A doctor treated his mentor. Time was critical. Attendants were absent.
The court was asked a simple but uncomfortable question: how long can a doctor wait for consent when delay itself may cost a life?
Irrefutable Facts
An elderly patient, a doctor himself, suffered a head injury at midnight and was admitted to the ICU of the first hospital under neurologist’s care. The doctor happened to be a student of the patient. The patient had arrived unaccompanied by any attendants.
The neurologist attended to the patient’s wound by suturing the cut. Subsequently, he personally signed the ‘Discharged on Own Risk Bond’ (DORB) and then shifted the patient to the second hospital under his care.
A CT scan was performed after 6-7 hours of admission, which revealed acute Subdural Hematoma (SDH). Based on these findings, the neurologist decided to proceed with the surgery and transfused Fresh Frozen Plasma (FFP) to the patient as a preoperative measure.
The surgery was performed in the evening, during which a blood clot of about 500 gm was removed. However, a post-surgery CT scan revealed cerebral oedema, a small contusion in the left temporal area, and a brain shift. The patient passed away after 2 hours of surgery.
His family sued the neurologist and hospital. It was alleged that the surgery was performed without obtaining informed consent from the patient’ s attendants. It was also alleged that the CT scan should have been performed within 8 hours of the head injury, and the clot should have been removed as soon as possible. However, in this particular case, the surgery was done almost after 10 hours.
Doctor’s Plea
The neurologist in his defence stated that there was torrential rain at the time of admission, and shifting the critical patient in such a situation would have caused adverse consequences, and therefore CT scan was delayed.
He further stated that he did his best for his friend and mentor – the patient, acting as any reasonable doctor would under such circumstances, and even donated his blood. Performing any intervention in a rush could have been harmful to the patient.
Court’s Observations
The court found from the medical records that when the decision was made to perform the surgery, none of patient’s attendants were present. Further, “for the sake of immediate and urgent operation,” the neurologist, who happened to be patient’s close friend and student, was justified in signing the consent form. The court further commented that “doctors cannot wait for an indefinite period of time” to save a patient’s life.
After reviewing medical records, the court acknowledged that the neurologist and his team” tried their best to save the patient who could not survive ultimately due to the reasons which were beyond the control of the medical persons”.
The case against neurologist and hospital was dismissed.
Prevention Is Better Than Cure
In cases where the patient is in a critical condition and requires immediate intervention, if there are no attendants present around, the doctor may proceed with the intervention without waiting for consent and may even sign the consent form on behalf of the patient, as in this case.
The court has very categorically commented on this aspect thus “for the purpose of obtaining the signature upon the consent form, the doctors cannot wait for an indefinite period of time.”
Source : Dr. Tripti Das & Anr. v/s Dr. Phani Bhusan Mandal & Ors.
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