Patient dies of Subarachnoid Hemorrhage: Rs 25 lakh compensation on KIMS Hospital & doctors for not conducting proper investigations

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently directed Krishna Institute of Medical Sciences (KIMS) and its doctors to pay Rs 25 lakh compensation to the family of the patient, who died frontal hematoma with massive herniation of brain.

After perusing the medical records and medical literature, the Apex consumer court opined that the doctors at KIMS hospital treated the patient only symptomatically and failed to do proper clinical assessment and crucial investigations to find out Subarachnoid Hemorrhage.

"Considering the entirety, the expected the standard of care from the tertiary care hospital (OP-1) was more, but it was missing in the instant case. The treating doctors failed in their duty of care, not done the CT angiogram to know the cause of SAH, it could have saved the patient as discussed supra. Thus, negligence is attributed to the treating doctors and the KIMS hospital," opined the Commission as it enhanced the amount of compensation from Rs 5 lakh to Rs 25 lakh.

The matter goes back to 2009 when the complainant's husband, a qualified Dental Surgeon, met with a car accident and thereafter was taken to Government General Hospital at Kurnool. On the same day, he underwent knee surgery at Gowri Gopal Hospitals for fracture of right superior pole of patella. After conducting CT Scan of brain at Shanthiniketan Diagnostic Centre in Kurnool, it was revealed that the patient had haemorrhagic contusion in the left postero-temporal love with minimal edema.  Another CT scan suggested Subarachnoid haemorrhage. 

Following this, the patient was shifted to Krishna Institute of Medical Sciences (KIMS) at Hyderabad for further management. He was conservatively treated by the Neurologists for two days. However, the complainants alleged that the treating doctors had not performed CT angiogram or MRI of brain to rule out bleeding. 

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After being discharged from the hospital, the patient fell down and vomited. He was also complaining of shivering and severe headache. Therefore, he was taken to Government General Hospital. However, the patient became comatose and therefore, the patient was shifted to KIMS Hospital since he needed brain angiography and ventilator for life support.

CT cerebral angiogram was performed and it revealed progressive bleed and large hematoma in the brain. Subsequently, the patient expired on 31.01.2010 and alleging negligence against the KIMS hospital and its doctors, the wife and children of the deceased patient filed Consumer Complaint before the State Commission and prayed for Rs 90,00, 000 as compensation.

On the other hand, the KIMS Hospital and its doctors informed the State Commission about the treatment procedure and informed that the patient had been managed medically with analgesics and anti-edema medicines and he had been discharged with advice to come for follow-up after two weeks. 

Thereafter, the patient was brought to KIMS with history of recurrent seizures for 6 times and the patient was in an unconscious and comatose state with dilated nonreactive pupils. CT Angiogram was performed which revealed frontal hematoma with massive herniation of brain. The hospital and the doctors submitted that cranial surgery had been performed after obtaining informed consent of the wife of the patient. However, the patient suffered multiple cardiac arrests and despite best efforts, the patient could not be revived and he was declared dead. So, the hospital and the doctors denied any negligence on their part.

After considering the submissions, the State Commission had partly allowed the complaint and awarded Rs 5 lakh compensation to the family of the deceased patient. Being aggrieved with the order, KIMS hospital and its doctors approached the NCDRC bench. Similarly, the complainants approached the Apex consumer court seeking an enhancement of the amount of compensation.

The counsel for the complainant argued that the treating doctors had ignored Subarachnoid hemorrhage seen in the 2nd CT scan and they had also failed to perform CT angiography of brain when the patient first visited the hospital. As a result, cause of progressive bleeding was missed.

It was argued that if the doctors would have detected the progressive bleeding, it could have been treated by neurosurgical intervention. It would have averted the delayed aneurysmal complications and death of the patient. However, the doctors discharged the patient. Therefore, the counsel for the complainant argued that it was the failure to exercise reasonable standard of care from the treating doctors at KIMS.

