Anaesthesiologist, are like aeroplane pilots, are essentially 99% of the time in a “watchful waiting mode”. It is when an untoward event occurs that they are called into action, their level of alertness, skill and response is critical. It is not the drug Propofol itself that is the culprit for it is an effective and fast acting anesthetic agent. It is the monitoring of the patient and the ability of an attentive physician to promptly act with the necessary staff and equipment that can make the difference between life and death.
These were the obervations made by the National Commission, while dealing with a case of medical negligence. The commission also observed, Michael Jackson and Joan Rivers both lost their lives secondary to the anesthetic agent, Propofol…!!
The National commission was dealing with the case of D. UMA DEVI V/s. Yashoda Hospital., A.P.
Facts in nutshell :
1. This started in 2008. The patient, was suffering from Jaundice, and after he was admitted in the Hospital, he was advised ERCP (Endoscopic Retrograde Cholangio- Pancreatogrpahy) with CBD endoscopy. But during ERCP, after the administration of anesthesia, there were complications causing the patient to go in a coma and the patient became brain dead.
2. Thereafter, it was also alleged that the Hospital refused to treat the patient and hence the wife of the patient, the complainant, approached National Human Rights commission (NHRC) which directed the Hospital to continue with the treatment along with case to be filed in Consumer court. Ultimately, after a long struggle of 2.5 yrs, the patient succumbed to death in the year 2010, at the age of 42 years. The State commission granted Rs.10 laks of Compensation. But both the parties feeling aggrieved, approached National Commission.
3. The Doctors denied all the charges. They attributed the initial complications to sudden cardiac arrest during ERCP.
The National Commission laid down the crux of the case as the following question:
“whether doctors at OP hospital followed the standard guidelines during ERCP procedure and whether the dose of anesthesia administered was correct?”
It narrated the State commission observations, which were as follows:
1. The principle of Res Ipsa Loquitor (the act speaks for itself) aptly applies in this case for the reason that; firstly it seems the doctors who have attended on the patient did not conduct necessary exercise before administering “Propofol”. Secondly, the patient was not admitted with complications.Mishandling or negligence for a spur of moment would adversely affect the life of a patient.
2. The court took into view an expert opinion of a cardiologist which stated that the doctor could have waited for some more time before conducting the ERCP procedures as the risk was high. He gave the opinion on the basis of medical documents; he noticed the documents are devoid of vital monitor recordings of the patient at the time of procedure. Also, the sequence of events leading to cardiac arrest was not there. He also submitted that the evidence from the case sheet shows that young healthy patient under anesthesia sustained cardio-respiratory arrest and brain damage that indicates that the anesthesia was excessive and timely intubation was not done for the patient, there are no reading between 3.30 p.m. to 3.50 p.m. i.e. for 20 minutes on 14.05.2008. The patient was hale and healthy, not suffering from liver and renal problems.
3. The cardiac arrest was not managed properly, therefore patient suffered coma. Thus, it is the case of medical negligence.If the hospital is having super specialty facilities, higher level of treatment facilities and cost of treatment; there will be higher expectations of treatment and care.
4. The court also reiterated the guidelines laid down by leading organisations including Royal College of Anaesthetists (UK), British Society of Gastroenterology as well as American Society of Anesthesiologists, on safe use of propofol in the context of sedation. As per the recommendation propofol sedation is ideally administered by dedicated and appropriately trained anaesthesia personnel. The hospital procedure required the monitoring and recording of a patient’s vital signs before and during the procedure. Some vital signs such as blood pressure, oxygen saturation, and pulse rate could be monitored by a protocol machine. Other vital signs were required to be noted and handwritten on the patient’s chart. In the instant case, there were no records of patient’s vital signs during the ERCP procedure. Therefore, the absence of any such record leads to the adverse-inference.
5. The National Commission took into account, the dependant person of the family of the deceased and hence enhanced the compensation to Rs.47 lacks plus 9% p.a. interest.
An important judgement for doctors to know what follies to avoid
Thanks and Regards
Adv. Rohit Erande
You can read the full guidelines by clicking on the following link