Better to consult a serious patient in person than over the telephone

  • Posted on: December 07, 2018

Gynaecologists and Obstetricians need to exercise extra caution when consulting patients with history of obstetric complications. And it is advisable to treat such patients in person rather than giving telephonic advice.

Anupama, a forty two year old lady, was diagnosed with pregnancy by Dr. Sumita, and was advised to visit for a follow up in a week. During follow up, the doctor diagnosed that the foetus was not viable and performed Medical Termination of Pregnancy (MTP).

The patient was keen on bearing a child and hence approached the doctor again after about a couple of months, and an In Vitro Fertilization & Embryo Transfer (IVF-ET) was performed. Much to Anupama’s disappointment, IVF-ET was not successful and she had to undergo another MTP.

Not the one willing to give up, the patient opted for yet another IVF-ET, which again unfortunately failed. While she was being taken home by her husband, the patient suffered bouts of vomiting and abdominal pain. She was taken to Combined Medical Institute where stones in gall bladder were detected. Dr. Sumita prescribed medicines, but to no avail. The patient was consulted by a surgeon and Dr. Pandey, and as her condition didn’t improve, she was referred to a higher centre in Dehradun where she eventually died due to acute pancreatitis with shock to LVF.

The patient’s husband angrily approached State Consumer Disputes Redressal Commission, Dehradun and blamed Dr. Sumita, Dr. Pandey, Dr. Chauhan of Combined Medical Institute and the ambulance service provider for his wife’s untimely death!

It was alleged that Dr. Sumita performed IVF-ET without performing any investigations or tests. It was further alleged that Dr. Sumita and Dr. Chauhan forged medicine bills whereas those medicines were not even administered! Even the ambulance was not equipped with appropriate facilities that is needed for a serious patient, claimed the bereaving husband.

He also presented medical literature on the nexus between acute pancreatitis and pregnancy, and stated that the doctors should’ve known this fact before treating the patient.

The doctors too were in a state of shock, perhaps partly due to the patient’s sudden death and certainly due to the type of allegations levelled against them.

Dr. Sumita stated that the patient had herself informed about the tendency of increased blood pressure during pregnancies. Moreover, when she complained of vomiting, the patient was advised over the telephone to take Pantop-D.

Dr. Chauhan of Combined Medical Institute stated that patient suffered abdominal pain due to presence of stones in the gall bladder. A senior surgeon also concurred that the patient has to be shifted to a higher centre, and she gave consent for same, further stated the doctor.

The ambulance service provider presented documents to prove that the ambulance was indeed fitted with appropriate equipment and stated that a doctor from Combined Medical Institute had also accompanied the patient to the higher centre.

The Commission had a complicated case at hand, but it also had ample of evidence and the report of Ethics Committee as assistance to deliver the ruling.

Citing the Ethics Committee report, the Commission observed that the patient had a bad obstetric history with multiple IUDs and high blood pressure. She also had undergone several abortions due to same reasons. The Commission further observed that the patient was investigated and found fit for IVF-ET and had given consent for same.

While the Ethics Committee report had stated that usually medicines are prescribed on telephone by medical practitioners without proper check-up which should not be done, the Commission observed that the Dr. Sumita knew about patient’s complicated obstetric history and prescribed Pantop-D over the telephone keeping in mind patient’s welfare.

The Commission ruled that the patient died due to acute pancreatitis and stone in gallbladder, which has no relation with IVF–ET.

All doctors and ambulance service provider were held not guilty.

Source: Order pronounced by State Consumer Disputes Redressal Commission, Dehradun on 30th October, 2018.