Being Legally Sound in the COVID-19 Era.

All the three Indian gastroenterology societies (Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver) jointly recommend to consider only emergency and urgent endoscopy procedures for the next 1 month or till the current threat due to coronavirus disease 2019 (COVID-19) is over. Two laws that are penal in nature are now applicable in the current pandemic, namely the Epidemics Diseases Act 1897 and the Indian Penal Code 1860. No act of an endoscopist should be seen to be in contravention of any of the aforementioned laws, and the sections thereunder as provisions of the Indian Penal Code can be attracted in the current scenario for spreading an infectious disease either knowingly (Section 270) or unknowingly or negligently (Section 269). Section 4 of the Epidemics Disease Act 1897 gives legal protection to every person who has acted under this Act or the directions issued under this Act subject to only one condition, that is, the act must have been done in good faith. Though the hospitals are obliged to ensure personal safety of its staff legally, morally and ethically, because of the huge gap in demand and supply of personal protective equipment (PPE), it is advisable to arrange PPE on one's own to first protect oneself and then, by extension, to prevent the spread to others. The dictum is "take care of yourself." Self-preservation is a supreme law. In the current COVID-19 pandemic conditions, certain additional information, to be agreed upon by the patient, needs to be incorporated in the consent. It should be incorporated in the consent that: • While all the necessary precautions are being taken, there is a finite though small risk that the patient may contract the infection from the hospital. • He/she indemnifies the hospital and the endoscopist against any such liability arising out of any action taken while doing the procedure. • Furthermore, to protect the patient him/herself, he/she agrees to get the preprocedural test for COVID-19 as well as bear the additional cost of the PPE used by the endoscopist and support staff. Several of those who have undergone an endoscopy would require a follow-up consultation. As it is difficult to have physical interaction, teleconsultation may be done as per the telemedicine practice guidelines issued by the Medical Council of India (MCI).