Year : 2009  |  Volume : 12  |  Issue : 2  |  Page : 175--176

Legal consequences of not making life saving equipments available to patients


 

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How to cite this article:
. Legal consequences of not making life saving equipments available to patients.Ann Card Anaesth 2009;12:175-176


How to cite this URL:
. Legal consequences of not making life saving equipments available to patients. Ann Card Anaesth [serial online] 2009 [cited 2020 Apr 10 ];12:175-176
Available from: http://www.annals.in/text.asp?2009/12/2/175/53428


Full Text

National consumer disputes redressal commission, New Delhi

 Facts of the Case



Patient was admitted in hospital (OP) as he was suffering from fever for 20 days. After treatment for few days, the patient developed complications. ABG analysis suggested acute respiratory distress syndrome (ARDS). He was discharged and was advised to be taken to DMCH, Ludhiana. Patient died on his way to DMCH, Ludhiana.

 Patient's Allegation/s of Medical Negligence



It was alleged that although the patient was advised to be put on artificial ventilator by the hospital's (OP) own doctors and the same was available, the hospital (OP) did not make it available to the patient.It was also alleged that medical records of the hospital (OP) were not maintained properly and had also been fabricated.Lastly, it was alleged that in a critical condition, the patient was discharged and referred mischievously to DMCH, Ludhiana though the hospital (OP) is itself a heart specialty hospital.

 Doctor's defense



It was stated in defense that after getting report of ABG and on the advice of a senior anesthetic and interventionist, oxygen concentration was increased through specialized ventimask. This was the recommended line of treatment and the patient also responded and got stabilized. Regarding mechanical ventilator, it was stated that it was available for use in another hospital running from the same premises and even there it was not free at the relevant time as they were being used by patients who had undergone by-pass surgery.It was contended that the patient had developed complication suggestive of ARDS. It was therefore suggested that further treatment should be done by a chest specialist in ICU with mechanical ventilation. As the hospital (OP) did not have these facilities, they referred the patient to DMCH, Ludhiana for further treatment.

 Findings of the Court



The court concluded that the patient was not put on artificial ventilation though rightly advised and was allowed to sink from critical condition to fatal condition. No records had been provided to show that the mechanical ventilator could not be spared. Court rejected OP's contention that Tagore Hospital and Tagore Heart Centre were two different entities under a common management, located in the same premises. Hence, the aforesaid was negligence.The court found many instances of medical negligence. The medical records were completely silence as to who interpreted investigative reports as there was no signature of any doctor. No effort was made to co-relate incompatible findings of x-ray reporting "lung fields clear" with the reports of echocardiogram, which showed 'pericardial effusion.' History sheet showed that the case was discussed with consultants but actually their entries and signatures were not taken contrary to the usual procedure. ABG was excessively delayed.The court found that at 1.00 a.m.: 103F, pulse normal (i.e. 72) was recorded. At 5.30 a.m.: 103F, pulse 'normal' was recorded but there was overwriting and the pulse was changed to '90 or 96'. The court relied on medical literature, which showed that with every 1F increase in temperature, the pulse goes up by about 10 beats. Hence at 103F, the patient's pulse ought to be around 100. Medical literature further showed that there cannot be such variation in pulse, i.e., from 72 to 90/96 within a few hours. The court therefore observed that the medical records were fabricated and not maintained properly.The court agreed with the patient's allegation that the patient was discharged forcibly, knowing fully well that he was in a critical condition.Hence the hospital (OP) was found negligent.

 Suggested Precautions



Hospitals/nursing homes must have sufficient numbers of life saving equipments like mechanical ventilators.Necessary diagnostic tests and procedures must not be delayed.In case of any doubt, it is advisable to repeat diagnostic tests and procedures.Extra caution is necessary if investigations have been done by patients on their own or on advice of other doctors or in non-standard laboratories.Consultants dealing with the patient, must duly record that they have referred to diagnostic reports.Co-relate different investigations inter se as well as with clinical findings.In IPD patients, the specialists who have been consulted and their respective advice must be properly recorded.In IPD patients, vitals must be checked at regular intervals and duly recorded.Referring a patient to another hospital must be an exercise in the best interest of the patient and not to avoid liability.