Being aware of internationally accepted standards and adopting them in appropriate cases while delivering medical care may not be a thumb rule, but it sure helps healthcare professionals deliver quality patient care and be on the right side of law.
Irrefutable Facts
The patient who had undergone Mitral Valve Replacement (MVR) surgery earlier was admitted to the hospital under the care of cardiologist with complaints of breathlessness.
Investigations revealed PT/INR value at 1.0. The anti-coagulant dosage was increased from 2 mg to 4 mg, and the PT/INR value increased to 4.1, which was well within the therapeutic range for such patients. However, the patient continued to complain. Later she got herself admitted to another hospital.
The patient sued the cardiologist. It was alleged that the doctor ignored her condition and doubled the dose of anti-coagulant, after which her condition started deteriorating. It was also alleged that the she was diagnosed with abdominal bleeding at the other hospital due to an overdose of the said medicine.
It was pointed out that the cardiologist had wrongly diagnosed her with twisting of intestine.
Doctor’s Plea
The cardiologist refuted these allegations and stated that the dose of anticoagulant was increased in accordance with the standard practice. He was further stated that the patient was advised intervention to know the cause of her abdominal pain.
Court’s Observations
The court perused medical literature and observed that “without proper anti-coagulation, the incidence of thromboembolism is 3-6 times higher” with any mechanical valve in the heart.
The court further observed that the patient had undergone MVR surgery with an artificial valve, and at the time of admission, her PT/INR was as low as 1.0, which was abnormal. Therefore, the dosage of the anti-coagulant was increased from 2 mg to 4 mg and thereafter the INR value reached 4.1, which was consistent as per laid international standards, and well within the therapeutic range for patients with MVR.
Therefore, the court concluded that the increase in the dose was justified and as per the standard of practice.
Patient’s case against cardiologist was dismissed.
Prevention Is Better Than Cure
- Prescribing / increasing / lowering the dosage of drugs should only be for a justified medical reason and as per standard national / international protocols. The reasons should be communicated to the patient / attendant and documented in appropriate cases.
- Indian courts are increasingly taking cognizance of the internationally accepted standards being used by Indian doctors. It is therefore imperative that doctors should keep themselves updated with international standards and best practices.
Source : Fortis Health Management (North) Ltd. v/s Santosh Modi
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