Medical science is an evolving subject. Doctors are supposed to keep themselves updated about new procedures, techniques, treatment methods, etc. in order to provide expected standard of care.
Attending medical conference to gain knowledge, therefore, is an important aspect of medical practice. But what should doctors do when they have patient/s who are critical or / and need immediate care during such times?
This case answers the question…
Irrefutable Facts
The patient with pain and discomfort while walking was advised a colour doppler which revealed an “Abd Aortic Aneurysm” just above the bifurcation with an irregular thrombus within. The patient was referred to the vascular surgeon, who immediately admitted him to the hospital.
An emergency Digital Sub-Traction Angiography (DSA) and Computerized Axial Tomography (CAT) scan were performed. Furthermore, the vascular surgeon based on physical examination noticed ‘ischaemic changes both lower limbs with impending gangrene’. Subsequently surgery and grafting were performed.
Post-surgery, patient was shifted to the recovery room on a ventilator with stable vital signs. Thereafter, it was noticed that his lower limbs were cold. This was brought vascular surgeon’s notice. A repeat DSA was advices which was delayed by three hours due to a non-functional DSA machine and hence, alternatively an angiography was performed.
Based on the report. vascular surgeon decided to perform re-exploration. All the OTs were preoccupied with ongoing surgery of other patients at that point in time hence, there was a delay of twelve hours in performing the surgery.
The patient was put on a ventilator post-surgery. There no movement in either of his lower limbs.
MRI revealed sensations reduced till the upper one-third of the thigh probably due to myonecrosis as opined by a neurologist. The patient was put on dialysis and remained under treatment by a panel of doctors at the hospital.
A month later it was observed that the patient had wet gangrene below the knee. Below knee amputation was performed, the patient developed septicaemia and died of septic shock two weeks later.
His family sued the doctors and hospital. There were many allegations levelled, one of the main among them was that the vascular surgeon left the patient under the care of inexperienced doctors for more than thirty days, while he was enjoying a vacation.
Doctor’s Plea
The hospital and vascular surgeon refuted the allegation, stating that the patient was under continuous observation of experienced resident doctors and senior specialists.
It was pointed out that vascular surgeon was abroad for a month to attend an important medical conference which was scheduled well in advance.
Court’s Observations
The court commented that a doctor is expected to provide reasonable care and “it is too much to expect from him / her to remain on patient’s bedside throughout the stay in hospital, which was expected by the patient’s family”.
The court accepted vascular surgeon’s defence that he was on a foreign visit for a medical conference in order to upgrade himself with the latest development in his field which cannot be termed as medical negligence; especially when the patient was admitted to the hospital that had specialists in multi-faculties and was left under the care of experienced post-graduates and specialist doctors.
The case against hospital and doctors was dismissed.
Prevention Is Better Than Cure
Medicine is a dynamic field with newer technologies, guidelines and protocols. There is a need to hear from peers about their experiences in managing patients / conditions. Doctors, therefore, have to attend conferences / seminars to update themselves on the emerging trends.
Doctors are often in dilemma when attending such conferences resulting in their absence when a hospitalized patient is critical. The Supreme Court in this case has cleared the legal position in such situations by holding that there is nothing wrong with attending conferences. But two precautions need to be taken in such cases.
First, the patient / attendants should be informed about doctor’s planned absence in advance. Second, an appropriately qualified and experienced locum, substitute or junior should be appointed to manage the hospitalized patient.
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Source : Bombay Hospital & Medical Research Centre v/s Asha Jaiswal & Ors.