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    Suggested precautions
   Facts of the case
    Patient's allega...
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 Table of Contents    
 
Year : 2013  |  Volume : 6  |  Issue : 7  |  Page : 99
Surgeon bound to be available to the patient post surgery or must make alternative arrangements

 
   Suggested precautions 
  1. Providing adequate postoperative care is the responsibility of the surgeon who performs the surgery. In case the operating surgeon is unable to provide post surgery care, the operating surgeon must provide requisite written information about some other doctor who can be contacted by the patient in case of any problem. (In this case, the orthopedic surgeon (OP) had performed a surgery in a camp organized by a non-government organization (NGO) in another city and was not available to the patient for a month after the surgery. The court held that the orthopedic surgeon (OP) "by not being available to the patient post-surgery and not giving the required written instructions of what is to be done in case of any complications or untoward developments was undoubtedly guilty of medical negligence"). ,
  2. Hospitals providing facilities to NGOs or other agencies to conduct free camps must first get a proper agreement executed clearly laying down the rights and duties of both the parties. The patient must also be duly intimated about such an agreement in writing. (In this case, the hospital (OP) had stated that the patient was operated in a camp organized by an NGO and they had only rented out the Operation Theater (OT) and general ward of the hospital and had no connection with the surgery nor had received any money from the patient. The court did not hold the hospital (OP) negligent).
  3. Failure to perform requisite investigations to confirm the results of a surgery/procedure could be construed as negligence. (In this case, the court drew adverse inference against the orthopedic surgeon (OP) for not taking a post surgery x-ray to confirm the results of the surgery). ,
  4. The discharge card must specifically record the patient's condition at discharge.
  5. Surgery notes must be in detail.



   Facts of the case Top


  • The patient had a mild deformity in her left leg diagnosed as Post Polio Residual Paralysis, and hence, approached the orthopedic surgeon (OP1). The surgery was performed on the patient under general anesthesia and she was discharged on the next day. A month later when the patient was bought to the orthopedic surgeon (OP1) for review her left leg had become completely black with loss of sensation. The patient was taken to the Medical College Hospital where it was found that gangrene had developed in the operated leg and the same was amputated.
  • The medical expert appointed by the court categorically stated that he could not give specific findings on medical negligence, as all the necessary medical documents were not given, and that the procedure done on the patient was the correct one.



   Patient's allegation/s of medical negligence Top


  • It was alleged that the patient was discharged without any adequate postoperative advice and no x-ray or any other diagnostic procedure was carried out to confirm whether the deformity had been corrected.
  • It was alleged that the orthopedic surgeon (OP1) advised her to come for review check up after one month even though she was in pain immediately after surgery. It was further alleged that when the orthopedic surgeon (OP1) was contacted on the phone he stated that there was nothing to worry and he would examine the patient on his next visit.



   Doctor's defense Top


  • It was stated by the orthopedic surgeon (OP1) that postoperative instructions were given and the patient was directed to contact the family physician in case of any post surgery problem.
  • It was stated that the orthopedic surgeon (OP1) had diagnosed gangrene; the development of gangrene was unrelated to the surgery; and was caused because of negligence in postoperative care by the patient.
  • It was stated by the hospital (OP2) that the camp was organized by an NGO and they had only rented out the OT and general ward of the hospital and had no connection with the surgery, nor had received any money from the patient.



   Findings of the court Top


  • The court observed that a surgeon is not expected to disappear immediately after surgery without any proper backup arrangement. The court further observed that if the orthopedic surgeon (OP1) was unavailable, he ought to have given advice, written or otherwise, as to whom the patient should contact in her city or vicinity in case of any complication. The court went on to observe that if the orthopedic surgeon (OP1) 'had no support systems and backups to continue with the treatment and care once he left, he should not have performed the surgery at all'.
  • The court held that the orthopedic surgeon (OP1) "by not being available to the patient post-surgery and not giving the required written instructions of what is to be done in case of any complications or untoward developments was undoubtedly guilty of medical negligence".
  • The court drew adverse inference against the orthopedic surgeon (OP1) for the following:
    • Failure to file any operation note.
    • Not taking any x-ray after the surgery to find out whether the deformity had been corrected or not.
    • Failure to record the patient's condition at the time of discharge.


  • The court did not hold the hospital (OP2) guilty, as it had only given the OT and general ward on rent to the camp organizer.
  • Hence, the orthopedic surgeon (OP1) was held negligent and the hospital (OP2) was not held negligent.



 

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