Medico legal cases :Confusions

Original post by Dr. Vivekashnu in emed India 
Is Animal bite an MLC?

All bites which are Grievous in nature or endangering life of victim or suspected foul play should be made MLC.

Snake bite can kill the victim within 24 hours, & many cases of foul play has been reported in which snakes were put in pot intentionally by rivals to kill others for property.

And it becomes non-bailable offence under 328 IPC (grievous hurt by poison).

If a farmer dies due to snake bite while working in fields, than Rs 50,000 compensation is given by Forest department under Wildlife protection act.

Same is applicable in death by bites by wild cats like Lion, Tiger, Leopard & Fox.

So hurt by all wild animals is MLC for claiming compensation. Recently, a man fell in Delhi Zoo in Tiger's cage, Govt provided 1lakh to the next of kin after it was proven in postmortem done in AIIMS that the man died due to tiger bite, due to negligence of zoo authorities in protecting visitors.

Human bite is an MLC, because it is intentional harm done, Mike tyson bited the ear of his rival player & resulted in permanent disfiguration of face.

Indian Law takes Human bite by cutting canine teeth as sharp weapon, & becomes non-bailable offence under 324 IPC (grievous hurt by sharp weapon).

Unprovoked Dog bite can be MLC, if bitten by pet dog because it is suspected foul play.

Police complaints are made that two neighbours, during mutual quarrel ordered the tamed pet dog to bite the other neighbour to settle scores.

Since dogbite can lead to rabies, a life threatening infection, so it is bailable offence  270 IPC (Malignant act likely to spread infectious disease dangerous to life) with imprisonment of 2 yrs.

H1N1

Forwarding the message sent by H1N1 nodal officer, Dr. Amar Fettle.

The Nation has been experiencing a spike of H1N1 Influenza cases and deaths from Jan 2015 onwards. Kerala State trends also have been showing a slight reflection of this trend

OP and IP based alertness, considering the possibility of H1N1 in the differential diagnosis of flu like illness(ILI) in patients, esp high risk groups, starting of Oseltamivir appropriately and judiciously as per ABC guidelines, public education etc are the factors which would help us to save the maximum no of lives

It is desirable to ensure that all doctors remain updated /refreshed about the existing guidelines

In this connection, I sincerely request you to take all steps possible to disseminate necessary and relevant information to doctors and relevant medical staff , and to the public whom they cater to

Oseltamivir is being made available at all levels of hospitals for judicious use, through KMSCL / KARUNYA / DMO store. Govt Hospitals needing the medicine may liaison with the respective DMOs.

Private hospitals are suggested to make theri own procurements from manufacturers direct/ Karunya, as they do for all their other daily requirements from paracetamol to the costliest medicines. In emergencies, however, an individual patient may be issued a course of Oseltamivir, as per discretion of the hospitals

Individual private hospital patients who need Oseltamivir can also be directed to the nearest Karunya Community Pharmacy services outlet/ shops known to stock the medicine if it is by any chance not accessible at any time.

Please widely disseminate the internet link below to all members of your organisation so that they can get access to periodically updated information.Note the word doc'; Updated ABC guidelines'; available at the website is the most recent reference version.The printed brochures are earlier versions.

http://www.dhs.kerala.gov.in/index.php/publichealth

Soliciting your earnest collaboration in achieving higher standards of public health in general, and bes
results in the management of H1N1 and Short Febrile Illness specifically

Please share the attachments also widely as they are v useful for Public information

Medical facts can be memorise easily through non conventional mode of teaching ...

From ER physicians

Is Animal bite an MLC?

All bites which are Grievous in nature or endangering life of victim or suspected foul play should be made MLC.

Snake bite can kill the victim within 24 hours, & many cases of foul play has been reported in which snakes were put in pot intentionally by rivals to kill others for property.

And it becomes non-bailable offence under 328 IPC (grievous hurt by poison).

