To what extent does the doctor’s responsibility lie in admitting / referring the patient to a higher center? What must the doctor bear in mind while doing so? This case answers these questions…
Irrefutable Facts
The patient was under obstetrician’s antenatal care (ANC) during her second pregnancy. The doctor advised her to get hospitalized for LSCS.
Post-LSCS at midnight, the patient experienced hypotension and reduced urine output. As a result, the patient was shifted to another hospital for further management.
Investigations revealed low potassium levels and urinary tract infection caused by post-operative abdominal distention. The patient was subsequently referred to a higher-level medical center for further treatment and was managed satisfactorily.
The patient sued the obstetrician, alleging that even though the doctor was practising at a government hospital, he insisted that she should be admitted in a private hospital even though ot did not have ICU / CCU facilities for post-operative care.
The patient also alleged that the delay in referral led to the development of a hematoma at the surgical site, resulting in ongoing repercussions.
Doctors’ Plea
The obstetrician stated in defence that the patient voluntarily chose to get admitted at the private hospital.
He pointed out that the patient was diagnosed with hypothyroidism during ANC, and was advised to undergo a thyroid stimulating hormone (TSH) test, liver function test and anomaly scan. However, she refused to undergo these tests.
Court’s Observations
The court, on perusal of medical records, observed that the patient, a case of ‘post C’ S pregnancy with hypothyroidism’, was referred to private hospital by the obstetrician which lacked the ICU or CCU facilities that were necessary to manage postoperative complications.
The court also pointed out that “the doctor is the only choice maker, who gives written advice of referral”. The court, therefore, held that negligence lay with the obstetrician rather than any administrative lapses on the part of the hospital for admitting such a patient.
Hence, the court held the obstetrician negligent.
Prevention Is Better Than Cure
A doctor usually chooses the hospital while advising hospitalization, although the patient is the final decision maker. Giving a few options to the patient is a healthy practice. But when the doctor makes the final choice, the responsibility to ensure that the referred hospital possesses the requisite facilities and expertise to effectively manage the patient’s condition and the common complications that the patient may suffer during hospitalization lies on the referring doctor.
Further contemplation is required on whether the facilities / hospitals that may be required in future, keeping in view the patient’s condition / anticipated complications, are available in the near vicinity or not. Emergencies, of course, will be an exception.
Source : Dr. Arup Dey v/s Sikha Dey & Anr.
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