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Court appreciates gynaecologist for taking opinion of more experienced peers when patient turns critical - Holds this is not an unauthorised involvement

May 16, 2024

Seeking opinions from other / senior doctors when in a doubt or dilemma is a healthy practice. No consent is required for such consultations and in many instances, such as this one, even courts appreciate the act of reaching out to peers which could benefit the patient.

Irrefutable Facts

The patient was under antenatal care (ANC) of the obstetrician at the hospital during the last two months of her pregnancy. The last USG advised by the obstetrician (OP2) revealed: “primi with preg with severe oligo with the cord around the neck with CPD”.

The patient was therefore advised to undergo elective LSCS. The same was performed 5 days before the expected date of delivery (EDD) and a female child was delivered successfully.

Bleeding at the surgical site was noticed on the same evening. The patient was taken to OT for exploratory laparotomy and a second opinion from another senior gynaecologist, physician and anaesthetist was taken in the OT.

Post-laparotomy the patient was diagnosed with DIC and was put on a ventilator. She was shifted to another hospital situated in a city that was about 100 kms away. At the second hospital, the patient’s condition worsened and she died next evening. The cause of death was reported as “interstitial pneumonia with pulmonary oedema with acute tubular necrosis in post-operative case of LSCS.”

Patient’s family sued the hospital and doctors. Their main allegation was that laparotomy performed without obtaining informed consent and without performing requisite investigations. Moreover, it was performed by unauthorized involvement of the other doctors.

Doctor’s Plea

In their defence, the hospital and doctors stated that the patient was monitored at regular intervals post-LSCS, and there was no active bleeding. Furthermore, immediately after noticing bleeding from the surgical site, she was shifted to OT to find out the reason for bleeding; second opinions of a gynaecologist, physician, and anaesthetist were sought; and based on the discussions it was decided to perform a re-exploratory laparotomy.

It was pointed out that patient’s attendants were informed about her condition from time to time.

Court’s Observations

The court perused medical records and observed that the patient was attended to and

examined from time to time during her postoperative period. It was also observed that there was a need for re-exploration without delay after LSCS and the surgery was performed after taking an informed consent.

It was therefore, concluded that it was a collective effort of the obstetrician and his team of experts, rejecting the allegation that it was an unauthorized participation / involvement as there was no consent.

The case against hospital and doctors was dismissed.

Prevention Is Better Than Cure

Courts appreciate when the treating doctor consults other doctors when in doubt or when the patient is critical. No consent of the patient / attendants is required for such consultations inter-se amongst doctors.

Source : Laxmikant Vittalrao Pandav & Ors. v/s Akar Hospital & Ors.