#LegallySpeaking: Medico-Legal Tip
1) Telephonic consultation by doctors should be avoided
2) In case of pre planned holidays or leaves, the patient should not be admitted and should be referred to another specialist.
3) Prescription without diagnosis and hence resulting into death of the patient amounts to criminal negligence on the part of the doctors
The patient rushed to the hospital when she had started having labour pains. The doctors were present. She was admitted in the hospital. Initially, the family members were informed that she would have normal delivery. On 6/2/2018 she was advised to undergo sonography. Upon seeing the sonography report, the doctors were of the opinion that she should undergo cesarean operation. On 6/2/2018 she had undergone cesarean operation. The female had given birth to a female child. On 6/2/2018 patient appeared to be normal.
On 9/2/2018 at 5 p.m. patient was discharged from the hospital. At the time of discharge, doctors were not available. The staff had also not informed the family members or the patient about the postoperative care. On 10/2/2018 patient was vomiting throughout the day. Her relatives had called upon doctor. She had asked them to call her from medical shop. The doctor had given instructions to the medical shop owner and accordingly, he had given them tablets which
she had taken. On the same day, in the patient had fever and she continued vomiting and therefore, she was taken to the same hospital at 8.30 p.m. In their presence, the staff nurse had called upon doctor. She was advised to admit the patient. The staff had informed that the doctors are not available in the hospital and were attending conference. The first informant had asked as to whether she should be taken to another hospital. However, he was informed that it was not necessary and that the patient would be admitted for one day and on the next day, she would be discharged.
Patient was being treated by two nurses, who were administering medicines on the telephonic instructions of doctor. The condition of the patient was deteriorating and the relatives, out of anxiety were accordingly informing the staff nurse. The relatives were insisting upon shifting the patient to another hospital. However, the staff nurse had informed the relatives that they need not panic and that they are in touch with doctor and she has guided them telephonically
Later, the tip of nose and lips of the patient had turned black. The relatives took the patient to another hospital where she was admitted in ICU. She was kept on ventilator and later she died.
The dead body of patient was sent for autopsy. The post mortem notes indicated that the cause of death was due to pulmonary embolism. Thereafter, it was sent for histopathological test. The findings recorded in the histopathological test are as follows :
Heart :No specific lesion
Lungs : Pulmonary thromboembolism and bone marrow embolism in medium sized blood vessels, Intraalveolar Hemorrhages and focal pulmonary edema.
Liver : Focal fatty change, portal triaditis.
Spleen, Kidney : Congestion
Uterus with bilateral adnexae : Postpartum changes.
LSCS suture site :Acute nonspecific inflammation.
Findings of the court:
1)The patient was admitted on the telephonic instructions of doctor
2)The doctor should have referred the patient to a specialist immediately. Her negligence is apparent on the face of the record.
3) The health condition was not monitored properly from 10/2/2018 8.30 p.m. to 11/2/2018 5.40 a.m. and therefore, negligence is apparent.
4) The absence of the doctor was pre-planned and therefore, the patient ought not to have been admitted in her absence. Except checking pulse and blood pressure, no other tests were performed on the patient.
5) The complications were not noticed immediately by proper medical officer.
6) There is no record to show that there was any effort to refer the re-admitted patient to another doctor in the absence of treating doctor and she continued to prescribe medicine telephonically.
7) The medicines were administered on telephonic instructions without even enquiring about the symptoms or nature of the pain suffered by the patient
The learned Senior Counsel vehemently submits that this would be a case of 304(A) of the Indian Penal Code. Section 304A. “Causing death by negligence-Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.”
Source: Bombay High Court Order. To read the order, click on the file attached below
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.