Sleeping on the job

Courts, particularly consumer courts, frequently have to deal with cases of medical negligence nowadays. In the field of surgery, the negligence of doctors is sometimes glaringly obvious.

A surgical operation is not a one-man show. A team of doctors, each with expertise in his respective field, are involved. A key person is the anaesthetist who plays a vital role in ensuring that the patient remains properly anaesthetised during the surgery and regains consciousness after it is over.

He has to ensure that the anaesthetic agent used is not harmful or hazardous to the patient, a proper dose is administered and there are no complications while reversing the patient from anaesthesia. Do all anaesthetists attend to these matters with complete dedication? Some cases demonstrate otherwise.

The Supreme Court noted the negligence of an anaesthetist as early as 1969, in the case of Dr Laxman Balkrishna Joshi vs Dr Trimbak Babu Godbole.

In that case, a 20-year-old boy was operated upon for an overlapping femur fracture and instead of being administered general anaesthesia, he was given morphia without the essential preliminary tests being performed. The boy died due to shock. The court held the anaesthetist fully responsible for his carelessness.

In the case of Rambiharilal vs J N Srivastava AIR 1985, chloroform was used while operating on the wife of the complainant for removal of the gall bladder. Medical negligence was alleged and the matter reached the Madhya Pradesh high court.

An expert, appointed to investigate the matter, opined that the patient's kidney and liver were damaged and her death occurred as a result of the prolonged chloroform anaesthesia resulting in peripheral circulatory collapse signified by fall in the blood pressure of the patient.

The high court, holding the doctors liable for the death of the patient, observed that "under the circumstances the defendant should not have put the deceased under chloroform anaesthesia without carrying out proper tests... it was not advisable to keep the deceased under chloroform anaesthesia for two hours in view of its toxic effects."

The Gujarat State Consumer Disputes Redressal Commission was also recently called upon to deal with a case of negligence on the part of an anaesthetist.

Chandrakant Patel underwent a hernia operation, with general anaesthesia administered by a Dr Pandya. The patient's breathing stopped soon after the operation and efforts were made to revive him but to no avail; he was shifted to Mayo Hospital, Baroda, where he died.

Patel's wife Mrs Harshaben and her children filed a complaint against the doctors before the District Consumer Disputes Redressal Forum. It was admitted that the operation was completed at 1 pm and the patient became serious at 1.10 pm.

During the course of the proceedings, it was found that the anaesthetist Dr Pandya had left the operation theatre at 1 pm despite the fact that the patient had not regained consciousness.

Holding the anaesthetist fully liable for his negligence, the district forum awarded a compensation of Rs 400,000 to the complainant and in addition awarded Rs 5,000 as cost of litigation.

In an appeal filed by the anaesthetist before the Gujarat State Commission, the court by its order dated January 22, 2004 held both the surgeon and the anaesthetist liable for deficiency in their services and maintained the award for compensation.

The State Commission referred to the observations made in the Text Book of Surgery. In the aforesaid treatise, it has been stated that " the management of the airway is perhaps the most vital aspect of the anaesthetic practice."

The case law handed down by the various courts unequivocally demonstrates the casualness shown by some surgeons and anaesthetists in treating patients.

Anaesthetists must note that constant vigilance during anaesthesia is part of their duty. Delegation of this duty to inexperienced juniors or nurses is a patent dereliction of their duty.

It is not only obligatory on the part of the anaesthetist to explain the anaesthetics administered, the technique used and pathological investigations recommended but to document the same clearly and accurately.