Choosing “lesser evil”, a necessity in some cases

  • Posted on: January 24, 2021

Is using life-saving drugs, in spite of known complications, negligence? No, says the Consumer Commission.

The patient underwent exploratory laparotomy. Code Blue was announced a day later as the nursing staff could not detect pulse. She was rushed to the ICU. Dopamine was administered intravenously on her right forearm. She recovered, but other complications set in.

Gangrene developed on patient’s hand and she underwent fasciotomy twice, but without any favourable result. The doctors advised to amputate her hand, which was rejected by her attendants.

She was taken to another hospital. The doctors at this hospital also advised to amputate her hand. The reluctant family eventually agreed.

They had also made up their mind to sue the doctor and first hospital. And they were well prepared too! Citing medical literature, it was alleged that extravasations due to dopamine caused significant tissue damage. Moreover, dopamine was administered as a bolus of whole ampoule instead of administering as continuous drip.

The doctor presented medical records and stated in defence – “We had to choose a lesser evil and it was chosen, by giving preference to patient's life over the side effect of lifesaving drug”.

The Commission accepted this defence and cited medical literature while stating the following:

“It is crystal clear that dopamine drugs have some serious side effects of gangrene which patient has faced after treatment. But as per hospital’s indoor case papers her condition was very critical and hence Code Blue team – experts in medical emergency – decided to administer dopamine. They decided the quantity and procedure after considering patient’s critical condition to save her life. Therefore, in the considered opinion of this Commission there is no medical negligence”.

Source: Order pronounced by Gujarat State Consumer Disputes Redressal Commission on 26th March, 2021.