Nothing in all world is more dangerous than sincere ignorance and conscientious irrelevance (anonymous)
Very recently, Supreme Court has delivered a judgment in a case where in a nursing home in Bengal was implicated for performing Hysterectomy on a patient and not been able to provide in house ICU facilities when complications arose. The judgment had an implied connotation that Hospitals/Nursing Homes which do not have Intensive Care Unit (ICU) facility if performs surgeries which eventually requires intensive care in post operative period shall amount to medical negligence in reference to consumer courts and shall be liable for compensation.
This judgment has far reaching repercussions for the healthcare delivery system in the country. Since, the judgment corroborated the plea of the appellant that the operation should not have been performed at a nursing home which does not have the ICU when it could be reasonably foreseen that ICU may be required in the post operative period. The judgment has direct implication that the transfer to ICU after any surgery from non-ICU institution is negligence ab-initio. While the judgement was pertaining to the particular case in question, indeed it can be implied that many future cases are now going to grow against small hospitals and nursing homes, only because of fact that they do not have intensive care facility and shift patients for better care.
The fact remains that it is 10-15% patients shall require intensive monitoring and care even after a routine surgery. A normal delivery which can be conducted by a mid-wife at a maternity center without any risk can convert into a very high risk procedure because of a post partum hemorrhage and shall require shifting to an ICU. It does not mean that all deliveries should be conducted in a hospital with an ICU.
There is also this reality, that in our country, maximum accidents and trauma reach to the nearest small hospitals and requires immediate attention and reparative surgery. If after surgery these patients are shifted to ICU to another hospital for better care, this can be misinterpreted by the patients as medical negligence amounting to compensation.
It is a fact that in today’s environment patients is becoming more litigant and are looking for reasons to exploit the medical professional for money. Transfer to ICU has been initiated as another reason for asking compensation from medical profession.
It is also a fact medical profession is becoming more and more defensive. High risk patients which are likely to be benefitted the maximum by the intervention and minimally treated creating a high risk benefit treatment paradox which is only harmful for the high risk patients.
This judgment obviously has come in discussion of one case which maybe was poorly represented on the part of the hospital on this issue but has got a large repercussion for the whole healthcare delivery system in the country where the healthcare planners shall be forced to spend their precious resources to tertiary care developments (creation of ICU) at primary and secondary care centers.
An ICU is a specialized wing of healthcare which is not created by infrastructure and installation of equipment alone but it also needs trained manpower round the clock with 24 hrs laboratory back up. With the judgment pertaining to the case in question, the honorable court did not specify the minimum eligibility criteria for setting up an ICU.
Having the above connotation, the judgment has left a wide gray area since it was case specific and did not specify the definition of a high-risk patient or the definition of an ICU for the purpose of generalizations.
It is important that a clarification over the judgment is taken by the medical community from the Supreme Court at the earliest in order to ward off speculations and avoiding extreme reactions both from small healthcare organizations as well as the patient community.
The author, Dr Prem Aggarwal is the founder of Medical Dialogues