#LegallySpeaking: Medico-Legal Tip
Precaution while taking Consent: In case there is doubt regarding the patient’s capacity, it is advisable to take the signature of a near relative.
The patient (a known case of Ankylosing Spondylitis) had undergone left and right hip replacement in 1992-1996 at PGI, Chandigarh. After a period of 10 years', the patient started getting pain in his right hip joint. It was diagnosed on 26-08-2002 at PGI that the cup of prosthesis has loosened and the doctor advised revision surgery for replacement of cup.
Due to heavy rush of patients at PGI, the patient approached another hospital where the doctor who claimed to be an expert in joint replacement or revisions surgery advised for replacement of acetabular cup. On 04-01-2003, the revision surgery was planned. Due to difficulty in giving Spinal anaesthesia, it was given through tracheostomy. The old cup, old cement was removed carefully. The doctor looking into the condition of the hip took a decision for an alternate procedure on girdle stone arthroplasty. The patient recovered well, with a pain-free hip.
The patient alleged that the hospital did not have the required special equipment for cement removal and complete inventory of implant. Therefore, in the absence of proper instruments, the doctor tried to remove a well set femoral component and damaged the bones into pieces leading to severe infection.
The doctor argued that due to the deformity and stiffness of the patient, consent was taken from the patient himself and his brother for the surgery; the operation was conducted with all care.
Views of the Court:
- "...we are of the considered view that the complainant was suffering from AS which is not completely curable and only corrective surgeries are helpful for mobility of the patient. Therefore, the alternative mode of surgery adopted by OP3 was not a negligence, whereas, it is only a recognised alternative mode of surgery, when THR is not possible...."
- A key statement was given by the court - "...Negligence cannot be attributed to a doctor, so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable, if the course of action chosen by him was acceptable to the medical profession..."
- "...It is known that no doctor will assure full recovery or give guarantee that result of surgery would be 100% cure. Therefore, on the basis of the foregoing discussion, keeping reliance upon medical texts and several judgments of Hon'ble Supreme Court, we agree with the well reasoned order of State Commission, and dismiss the first appeal..."
A reason for the case going in favor of the doctor is that he had taken consent from the patient and even his brother keeping in mind the deformity and stiffness of the patient.
Note: The objective of the #LegallySpeaking initiative is to spread awareness about the medicolegal implications of commonly encountered scenarios in a clinician's daily practice.