Doctors are human beings and are not expected to be present around the patient round the clock. However, examining the patient upon admission, advising / performing diagnostic tests and starting the treatment must be done at the earliest – depending on patient’s medical case.
In any eventuality that the principal doctor is not available, another competent doctor / team of doctors / qualified medical staff must be employed to deliver patient care. Not doing so could be construed as medical negligence.
Irrefutable Facts
Due to deliver, the patient was admitted late at night to the hospital under the care of obstetrician. However, he was not present at the time and hence, the patient was examined by a nurse and treatment was started as per telephonic instructions given by the doctor.
The patient delivered a male child next morning. There were some complications, the newborn was shifted to NICU. The patient’s condition worsened suddenly. She was shifted to another hospital for better management, but succumbed to complications within a few hours.
The patient’s family sued the obstetrician. It was alleged that the doctor was not present to look after the patient. Her condition worsened after the nurse administered an injection, upon telephonic instructions given by the doctor.
It was pointed out that the doctor could not explain what happened inside the labour room; what led to complications and patient’s death. It was also alleged that patient developed cyanosis as there was lack of oxygen, which eventually resulted in her death.
Doctors’ Plea
The obstetrician stated that he was present at the time of patient’s admission, and added that she died due to ‘premature rupture of membrane’ (PROM) and not due to lack of oxygen. The doctor also stated that patient was checked by a team of doctors from time to time.
Court’s Observations
The State Consumer Commission refused to believe that obstetrician was present at the time of patient’s admission, or that she was checked from time to time as he could not provide proof of the same. The Commission also refused doctor’s defence that the patient died due to PROM as it was observed from second hospital’s medical records that she suffered from cyanosis and had to be immediately put on oxygen.
The obstetrician was held negligent for these lapses and ordered to pay compensation to patient’s family.
Prevention Is Better Than Cure
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It is always advisable to physically examine the patient on admission or at least before the treatment is started. On the other hand, it may not be practically possible for any doctor to be physically present round the clock hence, there should be other qualified persons who can examine, inform and take instructions, and start treatment on behalf of the primary consultant. In all such cases, the primary consultant should physically examine the patient and endorse the treatment rendered at the earliest. Even the Telemedicine Practice Guidelines 2020 limits teleconsultation in emergencies to first-aid only.
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When a patient is hospitalized, his / her examination, findings of the examination and regular monitoring should be recorded religiously. The only exception is emergencies where saving patient’s life takes precedence over paperwork.
Source : 15MLCD (j85) Minor Nijal Kiritbhai Tailor & Ors. v/s Dr. Mukund R. Patel & Anr.
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