New Delhi: The National Consumer Disputes Redressal Commission recently held Kerala based Hospital and a Facio Maxillary Surgeon, vicariously guilty of medical negligence while conducting interdental wiring on a patient suffering from maxillo facial injuries.Observing that the doctors of the hospital had not even adopted even the basics of ABC of trauma while handling the patient, who...
New Delhi: The National Consumer Disputes Redressal Commission recently held Kerala based Hospital and a Facio Maxillary Surgeon, vicariously guilty of medical negligence while conducting interdental wiring on a patient suffering from maxillo facial injuries.
At the hospital, Dr. Ravindran Narain, the Facio-maxillary Surgeon had performed the wiring procedure with the help of other doctors (Anesthesist and Plastic Surgeon) for the fractured maxilla. During the procedure, there was a sudden spurt of bleeding resulting in airway obstruction and consequently, the patient died due to oxygen insufficiency.
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It was alleged by the Complainants that the doctors had failed to secure the patient's airway, prior to the wiring and they rather performed tracheostomy or Intubation. Further, the complainants alleged that the Postmortem report of the deceased clearly showed that the patient's air passage was full of blood and her finger nails were blue, which was suggestive of her death due to hypoxia i.e. insufficiency of oxygen.
Alleging medical negligence by improper clinical evaluation and wrong treatment from the doctors at KVM Hospital, the Complainants filed a complaint before the State Commission seeking compensation of Rs. 20,00,000 with 12% interest.
On the other hand, the doctors filed a joint reply and denied the allegations of negligence leveled against them. KVM Hospital and its Casualty Medical Officer filed separate versions and submitted that the patient had major facio-maxillary fractures with bleeding from mouth and nostrils at the time of admission.
The doctors of the Hospital submitted that they had conducted all emergency investigations including blood investigations, X-ray of the skull including upper cervical spine and C.T. scan of the head with scanogram of the upper cervical spine. Thereafter, Dr Nair, the facio-maxillary surgeon had been called from Medical College, Alleppey for attending the patient. The doctors further submitted that the patient was fully conscious and well oriented and answered all the questions regarding the previous history. On examination, the airway was patent and the patient did not experience any difficulty in breathing. Moreover, at the time when the patient was taken to the Operation Theatre, the bleeding was not active.
It was further submitted that one of the doctors discussed with the patient, who herself was a doctor, regarding the possible need of a tracheostomy, for which the patient had given her consent in case of absolute necessity. Hence, it was the consent given only for First Aid under a local anesthesia to prevent further bleeding from the maxillary fracture and then to shift her to another center for definitive surgery.
They also informed the court that the condition of the patient did not warrant tracheostomy or any intubation as she had no difficulty in breathing before or during the First Aid procedure. As the wiring was near to complete, the patient complained of breathlessness due to severe bronchospasm. As mask ventilation was difficult, the Anesthetist tried auro-tracheal intubation, but it was difficult to visualize the larynx through laryngoscope.
Therefore, the Plastic Surgeon had been asked to continue with an emergency tracheostomy and the procedure became practically difficult as the patient was struggling. Following this, the Oro-tracheal intubation was tried again and intubated. But it was impossible to ventilate through the tube as the 'bag' was too tight, due to severe Bronchospasm (Reflex Shrinking of lumen of the air passages). Immediate and prompt measures were taken to facilitate ventilation, including endotracheal suction and bronchodilator drugs. As the ventilation through the oro-tracheal tube was still difficult, the Anesthetist again proceeded with tracheostomy with the help of an ENT Surgeon, a colleague of the Patient who volunteered to come in and help. The patient developed cardiac arrest and immediately cardio pulmonary resuscitative (CPR) was started.
Barsha completed her MA from the University of Burdwan, West Bengal in 2018. Having a knack for Journalism she joined Medical Dialogues back in 2020. She mainly covers news about medico legal cases, NMC/DCI updates, medical education issues including the latest updates about medical and dental colleges in India. She can be contacted at editorial@medicaldialogues.in.