To What Extent are Healthcare Professionals Immune from Liability for Professional Negligence? A Review of the Cases of Bolam and Bolitho

This paper reviewed the extent to which Bolam provided healthcare professionals with immunity from claims based on negligence in the past, and whether Bolitho was able to resolve that issue.During the early 1950s, when the NHS was in its golden era, the medical profession was still “unregulated and paternalistic” in approach. Consequently, the medical profession had enjoyed unreserved obedience from patients and was treated with great reverence by society. John Hector Bolam was a patient who sustained fractures because the defendants applied unmodified electro-convulsive therapy on him. So, his suit for negligence provided the much-needed opportunity for grounding the principles of medical negligence which was still in its early stage of development. The issue was unprecedented, and therefore the dictum of Lord President Clyde in the Scottish case of Hunter and Hanley became handy. The ruling gave doctors the latitude to set standards of care and justify their actions by simply having their peers support them. It placed the onus of proving “Wednesbury unreasonableness” on the patients in order to succeed in medical negligence litigation against a doctor. That was very difficult to prove. This attracted criticisms against Bolam that it provided excessive immunity to doctors and difficulties to the patients. Several cases had been decided in favor of the doctors and allied healthcare professionals.A similar opportunity arose in 1984 when the Bolitho rule was propounded which empowered the courts to intervene and determine if a body of medical opinion is indeed responsible, by subjecting their evidence to the logicality and risk/benefit analysis tests.Issues for consideration include, to what extent did Bolam provide immunity to healthcare professionals and, post-Bolitho, if the issues have now been resolved. To accomplish that, the author will examine the various court decisions pre-and post- Bolitho with a view to coming up with the answer(s) to the issues raised

Mental Health Act 1983

This chapter covers the Mental Health Act 1983 and includes topics on The definition of mental disorder under the Mental Health Act, Criteria for admission under s.2 Mental Health Act, Criteria for Admission under section 3, Criteria for Emergency Admission under section 4 Mental Health Act, Brain Tissue Treatment under Mental Health Act, Electro-convulsive Therapy.

Increased electro-convulsive therapy stimulus intensity and cognitive functioning in manic patients

Background: Temporary changes in cognitive functions after electro-convulsive therapy (ECT) have been documented. The researchers are exploring if increasing the stimulus intensity of ECT produce better recovery from psychopathology also trying to map effects of increased stimulus intensity on side effects profile including cognitive functions. In the present study, we are reporting effects of increased stimulus intensity of ECT on cognitive functions in manic patients.Methods: The present study is a prospective analytical case control study conducted in the department of psychiatry, Institute of Mental Health and Hospital, Agra, after getting clearance from hospital ethical committee. The study included 60 patients with the diagnosis of manic psychopathologyfrom May 2018 to September 2019. Sample was divided into two groups: 1.5 times of threshold and 2.0 times of threshold. The ECT was delivered as per specified protocol of the study. The scores on Montreal cognitive assessment (MoCA) were compared both within and between groups at baseline and follow up.Results: The results suggested that both level of stimulus intensity produced mild level of disruptions in cognitive functioning at follow ups and the higher stimulus intensity i.e. 2.0 times of threshold resulted in more impairment in cognitive functions.Conclusions: The impact of ECT by increasing its current intensity for two times, on cognitive functions as seen clinically, suggested no serious adverse effects on any of the patients included in the sample.

Clinical and demographic profile of patients treated with electro convulsive therapy from a tertiary care psychiatry hospital in North India

Background: Electro-convulsive therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. This study was undertaken with the aim of exploring the clinical and demographic profile of patients treated with ECT from a tertiary care psychiatry hospital in north India.Methods: It was a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Institute of mental health and neurosciences Kashmir during a period of one year (March 2017 to February 2018).Results: A total of 70 patients received ECT during the course of one year. About 72.85% of the patients belonged to 20-39 years age group. Female patients constituted more than half of the subjects (55.71%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (35.71%), followed by bipolar affective disorder (28.57%), depressive disorder (28.57%), schizoaffective disorder (4.28%) and substance induced mood/psychotic disorders (2.85%). A significant majority of subjects (57.13%) received about 7-9 ECT sessions. No any major complications were noted during ECT treatment.Conclusions: This study suggests that ECT, use as a treatment modality is common in adults between 20 to 39 years of age and females with Schizophrenia being the most common indications.