SHAHLA IMAM Vs. DR. NAHID FATIMA

JUDGEMENT

(1.) On 11/5/2007, Mrs. Kusum Nehra, mother of the Complainant (hereinafter referred to as the 'patient'), 68 years, consulted Dr. Ashok Raj Gopal (OP-2), an Orthopedic Surgeon at Fortis Hospital, Noida for her deformities in both the knees and difficulty in walking and bound to wheel chair. The OP-2 advised Total Knee Replacement (TKR) Surgery. On 13/5/2007, the patient got admitted to the OP-1 - Hospital. The blood tests and other investigations were found normal. On 14/5/2007, the OP-2 and his team performed bilateral TKR. It was alleged that on 17/5/2007, despite breathing problem, the patient was shifted from ICU to the ward (room) with Oxygen mask. The on-duty doctor told the Complainant that the mask was displaced in night, therefore oxygen supply was reduced. The breathing problems continued and on 20/5/2007 around 1.00 to 2.00 p.m., she was again shifted to surgical ICU and was put on ventilator at 3.00 p.m.

(2.) It was alleged that till 12/6/2007, the OP-2 never disclosed about the real condition of the patient. The Complainant raised few allegations like non-functioning of AC in the room, improper electric supply to the ICU instrument; the attendants were not allowed to visit ICU during 20/5/2007 to 30/5/2007. It was further alleged that on 4/6/2007, the hospital issued one incomplete handwritten case summary, devoid of details of Acinetobacter and Pseudomonas infection. After the death of the patient, the medical record and the remaining discharge summary was issued with the delay till 27/6/2007. Though, the laboratory was inside the hospital, the blood samples for culture and sensitivity (C&S) were taken on 20/5/2007, but the report of presence of Acinetobacter was made available on 23/5/2007. Similarly the ET sample taken on 30/5/2007 was reported on 1/6/2007 as Pseudomonas. Thus, such delay clearly indicates the carelessness during the post-operative period.

(3.) The OPs filed their reply and denied any negligence during the operation or post-operation. It was submitted that a Pre-operative Check-up was done by the anaesthetist and cardiologist and found within normal limits after thorough discussion and understanding of the procedure. The informed written High Risk Consent Form was signed by the patient and the Complainant. The Bilateral TKR under Combined Spinal and Epidural anesthesia was performed by OP-2 and his team on 14/5/2007. Post-operatively, the patient was shifted to the Surgical ICU (SICU). The vital parameters - heart rate, respiratory rate and blood pressure were normal. Two units of Packed RBCs' were transfused to increase Hb% and to make up the blood loss during major surgery like TKR. On 15/5/2007, Deep Vein Thrombosis (DVT) Prophylaxis with Inj Enoxaparin was started and Graduated Pressure Stockings were applied due to prolonged immobilization of the patient. The patient was shifted from ICU to the ward on 17/5/2007, with O2 mask. At 10 p.m. on 17/5/2007, the patient's SPO2 was (84%), although she was asymptomatic. Her chest X-ray showed B/L mid zone haziness. The air entry was good on auscultation and there were few respiratory crepitations. The Oxygen inhalation by mask was started, which improved the SPO2 and it remained above 90% overnight. On 17/5/2007 itself, the wounds were checked, the wounds were healthy, there was no soakage and the patient was comfortable. The patient remained fairly well till 8:00 pm on 18/5/2007. Thereafter, when her breathlessness increased and oxygen SPO2 decreased to 91%, immediately, the patient was put on BiPAP support and emergency lab investigations were sent for Hb, TLC, DLC, Serum Proteins, Serum Albumin, D-Dimer and urine for fat globules. The chest X-ray showed bilateral mid zone haziness. Clinically, the infection was suspected and Inj Zosyn (Piperacillin+Tazobactam) was started. In addition, Inj Tiecoplanin and Inj Levofloxacin were started. These are higher generation Antibiotics with broad spectrum of antibacterial activity. The x-ray chest was done on 22/5/2007 after the treatment, which revealed haziness in lung was cleared.