Case Study No. 6: Sudden death due to Acute Toxic Myocarditis as a result of Lignocaine, without taking Specific Written Informed Consent

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Disclaimer: The author has not shared details of patient or hospital, and is sharing information available from the Public domain and from his own knowledge. The information is for "pro bono" -for Public good. The Name of the Parties is not mentioned by the Author in his writings. There is no breach in confidentiality

Case studies in Medical Negligence

Case Study No. 6: Sudden death due to Toxic Myocarditis as a result of Bupivacaine, without taking Specific Written Informed Consent

Learning Outcomes: Adverse outcome and medical negligence

Medical Subject Topics: Toxic Myocarditis, Allergic testing, Written Informed Consent, Blanket Consent

The patient was late Dr XXX who was the daughter of the Complainant, and a Victim of Gross Medical Negligence leading to Death due to misadventure on the Operation Table.

The patient Dr XXX was a BDS doctor, and a patient with infertility who was following up with Dr. YYY

The patient Dr XXX was admitted for the purpose of DIAGNOSTIC HYSTERO-LAPAROSCOPY on 06/1/14. The Doctors have neglected to obtain the Required SPECIFIC WRITTEN INFORMED CONSENT for performing Diagnostic Hystero-laparoscopy under Spinal anaesthesia, and hence the Procedure is done illegally. The GENERAL BLANKET CONSENT for admission and minor tests is not legally considered SPECIFIC CONSENT in accordance with law, which has no specific risks, benefits and alternatives evident.

This is in consonance with Judgement of Samira Kohli Vs Dr Prabha Manchanda and anr (2008) 2 SCC 1: AIR 2008 SC 1385 and other Judgments

ECG was within normal limits and that patient was fit for surgery.

The doctors have not done the MANDATORY TESTING FOR ALLERGY of the drugs and Bupivacaine. This also amounts to GROSS MEDICAL NEGLIGENCE.

The Doctors have operated on the patient, and committed a GROSS NEGLIGENCE which has led to Cardiac arrest of patient and death; due to either excessive Carbon dioxide insufflation, Toxic reaction to the drugs leading to ACUTE TOXIC MYOCARDITIS, or anaesthetic reactions.

Acute Toxic Myocarditis

The doctors have delayed in inserting Endotracheal tube and intubation.

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Dr Savio Pereira is an experienced and Expert Medico-legal Consultant with Trans-disciplinary knowledge of Medicine, Law and Management. His interests are Consumer Law, Medical Negligence and Medico-legal matters.

Dr. Savio Pereira

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We heDisclaimer: The author Dr Savio Pereira has not signed details of patient or hospital, and is sharing information available from the Public domain and from his own knowledge. The information is for "pro bono" -for Public good. The Name of the Parties is not mentioned by the Author in his writings. There is no breach in confidentiality

Case studies in Medical Negligence

Case Study No. 5: Blood Cancer (Acute Myeloid Leukemia) developed as a Result of unmonitored treatment with High-dose METHOTREXATE for RA factor Negative patient with Vitamin D Deficiency treated wrongly as Rheumatoid Arthritis

The patient developed Blood cancer as a result on unnecessary treatment which was treated with Bone marrow transplantation.

Learning Outcomes: Adverse outcome and medical negligence

Rheumatoid Arthritis

Medical Subject Topics: Rheumatology, Haematology, Bone Marrow Transplantation, Adverse outcome Vs Medical Negligence, Chemotoxicity

Mrs. XXXX was suffering from BONE PAIN in the Small fingers, which was not diagnosed properly as Vitamin D Deficiency and Wrongly diagnosed as RHEUMATOID ARTHRITIS for JOINT PAIN.

The patient was treated by a Superspecialist Rheumatologist in reputed hospital in Bengaluru.

The patient had no signs of Rheumatoid Arthritis (R A) Factor Positive

Rheumatoid arthritis, and was wrongly investigated, treated with Methotrexate.

The Unnecessary prolonged Methotrexate therapy has led to development of Preventable Therapy related AML Blood cancer.

Acute Myeloid Leukemia

The State Medical Council has agreed that the BLOOD CANCER is Therapy related. The Point is that the Superspecialist should have investigated for BONE PAIN Causes including Hypocalcemia/Bone density/Vitamin Deficiency -which was diagnosed much later.

The point is that the Superspecialist should have given superspeciality Rheumatology care. The Point is that the THERAPY was not Methotrexate, but Vitamin D and Calcium replacement therapy. The unnecessary Methotrexate treatment has led to Preventable blood cancer.

The blood cancer of Mrs. XXX on account of their gross medical negligence, unethical medical practices and rash and negligent actions at the treatment stage itself -which is directly linked with Methotrexate toxicity (whether at low dose or high dose)

ISSUES

Mrs XXX had no signs, symptoms, Clinical Findings and Diagnostic tests suggestive of SEROPOSITIVE RHEUMATOID ARTHRITIS?

Mrs XXX had no signs, symptoms, Clinical Findings and Diagnostic tests suggestive of SERONEGATIVE RHEUMATOID ARTHRITIS?

It is submitted that the blood cancer in the patient is directly linked to methotrexate toxicity as mentioned in the discharge summary provided by the same hospital verbatim

“In view of long standing arthritis and methotrexate therapy and bone marrow morphological changes, a possiblility of underlying myelodysplasia is quite strong although cytogenetics was normal ”moreover Mrs. XXX did not have any other risk factors predisposing to leukemia as confirmed by a normal cytogenetics report

There have been several reports and case series all around the world in which drug induced pancytopenias and hematological malignancies have developed in autoimmune diseases receiving low dose MTX the citations for which are provided below and the original articles for the same is being procured and will be produced at the later stages if necessary.

Therefore it is submitted that the patient not only developed leukemia as a result of methotrexate toxicity but also at the risk of developing other hematological malignancies as described in the citations

About Abel Medico-Legal Consultants India

Abel Medico-legal Consultants are Associates based in Bengaluru, Karnataka, India. The Associates include Lawyers, Medical Experts and other Subject matter experts.

Key Associates

Advocate D Dominic James (M.Com, L.L.B.)

Dr. Savio Pereira

(M.B.B.S., M.S. (General Surgery), M Med. Family Medicine, M.Sc. Healthcare Informatics, M. Phil (Hospital and Health Systems Management), MBA (Hospital Management), L.L.B.

Dr. Savio Pereira

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