Managing blood / expected complications should be done at the earliest. This fact is even more important when the patient has a rare blood type / past medical history.
Irrefutable Facts
The patient, with a rare blood group (A Rh-negative), was consulting the obstetrician during her second pregnancy at the hospital. On the due date, she was brought in labour to the hospital at 6:30 AM. The obstetrician examined her at 6:45 AM and advised LSCS for which consent was taken from the husband. The anaesthetist arrived at 8 AM and the patient was wheeled into the OT. The baby was successfully delivered at 9:30 AM.
The patient started bleeding profusely post-delivery and despite all conservative measures it could not be controlled. A decision was taken at about 2:30 PM to transfer her to another hospital
The patient started from the hospital at 3 PM and reached the other hospital at 4:30 PM where she was declared brought dead. Post-mortem reported the cause of death as haemorrhagic shock following surgery.
Patient’s husband sued the hospital and obstetrician. It was alleged that though it was known that patient’s blood group was rare, its arrangement was not made by the hospital, and the attendants had to rush to procure it.
It was further alleged that the sample of blood given for grouping and cross matching was contaminated and hence a fresh sample had to be taken again.
It was pointed out that the obstetrician of second hospital, who had performed first LSCS, advised the obstetrician to shift the patient immediately, but it was ignored. Only upon realizing that patient’s complications were not manageable, the obstetrician followed the advice, but by then it was too late.
Doctor’s Plea
It was stated that due to history of first LSCS and rare blood group, the patient was advised to be admitted at some other hospital where a blood bank facility was available, but due to inconvenience, the attendants insisted to continue consultation till delivery at the first hospital.
It was further stated that the attendants assured to arrange the blood if required but failed and therefore the hospital had to arrange it from the blood bank.
Conclusively, it was pointed out that the patient was shifted to second hospital in an ambulance accompanied by the obstetrician and anaesthetist, but unfortunately, she died on reaching the second hospital.
Court’s Observations
The court observed that the “patient was ‘A’ Rh-Negative which was known from the first LSCS delivery and there were chances of unexpected uncontrolled haemorrhage” during the second delivery for which the blood should have been kept ready or live donors should have been on standby.
The court, after perusal of medical records, rejected the defence that hospital had taken sufficient steps to keep ‘A’ Rh-Negative blood ready as medical records indicated otherwise.
The court further commented that the obstetrician lost a crucial period of 5 to 5 ½ hours before transferring the patient to second hospital. The court held that this delay in transferring the patient proved fatal.
The obstetrician and hospital were held negligent.
Prevention Is Better Than Cure
- It is hospital’s responsibility to arrange blood for a hospitalized patient. Any assurance from the patient / attendants to arrange blood or their failure to do so after assuring will in no way mitigate the hospital’s responsibility. Keeping blood ready / standby in anticipation is rather mandatory.
- Contemplate about the facilities / consultants available in the hospital before admitting any patient. In case of any insufficiency, direct the patient to another facility rather than admitting. If the patient / relatives insist, and if there are justifiable reason/s for admission, take the request in writing and preserve it with the patient’s medical records. Inform them of the deficiency and take their acknowledgement.
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Source : Tate Hospital & Anr. v/s Sushrut Brahmabhatt & Ors.