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    Suggested precautions
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 Table of Contents    
 
Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 17
Transferring a patient or receiving a transferred patient - A double-edged sword for both the hospitals

 
   Suggested precautions 
  1. Transferring a patient can be a double-edged sword for both the transferring hospital as well as the receiving hospital. The transferring hospital should clearly mention the reasons and condition of the patient during the transfer, whereas the receiving hospital should clearly document the patient's condition at the time of receiving the patient. There is always a possibility of either of the hospital trying to dump responsibility of mismanagement of the patient on the other hospital. (In this case, it was alleged that the patient had died much before the transfer and the receiving hospital had clearly mentioned brought dead on arrival. The court found this allegation to be true).
  2. A surgeon cannot be both a surgeon and a qualified anesthetist at the same time. Law mandates that anesthesia should be administered by qualified anesthetists only. (In this case, the ENT surgeon (OP) was held negligent for administering local anesthesia which he said was a routine practice followed by other surgeons also. The court rejected this defence observing "One thing is certain that anaesthesia is supposed to be administered by anaesthetist who is an expert in the field, but in the present case, it is admitted that the anaesthesia was given by the surgeon himself").
  3. Postoperative care should always be prompt and appropriate. (In this case, one of the allegations was that inspite of the ENT surgeon (OP) being repeatedly informed about postsurgical oozing of blood from the patient's ears, the ENT surgeon (OP) did not respond till the next day. The court found that the allegation was true and has very specifically and adversely commented on the same).
  4. Delay in calling the appropriate consultants when the same is indicated is per se negligence. (In this case, one of the allegations was that the surgeon (OP) called the anesthetist late inspite of falling oxygen saturation level and by the time the anesthetist arrived oxygen saturation was 10% and it was too late to actively do anything).
  5. Every hospital must regularly audit and replenish emergency medicines/kit/facilities. (In this case, one very specific allegations was that the relatives were asked to buy emergency medicines as the hospital of the ENT surgeon (OP) did not have medicines in stock at the relevant period).
  6. Every hospital and nursing home where surgeries are performed must have the requisite facilities to handle expected common complications of those surgeries. (In this case, the court remarked adversely as the hospital of the ENT surgeon (OP) did not have facilities to treat convulsions or handle unconscious patients).
  7. Document both the name and dose of anesthesia drug. (In this case, the medical expert, had specifically reported to the court that "the nature and the dose of anaesthesia was not mentioned").
  8. Consent must specifically record the type of anesthesia. (In this case, the medical expert had clearly expressed displeasure as the "the patients informed consent was not taken for the type of anaesthesia administered").
  9. Medical negligence cases are very difficult to prove in a court for a lawyer, except when the doctrine of res ipsa loquitor (the wrong done speaks for itself and needs no further proof) is applied. In this case, the court has not specifically mentioned but impliedly applied this doctrine. The patient came to the hospital for a surgery but died due to complications unrelated to the said surgery.The court found that the cause of death mentioned in the post-mortem report was "pulmonary oedema and cerebral oedema," and that this aspect was not explained either by the ENT surgeon (OP) or by any other report available on the record. The court observed that it can be "impliedly concluded that this may be due to internal injury during the operation or due to delayed effect of anaesthesia administered by the surgeon himself." The court, therefore, held that some event happened in hospital which led to the death of the patient and for which the hospital (OP) alone was responsible.



   Facts of the case Top


  • The patient was admitted for a right-sided stapedectomy in the ENT surgeon's (OP) hospital. He was operated on the same day by the ENT surgeon (OP) under local anesthesia administered by the ENT surgeon (OP) himself. Next day, the patient collapsed coming out of the bathroom and had convulsions. The ENT surgeon (OP) came to the clinic/hospital and an anesthetist was also called. The patient was transferred to another hospital where they declared the "patient brought dead."
  • Postmortem report stated that the death was due to "pulmonary oedema and cerebral oedema."
  • The court sought opinion of a forensic expert who opined that "The cause of death in this case was due to the sudden unexpected death in epilepsy."



   Patent's allegation/s of medical negligence Top


  • It was alleged that the patient was already dead in the ENT surgeon's (OP) clinic/hospital and yet was transferred to another hospital. It was pointed that in the medical records it was clearly recorded "Pt. developed bradycardia & later on arrested. CPR was done... Pt. could not be revived. So, shifted to a higher center for a ventilator care."
  • It was alleged that local anesthesia was administered by the ENT surgeon (OP).
  • It was alleged that no informed consent was taken for anesthesia.
  • It was alleged that, even though the patient had lot of pain and blood oozing from the wound throughout the day of the surgery, he was not attended to by the ENT surgeon (OP), and only on the next day, when the patient's condition deteriorated, the ENT surgeon (OP) visited the patient.



   Doctor's defense Top


  • It was stated that the patient was transferred to another hospital only on the advice of the anesthetist who had recorded oxygen saturation less than 30% and within the next 10 minutes below 10%.
  • It was stated by the ENT surgeon (OP) that local anesthesia is given by other surgeons as a routine practice and is followed by most of the other ENT surgeons.
  • It was stated that local anesthesia cannot have delayed complications beyond a few hours,but this patient had complications after 24 hours.
  • It was pointed out that post mortem reported that the death was due to "pulmonary oedema and cerebral oedema" whereas the forensic expert opined that it was due to the "sudden unexpected death in epilepsy." It was stated that both the reasons cannot be correlated with complications of surgery performed or local anaesthesia administered to the patient.



   Findings of the court Top


  • The court agreed with the allegation that the patient died in the ENT surgeon's (OP) clinic/hospital, and was thereafter transferred to another hospital.
  • The court held the ENT surgeon (OP) negligent for administering local anesthesia observing that "one thing is certain that anaesthesia is supposed to be administered by anaesthetist who is an expert in the field."
  • The court observed that the cause of death mentioned in the post-mortem report was "pulmonary oedema and cerebral oedema" and this was not explained either by the ENT surgeon (OP) or by any other report available on the record. The court further observed that it can be "impliedly concluded that this may be due to internal injury during the operation or due to delayed effect of anaesthesia administered by the surgeon himself."
  • The court drew adverse inference against the ENT surgeon (OP) for lack of proper facility to treat convulsion or unconsciousness of the patient in his hospital; for failure to provide post-surgery care as he did not visit the patient post surgery despite complaint of severe pain and blood oozing out of the ear; for not mentioning the "nature and dose" of the drug administered to induce anaesthesia in the surgery notes; and for not taking informed consent for anaesthesia.
  • Hence, the ENT surgeon (OP) was held negligent.



 

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