Apex medical regulator reiterates that Only Specialists Should Perform Elective Procedures

New Delhi: Elective Surgeries such as Lower Segment Cesarian Section (LSCS) operations should be performed only by a specialist doctor qualified in that speciality, reiterated the National Medical Commission (NMC) recently.

The Commission made this observation in the recently released E-Book "Professional Conduct Review- Lessons from Case Archives" while discussing a previous case concerning the death of a patient, who expired after undergoing LSCS surgery.

Apart from clarifying that all elective procedures should be performed by a specialist doctor, the Commission also emphasized on the need for valid consent in all cases. NMC clarified that the patients must sign the consent in all elective cases unless the patient is minor, unconscious, or incompetent.

The Ethics and Medical Registration Board (EMRB) of NMC released its E-Book titled "Professional Conduct Review-Lessons from Case Archives" on October 05, 2023.

Medical Dialogues had earlier reported that altogether nine (9) case archives were discussed in Volume I of the book. In respect of each and every case, NMC discussed different topics including Communication Between Doctor and Patient's Relatives, Allegations of Wrong Diagnosis Leading to Delay in Treatment, Specialty Practice-Without Adequate Qualification/Training etc.

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For each of the cases, the book elaborates on different aspects such as the keywords, context/category, abstract, summary of the case, discussion, decision of State Medical Councils or NMC Ethics Board, lessons learned from the case, take-home message, etc.

One of the cases relates to Ms.Y, who was receiving antenatal care from a gynaecologist Dr. A at a private hospital. The couple requested an elective LSCS on a date of their choice.

However, due to the unavailability of Dr. A on the scheduled date, the concerned doctor informed the couple that Dr. B and Dr. C would provide care in her absence.

Following this, the patient was admitted to the hospital and after obtaining written consent from the husband of the patient, the general surgeon Dr. B assisted by Dr. C (MBBS) performed the LSCS operation.

After the surgery, the patient developed bleeding complications from the operation site and for this, the same medical team performed another surgical procedure. However, the condition of the patient did not improve and became critical due to further bleeding. Thereafter, the patient was shifted to another hospital for further care where she died. In the post-mortem report, the cause of death was mentioned "DIC consequent upon LSCS."

Following this, the husband of the patient filed a complaint before the State Medical Council (SMC). Mainly, the patient's husband alleged that the medical negligence led to the death of his wife.

On the other hand, the doctors defended the case by saying that it was an emergency LSCS and the gynecologist was unavailable at the time. However, after reviewing the case records, the SMC did not find any indication of emergency LSCS. Moreover, the written informed consent indicated that the consent was for elective LSCS to be performed on the pre-decided date.

The State Council observed that the likely cause of the patient's deterioration was post-operative blood loss which went undetected because of improper monitoring. Therefore, the SMC held those two treating doctors responsible for venturing into the field beyond their qualifications and competence and removed their names from the State Medical Register for 30 days as a penalty.

NMC Observations: 

However, the order of the SMC was challenged by those two doctors before the Ethics and Medical Registration Board (EMRB) of NMC and after hearing the case, the NMC Ethics Board upheld the decision of SMC.

While discussing this case, NMC in the E-Book referred to the Supreme Court's landmark judgment in the case of Samira Kohli vs Dr. Prabha Manchanda and the Commission urged the readers to read this judgment to understand the importance and implications of obtaining real and valid consent.

In the concerned judgment, the Supreme Court had clarified, "The correctness or appropriateness of the treatment procedure, does not make the treatment legal, in the absence of consent for the treatment."

Referring to this order, the National Medical Commission (NMC) emphasized the necessity of valid informed consent and observed in the E-Book, "Valid real informed consent is to be taken in all cases. The patients must sign the consent in all elective cases unless the patient is minor, unconscious, or incompetent. In this case, the consent form did not have a signature or thumb impression of the patient despite her being fit to give the consent. Instead, the consent was signed by the husband only."

Apart from this, the Commission also clarified that only specialist doctors should perform elective procedures and noted, "All elective procedures should be performed by a doctor qualified in that particular specialty."

The Commission referred to the case at hand and further observed, "In this case, elective LSCS was performed by a General surgeon who was not qualified to undertake such a procedure. No efforts were made to refer to another gynaecologist for the planned LSCS. Even if the consent is taken for the procedure to be performed by an unqualified Medical Practitioner, such consent would be invalid."

To view the Supreme Court order, click on the link below:

https://medicaldialogues.in/pdf_upload/supreme-court-consent-223147.pdf

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