If a farmer dies due to snake bite while working in fields, than Rs 50,000 compensation is given by Forest department under Wildlife protection act.

Same is applicable in death by bites by wild cats like Lion, Tiger, Leopard & Fox.

So hurt by all wild animals is MLC for claiming compensation. Recently, a man fell in Delhi Zoo in Tiger's cage, Govt provided 1lakh to the next of kin after it was proven in postmortem done in AIIMS that the man died due to tiger bite, due to negligence of zoo authorities in protecting visitors.

Human bite is an MLC, because it is intentional harm done, Mike tyson bited the ear of his rival player & resulted in permanent disfiguration of face.

Indian Law takes Human bite by cutting canine teeth as sharp weapon, & becomes non-bailable offence under 324 IPC (grievous hurt by sharp weapon).

Unprovoked Dog bite can be MLC, if bitten by pet dog because it is suspected foul play.

Police complaints are made that two neighbours, during mutual quarrel ordered the tamed pet dog to bite the other neighbour to settle scores.

Since dogbite can lead to rabies, a life threatening infection, so it is bailable offence  270 IPC (Malignant act likely to spread infectious disease dangerous to life) with imprisonment of 2 yrs.

Tamorish from Delhi in emed India

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Dr.Gujral ,Forensic Surgeon

Dr Dheeraj in Emed India

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[07/02 1:34 PM] Dheeraj Delhi: The Most Life-Saving Emergency Medicine Articles of 2014 - http://www.medscape.com/viewarticle/836952?src=wnl_int_edit_tp10&uac=220396BY

From emed India 3

[03/02 9:51 PM] Dr Vivekanshu: Weapon caused lacerated or incised wound.  What is its significance in law?
Judge wants to know the weapon which has caused injury is dangerous weapon or not.
Dangerous weapon is any instrument used for stabbing, shooting, cutting, corrosive, fire or poison endangering life.

Most of sharp weapons can endanger life. So if even one incised wound caused by weapon, than judge will verify with eye witness & police whether any dangerous weapon was used or not.
If it is proved that the weapon can endanger life, than judge will ask whether weapon caused simple hurt or grievous. Punishment will be 3 yrs for simple hurt caused by dangerous weapon voluntarily & 7 yrs for grievous.

324 IPC if the dangerous weapon causes hurt voluntarily.
326 IPC if the dangerous weapon causes grievous hurt voluntarily.  Both are non-bailable.
[03/02 10:14 PM] Dr Vivekanshu: Importance of Doctor patient communication.                                                                  
Around 90 percent of the patient-doctor disputes are due to improper communication and misconceptions.                                                                            (IMA) has constituted an ‘IMA Mediation, Conciliation and Grievances Redressal Cell’, which will meet twice on 1st and 3rd Saturday every month to listen and dispose of complaints from patients.

The cell has been created with the objective of providing a platform and mechanism for amicable and peaceful settlement of any dispute between a patient and doctor member of IMA.

According to IMA, the association has written a letter to all its 1700 local branches and 30 state branches to open a similar ‘IMA Mediation, Conciliation and Grievances Redressal Cell’ in their respective state/local branch and meet twice in a month to mediate between patients and doctors.

Upon receiving a complaint by IMA from an aggrieved person, the same shall be handed over to the cell who shall issue notice of the said complaint to the concerned doctor member with directions to file their response.

The cell shall obtain the consent of both the parties in writing in the prescribed form before the proceedings.

It shall pass an award on the basis of settlement arrived between the parties out of their mutual will and choice, free from any pressure and influence.

If no settlement can be reached between the parties, then the matter would be closed by the cell subject, however, to the condition that all the records of the case would be kept confidential and consigned to records.

The cell will only facilitate in arriving at a decision to resolve the disputes and it will not impose any settlement or decision on the parties.
The complaint will be settled within 90 days, according to the IMA.

The cell will attempt to facilitate voluntary resolution of the dispute between the parties and will assist them in identifying issues, reducing misunderstandings, clarifying priorities and exploring all possibilities of amicable compromise but in any case it will not impose any terms of the settlement upon the parties.

