Not referring to a higher facility but managing an emergency patient - Not an act of omission

July 13, 2023

During an emergency, the treating doctor is always in a dilemma to choose between the devil and deep sea. Admittedly he / she has to choose the lesser evil, in the best interest of the patient with a lower element of risk.

Transferring the patient to another facility is one such dilemma that is very often faced by doctors. The courts are aware of these situations and are very accommodative. This case is an excellent example of the aforesaid.


Irrefutable Facts

A pregnant patient, in labour pain, was brought to the hospital after being admitted to another hospital for seven hours.

Emergency C-section was performed keeping in view of increasing labour pains and acute foetal distress. A female baby was delivered.

The patient developed hypotension and convulsions. She was managed conservatively and revived, and was thereafter shifted to ICU. She developed hypotension again, but it was managed.

Subsequently, the patient was transferred to a higher centre for further management but died on the way and was brought back to the hospital. The doctor issued a death certificate noting the cause of death as ‘septicaemia with labour pains’.

The patient’s family made wild allegations – that the doctor was an anaesthetist, not competent to perform C-section. He administered anaesthesia in excess that resulted in spinal shock, leading to patient’s death!

Doctors’ Plea

The doctor defended the actions, stating that the patient was admitted in critical condition; diagnosed with septicaemia and treated immediately to save her and the baby.  The doctor pointed out that patient developed hypotension during closure of the operative wound and she did not improve despite further treatment.

This complication necessitated transfer to a higher centre for further management. The patient was taken in an ambulance accompanied by a nurse. However, she was brought back with unrecordable BP, pulse and died despite resuscitative measures. 

Court’s Observations

National Consumer Commission accepted doctors’ defense.

The top Consumer Court observed from surgery notes that allegations levelled by patient’s family were unfounded and without any basis as the doctor who performed C-section was a surgeon and not an anaesthetist. 

The Commission further observed that given patient’s critical condition, she should have been taken to the higher centre by her family in the morning itself from first hospital; “but crucial time was wasted”.

The Commission also observed that the patient was admitted to this hospital in advanced labour with the deteriorated condition and concluded that “it was an emergency managed by the doctor as per the standard reasonable practice” and decision to perform emergency C-section surgery was correct to save the life of patient and the foetus.

The case against doctor and hospital was dismissed.

Prevention Is Better Than Cure

  1. Not referring the patient, who needs immediate critical care, to a higher centre is not negligence as long the risks & benefits of treatment / procedure and the pros & cons of not shifting the patient to higher centre is explained to patient’s relatives, and an informed high-risk consent is taken for same.
  2. OT notes must be carefully prepared and must have details of the surgery performed along with name of the doctors involved during surgery. This aspect should also be communicated to the patient.


Source : Source: 15MLCD (j6) J. N. Shori Multi Speciality Hospital & Anr. v/s Krishan Lal & Anr.

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