A Must-Read for Doctors: Delhi High Court’s Ruling on Medical Negligence

The Delhi High Court has made a significant ruling regarding the assessment of medical negligence, emphasizing that evaluations should be based on established standards of professional competence rather than personal dissatisfaction or preconceived expectations.

Background of the Case

The petitioner’s wife was suffering from the disease Systemic Lupus Erythematous. She was admitted to Max Super Speciality Hospital, Delhi. The petitioner who alleged medical negligence and misconduct against respondent-doctors. One of the allegations by the petitioner was that the infusion of 850 mcg of the drug Fentanyl within a short timeframe was reckless, effectively poisoning the patient and leading to her death.

Findings of Medical Councils

Initially two doctors were held responsible for professional negligence of duty by Delhi Medical Council.
Later on National Medical Council concluded that there was no sufficient basis to establish negligence against the respondent-doctors.

Court’s Ruling on Medical Standards

“While it is acknowledged doctors are expected to apply a reasonable level of expertise and exercise due diligence in their practices, their conduct must not be judged against preconceived notions of a specific procedure or outcome. Consequently, the proper criterion for determining medical negligence lies in assessing whether the actions of the doctor fall below the accepted standards of a reasonably competent practitioner within the relevant field.” – Justice Sanjeev Narula

Court’s Ruling on Dosage

The Court noted that the respondent-doctor’s case record provided a detailed explanation regarding the calculation of the dosage of the drug taking into account the patient’s specific health condition and weight requirements. It noted that this was duly considered by the NMC during its peer review process.
The Court asserted that determining the correct dosage and administration of medications like Fentanyl is a matter squarely within medical professionals’ expertise.

Final Statement of Court-

“While the Court empathizes with the Petitioner’s loss and appreciates the earnestness of his pursuit, it must emphasize that the findings of medical bodies, composed of experts in the field, carry considerable weight. Their determinations, supported by peer review, merit deference unless tainted by palpable perversity or illegality.”

What is SLE

An inflammatory disease caused when the immune system attacks its own tissues.
While there is no cure for lupus, current treatments focus on improving quality of life through controlling symptoms and minimizing flare-ups.

Fentanyl

Fentanyl is a potent synthetic opioid used primarily for pain management. When considering its use in patients with Systemic Lupus Erythematosus (SLE), here are some detailed aspects to consider:

Advantages:
1. Potent Pain Relief: Fentanyl is effective for managing acute and chronic pain, which can be beneficial for SLE patients experiencing severe pain or flares.
2. Rapid Onset of Action: Fentanyl provides quick relief, especially when used in forms like patches or intravenous administration.
3. Controlled Dosage: The drug can be dosed accurately, making it easier to titrate based on patient needs.

Disadvantages:
1. Risk of Addiction: As with all opioids, there is a significant risk of dependence and addiction, which can exacerbate psychological issues in SLE patients.
2. Side Effects: Common side effects include sedation, respiratory depression, constipation, and possible hyperalgesia (increased sensitivity to pain).
3. Drug Interactions: Patients with SLE may be on various medications, increasing the potential for drug interactions that could affect fentanyl’s efficacy or safety.
4. Potential for Overdose: Fentanyl’s potency means that there is a high risk of overdose, especially when not monitored closely.

Monitoring:
Close monitoring for efficacy and adverse effects is essential, especially in patients with SLE who may have multiple comorbidities. Adjustments may be necessary based on overall health status, pain levels, and potential side effects.

The Medical Bulletin