1. DEATH
on
Operation Table
(DOT)
A Gynaecologist View point
Dr. Sharda Jain
Director s:

2. I Dedicate this PPT to my
Colleagues ,Students & Patients
Review this lecture at
slide share.net
Presented in PCCON 2014

3. Hippocratic
Oath

4. “ W.H.O.”
Surgical Safety

5. Even with simplest operation it
can not be
taken for granted that patient
will come out
Better of or even alive

6. People do want a
Top / GOOD surgeon;
But “LUCKY SURGEON”

7. The 100% successful surgery is
impractical….
unexpected Complications do strike
A BOLT FROM THE BLUE

8. DOT
80/20

9. A surgeon is caught at least once in lifetime
in this tragedy !!

10. WHAT IS D.O.T.

11. DOT is Always Possibility
in any surgery

12. D.O.T. : Survey of 100
Gynaecologists / Surgeons ..
done by our Team
80/20
IT CANNOT ALWAYS BE ELIMINATED ALL TOGETHER !

13. I become a Gynae surgeon I, realized that
despite a bad prognosis some patients
survive and despite good chances some
payients die.
I have never found out why this is so.
I have now stopped taking CREDIT for a
successful surgery. Before every surgery
I pray to god to help me do my best.
Dr. Sharda Jain

14. Do Not be aggressive to pick up knife
… “A living soul on chair is far better than dead”
In complicated surgeries I often regret
operating on patients who don’t survive.
The thought that perhaps an alternative
palliative therapy would have suited them
keeps nagging me.
Regret
Prof. PK Devi

15. Risk of Death
 Caesarean Section 1 in 12,000
 Hysterectomy 1 in 4000
 Laparoscopy 1 in 8000
 Minor Procedure 1 in 15000
Gross Underestimation !!

16. STRATEGIES
to decrease problems for Doctors

17. INFORMED CONSENT
Is to be taken Seriously
o Is vital for gynaecologists & Anesthetists to fully
understand the importance of counseling & take
STD / High Risk Consents

18. Video Recording
(if smelling problems !!)

19. INSURANCE COVER
is must for all gynaecologists

20. D.O.T.
Raises a Number of Special
Medico - Legal Questions.

21. Few Facts
D.O.T.
It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
Litigation Arrest

22. Cause of Litigations
*Total Lack of Empathy
* Lack of Good
Communication skills

23. Handling a Death on OT Table
(Support System)
Challenging & Difficult Task

24. What are we worried
ABOUT – Breaking Bad News
• Damage to reputation
• Facing questions of relatives
• Fear of mob violence
• Handling police enquiry
• Medico-legal issues – arrest,
courts, case, judgment…
• Compensation amount
• Loss of confidence
• Stress in future cases

25. Loss of Reputation
What we fear most is the loss of our
reputation, which we build on hundreds of
good surgeries. If one case goes against us
in the court, and it gets publicized, we may
lose our hard – earned reputation.
Dr. Yogesh Agarwala

26. How to Break Bad News !
Is the MOST DIFFICULT TASK !!

27. Support Systems is Vital
(Surgeons & Anesthetists)
•OT Staff,
•Administration of Hospital
•Sr. Colleagues Have to extend helping hand

28. Before Declaring to Relatives
& Informing Police….
• During intra-operative procedure keep relatives
informed if patient is serious and collapsing.
• Complete all relevant documents such as case paper
with detailed anesthesia and surgeon notes,
resuscitation notes, any visiting consultant notes.
• Notes should tally among consultants and there should
not be any contradictions.
• Preserve all the broken ampoules of injections, no
expired drugs should ever be found in OT.
• Leave things as they are, do not clear up the OT.
• Take back all prescriptions if any, from relatives
especially for emergency drugs.

29. Help Yourself Not to be Beaten Up
INFORM
Superintendent of hospital
Police Station
Security Guards
Keep Emergency Exit available

30. Interaction with the POLICE
• Informing the police
• Police perform “Panchnama”
• Handing over the papers after numbering
• Information to police shall preferably be in
writing and the written acknowledgement should
be obtained.
• If the information is telephonic
one must note down name,
buckle number and
designation of the police.

