Absence of Informed Consent, Proper Investigations for treating Acute Pancreatitis patient: Consumer Court directs hospital, doctor to pay Rs 9 lakh compensation

Gondia: The district consumer disputes redressal commission, Gondia has recently directed Gondia city hospital and its doctor to pay Rs 9 lakh compensation to the family of a patient, who died while undergoing treatment for Acute Pancreatitis.

Such a decision was taken by the District Consumer Court after it noted that the hospital did not obtain any informed consent from the patient and his family members and also did not conduct proper investigations.

Therefore, the hospital and the doctor have been directed to pay Rs 9 lakh compensation to the family of the deceased within a period of four weeks.

The matter goes back to 2006 when the deceased patient who was 35 years old at that time, had approached Gondia City Hospital as he was suffering from pain in the abdomen, vomiting and headache problem. It was submitted by the complainants, who are the parents and wife of the deceased, that the patient was recovering speedily. 

However, suddenly the patient complained about chest pain and thereafter the doctors and the nursing staff had been informed. It was alleged by the complainants that the staff nurse had given some unknown injection to the patient and after that the patient became unconscious and his movement became unstable and there was no other doctor available at the relevant time. Although the treating doctor, Dr. Agrawal had reached the hospital late in the night and the treatment was started, the patient could not be saved.

Although the hospital authorities claimed that the patient had died due to heart attack, the complainants were convinced of negligence on the part of the hospital authorities. Therefore, they demanded the Indoor medical files. However, the hospital authorities refused the request. Finally when the hospital authorities provided the complainants with the records, there were no signatures in it. 

Claiming that the copy of the records were fabricated, the complainants alleged that the staff nurse had given an unknown injection to the patient without informing specialist doctor about his chest pain. Submitting that the deceased was earning Rs 20,000 per month, the complainants claimed Rs 19,50,000 as compensation from the doctor and the hospital.

On the other hand, the hospital and the doctor claimed that the complaint had been filed only to grab money. They submitted that the patient was behaving abnormally and having tremor, searching movements and irrelevant talks. Therefore, they had suspected the possibility of alcohol withdrawal. Several tests had been conducted including the ECG, malaria test, but nothing abnormal was found.

However, the blood test reports revealed that the total leucocytes, serum creatinine, serum amylase and serum lipase were raised and it confirmed the diagnosis of Pancreatitis. Thereafter the patient had been given injection Contramal for relief of pain, injection fulsed 1 ml iv for sedation. Howevr, the patient was still behaving abnormally so he was given Injection Serenace 0.5 ml diluted with 10 ml distilled water after half an hour. Due to this, the patient was sleeping but moving intermittently. However, the patienr had a sudden cardio respiratory arrest and he died. It was submitted that the hospital and the doctor had made all the possible efforts to save the patient and there was no deficiency on their part.

Both the parties had relied upon several important judgments and referred to several medical articles as well to prove their case.

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The Complainants had also filed an application for appointment of the expert/ independent Court commissioner to verify the medical records of the deceased filed in the proceedings and declare the opinion.

On 25/09/2019 the complainant filed application for appointment of Director of Government Medical College & Hospital Nagpur to submit its report on the basis of documents filed before the forum.

Following this, the forum had received a letter from the Medical Superintendent, Government Medical College and Hospital, Nagpur demanding certain documents i.e medical test reports. Consequently the Complainant informed on 12/10/2021 that he does not have any other documents.

After taking note of the submissions of both the parties, the first thing that the Consumer Court considered was whether there was any procedural lapses in obtaining the informed consent. In this regard, the Commission referred to the Supreme Court order in the case of Samira Kohli v. Dr. Prabha Manchanda & Anr, where the Apex Court had summarized the principles relating to consent.

Holding the hospital and the doctor deficient in obtaining the consent, the Commission noted,

"We certainly consider that there is deficiency in service in not obtaining the informed or even simple consent of the deceased who was conscious, mentally alert and was in a position to give it nor obtained from the complainant's No. 1 to 3...There is no proof to show that the rationale for performing treatment and attendant risk involved were communicated to the patient prior to the treatment."

For this, the Commission directed the hospital and the doctor to pay Rs 1 lakh compensation to the complainants and mentioned in the order, 

Therefore, drawing inspiration from the landmark judgment (supra), we conclude that there has been deficiency in service by the treating doctor in not obtaining the informed consent from the patient. Accordingly, we hereby award Rs. 1,00,000 as compensation to be paid by the opposite parties to the complainants on procedure lapses."

While considering the question if the doctor failed to provide proper diagnosis and treatment as per standard protocol, the Commission referred to the report and noted that the treatment had been given for Acute Pancreatitis. The Commission also perused the relevant medical literature and noted that the standard investigations for Acute Pancreatitis include a detailed history and physical examination, and investigations such as liver function tests (LFTs), lipid profile, serum calcium and imaging.

"LFT, serum calcium, serum TG, abdominal USG and CECT scan are the standard phase I investigations," observed the commission.

Referring to this, the Commission observed,

"From records it is clear that investigation of phase I has not been carried out and due this proper diagnosis of Late Rajeshwar Gautam is not properly done which amounts to deficiency in service."

Besides, the consumer court also referred to the Nagpur Hospital Committee which had suggested that in absence of proper reports it was not possible for them to submit report on what treatment was given and whether the hospital and doctor had committed any deficiency.

Taking note of this, the Commission held the doctor guilty of deficiency in service and also held the hospital vicariously liable for the same. Directing them to pay another Rs 8 lakh compensation to the complainants, the Commission mentioned in the order,

"The opposite party No. 1 & 2 are jointly & severally liable to pay Rs. 9,00,000/- (Total compensation Rs. 1,00,000/- + Rs. 8,00,000/- as per Issue No. 1 + 2)in total for procedure lapses and for deficiency in service to be paid within four weeks from the date of receipt of this order to the complainant 1, 2 & 3 equally. If fails to comply, penal interest @ 10% p.a. would be applicable after four weeks till realization."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/maharashtra-9-lakh-compensation-191901.pdf

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