On the other hand, the hospital and the doctors submitted that the patient did not follow the instructions and did not approach the hospital for follow-up after two weeks. Therefore, it could be presumed that the patient was totally normal, argued the counsel for the doctors and the hospital. Further, it was submitted that there was no relation with the previous treatment and the episode occurred after 45 days after discharge.

After considering the submissions and perusing the medical record and relevant medical literature on neurology and neurosurgery, the Apex Consumer Court noted that the discharge summary of KIMS was silent about the finding of Subarachnoid hemorrhage.

Referring to this, the NCDRC bench mentioned, "The CT scan of brain dated 11.12.2009 was reported to be hyper dense collection in right quadrigeminal cistern and anterior interhemispheric fissure. It was suggestive of Subarachnoid Hemorrhage. The doctors at OP-1 hospital treated the patient symptomatically, but failed to do proper clinical assessment and crucial investigations."

Holding the hospital and its doctors negligent, the top consumer court observed, "It is pertinent to note that the patient himself was a doctor and brought all the way from Kurnool to the KIMS, with a hope of better tertiary care. The expected duty of care at the tertiary care hospital is more. It was the duty of treating doctors to rule out the cause of Subarachnoid hemorrhage due to aneurysm. But in the instant case, the patient was discharged within short period of 2 days, it was a failure of duty of care. The CT angiography of brain if done on 12.12.2009, it could have detected the cause of SAH or any aneurysm. Thus the surgical intervention like clipping/coiling of aneurysm could have prevented from complications and saved the life of patient."

"Considering the entirety, the expected the standard of care from the tertiary care hospital (OP-1) was more, but it was missing in the instant case. The treating doctors failed in their duty of care, not done the CT angiogram to know the cause of SAH, it could have saved the patient as discussed supra. Thus, negligence is attributed to the treating doctors and the KIMS hospital," it further noted.

"The instant case was not a case of Error of Judgment, but it was the failure of duty of ordinary care, thus negligence. The Hon'ble Supreme Court in Dr. Laxman Balkrishna Joshi vs. Dr. Trimbak Bapu Godbole[3] had observed on "Duty of Care", that every doctor must exercise "reasonable standard of care" that are set out in the profession. Any breach towards these duties shall hold him liable for medical negligence. In the recent decision of the Hon'ble Supreme Court in the case of Arun Kumar Manglik V Chirayu Health and Medicare Private Limited and anr[4]. has traced the developments of law regarding medical negligence by referring to various Indian and foreign decisions and has held that a medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care," read the judgment.

While deciding the amount of compensation, the NCDRC bench also discussed the doctrine of contributory negligence by the patient, who did not approach the hospital for follow-up. At this outset, the Commission opined, "The patient himself was a doctor (Dentist) and after discharge for a month he had no symptoms, therefore he did not come for follow-up. Therefore, in my view, in the instant case an act of omission on the part of the patient has not materially contributed to the damage."

Referring to the Supreme Court order in the case of Sarla Verma vs. Delhi Transport Corporation, the Commission decided to enhance the amount of compensation and mentioned in the order, "Considering the facts and peculiar nature of the instant case in my view, the interests of justice would be met, if the amount of compensation is enhanced. Accordingly, the Complainants shall be entitled to receive an amount of Rs. 25 lakhs by way of compensation from the OPs. The hospital shall pay 16 lakhs and 9 lakhs shall be paid by the treating doctors OPs-2, 3 and 4 in equal proportion. The compensation, as awarded, shall carry interest at the rate of 6% per annum from the date of the institution of the Complaint before the State Commission until payment or realisation. In addition, the hospital shall pay Rs.1 lakh towards cost of litigation."

"The payment should be effected within two months of the pronouncement of this Order, failing which the entire amount shall carry interest @ 9% per annum till its realisation," the judgment mentioned.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kims-rs-25-lakh-compensation-195348.pdf

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