A patient developed pulmonary complications after delivery by LSCS, prompting allegations that routine ante-natal checks and pre-surgery investigations had been missed. The dispute centered on whether asymptomatic conditions required additional cardiological tests before surgery.
Irrefutable Facts
The patient was under gynaecologist’s ante-natal care (ANC). During routine checkups, the patient was diagnosed with gestational diabetes with high BP. The gynaecologist advised LSCS.
Accordingly, the patient was admitted to the hospital; elective LSCS was performed, and a girl was delivered. Post-delivery, after extubating, there was a fall in oxygen saturation. The patient was intubated with 100% oxygen.
She was diagnosed with Pulmonary Edema, which was managed effectively. Thereafter, the patient was shifted to ICU; and then to Cardiac Intensive Care Unit (CCU) for further expert management, yet she died of cardiac arrest.
Her relatives sued the gynaecologist, alleging that the doctor did not record regular BP and weight during patient’s ANC visits; therefore, Pregnancy Induced Hypertension (PIH) was missed and remained untreated, and this was the cause of cardiac complications that developed post-delivery.
Doctors’ Plea
The doctor stated in defence that the patient was asymptomatic for PIH; therefore, no further cardiological investigations were performed. It was pointed out that preoperative ECHO and ABG are not standard pre-LSCS investigations for asymptomatic patients below 40 years of age. However, ABG levels were checked twice post-LSCS.
The doctor further stated that patient’s high BP was detected for the first time in the month of expected delivery, and she was managed conservatively.
It was also pointed out that post LSCS, the patient developed pulmonary edema, and a cardiologist’s reference was immediately sought for further management.
Court’s Observations
The court accepted the defence that the patient’s asymptomatic cardiac disease did not warrant an ECHO test before LSCS.
The court perused medical records and observed that peripartum cardiomyopathy manifested post-extubating; patient’s SPO2 level started to fall despite administration of 100% oxygen; she was re-intubated and was diagnosed with Pulmonary Edema; and later shifted to ICU for expert management. The court, therefore, concluded that the post-operative event was effectively managed in the OT.
The case against gynaecologist was dismissed.
Prevention Is Better Than Cure
The allegation that the doctor had performed an intervention / investigation overenthusiastically when it was not indicated is quite common. On the other hand, there are allegations that the doctor had failed or delayed in performing an indicated intervention / investigation.
Law merely expects a doctor to act as per medical science. An intervention / investigation must be advised or performed only when medically indicated and not otherwise. Failure to perform an intervention / investigation for which the patient is asymptomatic or holds no medical history is not negligence, as illustrated in this case.
Source : Mrityunjay Kumar & Ors. v/s Pushpanjali Crosslay Hospital & Ors.
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