Oh what a numbing loss

The patient was under antenatal care of a gynaecologist at the hospital. She reported some breathing complications in the fourth month of pregnancy. The patient also expressed desire for sterilization after the delivery.

The patient delivered a healthy baby girl at full term. However, she developed severe chest infection immediately after the delivery. Hence, the sterilization procedure was postponed.

It was eventually performed after two days. Unfortunately, the patient developed acute respiratory distress syndrome (ARDS) and suffered a fatal cardiac arrest.

Her husband sued the doctors and hospital, alleging that they ought to have not performed the procedure as the patient was suffering from bronchopneumonia. It was also alleged that pre-anaesthetic check-up was not performed, and they proceeded with laparoscopic sterilisation under general anaesthesia (GA) which was against the guidelines and protocol.

The doctors presented a strong defence. It was stated that the couple were asked to defer or delay their decision of sterilization due to patient’s chest infection, but were insistent. They denied that patient suffered from bronchopneumonia at the time of performing laparoscopic sterilization.

The Commission perused medical records and concurred with the doctors that there were no clinical symptoms of bronchopneumonia. Moreover, the patient had herself informed that the cough had subsided.

The Commission also perused an expert’s opinion and observed that unless it was an emergency, GA was contraindicated for five weeks if the patient had respiratory infection and breathing difficulty. GA in such patients usually precipitates bronchopneumonia.

Citing medical records, the Commission observed that there were lapses on part of the doctors, especially the anaesthetist, and stated the following:

“We are surprised that pre-anaesthetic check-up was performed by the anaesthetist in operation theatre on the day of operation just few hours before the operation. He was aware about patient’s respiratory infection and that she was on antibiotics and bronchodilators. Moreover, in the instant case laparoscopic sterilization was not an emergency surgery; it could have been postponed till the complete cure / control of respiratory infection”.

“It appears the doctors were shunting their duties between surgeon, junior doctor and anaesthetist. Therefore, in our considered view, the surgeon and anaesthetist involved in the laparoscopic sterilization surgery are responsible for the negligence. Post-operatively the patient developed respiratory distress and hypoxemia leading to pulmonary oedema, the possibility of aspiration pneumonia cannot be ruled out. We find the post-operative complications and resuscitation were managed with consultation of specialists. But, to save the life of patient, the doctors failed to refer her to a higher centre”.

The hospital, surgeon and anaesthetist were held negligent and ordered to pay a hefty compensation.