A patient ,accusing a doctor of malpractice,will find it difficult to prove damage unless there is another doctor to testify about proper medical procedures.
Sequence of tenses is important for not causing ambiguity and you will realise that it will be ungrammatical if you use was after a present sentence.First of all just decide whether you are talking about a general event, an event happened in the past or a future event.Then use the proper tense according to your sentence.Of course you may change the tense if you form your sentence like that a patient accusing a doctor of malpractice will find it difficult to prove damage if they don't have necessary proof that doctor has prescribed them wrong medicine.Moreover, in the past it was much more difficult ......
Though you can change the tense it must have a sequence with the other tenses in your sentence.Also words like in the past, nowadays , from now on...will help you to decide which tense to choose.
2)I wanted to ask if there is a framework or set of rules for switching the tenses like this one. To find the answer ask yourself whether this sentence is writtin in the form of question or not.This sentence isn't in a question form. If not, are there a set of exceptions where we should or should not switch the tenses. For this sentence put a question mark because it is a question form.
I don't know what to tell him.
What can I tell him?
I tried to help you as much as I can lets wait for the other answers