Here are some extracts of a judgment of the honourable
District Consumer forum, Aurangabad. The honourable consumer forum has
confirmed deficiency in service based on the facts, which are, in fact, acts of
serious medical negligence. The Doctors are absolved of medical negligence.
Extracts –
It is undisputed that the deceased was admitted in the
hospital i.e. respondent No.1 on 11.01.2009 for Coronery Artery Bypass Graft
(CABG). The CABG surgery was performed on 12.01.2009. Complainants allege that
the patient died because the surgeon i.e respondent No. 2 bungled the surgery.
Thus according to the complainants, the respondent No.2 has done something
wrong while doing the surgery and as a consequence the patient died. The
relevant documents which touches to this dispute are the operation note,
Perfusion Data sheet and various other papers.
Our observations in the matter are as
follows:
2. In reply to the complainants’ demand for
the CD recording of operation procedure, the respondent No.1 vide their letter
dated 17.1.2009 has replied that normally operation CD is not made and
hence that could not be given. This reply leaves scope to draw an inference
that in specific situation only the CD of actual operation is taken. Respondent
No.2 did not explain in detail as to why then the present case does not fit
into such situation or how it was a normal situation calling for not taking the
CD.
4. According to the operation note, the
operation team consists of respondent No.2 as surgeon and two anesthetists.
Perfusionist also form part of operation team. But his name is not seen on
operation note.
There is no mention of cardiologist or
assistant surgeon. CABG of 75 years old patient is a high risk and major
operation. Respondent though says that the cardiologist was present, the operation
note does not speak of cardiologist being present there from the beginning of
operation. We find substance in the allegations of complainants that the
cardiologist was called only when situation of emergency occurred during the operation.
However, a physician/cardiologist has no role to play once the heart of patient
is opened. Thereafter it is for the surgeon and anaesthetist to deal with the
patient.
5. The fees taken by the respondent No.1
hospital also includes the charges of assistant surgeon. But in the present
case, there is no presence of assistant surgeon as can be seen from the
contents of operation note.
An operation which is complicated and
requiring stay in OT for 8-9 hours done without presence of a qualified
assistant surgeon is a grave negligence on the part of respondent No.1 hospital
for not providing the assistant surgeon and respondent No.2 for performing such
a operation without assistant surgeon. It is noteworthy that the charges taken
from the complainants also include the fees of assistant surgeon. On this count
also, it is deficiency in service of respondent No.1 hospital in not providing
the assistant surgeon during the operation process and respondent No.2 for
doing the surgery without the assistance of Assistant Surgeon.
6. “Operation
Note” is a document which describes as to what happened during the surgery and
in the operation theatre. The ‘Findings’ part of the note read that the LAD was
intramyocardical and could not be found even after extensive dissection and
that all coronaries were intramyocardial badly diseased . An intramyocardial
course of the LAD artery is relatively common in patients undergoing CABG and
poses a challenge in bypass grafting. There are techniques to address this anatomical
variation when it is encountered at surgery. In fact, the patient under goes
CABG because of blockages in arteries. Therefore these findings are obvious in
patient going for CABG.
7. Arrhythmias are also common complication
after cardiac surgery. In the present case the heart of the patient had
arrhythmias and ventricular tachycardia. Heart arrhythmias, are commonly called
rhythm problem. It occurs when the electrical impulses that coordinates heartbeat,
do not work properly causing the heart to beat too fast or too slow or
irregularly. Sustained ventricular tachycardia prevents the ventricles from
filling adequately consequently the heart cannot pump the blood normally, resulting
in loss of BP, loss of consciousness and heart failure. There is no mention as
to at what time this happened during the surgery. How long the ventricular
tachycardia sustained is also not mentioned in the operation note. We correlate
this timing with the calling of the cardiologist at about 12.30 pm as noticed by
the complainants with some alleged hectic activities in OT. According to the
operation note, the problem was solved by giving a Direct Current shock and
operation was continued thereafter. The operation note further says that after
a short while the blood pressure of the patient was dropped with ECG changes. Timing
of this incident too was not noted. BP reading is also not mentioned. However,
the operation continued thereafter and the operation note ends with a mention
that “Patient shifted to ICU with poor Haemodynamics and high doses of
inotropes. Poor general condition informed to relatives.” There is no mention
of timing on the operation note as to when the patient was shifted to ICU. This
coupled with not mentioning the timing of Heart arrhythmias & ventricular
tachycardia is a lapse on the part of the respondents. It had deprived the
complainants from knowing as to when & what had happened to their patient.
It is true that the job of the surgeon is to carry out the surgery and not to spend
his time in preparing a record while doing surgery. . But when the “operation
note” is prepared afterwards, probable timings of vital happenings need to be
mentioned. The column of timing is left blank in “Transfer Note” of shifting
the patient from OT to ICU. “Transfer Note” is not prepared by surgeon but by
other staff. Thus at three vital incidents, there is no mention of timing. This
is a positive proof or irregularity and amounts to deficiency in service.
8. It
can be seen from the receipt of Blood Bank that the blood was taken from blood
bank at 3.15 pm. The blood bank is situated 4-5 kms away from the hospital
where the surgery was being performed on the patient.
Complainants
have alleged that it was the duty of the respondent hospital to keep the blood
ready before the start of surgery. Respondents says that requirement of blood
was not an emergency. When a surgery of heart is going on, whatever may require
in even remotest possibility should be considered an emergency. Because, here
the life of somebody is at stake. Therefore we do not accept the argument of
the respondents that the blood was not kept ready because it was not required
as an emergency. Respondent hospital is negligent in proceeding ahead with surgery
without ensuring that the blood is ready with them.
9. It
is also an important aspect to be noted that the blood was reached to the OT at
about 3.45 pm ( It was taken at 3.15 pm from a blood bank which is 4-5 kms
away). Respondent has taken a stand that the patient was shifted to ICU from OT
at 5.00 pm. If we take this time to be genuine time of shifting the patient
from OT to ICU, this means the CABG was over. at least one hour before say at
4.00pm. In such situation, the question remains unanswered as to what is done
with the blood which is received at 3.45 pm in OT in a major surgery completed
by 4.00 pm. This leaves scope to draw an inference that the respondents are
hiding something. The figure of blood loss as mentioned on Cardiac Anaesthesia
record and post-operative receiving chart indicate some tampering. However, in
the absence of any computerised record or concrete evidence, we are not inclined
to come to a direct conclusion that the respondent No.2 i.e. the surgeon was
deficient in performing actual operation.
