the complex medical condition. In the present case, respondent No. 2 has filed the report by Dr. Preet Singh Chawla which was sketchy and it is fit to mention here that the certificates given by Dr. Chawla’s nursing home have been doubted by the Court earlier in bail applications on medical grounds.
Contention of parties to the case
Respondent No.2 has been asked to surrender but still, the Court is inhibited to mull over the given matter due to the submission of wishy-washy medical reports given by the jail authorities.
Respondent No.2 contends to seek interim bail on the ground of several serious ailments. He is said to be suffering from right-sided gynecomastia, a medical condition in which the breast tissue enlarges and the report also made the apprehension of a critical chest tumor that can turn into cancer. So, the treatment of the same is quite necessary.
He was advised to refer to DDU hospital for a workup surgery. Apart from these disorders, he also complained of decreased appetite, pain in the bilateral sides of the abdomen. A significant weight loss was also noticed. A Senior Resident Surgeon advised him to undergo a surgery of hemorrhoidectomy. Thus, making it necessary for respondent No.2 to secure an interim bail on these medical grounds.
However, there have been various contentions posed by the petitioner challenging the bail granted to respondent No.2. The petitioner contends that in simple terms, respondent No.2 has got nothing more than the issue of enlargement of breast tissue and piles apart from hypertension and diabetes. The gynecomastia too does not inflict any serious problem of developing benign/malignant tumors.
So, hypertension, hemorrhoids, diabetes, are the other ailments from which respondent No. 2 is suffering and they are easily treatable in the jail hospital. Even if at all, an operation is needed, it ought to have been for hemorrhoids and not for gynecomastia as it is a simple condition and the procedure for the same is a cosmetic surgery only. These medical issues must not be treated as the ground for granting bail to Respondent No.2. Secondly, such conditions as hypertension, hemorrhoids, and diabetes are quite common among 70-80% of the jail inmates. In the medical report, the term “uncontrollable” has been used for hypertension and diabetes but any such recording has not been noticed as the same was brought under control later, which means that the term “uncontrollable”’ was wrongly used.
Such medical reports are merely a ruse used by the jail respondents to secure an interim bail. Even after performing the surgery, the report mentioned ‘removal of tumor’ when there had been no tumor at all. This puts the entire procedure of the treatment done in the hospital in serious doubt whether the private medical authorities are doing their work in good faith.
Often the lack of familiarity of the judges with the medical terminologies is used as an advantage to secure the bail of jail inmates on non-serious medical grounds claiming it to be serious.
This order of bail granted to Respondent No. 2 is challenged by the petitioner by the fact that he was granted interim bail on Nov. 01, 2018, following which he remained hidden from the authorities for 461 days till he was arrested again on July 09, 2020. It is also stated that Respondent No.2 has eight other criminal cases filed against him, suggesting that granting bail to him would not be a just decision.
Findings of the court
This Court has found that the medical reports given by the many private hospitals are very ill-defined and surreptitious and do not explicitly mention the correct or simple diagnostic terminologies. This leads to confusion and lets them gain the unjust advantage of the fact that the judges are not from a medical background. Also, on a large scale, such bail applications on medical grounds are used as an expedient to secure bail and prolong it even if in reality, it is not required. The court held that the following points are mandatory to fill the bail application:
- The jail hospital must let the Court know the history and the clinical diagnosis of the inmate.
- The diagnosis of the disorder(s) and related terms must be mentioned in simpler terms so that the judges can examine the medical condition of the inmate.
- Whether the ailment can be treated in the jail hospital itself.
- If the inmate has been referred to a referral hospital then, whether it can be treated by conservative medical management or surgical method is required.
- The nature of the investigation, if any required, and whether it can be done in the jail hospital itself.
- The nature of a medical emergency, if any, must be mentioned.
In a case, medical reports are not clear and create suspicion in the mind of a Judge then it needs to be sent for scrutiny by a Medical Board consisting of two or 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.
The checks and balances concerning medical reports of accused
The system of checks and balances has to be maintained concerning the medical reports of the accused as it is important to make the medical condition of the inmate free from any ambiguity. Maintenance of checks and balances in this regard is necessary so that it can be ensured that no inmate is being tortured due to a deteriorating medical condition in the jail and gets required treatment. On the other hand, if the inmate is using the sketchy medical reports only intending to get bail, then it must be ensured by the Jail superintendent that submission of such misleading reports does not take place. The courts must keep a check on the authenticity of the status reports of the concerned accused, submitted by the jail hospital so that unjust advantage for securing the bail cannot be taken.
The Delhi High Court, in the present case, has emphasized the need for doctors to be cautious while issuing medical certificates for bail. The use of medical jargon makes the report of a patient more complex to comprehend which ultimately poses difficulty for the Judges to carry out the perusal of the same. So, the doctors need to use simpler terms so that the Judges can interpret the medical condition of the accused and decide the bail application. Various factors regarding the seriousness of the accused have to be scrutinized such as the emergency condition or whether the treatment can be done in the Jail hospital itself.
A copy of the order of the present case had been circulated to all the Jail Superintendents to make sure that accurate medical reports are prepared with decipherable terms so that the judges can be assisted while considering a bail application on medical grounds.
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