Negligence in Blood Transfusion: Hospital Faces Rs 20 Lakh Penalty

Iatrogenic diseases and complications, those caused by medical treatment or diagnostic procedures, are becoming increasingly common. This rise can be attributed to several factors, including the complexity of modern medical treatments, the use of sophisticated technology, and the growing number of invasive procedures. The term "iatrogenic" encompasses a wide range of medical errors, from minor adverse effects to severe complications, and even death. One tragic example of physician-induced death involves a woman who died following a blood transfusion. Blood transfusion, a vital medical procedure, involves administering blood from a donor to a recipient. This is often done in cases of significant blood loss or blood-related disorders. Typically, only red blood cells are transfused; however, other components like white blood cells, plasma, and platelets may also be used if needed. While this process is generally safe and performed intravenously, it can sometimes lead to severe complications, such as Transfusion-Related Acute Lung Injury (TRALI).

In 2018, a woman experienced a severe scooter accident, resulting in significant injuries to her mouth and face. Specifically, she sustained a fractured neck condylar process of the mandible, with dislocation noted on the right side, and an undisplaced linear fracture at the angle of the right side of the mandible, extending to the socket of the last molar tooth. Due to these injuries, a face and maxillary surgeon recommended open reduction and internal fixation surgery, which involves realigning broken bones and securing them with screws. The surgeon advised the woman's husband to admit her to the hospital under his care and provided a referral for the necessary procedures.

According to standard medical protocol, a blood transfusion was performed on the patient. However, immediately after the transfusion, the patient began experiencing severe body and leg pain. She reported this to a nurse, but it is alleged that the nurse did not provide adequate assistance. Subsequently, medical officer Dr. Selvan was informed of the symptoms. Along with Dr. Antony, he administered an injection to the patient. Unfortunately, the patient remained febrile, and her condition deteriorated further. Despite the administration of medication, no emergency intervention was initiated. As her condition became critical, she was transferred to the intensive care unit, but the delay in treatment proved fatal, and she succumbed to death.

The hospital issued a death certificate, citing "Sudden Cardio Respiratory Arrest" as the cause of death. The woman's husband, suspecting medical negligence, filed a police complaint. A post-mortem examination conducted by the Associate Professor and Head of the Department of Forensic Medicine at Coimbatore Medical College revealed that the cause of death was Transfusion-Related Acute Lung Injury (TRALI), linked to the blood transfusion carried out during the surgical repair of the fractured mandible.

The husband subsequently filed a complaint in consumer court, alleging that the hospital and attending doctors failed to properly monitor and address his wife's complaints of pain, showing a lack of diligence. He argued that standard protocols for blood transfusion were not adhered to, and no steps were taken to mitigate the complications that eventually led to his wife's death.

In response, the doctors and hospital presented evidence that all standard pre-transfusion tests were conducted. They claimed that the patient's reaction was due to an immune-mediated process that could not have been foreseen. They maintained that they provided the best possible care and argued that the incident was a medical accident. The defense also pointed out that factors such as immune mediation, particularly in patients with a history of multiple pregnancies, could potentially lead to TRALI.

An official investigation was ordered by the District Collector of Coimbatore, led by the Joint Director of the Medical and Health Services Department. The investigation confirmed that the woman died from Transfusion-Related Acute Lung Injury. The consumer court reviewed the case, focusing on whether the standard medical protocols were followed. The hospital asserted that they had obtained a consent letter from the husband, but the court found this claim to be unsubstantiated, as the husband testified that no such consent was obtained.

The court highlighted that prior to a blood transfusion, two crucial blood tests, known as "type and crossmatch," should be performed. These tests ensure that the donor's red blood cells are compatible with the recipient's serum. However, upon examination of the medical records, the court found no evidence that these tests had been conducted.

In its conclusion, the consumer court determined that the doctors' failure to adhere to standard medical procedures constituted negligence, which directly led to the patient's death. Referring to the expert testimony of Dr. K. C. Usha, the Professor and Head of Transfusion Medicine at Medical College Hospital, Thiruvananthapuram, the court noted that the doctors and hospital did not provide any substantial evidence of compliance with the guidelines for managing transfusion reactions. The court also referenced the case of Samad Hospital vs. Muhammed Basheer, where it was emphasised that medical practice should follow established protocols, particularly in managing adverse reactions.

The court's decision invoked the legal doctrine of res ipsa loquitur . As a result, the court awarded a compensation of Rs 20 lakh to the husband, holding the hospital and medical staff accountable for their failure to provide the necessary standard of care. This case underscores the critical importance of adhering to established medical protocols and the need for vigilance in monitoring and managing potential complications during medical procedures.

Reference :

1. Blood transfusion - Mayo Clinic. (2022, April 27). https://www.mayoclinic.org/tests-procedures/blood-transfusion/about/pac-20385168#:~:text=Overview,due%20to%20surgery%20or%20injury

(Input from various media sources)

(Rehash/Yash Kamble/MSM)