Questions Answered by Delhi High Court Duty of Police/IO/ DAC/Court • Whether the ultrasound machines that have been sealed are liable to be de-sealed and released to the Hospital? • Whether the said Hard Disks or the data comprised therein or the ultrasound machines have been relied upon in the said case? • Where is the question of denial of NOC for purchasing a new ultrasound machine merely on the ground that the Hospital has violated the provisions of the Act and the Rules?

Anaesthesiology is a high risk specialty. However the public at large are not aware of the risks involved in anaesthesia. Moreover, in the present system of anaesthesia practice in India, there is not much scope for interaction between the patient and the anaesthesiologist and hence there is no rapport between them. Under such circumstances, when something goes wrong, the patient or his relatives react in a hostile manner towards the anaesthesiologist and many a times they land up in a police station or court to seek redressal. [5] Spinal anesthesia is an alternative to a general anesthesia and can be used for most operations below the waist. A spinal anesthesia is performed by an anesthetist. A very fine needle is inserted into the middle of the lower back and local anesthetic is injected through the needle in to the fluid that surrounds the spinal cord. It further states that spinal anesthetic will be performed in the anesthetic room or in theatre. Before the spinal anesthesia is given the anesthetist will put a drip in patient’s hand and patient will be attached to a monitor (ECG, blood pressure and oxygen saturations] It further states that spinal anesthesia is an important anesthetic technique in anesthesiology. Among possible spinal block anesthesia related complications cardio pulmonary arrest is the most serious. The increased knowledge on the physiology of spinal anesthesia together with use of less toxic local anesthetics and improved monitoring incidence of cardiac arrest can be reduced. The effects of spinal block anesthesia on the cardiovascular system include reduction of blood pressure and central venous pressure. The sympathetic blockade proved by spinal anesthesia causes significant peri pheral vasodilation (widening of blood vessels) which results in bradycardia. It further suggests the precautionary measures like early diagnosis and effective and aggressive treatment are necessary when facing significant bradycardia during spinal anesthesia. It is essential to monitor the respiration, pulse and blood pressure closely. The blood pressure can fall precipitously following induction of spinal anesthesia. Bradycardia is quite common during spinal anesthesia .Patient should be well hydrated before local anesthesia is injected and should have an intravenous infusion in place so that further fluids or vasoconstrictions can be given if hypotension occurs. Hypotension and bradycardia should be treated with intravenous fluids, atropine and vasopressors. Treatment if not started quickly the combination of hypoxia, bradycardia, hypotension may result in cardiac arrest.

Facts of the Case: The deceased had some menstrual problem in June, 1993. She consulted Dr.Bishwanath Das, respondent No.1, a Gynecologist on advise of her family physician, Dr. Pransankar Shah. It was found that she had multiple fibroids of varying sizes in uterus. She was advised to undergo Hysterectomy. After about five months, she had severe bleeding and was advised emergency Hysterectomy at Ashutosh Nursing Home. She was also suffering from high blood pressure and her hemoglobin was around 7 gm% which indicated that she was anemic. The treatment was given for the said problems but without much success. Finally, operation was conducted on 01.12.1993 at about 8.45 A.M. She did not regain consciousness and since the Nursing Home did not have the ICU facility, she was shifted at 2.15 PM to Repose Nursing Home and thereafter to SSKM Hospital where she died on 17th January, 1994. [Para 2] Case before SCDRC: Alleged Medical Negligence The appellant filed a complaint before the State Commission on 16th June, 1994. The appellant’s case was two-fold. Firstly, the decision to perform surgery without first controlling blood pressure and hemoglobin amounted to medical negligence. The surgery was not an emergency but a planned one and conducted six months after the disease first surfaced. Secondly, having regard to the foreseeable complications, the decision to perform surgery at a nursing home which did not have the ICU for post operative needs also amounted to medical negligence. [Para 3] Following Questions emerged for consideration before the Supreme Court of India 1. Whether the National Commission applied the right test for holding that there was no medical negligence in the decision of the surgeon to perform surgery? 2. Whether the choice of nursing home to perform surgery amounted to negligence as requirement of ICU was a clear forcibility and centres with ICU were available nearby? [Para 10] Other important Issues emerged: • Consequences and remedies of Delay in Disposal of Consumer Court Cases • Issue of clinical decision in emergency situations • Need for ICU in case of Operation

Obstetric hemorrhage is one of the major causes of maternal death in developing countries. Placental abruption is known to be a significant cause behind both ante partum and postpartum bleeding. Abruption is often an unanticipated emergency and a small bleed can suddenly evolve into a major abruption. Therefore, vigilance is very essential. Placental abruption often happens suddenly. Left untreated, placental abruption can lead to significant maternal and fetal morbidity and, ultimately, maternal and fetal death. Current understanding of coagulopathies and replacement of clotting factors along with increasing confidence in uterotonic agents have reduced the necessity to remove the couvelaire uterus to a rare circumstances.

Following Questions for Consideration: • Who is responsible for missing the Diagnosis? • Gynecologist who referred the case or radiologist who performed the USG? • Whether Gynecologist who referred the case to radiologist? or • Radiologist who performed the USG and not able to detect the anomaly? NCDRC opined that so far as the allegation made in the complaint that OP-1 wrongly advised the complainant regarding medicine taken for dental treatment will not have adverse effect is concerned, I find that there is no evidence available on the record that the abnormality developed due to the effect of medicines taken for dental treatment. No expert opinion has been made available on record to prove this allegation. [Para 17] Based on the above discussion, NCDRC find no merit in the revision petition and the same is liable to be dismissed. Consequently, the Revision Petition was dismissed.

Questions for Consideration: 1. Is there need for registration of additional degree with the concerned council under the provisions of the Indian Medical Council Act, 1956? 2. What is a valid consent? 3. What is professional misconduct? 4. Can consent of husband for Hysterectomy of wife is a valid consent? 5. Can consent of husband and wife both are needed for Hysterectomy?

Res Ipsa Loquitur doctrine is a rule of evidence not rule of law. Its applicability in gross medical negligence cases shifts the burden of proof of medical negligence from complainant to doctor.

Right to Information Act, 2005 has inherent tension between conflicting rights i.e. right to privacy, right to autonomy, public interest etc. especially pertaining to medical profession. Many situations do come in direct confrontation with RTI as in case of Medicolegal Reports, Post-mortem Reports, medical records etc. many such issues come for appeal before appellate authorities i.e. Central Appellate Authority appointed under Central Information and various courts including High Courts and Supreme Court of India.

This is a case of alleged medical negligence against M/s. Sun Flag Hospital & Research Centre, Faridabad, the treating doctors and the staff of this hospital (opposite parties). The important issues to be decided in this case, inter alia, are as follows:

The Greek playwright Sophocles writes as, “It is a painful thing to look at your own trouble and know that you yourself, and no one else has made it.” “Don’t Shift Responsibility and Blame” it is the situation frequently come across that, how some people not only refuse to accept responsibility when they’ve made a mistake, but they even shift the blame onto someone else…!! Hippocratic Oath hastens the moral conduct of physicians, assuming the respect for all human life, even the unborn. NCDRC discussed Duty of Reasonable care, casual approach in USG Study, Doctrine of Res Ipsa Loquitur, Vicarious Liability, Issue of Expert Opinion Discussed, and Opinion of Forensic Medicine Expert a Case was filed against Hospital and two radiologists for Compensation. This paper deals with ethical duties of radiologist in taking reasonable care in report writing. Complainant asked for 1.5 Crore compensation, but on the objection of opposite parties considered it as highly exaggerated compensation and awarded rupees fifteen lacks only.