The cell will include doctors, an advocate and a social person of eminence as members.
[03/02 11:58 PM] Dr Vivekanshu: Even Numbers & Offences in Law.

So mostly odd numbers in end of IPC section are safer in law & bailable than even numbers, which are non-bailable.

Some examples of non-bailable offences related to forensic medicine.

274 IPC(adulteration of drugs).

302 IPC(murder).

304 IPC(culpable homicide)- 304B dowry death.

306 IPC abetment of suicide.

308 IPC attempt to commit culpable homicide.

314 causing Death by act with intent of miscarriage.

316 causing Death of a quick unborn child.

324, dangerous weapon causing hurt.

326, dangerous weapon causing grievous hurt.

332 voluntarily causing hurt to deter public servant from duty.

354 outrage modesty of woman (354B-intent to disrobe woman).

364 kidnapping for murder/ransom.

370 human trafficking.

372 selling/hiring minor for prostitution.

376 Rape.

384 Extortion.

392 Robbery.

406 Criminal Breach of trust.

420 Cheating.

436 Mischief by fire/ Explosive.

466 Forgery of a record of -court/ Birth & Death register/ kept by public servant.

498A cruelty to married woman.

Exceptions of odd numbers in end of IPC which are non-bailable.

303 murder by person under sentence for life imprisonment.

305 abetment of suicide committed by child, insane or intoxicated.
307- attempt to murder.
313 -miscarriage without women’s consent.
333-voluntarily causing grievous hurt to deter public servant from duty.
377unnatural offences.
379 theft.

Abert

[01/02 9:52 PM] emn vimal: ABERT first batch successfully completed their course.....thanks for Venu sir for making me as course coordinator.I would like to thank you on behalf of Dr.Shihana (coordinator)and other faculty for making this a huge success.... Exam for vadakara volunteers will be on next Sunday. Once again thank you all who supported this academic programme for public rescures with true humanity and passion😇
[01/02 9:55 PM] emn vimal: Sorry for not mentioning one true socially committed dignitary Aboobacker sir....if Venu sir is the brain....he is the heart of this programme
Congratulations shihana ;vimal and team

Side effects of social media

From Madurai

MCI prescription Giudelines

MCI issues new prescription format for doctors to ensure accurate & uniform prescriptions.

MCI will issue standard prescription format for allopathic doctors to boost an accurate, uniform, standard and clear prescription for the sake of patient safety. The new format, prepared by MCI, is applicable for all doctors who practice allopathy in the country.

MCI-affiliated doctors are expected to start using the new format from April onwards.

MCI is a statutory body having powers to suspend the license of a doctor who is found guilty of malpractice. 
The new format will be made available on the website of MCI.

This standard hard copy format is very much required for prescribing medicines in the interest of patient safety.

The format also offers the physician to write generic medicines based on the efficacy, affordability and availability of drugs."

As per the new guidelines, allopathic doctors must write prescriptions legibly and in capital letters as well as furnish a complete and detailed prescription.

The physicians have to also mandatorily mention the patient's address and keep blank space in which the pharmacist can specify his/her address.

The comprehensive format includes the doctor's full name, his/her qualification, patient's details, name of the generic medicine or its equivalent along with the dosage, strength, dosage form and instruction, name and address of medical store with pharmacist's name and date of dispensing, as well as the doctor's signature and stamp.

Experts say that doctors in some countries, including the United States, print out prescriptions for the sake of clarity.
In several countries, printed prescriptions are mandatory because they are not only legible, but also constitute a database of medication that the patient has taken over the years.
This is in consonance to the trend picking up for patients looking at online websites also likeHelpingDoc.com, Ask4Healthcare, bookmydoctor.com, Lybrate offering doctor appointment and consultation.

