Act of omission and act of commission – This case is an exemplary example of these legal aspects of healthcare delivery.
Irrefutable Facts
The patient, a road traffic accident victim, was admitted to the hospital. The orthopaedic surgeon examined him; investigations revealed hypoxia, left femur shaft fracture, and acute lung injury with ARDS.
The patient was kept on ventilator support for urgent immobilization. After repeated investigations, fat embolism was suspected. The patient was operated on for Inter Locking Nail (ILN) fixation and died after a few days.
His family sued hospital and orthopaedic surgeon. It was alleged that the patient was operated hurriedly without informed consent. It was further alleged that the patient was
kept on ventilator support, but the doctors and nurses did not attend to him regularly.
Doctor’s Plea
The hospital and orthopaedic surgeon stated in defence that surgery was performed after obtaining clearance from the critical care consultant and ‘special informed risk consent’. It was also stated that the patient was under continuous care of anaesthetist and the cardiologist. Therefore, if he was hypoxic, they would have detected it.
Court’s Observations
The court perused medical records and found that “the patient was already in the compromised hypoxic state due to fat embolism and lung injury”. Furthermore, the court observed that the orthopaedic surgeon had failed to seek a physician’s opinion and perform a proper evaluation before the surgery. The court concluded that this overenthusiasm was an ‘act of commission’ on part of the orthopaedic surgeon, and hence negligence.
The court observed that the anaesthetist had failed to do a pre-anaesthetic check-up before giving the fitness for the proposed ILN surgery and held that this was an ‘act of omission’.
The court held the hospital vicariously liable for the negligence of the anaesthetist, who was not made a party in this legal proceeding by patient’s attendants.
The hospital and orthopaedic surgeon were held negligent.
Prevention Is Better Than Cure
- A doctor can be held negligent for an ‘act of commission’ – acting in a way that was not indicated, contraindicated or premature or an ‘act of omission’ – failure to perform or delay in performing the indicated action. This case illustrates both propositions aptly.
- In case of negligence of the treating doctors, the hospital is usually held vicariously liable.
Source : Peddi Narayana Swami v/s Kamineni Hospitals & Anr.
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