A critically ill elderly patient presenting with severe bleeding complications was admitted for emergency management at a hospital. As the patient’s condition continued to remain precarious, the treating team took a call to shift her to another centre for further care.
Following the patient’s death shortly thereafter, allegations of delay, improper management, and loss of crucial treatment time led to a medico-legal battle over whether the transfer reflected negligence… or necessary medical judgment.
Irrefutable Facts
The patient, aged 87 years, was brought to the hospital with complaints of bleeding through urine and Per Rectum (PR). The patient was diagnosed with hemorrhagic shock, was advised immediate admission and blood transfusion, shifted to the Critical Care Unit (CCU), and was managed conservatively.
On the same day, the patient was transferred to the second hospital for further management, where she died the same evening.
Patient’s family sued the hospital and doctors. It was alleged that blood transfusion was the need of the hour; however, the hospital wasted four golden hours, leading to patient’s critical condition.
It was further alleged that the doctors diagnosed multisite bleeding with hemorrhagic shock of unknown origin but did not attempt to identify the actual site of bleeding. It was also pointed out that the doctors advised urgent blood transfusion without performing the blood grouping or Rh typing.
Hospital’s Plea
For unknown reasons, the hospital did not contest the case.
Court’s Observations
The court, upon perusing the medical records, observed that the patient was experiencing urine and PR bleeding for last three days, with a Hb level of 5.4%. Hence, the court held that the patient was in a difficult and critical condition.
The court, on further perusal of medical records, observed that although the doctors had planned for blood transfusion and managed the patient conservatively, the bleeding from the vagina and PR persisted. Therefore, the only option left was to try to save her life by shifting her to a higher centre for further management.
The court held that this course of action was bonafide.
Hence, the court dismissed the case against the doctors and hospital.
Prevention Is Better Than Cure
- Referring a patient to another centre in the patient’s best interest and for a justified medical reason, such as higher management, is not negligence.
- The golden hour in medical practice signifies the critical time following an emergency / critical condition / traumatic injury, during which prompt treatment is highly likely to prevent death or harm to the patient. Therefore, act appropriately and with a sense of urgency during the golden hour of that medical condition, as every minute counts.
Source : Utpal Roy Chowdhury v/s Calcutta Heart Clinic & Hospital & Anr.
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