Sometimes patients need not to visit India for the consultation, they get advice by the senior medical consultant through internet."
This may be some good news for Indian patients as the overall cost of in-person primary physician appointment is high than compared to online appointments.
E-visits or online consultation is gaining traction in the US. 
"Online consulting is permissible but a standard prescription format will always offer authenticity and clarity in the form of doctor's stamp and signature." 

Dr Tamorish in emed India 1

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Semicon at Chennai

Must read

Post by Dr Vivekshu in emed India3

Burnout is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In  Physician Lifestyle Report 2013, 43% of family physicians responded that they were burned out. This year that number went up: 50% reported burnout. An editorial published in the Journal of General Internal Medicine reported burnout rates ranging from 30% to 65% across specialties, with the highest rates of burnout incurred by physicians at the front line of care, such as emergency medicine and primary care physicians.The 2015 survey results reflect this same pattern, with the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout.

From EmedIndia 3

A chat with Dr.Devi Shetty, Narayana Hrudayalaya (Heart Specialist) Bangalore was arranged by WIPRO for its employees. The transcript of the chat is given below. Useful for everyone.

Qn: What are the thumb rules for a layman to take care of his heart?
Ans:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week;
avoid lifts and
avoid sitting for a longtime
3. Quit smoking
4. Control weight
5. Control BP - Blood pressure and Sugar

Qn: Can we convert fat into muscles?
Ans: It is a dangerous myth. Fat and muscles are made of two different tissues, fat is fat ... Ugly and harmful... Muscle is muscle. Fat can never be converted into a muscle.

Qn: It's still a grave shock to hear that some apparently healthy person
gets a cardiac arrest. How do we understand it in perspective?
Ans: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.

Qn: Are heart diseases hereditary?
Ans: Yes

Qn: What are the ways in which the heart is stressed? What practices do you suggest to de-stress?
Ans: Change your attitude towards life. Do not look for perfection in everything in life.

Qn: Is walking better than jogging or is more intensive exercise required to keep a healthy heart?
Ans: Walking is better than jogging, since jogging leads to early fatigue and injury to joints

Qn: You have done so much for the poor and needy. What has inspired you to do so?
Ans: Mother Theresa, who was my patient.

Qn: Can people with low blood pressure suffer heart diseases?
Ans: Extremely rare.

Qn: Does cholesterol accumulates right from an early age (I'm currently only 22) or do you have to worry about it only after you are above 30 years of age?
Ans: Cholesterol accumulates from childhood.

Qn: How do irregular eating habits affect the heart ?
Ans: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.

Qn: How can I control cholesterol content without using medicines?
Ans: Control diet, walk and eat walnut.

Qn: Which is the best and worst food for the heart?
Ans: Fruits and vegetables are the best and oilis the worst.

Qn: Which oil is better - groundnut, sunflower, olive?
Ans: All oils are bad.

Qn: What is the routine checkup one should go through? Is there any specific test?
Ans: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.

Qn: What are the first aid steps to be taken on a heart attack?
Ans: Help the person into a sleeping position, place an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him to a coronary care unit, since the maximum casualty takes place within the first hour.

Qn: How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?
Ans: Extremely difficult without ECG.

Qn: What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious heart problems.
Ans: Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.

Qn: Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?
Ans: Yes.

Qn: Marriages within close relatives can lead to heart problems for the child. Is it true?
Ans : Yes, co-sanguinity leads to congenital abnormalities and you may NOT have a software engineer as a child

Qn: Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart? What precautions would you recommend?
Ans : When you are young, nature protects you against all these irregularities. However, as yougrow older, respect the biological clock.

Qn: Will taking anti-hypertensive drugs cause some other complications (short/long term)?
Ans : Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.

Qn: Will consuming more coffee/tea lead to heart attacks?
Ans : No.

Qn: Are asthma patients more prone to heart disease?
Ans : No.

Qn: How would you define junk food?
Ans : Fried food like Kentucky , McDonalds , Samosas, and even Masala Dosas.

Qn: You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?
Ans: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease.

