Two key learnings for doctors are up for grabs for doctors and hospitals from this case. Only a doctor is competent to decide when to start a particular line of treatment. And, the principal doctor / doctor / specialists should inform the patient / attendants about their role in delivering patient care.
Irrefutable Facts
The patient consulted cardiologist at the hospital, and was advised pathological investigations. The investigations revealed random blood sugar of 175mg and other pulmonary issues.
The cardiologist recommended repeat investigations after 4–5 days and referred the patient to a pulmonologist. The pulmonologist added a new medication to previous prescription and
advised a sputum C/S test.
The sputum C/S reported positive, prompting the pulmonologist to add another medication. Additionally, repeat investigations revealed high blood sugar levels, leading to a referral to the endocrinologist at the hospital.
The patient consulted some other endocrinologists who recommended insulin. Furthermore, the patient sought another opinion from a different pulmonologist. Unfortunately, after a few days, the patient lost consciousness and was subsequently taken to another hospital, where he was declared dead.
The post-mortem report revealed the cause of death as a ‘natural disease process due to circulatory failure as a result of constrictive Pericarditis.’
Patient’s family sued the cardiologist and first hospital. It was alleged that the patient, while under the care of cardiologist, was seen by a doctor who lacked the necessary qualifications but gave the prescription which had cardiologist’s stamp.
It was further alleged that the other endocrinologist had stated that the cardiologist had delayed referring the patient for diabetes treatment.
Doctor’s Plea
It was stated that the patient was receiving treatment on an OPD basis under the care of cardiologist, while the doctor, who wrote the prescription, served as a clinical assistant responsible for patient documentation.
It was stated that the patient’ s random blood sugar was 175mg, which does not warn necessity of any medication. However, when urine and blood investigations indicated high blood sugar levels, the patient was referred to endocrinologist.
It was also stated that the patient had pre-existing cardiovascular disease and had developed some pulmonary issues for which proper medications were prescribed.
It was pointed out that the PM report attributed the cause of death to cardiovascular disease, not diabetes or any other ailment.
Court’s Observations
The court, upon examining the prescription, agreed with the defence that the doctor was a clinical assistant to the cardiologist, and that the cardiologist had been providing medical care to the patient from the beginning rather than the other doctor.
After reviewing medical records, the court accepted the defence that patient’s random blood sugar level of 175mg was within the normal range for a non-diabetic individual.
When the subsequent blood investigations revealed high blood sugar, the cardiologist appropriately referred the patient to hospital’s endocrinologist. However, it was noted that the patient sought consultation with another endocrinologist elsewhere.
The court further perused medical records and observed that the cardiologist had properly managed the patient’s condition.
Conversely, it was established that the patient was not under the care of cardiologist in the days leading up to the death; hence, no negligence can be attributed to the cardiologist.
Hence, the case against cardiologist and hospital was dismissed.
Prevention Is Better Than Cure
- Take the right actions at the right time while managing a patient. Refer the patient to another speciality / hospital when indicated.
- It is important to note that all white apron-bearing individuals in the hospital are not doctors. Not knowing the identity of the treating doctor may trigger a spark of doubt in the patient / attendants. The treating doctors should introduce themselves to the patient and authenticate the documentation done under their instructions with their stamp and signature.
Source : Manas Ranjan Samantaray v/s Care Hospitals & Ors.
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