A patient with a serious cardiac condition travelled abroad seeking advanced treatment and underwent a high-risk cardiac intervention involving an implantable device. What followed was a sequence of post-procedure developments, including a re-intervention and later allegations surrounding the treatment decisions taken by the medical team.
The dispute eventually raised larger medico-legal questions around changing treatment strategies, device-related complications, and whether every corrective medical step can be viewed through the lens of negligence.
Irrefutable Facts
The patient, a resident of Ethiopia, was diagnosed with Coronary Artery Disease (CAD) with wide complex Left Ventricular (LV) dysfunction. Doctors in Ethiopia advised treatment abroad with a recommendation to undergo angiography and Implantable Cardioverter Defibrillator – Cardiac Resynchronization Therapy (ICD+CRT).
The patient travelled to India, was admitted to the hospital under the care of the cardiologist, and underwent a procedure for ICD implantation. The patient was discharged with advice to follow up.
During the follow-up visit, the patient was reoperated to adjust the ICD device. After a couple of days, the patient returned to Ethiopia.
After about 6 months, the patient drove to an office to collect his retirement benefit and sat on a bench where he collapsed. The patient was taken to a nearby clinic in an emergency ambulance, but unfortunately, he was declared dead.
His family sued the cardiologist, hospital and the ICD manufacturer. It was alleged that the cardiologist initially informed that a pacemaker was unnecessary. However, after consulting a cardiac surgeon, he changed the mode of treatment to ICD implantation.
It was also alleged that the ICD device implanted by the cardiologist was defective and hence could not save the patient from a heart attack.
It was further alleged that the patient had to be re-operated to re-adjust the ICD device, which amounts to an admission of negligence by the cardiologist.
Doctors’ Plea
It was stated in defence that AICD prevents only sudden cardiac death due to arrythmia in majority of cases but the patients continue to be at risk because of LV dysfunction.
It was further pointed out that the device was working properly. The patient had not filed any document to show that the doctors, Indian, Ethiopian or others, ever found fault with the implanted device.
Court’s Observations
The court on perusing medical literature found that “lead related problems are known to occur after device implantation and require re-exploration as a corrective measure”.
The court observed that “high voltage lead impedance or shock was out of range. Therefore, the treating doctors decided to re-explore the site wound for readjusting the AICD and to correct lead impedance”.
Hence, the court held that the conduct of cardiologist was proper.
Prevention Is Better Than Cure
- Every doctor owes a duty and exercises a privilege to determine the mode of treatment suitable for the patient’s health condition. Further, the treating doctor is at complete liberty to change the mode of treatment / choose an alternative after due contemplation and deliberations with other doctors. This is not negligence.
- Reopening the patient after an intervention is a possibility. It may happen due to reoccurrence, complications or in cases of devices due to malfunctioning or for readjustment. This proposition is all the more applicable in complex, critical and risky interventions. This fact should be duly communicated to the patient / attendants and also documented in the medical records.
Source : Moges Alemu v/s Indraprastha Apollo Hospitals & Anr.
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