Relief: Madras HC Quashes Suspension of Hospital's License after patient dies post bariatric surgery

Chennai: Granting relief to a private hospital, whose license was cancelled following a patient's death after bariatric surgery, the Madras High Court has quashed the suspension order. 

After undergoing bariatric surgery at the hospital, a young patient suffered cardiac arrest and consequently passed away. Following this, the Joint Director of Health Services, Chengalpattu conducted a surprise inspection and cancelled the hospital's licence.

While considering the plea by the hospital the, Madras HC bench of Justice G.R. Swaminathan observed that even though the incident that took place was unfortunate, "For such a solitary occurrence, recourse to suspension or temporary cancellation of registration was an extreme measure. I come to the conclusion that the response of the second respondent (Joint Director of Health Services)  has been a knee jerk reaction and grossly disproportionate."

Earlier this year, the concerned patient with morbid obesity and other issues such as uncontrolled Type II Diabetes approached the concerned facility i.e. B.P. Jain Hospital to undergo Bariatric Surgery. He was getting treatment at a different hospital- Dr.Rela Insitution of Medical Sciences Hospital at Chromepet. Since the surgery cost at Dr Rela Institute was comparatively high, the patient was advised to undergo the said procedure at the petitioner hospital and accordingly, he underwent surgery.

The hospital informed the court that an experienced surgeon and a qualified anaesthetist assisted the treating doctor. However, after the surgery, the patient developed complications and therefore he was shifted to Dr. Rela Hospital. Despite being treated, the patient expired the next day i.e. 23.04.2024. As per the records, the patient died 36 hours after he was discharged from the petitioner hospital. 

Even though the deceased's family did not want postmortem, the issue became a matter of discussion in the media. In this background, a surprise inspection was conducted on 03.05.2024 and the order of temporary cancellation followed it. Challenging this order, the hospital approached the HC bench.

While considering the matter, the HC bench noted that one of the reasons set out in the impugned order of temporary cancellation was that no proper informed written consent was taken from the patient.

However, the HC bench took note of the consent form and observed, "Consent had been obtained by them for conducting surgery as well as for administering anaesthesia. Complications that may occur have also been set out in the consent form."

"If only the second respondent  (Joint Director of Health Services) had called upon the petitioner to produce the signed consent form, the petitioner would have produced the entire material and satisfied the respondents, that consent was indeed obtained from the patient. Nonissuance of prior notice, has thus seriously prejudiced the interest of the petitioner," it further noted.

The Court also noted that after the license was cancelled, the hospital had written to the authorities setting out point-by-point clarification.

"A mere reading of the aforesaid tabulated information would indicate that, if only the second respondent had put the petitioner on notice, probably the impugned order would not have been passed. That is why in case after case, Courts have insisted on compliance of the principles of natural justice," the Court noted at this outset.

Referring to the Hospital and Clinical Establishments (Regulation) Act, 1997, the Court highlighted that "Of course, proviso to Section 5 of the Act enables the authority to suspend the registration of any clinical establishment even without issuing any prior notice. But, recourse to the proviso can be taken only in exceptional cases. The authority must form an opinion that it is necessary or expedient so to do in the public interest. Formation of opinion is a condition precedent for invoking the proviso to Sec.5(2) of the Act. Of course, an independent order need not be passed. But, the formation of opinion must be reflected in the impugned order."

"From a reading of the impugned order, I am not able to discern the formation of such opinion. That apart, an order of this nature should be issued only if public interest really demands," it further noted.

The Court observed that the petitioner hospital has been in existence for 23 years since 2001. It noted that so far 2 million out-patients have been attended, and there have been 45,000 in-patients and 8500 surgeries which were carried out successfully. 

"Therefore, the authority must balance the competing considerations. That is why an administrative order is tested among others on the ground of proportionality. It is true that an unfortunate occurrence had taken place. For such a solitary occurrence, recourse to suspension or temporary cancellation of registration was an extreme measure. I come to the conclusion that the response of the second respondent has been a knee jerk reaction and grossly disproportionate," noted the Court.

With this observation, the bench allowed the plea and permitted the hospital to operate. It further observed,

"As a result of the impugned order, the sufferers will be the patients. We are witnessing an era of corporatisation of medical care. In such a situation, the existence of Government hospitals, Primary Health Centres and Hospitals which do not charge much are highly necessary. Therefore, the role played by such institutions will have to be recognized."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-239469.pdf

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