Death Due to Pulmonary Embolism Complication: Kolkata Hospital asked to pay Rs 10 lakh Compensation

Kolkata: The District Consumer Disputes Redressal Forum has recently directed the Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata to pay compensation of Rs 10 lakh while holding the institute guilty of gross medical negligence in providing treatment to a patient who died after having a pulmonary embolism

The case concerned a 50-year old man from Kolkata who had his open heart surgery in August 2010 at the said hospital

Suffering from breathing difficulty coupled with chest pain at the same time, On 24^th October 2013, the patient was admitted to the hospital. He was transferred to the ICCU on the same day where his condition was stable

The concerned doctor informed that the patient developed pneumonia and chest infection. The patient was referred to the Chest Specialist  who found a little deposit of fluid in the chest. On 26^th October, USG of the chest was done and the presence of plural effusion was found on both sides of lungs. Both doctors informed the family that the patient would recover fast by full dose of antibiotic and doctors would drain out the fluid by syringe. The condition of the patient was stable at that time.

On the very next day, it was informed that deposit of fluid was quite high and they would clear it by drain.

On 31^st October about 50 ml fluid was cleared by drain. The doctors informed that the residue fluid would be cleared by antibiotics. However on 1^st November, another doctor informed that a minor operation of 45 minutes’ duration was to be done on the patient to clear residuary fluid.

 With the consent of the family,  on 5^th November at about 5 pm operation was conducted. The condition of the patient was deteriorated. On 7^th November 2013, the family was informed that blood had clotted in artery of lungs and, therefore, the patient needed a further operation.

On 8^th November, Thoracoscopic Decortination operation was done upon the patient. On the next day, the blood was found coming out from the operation side. Patient’s condition became critical; he was referred to Hematologist on 10^th November. On 11^th November, dialysis was advised due to poor output of urine. However, at 2.20 pm it was reported that the patient was dead.

After the death of the patient, his wife registered a case against the hospital and its doctors, alleging gross medical negligence on their part.

The complainant mentioned that the cause of death was shown to be “Acute Pulmonary Thromboembolism”. She alleged that the doctors in the hospital conducted “Thoracoscopic Decortination” operation at their own risk in order to make professional and commercial gain. They are all guilty of medical negligence as well as deficiency in service.

The doctors and the hospital jointly submitted the steps of treatment and operations as stated by the complainant in the petition of complaint are admitted. They mentioned that the patient died due to Acute Pulmonary Thromboembolism, which is a known complication. There is no medical negligence or deficiency in service on their part, they claimed.

The Court went through the literature of the case and quoted the order of Apex Court-

 A doctor is to seek and secure the consent of the patient before commencing treatment/surgery and that the said consent must be voluntary and should be on the basis of “Adequate Information “regarding the nature of the treatment, procedure ,so that the patient or the patient party knows what is consenting to.

The Consumer Court observed that the doctors did not follow the said guidelines of the Supreme Court.

The operation has been conducted upon the patient several times. But, no valid consent has ever been taken by the Opponent Parties, though it is incumbent upon them to take such consent either from the patient or from the patient party. It has been stated by the complainant herself in her evidence and also in her pleadings that the hospital authority has managed to get some papers signed from her without informing her about the consequences of the operation to be conducted upon her husband. The hospital authority would have been able to file the consent form from which it would be clearly discernable what kind of consent had been accorded by the complainant to the surgery or treatment procedure conducted upon her husband by the doctors. Had that consent form been produced before the Forum, it would have been available from that form whether the opponent parties have explained the risk involved with the treatment/operation conducted upon the patient. But no such consent form has been produced before the Forum. In absence of such consent form, we feel no hesitation to say that the Opponent Parties did not ever take any consent from either the patient or the patient party for the treatment and operation conducted on the patient in the hospital.

The Court received an expert opinion dated 28^th May from the Medical Superintendent cum Vice Principal of SSKM Hospital, Kolkata. The relevant portion of the expert opinion runs as follows:-

“The complications developed following the surgery quite common in view of compromised cardiac status of patient. Ultimately the patient developed pulmonary Embolism which itself is a very fatal complication. This complication bears near 100% mortality. Unfortunately the patient had succumbed to death due to this very grave complication inspite of the best efforts of the doctors”.

After going through the entire case, the forum observed-

The operation has been conducted thrice upon the patient i.e on 31.10.2013, 7.11.2013 and lastly on 5.11.2013. On 31.10.2013,  50ml fluid had been aspirated from the chest of the patient, on 7.11.2013 pulmonary-CT-angiography was done and on 5.11.2010 “Thoracoscopic Decortination” operation was done upon the patient. All these are admitted by the O.Ps in the written statement filed by them. But , in no case of the operations, consent was taken by the O.Ps. There is no pleading that the operating doctors themselves explain the risk of operations to the patient or the complainant. Regards being had to this aspect in particular, we do say that it is gross medical negligence on the part of the O.P Doctors and also deficiency in service on their part.

The forum observed-

 It is established by the expert report that the patient died due to pulmonary embolism which is a fatal complication and it bears near 100% mortality. From this opinion of the expert, we can imagine how grave the complication is. This complication arose out of “Thoracoscopic Decortination” operation. If a particular operation is involved with such high risk, the surgeon who conducted such operation should have taken a second opinion before jumping into action.

The forum added-

Every prudent person will do it. Every prudent person will think twice over this matter while going to take such a risky step. But the doctors of the O.P-1 hospital did never bother to take a second opinion from any other especialised doctor of the field. They did not even care to explain the risk to the patient or the patient party. They kept all these suppressed.  Is it not negligence on their part? Is it not deficiency in service on their part? In our opinion, the doctors of O.P-1 hospital had some ill intention in their mind. May be, they wanted to squeeze money from the complainant and ,therefore, they kept these suppressed to the complainant, because had they divulged the high risk factor of the said patient to the complainant, the patient would have gone out of their hospital. Such a conduct on the part of the hospital and the doctors of the hospital tantamounts to unfair trade practice.

The Consumer Forum finding the treating doctors to be guilty of gross medical negligence and directed them to pay are directed to pay compensation of Rs10 lakh to the complainant.