Vigilance and timely action are crucial aspects while delivering medical care to pregnant patients and to patients that may require critical care. Missing out on these could be held as negligence, as happened in this case.
Irrefutable Facts
The patient was under antenatal care (ANC) of obstetrician at the hospital. During one such consultation, when the pregnancy was at an advanced stage, she complained of weakness, no movement of the foetus, recurring pain, and was diagnosed with pregnancy-induced hypertension (PIH).
After a few days, the patient visited the hospital again, and in absence of the obstetrician, she was examined by the general surgeon. The patient was advised USG, which revealed 37 weeks and 5 days old fetus with less amniotic fluid. ‘Intrauterine fetal death’ was reported.
The patient was admitted to another hospital, and a stillborn baby was delivered.
She sued the hospital, obstetrician and the general surgeon.
It was alleged that despite repeated complaints, the obstetrician did not advise requisite investigations to save the life of foetus. It was further alleged that in absence of the obstetrician, the patient was examined by her husband, the general surgeon.
It was pointed out that when intra uterine death was reported, the patient was denied admission to the hospital and had to be admitted to another hospital where a still born baby was delivered.
Doctor’s Plea
It was stated that the patient was a case of late pregnancy as she was 37 years old with a history of a first pregnancy ending up with miscarriage after four months. During ANC, USG was advised to the patient on her complaints of pain in the lower abdomen, but she reported after a delay of over 20 days.
Moreover, the patient was diagnosed with PIH and was advised medicines to control her BP but the she did not come for follow-up thereafter and reported only when her BP again shot up to a high level.
It was further stated that the patient herself was negligent in taking proper precautions to control her BP, which resulted in the unfortunate foetal death.
Court’s Observations
The court after perusal of medical records observed that high BP with weight gain of more than 1kg/week is an indicator of preeclampsia, and questioned that despite such danger signs “why wasn’t the USG advised earlier when patient showed the first indication of preeclampsia… i.e., 31 weeks of pregnancy?”, “why wasn’t the fetus delivered at 37 weeks of pregnancy in a diagnosed case of PIH?”.
The court, therefore, concluded that “it is a case of lack of obstetric care”.
The court further perused medical records and found that it was poorly maintained and also lacking in many aspects.
The court accepted the fact that the patient failed to follow obstetrician’s advice, but went on to hold that negligence on part of the doctors and hospital was “writ large”.
Prevention Is Better Than Cure
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Doctors’ duty to monitor the patient, look for signs of complications, remain vigilant, and take the indicated action in accordance with ‘accepted medical practice’ and that too on time increases manifold in critical / complicated cases. Every action, inaction, decision, and diagnosis must be in accordance with medical science and with proper justifications. Failure to do so is obviously negligence.
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In any pregnancy, ANC and ANC card play an important role in identifying impending complications and managing the same. An ANC card must be maintained appropriately documenting all the parameters at each follow-up, preserved with medical records, and produced in court if required.
Source : Gagandeep v/s Chunni Lal Memorial Gulati Hospital & Ors.
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