You Can’t expect Doctors to subject every patient coming with chest pain to advanced cardiac investigations, when ECG is normal : Court

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Facts in short :
1. The Wife of the Complainant (since deceased), was under the treatment of a Gynecologist. The Gynecologist advised to go to KEM Hospital Mumbai for cardiac check-up.
2. The patient also had the history of Chest Pain/Epigastria, Hypertension and 9 months Amenorrhea. In the Hospital An ECG was performed and primary treatment for Acidity and Gastric disorder was given and she was again asked to come to hospital after 2 days.
3. After 2 days when she came to Hospital at about 11 am and she was declared dead at 03:10 pm on next day.
4. The post mortem report would show that at KEM Hospital, her ECG & Obstetrics USG were normal but she collapsed all of a sudden & cause of death was assigned to consequence of Aortic Dissection.
5. It was alleged that when the gynecologist referred the patient for Cardiac problem, she should have been subjected to extensive cardiac evaluation to rule out a Coronary Artery Disease (CAD). She should not have been discharged at the first instance and hence all the Doctors are negligent.
6. The Doctors refuted all the allegations followed the universally accepted protocol in the treatment of the wife of the complainant. It was further condended that the death was natural due to consequence of Aortic Dissection in the patient taken up for delivery for the use of Prostaglandins.

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Held :
1. The National Commission dismissed the Complaint. It was observed at the first instance that the onus to prove the medical Negligence rests on the person who alleges it.
2.No expert opinion much less that of a Cardiologist has been submitted by the complainant to prove the alleged negligence in the treatment of his wife at KEM Hospital.
3.The ECG was found to be normal and there was no indication of any coronary artery disease in the ECG. Therefore, it would be difficult to say that the doctor at KEM Hospital should necessarily have subjected her to further cardiac evaluation in the form of 2D ECO, MRI, Angio CT Scan, Stress Thallium etc.
4.It would be unrealistic to expect the doctors in such a hospital to subject every patient coming with a complaint of chest pain to advanced cardiac investigations , when the ECG is normal nor any Protocol was brought to the notice of the Commission.
5. Thus the Complaint was dismissed, without prejudice to the Complainant’s right to approach regulatory body like MCI.

It’s true that the person who is gone forever, no amount of money can replace it. But one should take an expert opinion to check whether his/her grievances are true or emotionally motivated.
Some of the Medicos are of the opinion that ECG should be taken as a course of prevention. In certain cases even if ECG and 2D ECHO tests are normal, but stress test may be positive… In such case advanced cardiac investigation may become necessary..
In a diabetic patient, he/she may not experience any pain.. Thus advanced investigation may be required..

Catch 22 situation for Drs.. :
If a Doctor doesn’t prescribe any test, he may be called negligent.. If the test is performed and no decease is diagnosed, still Doctors may be blamed for asking to perform unnecessary tests…. Again this is the glaring example to vicious circle of Doctor-patient relationship.
I feel it’s bit a tricky Decision… A Dr should take call as per his/her experience.. At times prescribing a test may amount to a stitch in time…

Article by Adv. Rohit Erande

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