Doctor's duty to treat in an emergency: what a small OPD does. The 2002 regulations, Parmanand Katara, and the desk's part.

A doctor's duty to treat in an emergency in India comes from two places. The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 say in regulation 2.1.1 that "in case of emergency a physician must treat the patient" and in 2.4 that a physician "should, however, respond to any request for his assistance in an emergency". The Supreme Court in Pt. Parmanand Katara v. Union of India (28 August 1989) held that "every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life", and that no law or state action can intervene to avoid or delay that obligation. For a small OPD that means: attend at once, do what the clinic can, send the patient to a hospital that can do the rest, and write it all down.

What exactly do the regulations and the court say?

Regulation 2.1.1 sets the general position. A physician "is not bound to treat each and every person asking his services", but "in case of emergency a physician must treat the patient", "no physician shall arbitrarily refuse treatment to a patient", and where an ailment is "not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician". Regulation 2.4 adds that a physician "is free to choose whom he will serve" but "should, however, respond to any request for his assistance in an emergency".

Parmanand Katara is the case every charter cites. The Court held that Article 21 casts an obligation on the State to preserve life; that "preservation of human life is of paramount importance"; that every doctor, at a government hospital or otherwise, has the professional obligation to extend services with due expertise for protecting life; and that "the obligation being total, absolute and paramount, laws of procedure whether in statute or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way". The judgment grew out of accident victims being turned away pending police formalities; its holding is wider than road accidents.

The NHRC Charter of Patients' Rights restates it as right 3: all hospitals "both in the government and in the private sector are duty bound to provide basic Emergency Medical Care", initiated "without demanding payment / advance", citing Katara and regulations 2.1 and 2.4. The charter is addressed to hospitals and clinical establishments generally; the regulations and the judgment are addressed to every doctor.

What does a clinic without emergency facilities actually owe?

Three things, read together from the texts above. First, to attend: the doctor sees the patient now, ahead of the queue, and does not send them away unseen. Second, to do what the clinic can with what it has, within the doctor's competence; regulation 2.1.1 itself allows referral where the ailment is outside the physician's range. Third, to send the patient on without delay to a facility that can do what the clinic cannot, and to help that happen: the ambulance call, a referral note, telling the family where to go. A small OPD is not asked to be a hospital. It is asked not to be a locked door.

What this post does not do is tell the doctor what to do for the patient. That is clinical, and it is the doctor's judgment under the doctor's training. What the clinic can decide in advance is the arrangement around it: who is called, who goes with the patient, what is written. Agree those with the doctor before the first time.

What does the desk do when an emergency walks in?

1. Inform the doctor at once, even mid-consultation. The desk does not judge whether it is "really" an emergency; the doctor does.
2. On the doctor's word, call the ambulance or the nearest hospital, or arrange the fastest transport the family has. Keep the ambulance and hospital numbers on the wall by the phone, not in someone's mobile.
3. Clear the way: a chair or the examination couch, the room's door, the waiting-room crowd. Keep the room calm and keep the queue where it is; nobody's place changes.
4. Hand the doctor paper. Whatever is noted at the time is what the clinic has later.
5. Register the patient after the doctor is with them, not before. Name and number from whoever came with them, if there is anyone; a line in the register if there is no one.
6. If the patient is sent on, give the family the referral note and the hospital's name in writing, and note who left, with whom, at what time.
7. Tell the room, once, that the doctor will be a few minutes, and update the wait.

What should be written down afterwards?

• Time of arrival, who brought the patient, and how.
• Time the doctor attended.
• What the doctor found and did, in the doctor's own note on the visit. This is the doctor's record, not the desk's.
• Where the patient was sent, the time they left, who went with them, and that a referral note was given.
• Whether the police were informed, if the case is one that needs it. Which cases are medico-legal, and the clinic's duties in them, are in handling a medico-legal case in an OPD; the legal formalities follow the treatment, never precede it, which is what Katara decided.
• Any fee: the charter says emergency care is initiated without demanding payment or advance. Whether and what the clinic bills afterwards is the clinic's decision; nothing is collected before the patient is attended.

One data point. The Digital Personal Data Protection Act, 2023 lists among its legitimate uses, in section 7(f), processing "for responding to a medical emergency involving a threat to the life or immediate threat to the health of the Data Principal or any other individual". The clinic does not need a signed consent form before it writes down an unconscious patient's name or calls the number in their pocket.

What to agree with the doctor before it happens

• The signal: how the desk interrupts a consultation (knock and enter, a word, a phone ring). Decide it, rehearse it once.
• The numbers: ambulance, the nearest hospital with a casualty, a second hospital. On the wall, checked monthly.
• What the clinic keeps for the purpose, and where. That is the doctor's list; the desk's job is to know where it is.
• Who accompanies a patient if nobody came with them, and who then runs the desk.
• The referral note format: the free referral letter format is enough to have printed and in the drawer.
• The queue rule: an emergency is outside the queue, not ahead of it; the room is told once. See patient queue management for a single doctor clinic.

Where Vitels fits