#LegallySpeaking: Medicolegal Tip
'Eggshell skull doctrine' applicable in India - Doctors will be liable even if the patient suffers unusually due to a pre-existing medical condition
Facts of the case
The patient, aged 69 years, was suffering from UTI and therefore consulted the doctor. After performing necessary investigations, the doctor prescribed injection Amikacin for 21 days. The patient's condition deteriorated. She was admitted to PGI Chandigarh for 10 days, where she underwent dialysis. The patient became absolutely deaf and one of her kidneys was also affected.
Patient's allegation/s of medical negligence
- It was alleged that the patient lost her hearing power, her kidney got severally affected, and she had to be admitted to PGI Chandigarh for dialysis due to overdose of Amikacin prescribed by the doctor
- It was alleged that after 2-3 days of taking Amikacin, the patient noticed that she was losing hearing power and she informed the doctor about the same but the doctor told the patient to continue the injection for another 14 days
- It was pointed that the patient had consulted two other doctors, an ENT surgeon and a nephrologist, who opined that due to overdose of Amikacin, she had become absolutely deaf and her kidney was also severely affected
Findings of the court
- The court applied the principle of "Eggshell Skull Doctrine" wherein a person is liable for all consequences resulting from his/her activities, even if the victim suffers harm due to a pre-existing vulnerability or medical condition.
- The court held that the doctor was liable as his prescription of overdose of Amikacin had aggravated the renal damage and ototoxicity, even though the harm caused to the patient was greater due to her previous illness and diabetic status.
- The court also found that the medical texts stated that:
The recommended duration of therapy of Amikacin is 14 days, i.e. 28 doses of 500 mg/dose.
- Amikacin is one of the aminoglycosides and should be carefully used to prevent nephrotoxicity, especially in high-risk patients.
- Amikacin's nephrotoxicity is directly dependent on the dose and duration of therapy, and therefore, nephrotoxicity is more likely to occur if large doses are given over prolonged periods, or usual doses are given to patients with underlying renal disease. Hence, the lowest dose and shortest possible course of therapy are advisable.
- Serial monitoring of renal function (serum creatinine every other day) should be carried out for early detection of nephrotoxicity and the patient should be under close clinical observation.
- The court observed that the doctor should have been more careful while advising such high doses of Amikacin for longer duration to an elderly patient having different co-morbidities. - The court further observed that in spite of knowing that the patient was above 60 years of age, with severe UTI, severe diabetic status, and altered Renal Function Tests (RFT), the doctor prescribed injection Amikacin in the dose of 500 mg BD for 21 days, which was certainly an overdose. Hence, the court held the doctor negligent.
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.