Qn: Does consuming bananas help reduce hypertension?
Ans: No.

Qn: Can a person help himself during a heart attack (Because we see a lot of forwarded e-mails on this)?
Ans: Yes. Lie down comfortably and put anaspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary care unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up.

Qn: Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?
Ans: No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.

Qn: Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
Ans : Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.

Qn: Is there a relation between heart problems and blood sugar?
Ans: Yes. A strong relationship since diabetics are more vulnerable to heart attacks than non-diabetics.

Qn: What are the things one needs to take care of after a heart operation?
Ans : Diet, exercise, drugs on time , Control cholesterol, BP, weight.

Qn: Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?
Ans : No.

Qn: What are the modern anti-hypertensive drugs?
Ans: There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugsand go for natural ways of controlling blood pressure by walk, diet to reduce weight and changing attitudes towards lifestyles.

Qn: Does dispirin or similar headache pills increase the risk of heart attacks?
Ans : No.

Qn: Why is the rate of heart attacks more in men than in women?
Ans: Nature protects women till the age of 45. (Present Global census show that the Percentage of heart disease in women has increased than in men )

Qn: How can one keep the heart in a good condition?
Ans: Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for health checkups if you are past the age of 30 ( once in six months recommended) ....

Please, don't hoard knowledge.
It takes sharing of knowledge to discover and understand the world in which we live.
Please send it to all your friends and relatives....... They might benefit as well...

Dr. Devi Shetty,
Narayana Hrudaya

From emed India 3 by vivekashnu

Dying declaration.

Hon‟ble Supreme Court after considering several pronouncements on the law relating to dying declaration summed up the principles governing the dying declaration as under:"

(i) There is neither rule of law nor of prudence that dying declaration cannot be acted upon without corroboration (Munnu Raja v. State of M.P.) (1976) 3 SCC 104; 1976 SCC (Cri.)376; (1976) 2 SCR 764.

(ii) If the Court is satisfied that the dying declaration is true and voluntary it can base conviction on it, without corroboration. (State of U.P. v. Ram Sagar Yadav) (1985) 1 SCC 552: 1985 SCC (Cri) 127: AIR 1985 SC 416; Ramavati Devi v. State of Bihar (1983) 1 SCC 211: 1983 SCC (Cri) 169: AIR 1983 SC 164.

(iii) This Court has to scrutinise the dying declaration carefully and must ensure that the declaration is not the result of tutoring, prompting or imagination. The deceased had opportunity to observe and identify the assailants and was in a fit state to make the declaration. (K. Ramchandra Reddy v. Public Prosecutor) (1976) 3 SCC 618: 1976 SCC (Cri) 473:AIR 1976 SC 1994.

(iv) Where dying declaration is suspicious it should not be acted upon without corroborative evidence. (Rasheed Beg v. State of M.P.) (1974) 4 SCC 264 : 1974 SCC (Cri) 426.

(v) Where the deceased was unconscious and could never make any dying declaration the evidence with regard to it is to be rejected. (Kake Singh v. State of M.P.) 1981 Supp. SCC 25 : 1981 SCC (Cri.) 645 : AIR 1982 SC 1021.

(vi) A dying declaration which suffers from infirmity cannot form the basis of conviction. (Ram Manorath v. State of U.P.) (1981) 2 SCC 654 : 1981 SCC (Cri) 581.

(vii Merely because a dying declaration does not contain the details as to the occurrence, it is not to be rejected. (State of Maharashtra v. Krishnamurti Laxmipati Naidu) 1980 Supp. SCC 455 : 1981 SCC (Cri) 364 : AIR 1981 SC 617.(viii)

Equally, merely because it is a brief statement, it is not be discarded. On the contrary, the shortness of the statement itself guarantees truth. (Surajdeo Oza v. State of Bihar) 1980 Supp. SCC 769 : 1979 SCC (Cri) 519 : AIR 1979 SC 1505.(ix)

Normally the court in order to satisfy whether deceased was in a fit mental condition to make the dying declaration look up to the medical opinion. But where the eyewitness has said that the deceased was in a fit and conscious state to make this dying declaration, the medical opinion cannot prevail. (Nanahau Ram and Anr. v. State of M.P.) 1988 Supp. SCC 152 : 1988 SCC (Cri) 342 : AIR 1988 SC 912.

