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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 : 3  |  Page : 25
Referring only to authoritative medical texts in difficult times

   Suggested precautions 
  1. In case of any dilemma, references must be made only to authoritative texts and commentaries. Additionally, seniors and peers of the same specialty can be consulted. (In the instant case, the court has rejected the doctor's defense which was based on a report clearly stating that "It is only a report and not an authorized medical text.").
  2. Patient's habits like drug addiction, alcoholism, etc. must be specifically recorded.

   Facts of the case Top

The patient developed an abscess with pain in the right inguinal region (groin region) and was advised surgery by the surgeon (OP2). While performing the surgery, the patient had profuse bleeding and was referred to Christian Medical College and Hospital, Ludhiana (CMC) for further treatment. The patient developed gangrene. The patient's right leg below the knee was first amputed but as gangrene could not be controlled, above knee amputation and knee stump closure were also performed.

   Patient's allegation/s of medical negligence Top

  • It was alleged that it was only during the treatment at CMC that the patient came to know that he had pseudo aneurysm femoral artery with abscess and that while operating the abscess, the surgeon (OP2) had negligently cut a big hole in the under lying femoral artery. This negligent act had resulted in huge loss of blood and blood supply of lower parts of the right leg was also cut off for a considerable longer period causing permanent damage to the lower leg, which subsequently developed gangrene and ultimately resulted in amputation.
  • It was pointed out that the medical records of CMC at the time of admission had clearly recorded "Cold, clammy foot. Absent movement at ankle. Absent sensation of foot." Thus the right leg of the patient was already dead when the patient was admitted to CMC.

   Doctor's defense Top

  • It was denied that femoral artery was negligently cut by the surgeon (OP2). It was stated that the under lying pseudo aneurysm got detected at the operation table after incision and drainage gave way because of necrosis of its wall and bleeding started, which was managed in the most efficient way by the surgeon (OP2). It was stated that second opinions of a Consultant Micro Vascular Surgeon and Plastic Surgeon were taken in the operation theatre, who confirmed good blood supply to the limb with good capillary filling in foot.
  • It was stated that bursting with hemorrhage is a usual complication of pseudo aneurysm as per medical literature. It was pointed that there are 11% incidents of amputation of limb in patients who suffer from pseudo aneurysm in the best centers of the world in spite of the best possible treatment.
  • It was further pointed out that the patient was shifted to CMC in a stable condition and nothing was done at CMC till the next day as all parameters i.e. B P, pulse, respiration remained stable as per records of CMC. Ligation of femoral artery was done on the next day of admission in CMC and gangrene of the limb developed 10 days after the admission in CMC.

   Findings of the court Top

  • The court rejected the defense of the surgeon (OP2) supported by medical literature on the ground that "It is only a report and not an authorized medical text."
  • The court relied on the following statements made by the medical experts, clearly indicating towards negligent conduct of the surgeon (OP2)

    • "While making incision for draining the abscess, the surgeon (OP2) made a deep incision producing a rent (cut) in the femoral artery which is the main source of blood supply to the lower limb. This resulted into profuse bleeding for which the surgeon just ligated the femoral artery above the rent."
    • "The surgeon of Bassi Hospital (OP1) should have repaired the rent caused by his scalpel rather than ligating the femoral artery, he had also ligated above the origin of profunda femoral artery. This is sure to cause gangrene of the limb."
    • "The femoral artery should not be left occluded either by ligature or tourniquet for more than 90 minutes to two hours whereas the complainant (patient) was referred to CMC after 6 hours after the operation."
    • "Dr. Naresh Bassi (OP2) has been negligent in diagnosing the patient, investigating the patient in a proper way and also in conducting the operation as he did not take recommended steps as are required in pseudo aneurysm problems i.e. control of the vessel below and above the Aneurysm. Had he taken such steps, profuse bleeding would not have taken place even as a result of the rent caused due to scalpel and the rent would have been repaired within a short time without any significant loss of blood."

  • The court found that though the hospital (OP1) records showed that the right foot of the patient showed good capillary filling but the records of CMC clearly indicated that on admission the patient's right leg had no sensation and it had become cold and clammy.
  • Hence the hospital and the surgeon (OPs) were held negligent.