Index Title:

RDELEON’s Medical Anecdotal Report [05-03] 

MAR Title:

            Medico-legal    

Date of Observation:

March 2005 

Narration 

            An 83 year-old male from a private hospital transferred to our institution due to financial constraints. He sustained a femoral neck fracture almost a month ago and sought consult with our service consultant in one of his private clinics.

             A cardio-pulmonary evaluation was requested by our consultant since the patient was elderly. Laboratory examinations were requested, but since these had been done in the private hospital from where he came, the patient and his relatives refused to repeat these. We informed the consultant of the situation and were advised to tell the relatives to retrieve all the results from the other hospital.

             During one of our night rounds, the relatives were asked me why there patient had not yet been operated on. They were expecting an immediate operation after admission. I calmly told them that the CP evaluation was not yet done since they haven’t given us a copy of requested labs, that when they do, I’d make sure that the CP evaluation would be done immediately.

             The following day they complied. The evaluation was done with an assessment of fair surgical risk for partial hip replacement. I informed the service consultant of this. He was then scheduled the operation and did it 3 days after.

             Partial hip replacement was done smoothly. Post-operative care was given and I gained their full trust. I personally did the wound cleaning and made sure that the patient was up and about.

             A week after the operation, the service consultant gave the order to discharge the patient.

             Unfortunately the patient suddenly had an episode of difficulty of breathing and subsequently died. The relatives were shocked. One of the relatives approached me. It was the first time I saw that particular relative. She began questioning me on what happened to the patient and why did he died. Another relative called and asked me the same questions.   She was blaming me and the operation for the fate of the patient.

             I tried to answer all her questions and at the same time tried to comfort her. It was really difficult. One of the relatives who were with the patient since he was admitted approached us and told her “Ginawa nila lahat. Hindi nila pinabayaan ang tatay. Inasikaso nilang mabuti ang tatay!”

INSIGHT (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcement) 

             For the past three years that I have been in this institution, we were taught that all patients/cases are potential medico-legal suit. There are 4 D’s in medical malpractice namely, Duties, Dereliction of Duties, Direct causation and Damage. NO malpractice suit should prosper in court in the absence of any one of the following elements.

             We were also taught how to handle and avoid such a scenario. Good communication with good rapport to our patients and there relatives is vital in avoiding medico-legal suit.