Dr Prakash Detroja arrested in a case of death due to medical negligence [TOI, IE]

Health Care Comments Off
  • The Crime Branch on Tuesday 21st August in Rajkot arrested Dr Prakash Detroja in connection with the death of an eight-year-old girl Drishti who died on the operation table in the city on June 4.
  • Drishti had a small boil on her tongue and was brought to Dr Detroja’s hospital, where he advised a minor operation.
  • However, Drishti’s condition deteriorated soon after anesthesia was administered and she died on the operation table.
  • The forensic report, which arrived on Tuesday, said the girl died after an anesthesia overdose.
  • According to the crime branch official V B Jadeja, efforts are on to nab the anesthetist Dr Anil Patel.

Source [Dr. Harkanwaljit Singh Saini, Hoshiarpur]

Lessons

  1. Over the past several decades, anesthesia related mortality rates have reduced from two deaths per 10,000 anesthetic administered to one death per 200,000 to 300,000 anesthetics administered.
  2. Complications are much more likely to occur in patients with preexisting disease states.
  3. The relative risk of serious perioperative complications is 2.2 and 4.4 for ASA patient status III and IV, respectively, illustrating that increasing serious co-morbidities increases perioperative morbidity
  4. Proper consent is a must.
  5. OT table details should be reported to police by ourselves.

American Society of Anesthesiologists physical status scale

ASA class Physical status Functional status Examples Risk status
1 Healthy, no disease outside surgical process Can walk up one flight of stairs or two level city blocks without distress

Little or no anxiety

Little or no risk

Green flag for treatment

2 Mild to moderate systemic disease, medically well controlled, with no functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop after completion of the exercise because of distress

ASA I with extreme anxiety and fear, a respiratory condition, pregnancy or active allergies

Well controlled disease states including diabetes, hypertension, obesity, epilepsy, asthma or thyroid conditions Minimal risk

Yellow flag for treatment

3 Severe systemic disease that results in functional limitation Can walk up one flight of stairs or two level city blocks but will have to stop enroute because of distress History of angina pectoris, MI, CVA; HF >six months ago, COPD, diabetes with vascular complications, poorly controlled HTN, morbid obesity Yellow flag for treatment
4 Severe incapacitating disease process that is a constant threat to life Unable to walk up one flight of stairs or two level city blocks. Distress is present even at rest. History of unstable angina, MI or CVA within last six months; severe HF, severe COPD; uncontrolled diabetes, HTN, epilepsy or thyroid condition

Advanced pulmonary, renal or hepatic dysfunction

The risk may be too great for elective surgical procedure

Medical consultation needed for emergency treatment

Red flag for treatment

5 Moribund patient not expected to survive 24 hours without an operation Ruptured abdominal aneurysm, pulmonary embolus, head injury with increased intracranial pressure Elective treatment is contraindicated; however, emergency surgery may be necessary

Red flag for treatment

6 A declared brain-dead patient being maintained for harvesting of organs
E Suffix to indicate emergency surgery for any class Any patient in whom an emergency operation is required Otherwise healthy young woman requiring D&C for persistent vaginal bleeding

MI: Myocardial infarction; CVA: Cerebrovascular accident; HF: Heart failure; HTN: Hypertension; D&C: Dilation and curettage.

Medical Emergencies in the Dental Office, Sixth Edition, Mosby Elsevier, St Louis 2007