Patient or attendant is nobody to question or dictate terms of treatment to the doctors

November 09, 2023

Medicine has moved from paternalism to patients’ autonomy. Earlier, doctors were expected to take decisions and act like parents. But now, the patient / attendants are also involved in decision making.

Yet the final decision on the course of treatment vests only with the treating doctor and no one else. This proposition is best illustrated in this case.

Irrefutable Facts

After consulting many hospitals with complaints of diminishing eyesight, the patient was referred to the hospital where she was diagnosed with Sjogren syndrome with renal tubular acidosis, with repeated attacks of hypokalaemia paralysis and optic atrophy.

After hospitalisation, the patient’s condition worsened. She was put on a ventilator, was administered steroids, developed mucormycosis and finally succumbed to complications.

Patient’s family sued the hospital, alleging that she developed mucormycosis, a ventilator-associated infection, due to unhygienic conditions in the hospital. It was further alleged that carcinoma of thyroid - revealed by post-mortem - remained undetected and un-diagnosed by the doctors.

Hospital’s Plea

The hospital authorities stated that patient’s condition was serious at the time of admission. MRI revealed a severe underlying involvement of the visual pathway. Furthermore, the treatment was provided as per medical texts.

It was pointed out that patient was administered steroids which were necessary not only to save her vision but also her life but unfortunately, she developed mucormycosis. It was admitted that steroids may have contributed to infection as the patient was immunocompromised.

It was further pointed out that the relatives were selective in relying upon only a few investigations and ignored others only to mislead the court. Finally, it was stated that an autopsy was performed after the patient’s death, indicating transparency in the hospital’s treatment.

Court’s Observations

The court, on perusal of medical records, accepted the hospital’s defence that the patient was already a case of hypokalemic paralysis for a long time, which was a potentially life-threatening clinical syndrome.

The court accepted hospital’s defence that patient’s condition was critical; therefore, the doctors had to “take the aid of last therapy, i.e., steroids which weakened her defence mechanism and contributed to the formation of sepsis”.

Importantly, the court further commented that mode of treatment has to be decided by the doctors and “patient or her attendant is nobody to question it or dictate the terms of treatment to the doctors, which is their field and they have expertise in the matter. We may say no science on this earth is perfect so is the case with medical science and there may be 101 idiopathic reasons on which medical science has not identified and simpliciter research work, which has been incorporated in the medical text books, has to be the standard of medical science.”

The family’s complaint and case against hospital stood dismissed.

Prevention Is Better Than Cure

  1. There are times when doctors have to decide between the devil and deep sea - to administer a medicine or perform an intervention known to cause fatal complications. Courts are very well aware of this dilemma. Taking a chance in the best interest of the patient is not negligence. But proper contemplation, care, precautions and documentation must be ensured.
  2. While hospitalizing, record a detailed history of the patient, especially if the patient is critical. Record specifically past history of the patient being treated in other facilities / doctors. This helps the court in knowing at what point of time treatment was started, what was patient’s condition on admission, whether the patient was diagnosed / misdiagnosed earlier, and so on.

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Source : 16MLCD (j5) Vinod Kumar v/s Post Graduate Institute of Medical Education & Research & Ors.