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What should a General Surgeon in Govt hospital do if the anaesthetist refuses to help for emergency LSCS?

Dr M C Gupta, a doctor turned lawyer, provides medico-legal opinion on what a surgeon in a government hospital should do if the anaesthetist refused to help him for an emergency LSCS (lower segment caesarean section).

Dr M C Gupta
Dr M C Gupta

Dr Gupta holds an MD (Medicine) from All India Institute of Medical Sciences (AIIMS), an LLB from Delhi University and LLM from Kurukshetra University. He has served as a faculty member at AIIMS for 18 years and as professor and dean at the National Institute of Health and Family Welfare. Currently, Dr Gupta is a practising advocate with health and medical law as the area of special interest. He is a member of the Supreme Court Bar Association and Indian Law Institute.

You Ask:

I am a Surgeon in a Govt hospital in Uttarakhand. I had to perform an emergency LSCS because no obstetrician was available (the post is vacant). The anaesthetist refused to assist me by giving anaesthesia on the ground that I am not an obstetrician. As per my knowledge, an MS General Surgeon is qualified enough to perform Obstetric procedures in case of emergency. What should I do?
— Dr Pranam Singh Pratap, Roorkee

Dr Gupta Responds:

1—An emergency life-saving surgery can be performed even by an MBBS in the absence of a specialist provided this is, as far as possible, explained to the patient/relatives and informed consent is taken.

2—In Surinder Kumar (Laddi) and Anr. V. Dr Santosh Menon and Ors. 2000; (III) CPJ 517, the Punjab State Consumer Commission held that there is no bar against an MBBS performing a Caesarean section merely on the ground that the doctor does not have a qualification in Gynae-Obs.

3—According to AP Medical Council:

“What can an MBBS Doctor do:-
(1) He can do all the Minor Surgical Procedures for which he is trained in MBBS Course and Housemanship.
(2) He can do Deliveries and its related procedures as trained.
(3) He can do National Programmes like Tubectomies & Vasectomies.
(4) In emergencies if a qualified surgeon is not available in the near vicinity as a life savings measures he can do first aid and a Surgical Procedure based on his experience.
(5) He should not do Elective Major Surgical procedures and the care should be taken to refer to a nearby Hospital where a Surgeon / Gynaecologist is available.”

http://imaapstate.blogspot.com/2010/12/can-mbbs-doctor-do-surgery.html

4—If it was life saving / emergency surgery, the anaesthetist, by withholding his services, committed a breach of the MCI Code of Ethics Regulations, 2002.

5—You may take the following actions:

i)—You may complain to the State Medical Council against the anaesthetist under
Regulation 1.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which reads:
“1.7 Exposure of Unethical Conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.”
ii)—You may complain to the State Health Department against the anaesthetist.

iii)—You may complain to the District Appropriate Authority set up under the Clinical Establishments Act, 2010, which has been extended to Uttarakhand—

http://www.thehindu.com/todays-paper/tp-national/tp-newdelhi/uttarakhand-doctors-to-protest-against-regulation-of-clinical-establishments/article4816042.ece

iv)—If the patient / relatives ask you as to whom they can complain in the circumstances, you may inform them that a complaint can be made by them to:

a)—State Medical Council (SMC) against the anaesthetist.
b)—District Consumer Forum against the hospital and the anaesthetist.
c)– District Appropriate Authority set up under the Clinical Establishments Act, 2010, against the hospital.
d)—Director, State Health Services.
e)—Police complaint, if so advised legally depending up on the facts of the case.

Dr M C Gupta (Former Professor and Dean)
MD (Medicine), LLM
Advocate (Delhi Bar Council No. 857/2001)

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