Grave medical negligence: Three patients on ventilator die at this city hospital

Dr KK Aggarwal and Ira Gupta

Three patients on ventilator support died on Tuesday night at Tamil Nadu’s Madurai Government Hospital due to an unexpected power failure. After the incident, the kin of the deceased patients sat on a dharna in front of the hospital seeking action against the apathy of the concerned officials.

According to the relatives of the deceased, three people died & two more who were on ventilator were fighting for life after a power cut that continued for nearly two & half hours in Madurai.

The power cut happened after rains accompanied by thunderstorms lashed the temple town yesterday night.

Mallika (55), a resident of Melur, Madurai, Palaniyammal (60), a native of Ottanchatiram, Dindigul, & Raveendran (52) from Srivilliputtur, Virudhunagar are the patients who died after the ventilator failure, sources said.

It was a 15 bedded emergency ward for accidental care of the Madurai Government Hospital near Anna bus stand in Madurai. When the thunderstorm happened, the power cut made the ventilators stop working.

Dean Vanitha Mani refuted the charge saying it was natural death due to the patients’ poor physical health. While it is true there was a power cut late in the evening, we had restored power immediately with the help of power back up. The deceased patients have not died due to ventilator failure. They were critical when their relatives brought them here from other private hospitals, she said. Earlier, at least 14 patients on ventilator support had died in a private hospital at Chennai due to a similar ventilator failure following power outages during the Chennai floods of 2015.  (Source: LatestLaws.com]

Unexpected fire, electrical failures are all accidents and will need to be compensated. These can also amount to negligence if the hospital had no ambu bag backup, electrical back up or no policy for medical accidents in the hospital. In the informed consent also there should always be a mention of unexpected complications and death. 

#AskDrKK: Starting enteral nutrition in a patient on ventilator

#DrKKAnswers: Starting enteral nutrition with a low infusion rate improves tolerability, compared to initiation at the target rate. A randomized study of 200 mechanically ventilated patients showed that enteral feeding (at the target rate or at 10 mL/hr for six days before being incrementally increased to the target rate) showed no differences in mortality, ventilator-free days, or ICU-free days, but the group that began at the target rate had more episodes of elevated gastric residual volumes and a trend toward more diarrhea.
Source: Crit Care Med 2011; 39:967.

#AskDrKK: Ventilator induced Diaphragmatic atrophy

#DrKKAnswers: Controlled mechanical ventilation can lead to a very rapid type of disuse atrophy involving the diaphragmatic muscle fibers.
An observational study found that diaphragmatic strength decreased progressively during mechanical ventilation and that long-term (>24 hours) mechanical ventilation was associated with diaphragmatic muscle injury, atrophy, and proteolysis compared to short-term mechanical ventilation (2-3 hours)

Source: Am J Respir Crit Care Med 2011; 183:364.