A REPEATED BLAME ON CONSUMER COURT

A REPEATED BLAME ON CONSUMER COURT  -   IT ALWAYS DELIVER ORDERS AGAINST DOCTORS.  AS I REPEATEDLY SAY,  IT IS THE DUTY OF THE ALLEGED DOCTORS TO PUT FORWARD THEIR COUNTER BEFORE THE COURT BY SHOWING SOME PERSONAL INTEREST ON THE CASE.   THIS CASE IS ONE OF THE GOOD EXAMPLES, WHERE THE ALLEGED DOCTORS REALLY HAD TAKEN SUCH A PERSONAL INTEREST TO PROVE THAT THERE WAS NO NEGLIGENCE ON THEIR PART. 

A patient is reduced to the stage of brain death due to hypoxia of brain. As per the MRI done on 30th April, 1990, “Diffuse/Swelling involving the grey matter in the high convexity region, probably due to hyposis with generalised narrowing of the verticles suggesting cerebral oedema.” It is his case that high spinal anaesthesia was administered against the suggested quantity of xylocain (Anaesthesia) being 8 c.c., whereas opposite party No. 2 administered 1.2 c.c. of xylocain, which is an admitted fact. Complainant argued that this excess dose of anaesthesia caused cardio accelerator fibres blocked and the sympathetic fibres at the thoracic level became immobilised resulting in only the vagal action of me heart. Due to this, the blood kept accumulating in the periphery which explains the blood pressure fall and hence the consequent cut of blood supply to the brain causing the patient to go into coma.

Anaesthetist’s counter statement

(a) Oxygenation to mother and new born is good compared to general anaesthesia

(b) Less chances of regurgitation

(c) Both hands are free to check pulse, B.P. etc.

(d) Used Hypertonic 5% Ligrocain 1.2. ml. for anaesthesia in a sitting position and took nearly 10 seconds to inject and the patient was moved to lie down with pillow below her head and bed sheet under her back to give left lateral tilt. 

(e) The patient’s pulse and B.P. which was 90 per minute and 110/ 20 mm. Hg.

(e) Controlled level of spinal anaesthesia was checked by needle pricks and level of ideal just above umbilicus.

(f) The quantum of anaesthesia prescribed or patients is between 1 to 1.5 ml. According to Miller, 1.2. to 1.8 ml. according to Wyeli and 1.25 to 1.5 ml. as per Gray-Nunn

National Commission’s Observation

We have gone through the standard anaesthesia procedures and the common norms of post operative analgesia. Opposite party No. 2 kept constantly the level of anaesthesia just above the umbilicus i.e. between umbilicus and xiphisternum (T6-T12 by ascertaining with needle pricks. Patient was given spinal anaesthesia in sitting position and then later was made to lie down with a rest of a pillow under the head and a blanket under the back to give an angular posture. Since Cardioaccelator fibres of heart are supplied by T1 & T2, the question of spinal anaesthesia causing blockage of cardio accelator fibre does not arise. Opposite party No. 2 was talking to the patient during operation and she asked about the child and this whole scenerio took more than fifteen minutes from the time anaesthesia was given. This also disproves the claim that adverse effect of anaesthesia as such reaction would have taken place within 10 minutes. Here hypoxia/cardiac arrest occurred after 26 minutes after giving anaesthesia, high spinal anaesthesia causes 2 possibilities where patient starts vomiting and severe hypertension will be observed by the Surgeon or the maternal hypotention leading to reduced placental blood flow which will lead to foetal distress. In the present case, baby was normal, B.P. was normal, till 26 minutes after the anaesthesia was administered. It proves that spinal anaesthesia was not high but low which was required.

We have noted few observations from H.E. Tunstall’s “Anaesthesia for Obsterics”, that out of a sample of 37, anaesthetic deaths of 18 died of hypoxic cardiac arrest and the cause was obscure. It is observed that pulmonery embolism is the leading cause of maternal deaths and is about 80-90% cases it occurs without any previous clinical manifestations of deep vein thrombosis. Although other major causes of maternal mortality have decreased, the disorder of amniotic fluid embolism still remains to be a problem. According to the text on Amnotic Fluid and Maternal Mortality/Morbidity, it is described as “Amniotic fluid with its particulate matter enters the pulmonery circulation, causing respiratory distress, systemichypotension, cardio vascular collapse, convulsions and death in the majority of affected women. There are no warning signs or symptoms. There are no known therepentic modalities other than support of the Cardiovascular respiratory system and symptomatic treatment of the- bleeding”. It continues to say “Hopefully, once the underlying mechanism of this condition is understood, specific therapy can be aimed at the causative insult. Meanwhile, it can be expected that this sudden catastrophic disorder will continue to be highly lethal, with maternal mortality rates i.e. 75% to 90% range.

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Lastly we would generally observe that the patients have the tendency to blow out of proportion the grievance against the doctors. When the patient does not recover the patient presumes that doctors are responsible for his ill- health. They spare no opportunity to blame the reputation of the doctors. In this case, the father of patient approached Medical Council, approached also the Press and the Video media and has thus tried to injure the reputation of the doctors. We have indicated here before that the doctors gave the appropriate treatment at the appropriate time. It is unfortunate that patient could not revive to normalcy but then that stage of health has to be attributed to the patient and not to the doctors. We therefore, censure the contention of the complainant, who has mudsling the reputation of both the doctors. However, without any more comments, we pass the following order.

ORDER

The complaint is dismissed with however, no order as to cost.