In other words is it mandatory to fulfill all the parameters of “Practice Guidelines for performance of……” in every patient? If a doctor is unable to fulfill a certain parameter, what is the option? For example fetal anatomy in I Trimester or fetal heart in II Trimester. Legally medical negligence means failure to act one or more perfectly proper standards and if one conforms with one of these proper standards, then he/she is not negligent. “Practice Guidelines for performance of……” reflects the concept of “standard of care” (
Quoted from one of the verdicts). So following guidelines is crucial. But what if? Does Guidelines provide a solution?
What if the examination cannot be performed in accordance with these Guidelines?
Recommendation • If the examination cannot be performed completely in accordance with adopted guidelines, the scan should be repeated to ensure a complete examination, or the patient should be referred to another examiner (GRADE OF RECOMMENDATION: C)
These recommendations represent minimum suggested Practice Guidelines for the mid-trimester fetal ultrasound scan. If time, equipment and skills allow, more comprehensive evaluation is encouraged. Consideration should be given to local circumstances, standard practice and regulations. Reasons for deviations from these recommendations should be documented. If the examination cannot be performed completely in accordance with adopted guidelines, the scan should be repeated to ensure a complete examination, or the patient should be referred to another examiner, as
abnormalities are eventually detected in 0.5–5% of such cases. This should be done as soon as possible, to minimize unnecessary patient anxiety and unnecessary delay in the potential diagnosis of congenital anomalies or growth disturbances. So if the doctor documents that he/she has not seen some fetal part that is described in guidelines, it should be documented in the report and suggest a scan at a higher centre. This is standard of care as per guideline and the doctor is not negligent. I am quoting here a case of recent verdict form NCDRC. The doctor who performed second trimester scan had reported “that limbs have not been assessed”. At birth the newborn had a missing limb. NCDRC concluded “Has to do anomaly scan even if not asked for” and awarded compensation to the couple. What is the solution? It is upto professional associations to ponder and protect its members.