(x) Where the prosecution version differs from the version as given in the dying declaration, the said declaration cannot be acted upon. (State of U.P. v. Madan Mohan) (1989) 3 SCC 390 : 1989 SCC (Cri) 585 : AIR 1989 SC 1519."

Em in India

What qualifies as emergency under Clinical Establishment Act to be treated as free?

Answer- As per Clinical Establishment Act, 2010 emergency is defined as

Emergency medical condition: means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) of such a nature that  the absence of immediate medical attention could reasonably be expected to result  in

(i) placing the health of the individual or, with respect to a pregnant women, the health of the woman or her unborn child, in serious jeopardy; or

(ii) serious impairment to bodily functions; or

(iii) serious dysfunction of any organ or part of a body.

http://clinicalestablishments.nic.in/cms/Home.aspx

question - Can a parent with crying child complaining of ear pain walk in as emergency and refuse to pay consultation.

Answer= So , a parent with crying child complaining of ear pain is not emergency and he can not refuse to pay. 

Pain management

Wound care workshop at Mims

Nbe work shop on em research

From emed India 1 whatsapp group

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[20/01 6:26 AM] Tamy Delhi: Intensive Care Medicine: Abstract - http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=3543_10.1007_s00134-014-3543-x&doi=

Dr.Babu KV in ethical medicine group

"Mr. Nadda said the cut was a procedure followed by the Finance Ministry taking into account unutilised funds.

“No flagship programme is being affected by the cuts; there is no dearth of funds. What you call cuts, I see as under-utilisation” Mr. Nadda told presspersons."

1   Who is responsible for the under utilisation of the health Budget ?  Health ministry under Dr Harsh Vardhan ?

2  When the Union Budget allocation for the period extending upto March 31st 2015,what is the rationale of slashing the under utilised funds,in between  ?

3  Was the "under utilised " budget allocation of other ministries slashed ?

4 In our country usually the alloted funds are more utilised in the second half of the financial year .This fact must be known to the Union Health minister himself.

5  It is surprising that,the Health Minister has come out with,rather strange explanations

http://www.thehindu.com/news/national/nadda-unfazed-by-health-budget-cut/article6789662.ece

Angels Kannur provided medical support for run kerala run

From emed India P by Tamorish kole

From emed India 3

[20/01 12:12 PM] Dr Vivekanshu: Diagnostic error(DE) can be defined as a diagnosis that is missed, wrong or delayed, as detected by some subsequent definitive test or finding. The ensuing harm results from the delay or failure to treat a condition present when the working diagnosis was wrong or unknown, or from treatment provided for a condition not actually present.--“Overall, DE have been underappreciated and under-recognized because they’re difficult to measure and keep track of owing to the frequent gap between the time the error occurs and when it’s detected,”

For example, patients with severe dizziness are misdiagnosed with benign inner ear conditions instead of stroke for a different set of reasons than an infection is missed due to misreading laboratory tests. Checklists may prevent misdiagnosis of some conditions, but not others.
[20/01 12:12 PM] Dr Vivekanshu: Diagnostic Errors More Common, Costly And Harmful Than Treatment Mistakes - In reviewing 25 years of U.S. malpractice claim payouts, Johns Hopkins researchers found that diagnostic errors — not surgical mistakes or medication overdoses — accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts --Diagnosis-related payments amounted to $38.8 billion between 1986 and 2010, they found — researchers estimate the number of patients suffering misdiagnosis-related, potentially preventable, significant permanent injury or death annually in the United States ranges from 80,000 to 160,000.