Stabilizing a critical patient and not shifting to higher centre is not negligence, holds National Consumer Commission

April 11, 2024

Managing patients in immediate need of critical care could be a challenging task for doctors and hospitals, from legal and medical point of views. This case offers an important learning on how to handle such situations. 

Irrefutable Facts

A young boy, hit by the train, was admitted to the hospital. He was initially managed

in casualty by a team of doctors consisting of general surgeon, orthopaedic surgeon and anaesthetist.

Investigations revealed haemorrhagic shock, multiple fractures and head injury. The patient was referred to a neurosurgeon for second opinion, was shifted to the ICU for observation but died in the evening. The post-mortem report revealed cause of death as fatal head injury and haemorrhagic shock.

The boy’s family sued the hospital and doctors. It was alleged that neurosurgeon was not available at the hospital, yet the doctors failed to immediately shift the patient to a higher centre.

Doctor’s Plea

The doctors stated in defence that injuries were sustained in a railway accident and such ante-mortem injuries were the cause of patient’s death.

Court’s Observations

The court rejected family’s allegation that the patient ought to have been referred to another centre sooner, observing that unless the condition stabilized “shifting the patient to a

higher centre was not advisable”.

Prevention Is Better Than Cure

Hospitalizing a patient in need of emergency care poses many dilemmas. The first is whether the patient should be admitted or not. If the requisite infrastructure and doctors are not available then the patient should not be hospitalized. First-aid must be given and the patient must be guided to the nearest appropriate facility.

The second dilemma arises after admission, where after initial investigations, the patient’s condition demands infrastructure, equipment or consultants who are not available in the hospital. A judgment call should be taken in the best interest of patient. Efforts must be made to stabilize the patient and then transfer to an appropriate facility.         

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Source : Malhe Ram @ Male Ram & Anr. v/s Jeevan Jyoti Hospital & Ors.