Morning MEDtalks with Dr K K Aggarwal 10th July 2018

Pay fine for invasive test without patient’s nod: NCDRC

NCDRC has directed the fortis Chandigarh hospital and treating doctor to pay Rs 10 lakh as compensation to the complainant under the Consumer Protection Act. The hospital claimed that it had obtained the patient’s consent, but the file was destroyed by water seepage in the room where the records were kept.

NCDRC said that it failed to obtain ‘informed consent’ from the patient before performing an invasive procedure. They set aside an earlier order passed by the state commission, which had given a clean chit to the hospital.

The NCDRC said “there is not even a whisper” to indicate that “the treating doctor had explained to the complainant the pros and cons: the material risks involved and the benefits of the procedure, particularly keeping in view her age and health condition.”

The case dates back to July 2012, when Manmohan Kaur (55), underwent colonoscopy. She claimed that she felt severe pain on insertion of the colonoscope, and requested the treating doctor to discontinue the procedure. However, it was not stopped, and caused perforation in the colon, resulting in deterioration of her condition.

NCDRC on June 29, said: “In our opinion, apart from the fact that the explanation for non-production of the consent form, claimed to have been got signed from the complainant, does not inspire confidence, even on merits, the treating doctor and the hospital have failed to prove that a valid/ informed consent had been obtained from the complainant before subjecting her to colonoscopy procedure. We are, therefore, of the considered view that the treating doctor as well as the hospital had failed to obtain a valid consent from the complainant, and the colonoscopy procedure conducted on her was unauthorised, amounting to deficiency in service on their part.”

“Fundamentally, the law requires the disclosure to the patient, information relating to the diagnosis of disease, nature of the proposed treatment, potential risks of the proposed treatment and the consequences of the patient refusing the suggested line of treatment,” it said. “Disclosure/ explanation of such information to the patient by the treating doctor and the patient’s conscious decision, in this behalf, before venturing into the suggested procedure/ treatment, is the basic attribute of an informed consent, which is considered mandatory in every field of surgical procedure/ intervention,” said the commission. ( I Express)

The Bolam test

The Bolam test was first recognised in the case of Bolam vs Friern Hospital Management Committee. It states that if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence. That is to say that if there is a group which is of the opinion that the practice is wrong, it does not automatically mean that the doctor was acting negligently. It also states that the standards should be judged by one’s own peers — not the longest-serving doctor or the senior consultant, but those who work in the same field and are peers of the doctor in question. Likewise, the standard to which the case should be compared is that of an ordinary and competent doctor acting in everyday practice — not that of an idealised worldview or the ‘perfect’ doctor.

The Bolitho test: was first decided in the House of Lords. It states that the defence could not be considered reasonable if the body of doctors or supporting witnesses were not capable of withstanding logical analysis. Simply providing a defence is not quite good enough, but that the defence and its body of opinion must be reasonable and responsible.

Gregg vs Scott case:  was brought before the House of Lords in 2002. This states that negligence can only be proven in the case of a missed diagnosis if the chance of survival would have been over 50% had the illness been diagnosed. For example, if a case of cancer was not found, but the patient would have only had a 35% chance of survival anyway, negligence would not be found. If the patient would’ve had a 75% chance of survival had the diagnosis been made and treatment proceeded, then it would be decided that the doctor had been negligent.

Disease to know

Human trypanosomiasis is commonly known as sleeping sickness in Africa (T. brucei) and Chagas disease (T. cruzi) in South America.

The insect is called the kissing bug as it likes to bite people on their face. While they’re biting you, kissing you in the middle of the night, they also happen to be defecating there. You wake up the next morning, you’re wiping the sleep out of your eye and you’ve just moved infected excrement into your eye and into your mouth mucous membrane. Then you become infected. The excrement contains the parasite that causes the virus. The symptoms include swelling of the eye or area where the parasite entered the body. It can also be associated with fever and headaches but in extreme cases the Chagas can be deadly.

What is virgin coconut oil

Virgin coconut oil is made using controlled temperature methods to retain the greatest amounts of phytosterols, tocotrienols, tocopherols, and other biologic active compounds in contrast to refined coconut oil or copra oil. However, industry standards are lacking.

Virgin oil may contain from 8 to 29 mg gallic acid equivalents per 100 g oil; in contrast, the refined counterpart contains about 6 mg equivalents per 100 g.

Fatty acid content does not differ however, with saturated fatty acid content (92 percent) that exceeds that of butter.

In one randomized, crossover trial in Norwegian women in which high and low fat coconut oil-enriched diets (identical polyunsaturated/saturated fat ratios) were tested, the high fat coconut oil reduced lipoprotein (a) levels by 5 percent [ J Nutr. 2003 Nov;133(11):3422-7}. 

Installing lifts without minimum power backup negligence

Installing elevators in housing apartments without minimum power backup is negligence as per NCDRC. The National Consumer Commission while awarding a compensation of Rs 50 lakhs to the kin of a man who died after falling into a lift pit, has said that it was necessary for the builder to provide minimum power backup for the lifts, in case of an emergency, before delivering possession of flats.

Family claims Rs 6 crore from Fernandez hospital

Claiming crores in compensation is now a common occurrence. In another case an infant allegedly contacted HIV after platelet transfusion and now, the family has claimed in March 2018 Rs 6 crore in damages from the Aarohi Blood Bank and Fernandez Hospital in Hyderabad.

The National Consumer Disputes Redressal Commission issued a notice after the infants family filed a petition.

The complaint alleges that the parties involved were responsible for a botched platelet transfusion resulting in an infant becoming infected with HIV.

The infant underwent anorectal surgery on September 7, 2016, during which the father was told that the baby needed platelet transfusion as there was a lot of blood loss and the baby was in critical condition. For this, a single donor had to be arranged, but platelets from random donors procured from a blood bank were transfused into the baby. On March 7, 2017, the baby was diagnosed with HIV.

Defences

1. Is the mother and father negative?
2. Was the platelet transfused tested?
3. If yes was the NAT test done?
4. Is it a case of window period?
5. Was the consent taken?
6. Who took the consent?
7. Who gave the consent?
8. What happened to the baby
9. Was the lab who issued the blood registered
10. Was the baby put on treatment the day was diagnosed HIV positive

Participate in survey on Inflammatory bowel disease: https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform