Referring patients to another hospital / higher centre, especially if emergency diagnostic facilities are not available, is a basic protocol expected from every hospital. Surprisingly, a hospital in this case did not follow it and was held negligent.

The patient sustained severe injuries in a road accident. He was rushed to the hospital where a team of doctors sprung into action. There was severe vascular compromise, and hence patient was shifted to another hospital for better management.

Unfortunately, patient’s left leg below knee had to be amputated at the second hospital.

Losing a limb was probably an unbearable shock. The patient sued both hospitals. It was alleged that proper care was not given at either of the hospitals, and he was not referred to the second hospital on time in interest of avoiding amputation.

The hospitals refuted the allegations. First hospital submitted that the patient was under the care of an orthopaedic surgeon, radiologist and other doctors. He was immediately attended and POP slab was applied.

The medical officer noticed that anterior distal pulse was not present and left foot was colder than the right one. The patient was shifted to other hospital same day around 9:30 PM for immediate intervention by a vascular plastic surgery expert. 

The second hospital presented treatment records and pointed out that the patient had suffered severe septicaemia and vascular compromise, and hence, the doctors were compelled to amputate the leg in order to save patient’s life.

The Commission perused medical records of both hospitals and observed that the Doppler test was not available at the first hospital. Citing medical texts, the Commission pointed out the following:

“For treatment of fracture of tibia, protocol is necessary to assess neuro-vascular status of the limb and fracture as to be splinted. Medical record does not indicate that fist hospital followed this protocol of performing doppler study of the limb / CT Anzio. In case of suspicion, the above investigations are very crucial in first six hours of the injury. The reason for amputation is delay presentation for vascular treatment by first hospital, which was twelve hours in this case, whereas first six hours are golden hours from the time of injury. In view of the above evidence, it is a foregone conclusion, that for not following the protocols of treatment in the first six hours led to the amputation of patient’s left leg”.

The first hospital was held negligent and ordered to pay compensation to the patient.

Source : Order pronounced by Telangana State Consumer Disputes Redressal Commission on 7th August, 2023.