The medical law reporter for Indian Doctors
Advertise with Medknow
Click here to view April 2016 issue as eBook Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 


 

 
     
    Search
 

 
 
     
  
    Add to My List *
* Registration required (free)  


    Suggested precautions
   Facts of the case
    Patent's allegat...
   Doctor's defense
    Findings of the ...

 Article Comments
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
 
Year : 2017  |  Volume : 10  |  Issue : 12  |  Page : 185
Ultimate object of punishing doctors is "not getting or giving compensation but to have flawless service" as it is question of life and death and effects the quality of life

 
   Suggested precautions 
  1. Doctors always wonder why courts are harsh on doctors and give out high compensation putting more burden on them. The court in this case has pointed out to the underlying reason thus: "The ultimate object of the enactment is not getting or giving compensation but to have flawless service. It is much more essential in the medical field as it is question of life and death and affect the quality of life."
  2. Failure to record in continuity or for a specific period of time could be construed as negligence. (In this case, one of the allegations was that nothing was recorded from "3.15 pm till birth of the child." Medical records produced before the court were pertaining to the period before 3.15 and after birth. The court drew adverse inference from this).
  3. Update yourself and follow the scientifically approved and accepted protocols stated in standard medical texts and journals, and SOPs/guidelines of medical associations/regulatory bodies/government bodies. (In this case, the guidelines published by the National Institute of Health and Family Welfare clearly mandated that, if the baby does not cry after birth, in that case do not slap the baby or hang it upside down but this is precisely what was done when the baby did not cry after birth).
  4. Medical records include investigation reports, prescription, and OPD card, and in a case of a hospitalized patient, the admission form, discharge card/summary, daily treatment chart, bed-head ticket, consent form, etc. A doctor/hospital is bound to preserve them, provide copies thereof to the patient on request, and produce them in court as and when required. (In this case, the doctor (OP) produced only the discharge ticket before the court. The court disapproved this conduct observing that "history and clinical findings recorded in the discharge ticket which are based on daily treatment chart or bed head ticket has not been submitted" and "it can very well be presumed that either no documents have been prepared or if prepared are against the non-applicants (doctor)").
  5. The importance of medical records has been aptly summarized by the court in this judgment as follows: "Medical record maintenance has evolved into a science of itself and form an important aspect of the management of a patient. ... It will help the doctor to prove that the treatment was carried out properly. The proper medical record it will help them in the scientific evaluation of their patient profile, helping in analysing the treatment results, and to plan treatment protocols. It is wise to remember that "Poor records mean poor defense, no records mean no defense."
  6. Complaints made by patients should be investigated with due diligence. (In this case, the patient alleged that the obstetrician (OP) did not investigate or take her complaint of reduced fetal movements seriously).
  7. Failure of the patient to follow medical advice should be specifically recorded.
  8. Reports of the investigations performed must be duly preserved and produced before the court. Failure to do so forces the court to draw adverse inference. (In this case, the doctor (OP) stated in the court that CT scan had reported that "cartex of the child is not developed," and therefore cerebral palsy was caused to the child due to genetic or birth defect. The court disbelieved as this CT report was not produced before the court).
  9. Perform requisite investigations when indicated. (In this case, the infant was suffering from severe birth asphyxia, but to ascertain this the first CT Scan was done when the infant was 3.5 months old whereas neuroimaging of the brain ought to have been done within 24 to 96 hours of birth).
  10. Ensure that doctors/nurses write their names and put signature/initials at appropriate places in medical records. (In this case, the court drew adverse inference observing that, even though the obstetrician (OP) had stated that a pediatric resident was in the labor room, the name was not disclosed / recorded).
  11. Manipulation/fabrication of medical records rarely work in courts. (In this case, one of the allegation was that "in column condition of baby at birth cuttings have been made and new words have been inserted").
  12. Compensation in cases of medical negligence is computed on the principle "that the aggrieved person (patient) should get that sum of money, which would put him in the same position if he had not sustained the wrong" (restitutio in integrum).
  13. Every aspect of the society needs to be transparent. Transparency is expected from health care providers also. In this case, the court lamented on the lack of transparency from the healthcare providers and directed "the Principal Secretary, Consumer Affairs and Principal Secretary, Medical and Health to formulate a scheme/guideline for keeping transparency in the hospital that patient and their attendants should know exact diagnosis, treatment procedure required and given to the patient from time to time without compromising the quality and urgent nature of the treatment and procedure given or required in the situation."



   Facts of the case Top


  • The patient was under the antenatal care (ANC) of the obstetrician (OP). The patient reached the hospital at full term for delivery, was admitted under the obstetrician (OP) at 11.15 am, and a male child was delivered normally at 3.34 pm. The infant did not cry after birth, suffered from convulsions, was resuscitated, and then transferred to a pediatric care unit for further management. The infant was treated in the pediatric care unit and was discharged as a "high risk baby."
  • The medical board set up by the court reported that the child suffered from birth asphyxia and related cerebral damage.



   Patent's allegation/s of medical negligence Top


  • It was alleged that when the patient came to the ANC OPD and complained of reduced fetal movement it was not investigated by the obstetrician (OP).
  • It was alleged that necessary care was not taken during delivery as the cord of the fetus was around his neck, he could not get enough oxygen, and therefore suffered birth asphyxia and related cerebral damage.
  • It was alleged that the patient was given an overdose of oxytocin during labor.



   Doctor's defense Top


  • It was stated that the patient was given due care since admission, heartbeat, and CTG of the fetus was normal. Doppler test was conducted and there was no cord around the neck of the infant. It was further stated that after birth the infant did not cry, and hence, was hanged upside down; the pulse rate was 100 for which oxygen from bag and mask was supplied, following which the infant was transferred to a neonatal unit.
  • It was pointed out by the obstetrician (OP) that, about a week before the delivery, the patient was advised a sonography which was ignored.
  • It was stated that the CT scan report found that the cerebral cortex of the child was not developed, which could be due to a genetic or birth defect and cannot be held as negligence.



   Findings of the court Top


  • The court made a very important observation in this judgment that the "ultimate object" of law in cases of medical negligence "is not getting or giving compensation but to have flawless service. It is much more essential in the medical field as it is question of life and death and effect the quality of life."
  • The court drew adverse inference against the obstetrician (OP) for the following:

    • For not recording the events happening from 3.15 pm till the time of birth; the events from 11.15 am to 3.15 pm were properly recorded.
    • For not submitting indoor medical records other than the discharge card in defence. The court commented that "Poor records mean poor defense, no records mean no defense."
    • For performing CT scan about 3.5 months after delivery to ascertain the full extent of the brain damage although the medical texts advised that the same should be performed within a span of 24 to 96 hours after birth.
    • For slapping and hanging the infant upside down as he did not cry after birth. The court referred to a publication of the National Institute of Health and Family Welfare, which clearly stated that if the baby does not cry in that case the baby should not be slapped or hanged upside down.
  • The court observed that "It is a common experience that patient and their attendants remain unaware about the diagnosis, treatment, and procedure during their stay in the hospital."The court directed the "Principal Secretary, Consumer Affairs and Principal Secretary, Medical and Health to formulate a scheme/guideline for keeping transparency in the hospital that patient and their attendants should know exact diagnosis, treatment procedure required and given to the patient from time to time without compromising the quality and urgent nature of the treatment and procedure given or required in the situation."
  • Hence, the court held the doctor (OP) negligent.



 

Top