Highest level of medical care and vigilance is expected by the critical care medical team. A lackadaisical approach in hospital’s critical care units often leads to dangerous situations, for patients and hospitals alike.
Irrefutable Facts
The patient was severely injured in a road accident. He was initially admitted to one hospital; from there he was referred to the second hospital.
Investigations revealed that he had sustained a fracture of mandible and ribs, but there was no head injury. After providing first aid, the patient was airlifted and admitted to the ICU of the hospital for better treatment. He was put on a ventilator and was advised to “care of ET tube (endotracheal tube) connecting ventilator and regular suction of ET”.
CT of skull was performed. It did not report bleeding inside the brain. Later, the patient developed cardiac arrest and hypoxia due to self-extubation. His vital parameters were brought under control after prolonged treatment for two months, but he did not regain consciousness.
Thereafter, the patient was transferred to another hospital where he remained in a vegetative state until death.
The patient’s family sued the hospital. It was alleged that the doctors did not take any efforts to rehabilitate the patient, but simply informed that he had slipped into coma with no chances of revival.
It was further alleged that the doctors simply relied on the CT scan, but did not perform MRI scan for a long time.
It was pointed out that one of the doctors had informed about improvement in patient’s condition and that he would soon be weaned off the ventilator. Thus, the theory of ‘self-extubation’ was falsely created.
Hospital’s Plea
It was stated that the patient was admitted to the ICU under Dangerously Ill List (DIL); the patient was managed conservatively with ET intubation and regular suction. He obeyed simple commands therefore; he was weaned off the ventilator.
It was further stated that the patient pulled out the ET and therefore, SPO2 level fell down, which led to cardiac arrest and subsequent development of cerebral hypoxia.
Court’s Observations
The court learned from the medical records that the patient self-extubated and thus, questioned the hospital about expected duty of care required in the ICU, especially at a hospital which is a tertiary care hospital.
The court went on to observe that the patient suffered faciomaxillary injuries from the accident, and there was no CT scan or MRI report available to confirm the head injury. Thus, the court observed that the root cause of hypoxia was due to extubation, which also meant failure in duty of care in the hospital’s ICU.
The hospital was held negligent.
Prevention Is Better Than Cure
- The highest level of care is expected in the ICU management of a patient, especially if the hospital is a tertiary care hospital. Any apathy or shortcomings which cannot be justified often results in harsh legal consequences.
- Hospitals should provide a critical / unconscious hospitalized patient needing 24/7 attention and care with a nurse / attendant. This fact must be communicated to the patient along with the financial implications. If the attendants want to bring their own nurse / attendant or are ready to give round-the-clock attention, this fact must be duly recorded, and their endorsement must be taken.
- Follow the algorithm of investigations. Perform appropriate investigations to diagnose and provide treatment to the patient accordingly.
Source : Sq. Ldr. N. K. Arora Retd Through Lrs. & Ors. v/s Army Hospital (R&R) & Ors.
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