Special: Cost of medical slip-up

Kollam: Ever wondered whether your kith and kin are safe inside operation theatres of hospitals? How much are you aware about their condition during a surgical procedure?

The recent verdict convicting three doctors and three nurses of a private hospital in Kollam points to questionablr medical practices, bordering on gross neglect.

Kollam Additional Sessions Court on Wednesday convicted a group of medical practitioners in connection with the death of a woman during surgery citing dereliction of duty.

The convicted doctors are Dr. Balachandran (62),  Madappally, Changanassery, the anaesthetist; Dr. Laila Ashokan (58), Jayalakshmi Illam, Punalur, gynaecologist; and Dr. Vinu Balakrishnan (49), Kumarapuram, Thiruvananthapuram, surgeon. Anila Kumari (35),  Punnala; Syamala Devi (54) Vadakkodu; and Sujatha Kumari (39) Vilakkudi are the nurses convicted in the case.

Mini Philip (37) wife of Philip Thomas  died during a laparoscopic sterilisation surgery at Deen Hospital at Punalur in Kollam in September 2006.

Mini Philip had come from Dubai to undergo a sterilisation surgery at the Deen Hospital in Punalur on  September 25, 2006. The hospital authorities conducted the  surgery at 4.30pm without proper tests as a result of which  she lost consciousness and was shifted  to a nearby private hospital, and then to Ananthapuri Hospital in Thiruvananthapuram, where she died.

The Consumer Dispute Redressal Forum in 2008 had ordered a compensation of Rs 7lakh from the three accused doctors in connection with the incident. Philip Thomas, husband of the victim had appealed against the order.

The court on Wednesday Addl. District and Sessions Judge S. Santhosh Kumar passed the judgment under Sections 304 (A), culpable homicide – 1 year, and 201 & 34, fabrication of evidence – 3 months.

Public prosecutor Albert Netto

In his successful arguments exhibiting a list of medical documents and reports from experts, Public prosecutor Albert P. Netto countered the medical practitioners who had even manipulated the case sheet of the patient. Albert P. Netto told DC that there are many instances in which perpetrators are not convicted.

“In most cases, these sort of cases are settled outside the court under apparent money settlements, which is one of the major reasons such cases do not stand in court. It is a herculean task to identify and provide evidences against doctors. No one knows what happens inside an operation theatre or such surgical procedures.”

Medical negligence in case history

Supreme Court in a case Jacob Mathew vs State of Punjab and others in 2005 had put forward a set of guidelines for  medical practitioners and supporting staff to follow. The guidelines include proper documentations to pre-surgical examinations.

Criminal liability in medical procedure: Bolam’s principle

According to the guidelines, in a case of medical negligence, it is examined whether the doctor involved in the issue has exhibited a minimal level of expertise in attending the patient, mainly the description of drugs, their quantity etc. and other procedures during  surgery or other medical practices.
The level of expertise of a doctor is measured according to the gravity of each action taken during a medical procedure. A simple negligence may lead to civil liability and a gross negligence may lead to criminal liability in terms of law.
A textbook of Medical Jurisprudence and Toxicology says the team that is involved in such a surgical procedure is liable to answer  for any mishaps that may occur during the time.

The course of the case

In this case, it was examined that apart from the operation register that had mentioned general anaesthesia, a spinal puncture was found in the post-mortem examination of the body.  Norms for a Laparoscopic procedure were violated, according to expert panel reports.

The case sheet was also fabricated after the team came to know the things were complicated and without proper consent.

No pre-surgical procedures were observed during the surgery. The doctors including the anaesthetist, gynaecologist, and the surgeon did not examine the patient.

According to the birth control programme in 2006 by the WHO, a set of guidelines have been insisted to be followed by the doctors who do the procedure.

It also include the accreditation of the doctor by the WHO and the doctor should undergo a 12-day training by the organisation, which the doctors involved in the case failed to follow.

Reason of death as a possibility

According to the advocate, the cause of death in this case could be hypoxia caused by hypertension that may be caused by wrong administration of anaesthesia.

Victim’s relative

“Truth wins. Medical negligence was very difficult to prove and this success is a result of our combined effort. Spinal puncture has been identified in this case and such a procedure is not required  for laparoscopy. So, we along with our advocate, decided to follow up,” said Jiji Jacob, a close relative of the victim.

Philip Thomas, husband of the victim

“I am very happy and I am proud of the verdict. A minor operation took my wife’s life due to medical negligence. Nobody else should suffer like this. We faced great opposition from the accused, but we continued to struggle till the end. I took leave from my job to stay back here for three years to follow up the case. I had a 1-year-old baby at the time of her death and I suffered a lot,” said Philip Thomas, husband of the victim, who is presently  in South Africa.

Next: Verdict only helps cause fear among medical practitioners

Verdict only helps cause fear among medical practitioners

Dr A V Babu

This is an unfortunate verdict and it will only force doctors to avoid risky cases.

Medical negligence is not something which is done deliberately. But if doctors are treated as criminals in the name of medical negligence, many medical practitioners might stop taking risks while treating patients.

In other words, they will prefer 'defensive practice'. Even patients with minor problems will be referred to major hospitals and corporate hospitals too, forcing people to pay more.

There is always risk involved in any type of surgery, and if all issues are branded as 'medical negligence', hospitals, especially the small ones, will shy away from entertaining even normal patients.

There could be a small percentage of doctors who are careless. But medical negligence is not intentional. When a patient comes to a doctor he never tries to delay or deny treatment irrespective of the facilities available at the hospital.

Complications can happen even after a normal delivery. Our ethics committee receives 20 to 30 cases at each sitting, held once in three months.

We verify the complaints and even initiate action, including recommendation for cancellation of registration.

We have 26,396 registered members in the state. Our emphasis has always been on proper documentation of patient details, investigation facilities, communication skills of doctors and good relations with the patients and their attendants.

IMA is not going to protest against the verdict. Our aim is to create awareness among doctors and patients.

(The author is the state president of the Indian Medical Association.)