Saturday, 4 October 2014

Case Study : Patient should disclose relevant truth and facts to the Doctor

Case Study – One should disclose relevant truth and facts to the Doctor

“if the patient willfully chooses to withhold information from the physician, the physician cannot be liable for a medical negligence”

By Mohit Popli
Manju Anil Chawla  & Ors.       Versus    Jivandhara  Hospital  & Ors.
Decided On 20th December , 2013
CONSUMER COMPLAINT NO. 45 OF 2002
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI

               Brief facts of the Complaint :
The complainant Smt. Manju’s husband, late Mr. Anil Chawla,(hereinafter, “ a  patient”  consulted the,  Dr.  at his clinic for his long standing and recurrent  cold problem since 10 years and he was taking anti-cold medicines for many years but  often he had inability to breathe from the right nostril, snoring at night and bitter taste in throat during nasal infection with running nose . The Dr examined him and diagnosed as the cartilaginous nasal septum was grossly deviated to right side and  blocking the nose on the right nostril. After X-ray and Endoscopy investigations the Dr advised the patient to undergo a surgery.
Doctor’s Submissions
The Dr conducted operation of Septoplasty with functional endoscopic sinus surgery with left maxillary clearance using Caldwell Luc Approach under General Anesthesia on the patient. Dr. Rajesh Kolte was an anesthetist. It was clear that, after proper radiological (x-ray)  and blood investigations  it was confirmed that the patient had gross deviation of the cartilaginous nasal septum. Surgery performed by Dr on the patient was a non-invasive surgery, which has no surgical complications.
Patient suffered Cardio Respiratory Arrest
  The Dr. Amit Chadha submitted that, the attendant of the patient called him at 11.25 PM there was sudden cessation of respiration. The Dr examined the patient whose Pulse and BP were not recordable. Therefore, all emergency measures were carried out by Dr and the Anesthetist Dr. Kolte. Immediately cardiac massage was one, patient’s throat was checked for secretions, blood, gauze, which were absent, then the patient was intubated immediately with endo-tracheal tube by the anesthetist. Intermittent positive pressure ventilation was given with 100% oxygen started by the anesthetist through the tube with the help of portable Boyle’s Machine apparatus. Cardiac massage continued, IV adrenaline, atropine, soda bicarb and I/C adrenaline were given but the patient did not respond. The Dr called the physician, Dr. Vinay Bhomia,  who came at about 11.30 p.m. and  in a couple of minutes he revived the patient with the help of DC shock and Intra Cardiac  adrenaline. There was no secretions/blood, in the oro-pharyngeal tract. The patient was thereafter shifted to ICCU of Navneet Memorial Hospital and was put on to ventilator with I.P.P.R. mode. The patient was attended by Dr. Guha, the doctor in-charge of the ICCU, at that time. Also opinion of Dr. Parindra Desai, Neuro-Physician was also taken. The patient was diagnosed to have suffered a cardio-respiratory-arrest.
 Observations/Finding:
 The Dr further, contended that, the Complainants have concealed the material facts about the true condition/ diseases suffered in pasts. In past the patient was admitted and took treatment for his Cardiac and Urinary /Renal problems at various hospitals in year 1997. There upon the Hon’ble National Commission found that, the patient late Anil Chawla suffered from Cardiac as well as Kidney problems in the year 1997.
Medical Text Ref:     The Hon’ble National Commission have referred medical text books and literature on ENT surgeries and searched for the complications of “Septoplasty with Functional Endoscopic Sinus Surgery”. There are no reports of fatal complications due to such surgery. It is well known that,  there are risks and complications for all surgeries; those for deviated septum and Septoplasty  surgeries are very infrequent, but it includes nasal obstruction, bleeding, chronic nasal drainage ,eye damage, numbness of facial structures, septal perforation, alteration of sense of smell or taste, and failure to resolve any associated nasal or sinus problem.
Decision:
 In this case, it is apparent to be a “Contributory Negligence”, that there was a mistake on the part of patient as well as the complainant who did not disclose about the previous medical treatment and disease to the treating Doctors. Sometimes the unexpected results may not be only due to negligence of the doctor but also due to negligence of patients or relatives. “If anybody undergoes any medical treatment, or is about to undergo a medical surgical procedure, one should take care to disclose relevant truth and facts to the doctor.” Thus, if the patient willfully chooses to withhold information from the physician, the physician cannot be liable for a medical negligence.


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