Doctors who fail to detect and subsequently manage birth defects could be held negligent under some circumstances. One of those is reflected in this medical negligence case.
Irrefutable Facts
The patient was admitted to the hospital under care of the obstetrician (OP3), who was assisted by the RMO. A male child was delivered, and 2 days later, patient and the newborn were discharged.
On the evening of discharge, attendants noticed that the newborn’s abdomen was swollen. They consulted another doctor who diagnosed the newborn with an imperforate anus and referred them to another hospital.
After being shifted to several other hospitals, the newborn was finally admitted to a higher centre’s paediatric surgery ward. The newborn underwent Sigmoid Loop Colostomy on the same day.
The parents sued both doctors of first hospital. It was alleged that the obstetrician and RMO certified the newborn as fit for discharge after a thorough check-up, despite newborn’s continuous discomfort and crying.
Doctors’ Plea
The obstetrician stated in defence that she never treated the patient before delivery. The patient was denied admission at the rural hospital and was therefore subsequently admitted to the hospital.
It was further stated that after the delivery, the newborn was examined and diagnosed with imperforate anus. This fact was brought to parent’s notice, and thereafter the newborn was referred to the paediatric surgery department.
The obstetrician pointed out that she was not a paediatric expert and, therefore, not qualified to treat the newborn. Furthermore, she pointed out that “birth defect is the act of God” and hence, no one can be held responsible for an “imperforate anus.”
Court’s Observations
The court perused the discharge certificate and prescription provided by the obstetrician and noted significant discrepancies. The discharge summary did not mention the time of discharge, the diagnosis of “Imperforate anus,” or the referral advice to paediatric department. However, the prescription, dated 2 days before discharge, included all these details.
The court held that this prescription was created only to submit before the court and was an afterthought to hide negligence
The court wondered, in the absence of a cogent explanation, “why they kept the newborn baby endangering his life even after alleged detection of the birth deformity”. The court found no evidence to suggest that the patient ignored the paediatric referral.
Hence, the court concluded that the doctors were negligent for not examining the infant thoroughly and appropriately managing the imperforate anus. They were both held negligent.
Prevention Is Better Than Cure
- The occurrence of a birth defect is not within the control of the doctor. However, the failure to take appropriate action to detect and manage such defects in newborns constitutes negligence. It is therefore important to thoroughly examine newborns before discharge. In case of the slightest suspicion, take efforts and indicated steps to diagnose further. If the condition is outside your expertise, refer the patient to the appropriate consultant or hospital further management. It is important to duly inform the attendants about such findings and document them in the medical records.
- All doctors involved in patient management share equal responsibility and accountability in the eyes of the law. RMOs / junior doctors should certainly follow the instructions of the senior doctors, but blind adherence to instructions will not be acceptable in a court of law.
Source : Dr. Susmita Bhattacharya v/s Marzina Bibi alias Begum & Ors.
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