PGI shock therapy: When surgery delayed became surgery denied

PGIMER put off schoolgirl’s operation because of a rush of patients.

Written by Smriti Sharma Vasudeva | Chandigarh | Published: July 27, 2012 12:29:18 am

On July 17,doctors at Chandigarh’s Postgraduate Institute of Medical Education and Research (PGIMER) put off a surgery on road accident victim Anupama,17,because there were other cases that they felt needed more urgent attention.

Anupama died on July 24,the surgery never done,and infection having spread all over her body from one of her legs,which had been crushed by a bus and was amputated three days later. During those seven days,one more surgery was postponed,again on the ground of other cases being more urgent. By the time she was finally taken to the operation theatre,her condition was too far gone to allow any surgery other than the amputation.

Today,Anupama’s parents Konika and Amit Sarkar say doctors had “dumped” her in the pre-operative hall for three days. “We kept requesting them,but they cited a rush of patients. Whenever we said our daughter was in pain,we were told every patient was in pain,” said Konika Sarkar.

Hospital authorities cited helplessness amid the rush. A patient should be prepared to expect delays at PGIMER,said Dr Mandeep Dhillon,head of its orthopaedics department.

Anupama was in Class XI at Government Senior Secondary School in Sector 18. She was climbing a bus home from school around 1.30pm on July 17 when it suddenly began to move; she slipped under.

The police took her to the Government Multi-specialty Hospital in Sector 16,the nearest. Two hours later,the hospital decided the injury was too serious and referred Anupama to PGIMER,which admitted her to its advanced trauma centre. Till then,her case was deemed serious enough to require surgery that very day. Doctors asked her family to bring the surgical items,before postponing the surgery.

“The next morning,she was taken to the pre-operative hall at the trauma centre. Then surgery was postponed again for the rush of emergency patients,” said Amit Sarkar.

On July 19,her condition worsened at night and she was taken into the operation theatre. “But the doctors told us she had been found intolerant to anaesthesia. She was brought back to the pre-operative hall,” her father said.

On July 20,doctors found the leg had developed gas gangrene and this had spread all over the body — the dressing had not been changed for two days. Even after the amputation,she was left with little hope of survival with the gangrene having reached the lower abdomen . By Tuesday,July 24,when Anupama was declared dead at 5.30am,she had developed sepsis due to gangrene in her entire body.

Anupama’s parents said they had wanted to donate her eyes but the infection had made it impossible.

The orthopaedics head said they never turn back any patient,even if he requires only a simple dressing. Unlike doctors who had cited more urgent cases in delaying Anupama’s surgery,Dr Dhillon said,“It is bound to take time for any patient who comes with a grievous injury as there are patients (in the queue) who may not require emergency treatment.”

He added,though,that priority is set based on a number of factors that senior consultants take into account: severity of the wound,neurological and vascular status,the time since reporting and stability of the patient.

He said his department has 17 beds in the advanced trauma centre and,as of today,the department has 90 patients. All the rest are on trolleys. At any given time,he said,40 per cent of the resident doctors in orthopaedics are posted full-time in ATC. That leaves 60 per cent for other areas like the regular operation theatre,wards and the OPD,which too are high-intensity areas.

Day by day

July 17: Anupama’s leg is crushed under a CTU bus in Sector 18. Taken to a hospital,then referred to PGIMER. Surgery planned in the evening but not done. “She could not be operated upon the same night due to prior pending open fractures and complex trauma cases,” PGIMER authorities said later.

July 18: Surgery postponed on the ground that “there are more serious patients to attend”.

July 19: Anupama taken to operation theatre but plunges into shock. Surgery cannot be done.

July 20: Infection spreads to her body,diagnosed with gas gangrene. Leg amputated. Declared critical.

July 21: Put on ventilator.

July 22: Blood pressures dips,sepsis all over body with severe inflammation.

July 24: Anupama dies at 5.30am

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