31. Practical Tips For
Great Interview

32. Keep a Bold Face !!
Never worry, “Be concerned”

33. How to Handle The Situation…
 Gather
 Ask for help in OT
 Relax
 Review sequence of events
 Do not adopt a “Blame Culture”
 Proper documentation
 No discrepancies in records
 No comments by junior staff
Never worry, “Be concerned”

34. RELATIVES WANT to know TRUTH
 Be honest
 Integrity pays
 Sympathetic approach

35. Anticipate Reaction of Patients /
Relatives & Handle it Well

36. Tips to Communication Skills
• Avoid AGGRESSION or putting BLAME
on relatives
• Staff SHOULD NOT CONTRADICT
statements made by consultants to
avoid misinterpretation by relatives.
• DO NOT REFUSE TO
GIVE RECORDS
or refuse postmortem,
rather suggest it from your side.

37. Being Sensitive to Verbal & Nonverbal
Language of the patients & Relatives
Give time & space:
EMOTIONAL DISCHARGE
Give opportunity to ask questions

38. Arrest of a Doctor
• Postmortem report
• Opinion of police surgeon
• Discretion of the Investigating Officer
after taking opinion of expert panel
Arrest of a Doctor
Should not happen / But does happen inspite
of Supreme court Ruling

39. • A survey in the British Medical Journal reported
the attitudes of doctors towards the intra-operative
death of a patient………
• 84% response rate
• 92% of respondents had experienced a DOT
• Majority of deaths being expected by 60%
• 77% say these DOT are non-preventable
• 80% says occurring during emergency surgery
• In 41% of cases involving vascular surgery
• 87% had given repeat anesthesia in next 24
hours.

40. • The KARNATAKA HIGH COURT, while
proceeding a case of DOT held that in the
absence of postmortem, histopathology,
etc, the possibility of other causes of death
can’t be ruled out. The death on the
operation table by itself is not sufficient to
prove rashness or negligence against the
accused.

41. Supreme Court 2014
11 – points code on med Negligence
1. Negligence is a breach of duty or an act which Prudent and reasonable
man will not do
2. Negligence to be established by the prosecution must be culpable or
gross and not the negligence merely based upon an error of
judgment
3. Medical professional is expected to bring a reasonable degree
of skill and knowledge along with a reasonable degree of
care but neither the highest nor the lowest degree of care and
competence
4. A doctor would be able only where his conduct fell below that of
the standard of a reasonable competent practitioner in
the field.
5. Difference of opinion cannot be cited as negligence.

42. Supreme Court 2014
11 – points code on med Negligence
6. Just Because a professional looking at the gravity of illness had
taken a Higher Element Of Risk to redeem the patient out
of his suffering which did not yield the desired result, it may not
amount to negligence
7. Merely because a doctor chooses one course of action in
preference to the other one available, he would not be liable if
the action chosen by him was acceptable to the medical profession
It would not be conducive to the efficiency of the medical
profession if no doctor could administer medicine without a hinter
round his neck.
8. It would not be conducive to the efficiency of the medical without a
halter round his neck.

43. Supreme Court 2014
11 – points code on med Negligence
9. It is our duty not to harass or humiliate medical
professionals unnecessarily so as to allow them to
perform their duties without fear and apprehension
10. Doctors at times have to be saved from such
complaints that use criminal process as a tool for
presuming them or hospital and clinics for
extracting uncalled for compensation
11. Doctors are entitled to get protection so long as
they perform their duties with reasonable skill and
competence and in the interest of patients.

44. Last, But Not The Least…..
Every new day brings CHALLENGES AND OBSTACLES
 Stop thinking about it constantly at HOME
 Keep your morale & self confidence intact
 Learn the lesson it teaches
 Take a small break

45. We all make mistakes
?
How many of you have ever felt that
“I” should NOT be practicing medicine
because
I am too dangerous and not good for society

46. ADDRESS
11 Gagan Vihar , Near Karkari Morh
Flyover Delhi -51
CONTACT US
9650511339
011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com

47. Left you with many Q unanswered