When doctor is not
ready
By
Pushpa Girimaji
A RECENT order of the National
Commission holding two doctors guilty of negligence for
operating on a patient without adequate preparedness for
emergencies should make all hospitals and nursing homes
in the country sit up and pay more attention to this
aspect of medical care.
In this case Mrs Pilankar
was operated upon at Sukhanda Maternity and Nursing home,
following a complaint of excess discharge during
menstruation. The surgery took seven hours and at the end
of it, Mrs Pilankar died on the operating table.
The Mumbai Grahak
Panchayat (MGP), which filed a complaint before the
consumer court on behalf of her husband, blamed the death
of Mrs Pilankar on the negligence of the doctors and
sought a compensation of over Rs 9 lakh. The patient had
died because of extensive blood loss and the inability of
the doctors to foresee this and keep units of blood ready
in the operation theatre for timely transfusion, the
complaint said. The consumer group also pointed to
several inadequacies in the nursing home which led to Mrs
Pilankars death. The doctor, on the other hand,
argued that the patient was fully investigated before
surgery and monitored throughout the operation. Immediate
post-operative cardiac arrest could occur as an accident.
The Commission, after
hearing both the parties, concluded that the doctors had
not anticipated likely complications that might arise in
a major surgery on an obese patient weighing 124 kg and
with a rare blood group. The commission said: "Not
withstanding the inconclusive position on the cause of
death, there are obvious deficiencies in the service of
the appellants which have contributed to the death of the
patient on the operation table. The appellants failed to
take even the minimum care by not keeping the blood in
adequate quantity before they started the operation,
knowing that the patient was having a rare blood group.
They failed to take normal care and diligence by not
providing for a mechanically operated artificial
respirator and an adequately long needle for an
intra-cardiac injection as the patient was obese. While
these are essential steps which should be taken in any
major surgery, these should have been particularly
essential in the instance case of a patient of potential
risk. That the appellants (doctors) totally failed in
these respects finally resulting in the death of the
patient on the operating table establishes their
negligence and deficiency of their service."
The commission referred to
the contention of the doctors that "morbid
obesity" itself posed a set of problems and pointed
out that despite being aware of the inherent risks, the
doctors did not make the requisite essential arrangements
in the operation theatre. "Although the appellants
had got done pre-operative tests on the patient, the
material on record points to conspicuous absence of
pre-planning for the operation per se having regard to
the specific physical and pathological condition of the
patient", the Commission said.
The National Commission
pointed to the doctors statement that their last
attempt to save the patient through intra-cardiac
adrenaline injection was unsuccessful because the needle
failed to penetrate the heart due to extreme obesity.
This, the commission said, also exposed the state of
unpreparedness as a longer needle was not kept in
readiness. On the absence of a machine-operated
artificial respirator at the nursing home, the commission
said it found force in the argument of the complainant
that with an obese patient with thick chest walls, a
manually operated respirator as used by the appellants
might not guarantee adequate ventilation.
The National Commission,
in its order dated September 4, 1998, thus upheld this
order of the Maharashtra State Commission, holding the
doctors guilty of negligent service. The state commission
had directed the doctors to pay jointly Rs 2,55,355 as
compensation to Mr Pilankar.
This case is important
from another point of view too. In an appeal filed by the
Grahak Panchayat against the order of the state
commission (First Appeal No 468 of 1993) earlier, the
National Commission had clarified that privity of
contract was not needed for a claim to be made under the
Consumer Protection Act so long as there was hiring or
availing of services for a consideration. The consumer
group had appealed against the order of the state
commission holding that the anaesthetist was not liable
under the Consumer Protection Act as there was no privity
of contract between the patient and the anaesthetist.
The National Commission
had held such a view to be erroneous. Besides, under the
Consumer Protection Act, even a beneficiary of a service
was a consumer and in this case, as the beneficiary of
the medical service rendered by the anaesthetist, the
patient was a consumer, the Commission had said.
However, it agreed with
the finding of the State Commission that there was no
evidence of deficiency in the service rendered by the
anaesthetist.
|