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    Suggested precautions
    Facts of the case
    Patient's allega...
    Doctor's defense
    Findings of the ...

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 Table of Contents    
Year : 2010  |  Volume : 3  |  Issue : 12  |  Page : 161
Directing patient to a particular chemist/dealer

   Suggested precautions 
  1. Avoid asking a patient to purchase medicines, disposables, implants, etc. from a particular chemist / dealer only. (In this case, the patient had made allegations that the knee implant was not proper and that he was made to purchase it from a particular dealer by the orthopedic surgeon (OP). The orthopedic surgeon (OP) refuted the said allegation by pointing that only one dealer in the town was having the recommended implant.)
  2. In legal proceedings, doctors must necessarily furnish in defense details of their credentials and experience in written defense. Indian courts draw favorable inference in favor of the doctor from the aforesaid.
  3. Record clinical history of the patient accurately. Specifically record all the deformities in detail that may have any bearing on the treatment.
  4. Proper care must be taken while giving postoperative instructions. Explain in detail to the patient / relatives / friends /attendants and duly record the same in the medical records / prescriptions / discharge card.
  5. Requisite preoperative investigations must be performed before each and every surgery / procedure and results thereof must be duly recorded.
  6. Post surgery / procedure care and supervision is the responsibility of the surgeon / doctor who has performed the same.
  7. Avoid passing any adverse comments on another doctor / hospital or on the treatment given to the patient unless it is absolutely necessary.
  8. Failure of the patient to follow any medical advice must be specifically recorded.
  9. Take consent of an oriented patient before performing any surgery / procedure.

   Facts of the case Top

  • The 70-year-old patient was having pain in the right knee while moving and walking. He consulted the orthopedic surgeon (OP2) at the hospital (OP1) and was diagnosed to be a case of Osteo-Arthritis Right Knee. The patient was advised and underwent total knee replacement (TKR). Post surgery the patient experienced difficulty in walking.
  • The patient consulted another doctor who advised complete scanning. On perusing the reports the patient was referred to the Christian Medical College and Hospital, Ludhiana (CMC) where after performing requisite investigations further surgical intervention was advised.

   Patient's allegation/s of medical negligence Top

  • It was alleged that the patient was directed by the orthopedic surgeon (OP2) to purchase implant from one M/s Arya Muni & Co. (Surgical).
  • It was alleged that the patient was assured that after knee replacement he would have no difficulty in moving and walking; preoperative medical tests were not done; consent of the patient was not taken before operating him; and post surgery the orthopedic surgeon (OP2) failed to pay personal attention and provide necessary supervision.
  • It was alleged that the doctor at the scanning centre as well as CMC made adverse comments on the medical treatment given to the patient. It was admitted by the patient that he had filed the complaint based on these opinions and that he cannot say of his own if there was any shortcoming in the surgery.

   Doctor's defense Top

  • It was stated in defense by the orthopedic surgeon (OP2) that the patient wanted the best implant and hence was recommended to purchase the implant manufactured by Orthopedics Inc. a subsidiary of Johnson and Johnson as it enjoyed the best reputation. It was further pointed out that the implant was available only with M/s Arya Muni & Co. (Surgical) as this firm was the only dealer of that company in the town.
  • It was stated that the patient already had shortening and deformity of the left lower limb and was unable to bear weight on left side. It was further stated that the patient was therefore warned to religiously follow postoperative instructions like physiotherapy and weight-bearing but he failed to do so.
  • It was denied that the patient was given any assurance that he would lead a normal life; was subjected to all pre-surgery investigations; had no contraindication for surgery of knee replacement and was medically examined by a medical expert and by an anesthetist who declared the patient fit for surgery.
  • It was stated by the orthopedic surgeon (OP2) that he was Professor and Head, Department of Orthopedics S.G.T.B. Hospital / Medical College Amritsar, had over 39 years of experience in conducting Orthopedic Surgery, had successfully conducted over 200 TKR operations, had so far trained 71 M.S. students and was member and office-bearer of many prestigious medical associations.

   Findings of the court Top

  • The court did not comment on the allegation of the patient that he was directed to a particular dealer to purchase the implant.
  • The court observed that the mild loosening of the knee replacement could have happened because of various reasons such as low healing power in old age or because the patient may not have carried out proper exercises of his knee and not necessarily because of medical negligence in performing surgery.
  • The court held that the orthopedic surgeon (OP2) was a duly qualified doctor, experienced and was competent to perform surgery of knee replacement.
  • The court perused medical records of the patient including the bed head ticket and treatment chart and found that consent was given by the patient's son, the patient was subjected to medical tests and post surgery the patient was attended from time to time on every day and a number of times a day and therefore rejected the other allegations of the patient.
  • Hence the hospital and the doctors (OPs) were not held negligent.