Bolam Test Fallout: AMRI Hospital Nephrologist told to pay Rs 5L compensation for fatal delay in blood transfusion

In the order pronounced on September 27, 2023, Justice Manojit Mandal, President; Samiksha Bhattacharya, Member; Shyamal Kumar Ghosh, Member observed that depending upon the principle of Bolitho Test there was no hesitation to hold that regarding delayed blood transfusion, to some extent medical negligence on the part of the nephrologist has occurred and in this respect the medical negligence on the part of the doctor was proved.

Case Overview

The case revolves around the treatment of the complainant's wife, a 67-year-old diabetic patient suffering from kidney damage requiring regular dialysis. The initial treatment commenced at Bellvue Hospital in Kolkata, later shifting to AMRI Hospital, Salt Lake. The complaint outlined instances where alleged negligence took place during her treatment.

Allegations and Timeline

The complainant presented a series of events accusing medical negligence. He alleged that the dialysis schedule was not maintained consistently, and on December 2, 2016, a dialysis session was missed due to a failed perm catheter, resulting in admission to AMRI Hospital. The complainant expressed suspicion that this admission was primarily for commercial purposes rather than medical necessity.

Further instances of alleged negligence included the mismanagement of a catheter infection in January 2017, inadequate treatment, and discrepancies in following prescribed medication regimens.

He claimed that on January 31, 2017, another Nephrologist, Dr Das, prescribed Vancomycin injection post-dialysis. Despite the prescription, AMRI Hospital allegedly refrained from administering Vancomycin, causing a deterioration in the patient's health.

Furthermore, delays in blood transfusions were reported, despite the patient's declining condition. Ultimately, the patient passed away on April 3, 2017, allegedly due to medical negligence.

Complainant’s Argument

The complainant, representing himself, argued that his wife was undergoing dialysis twice a week, initially at Bellevue Hospital, Kolkata, and later at AMRI Hospital. He alleged that on December 2, 2016, the patient was advised admission for a malfunctioning perm catheter. However, suspecting commercial interests, the complainant opted for a different clinic for the catheter replacement.

The complainant highlighted instances where Vancomycin was not administered despite being prescribed, and the delayed blood transfusion, which ultimately led to the patient’s demise.

The complainant sought proper relief and compensation to the tune of Rs 50 Lakh against the hospital and its staff.

Response to the Allegations

In response to the allegations, in a detailed written version submitted to the commission, the primary accused, the Nephrologist, contested the allegations, highlighting a sequence of events concerning the patient’s treatment. The respondent, a senior practising nephrologist, expressed that the medical treatment provided was prudent and in accordance with acceptable medical protocols.

The nephrologist explained that the patient was diabetic, hypertensive, and undergoing dialysis through a perm catheter. It was further elucidated that recommendations were made for the patient’s admission to the hospital to address the malfunctioning perm catheter, but the patient and her relatives opted for an alternative medical procedure, inserting the perm catheter in a femoral vein.

Moreover, the doctor emphasized that the use of Vancomycin, an antibiotic, was carefully considered based on the patient’s clinical condition and medical protocols. He contended that the treatment provided was as per accepted medical protocol and refuted claims of negligence.

Meanwhile, the CEO representing AMRI Hospital, also defended the actions of the hospital, dismissing the claims made by the complainant as exaggerated and lacking merit.

Medical Committee and Recommendations

A case was filed by the husband of the deceased patient, against a prominent nephrologist (OP No.1) attached to AMRI Hospital and associates from the facility, alleging medical negligence and seeking a compensation of Rs. 50,00,000/-. Following the complaint, an Enquiry Committee was constituted by the Chief Medical Officer of Health (CMOH), Barasat, which made several recommendations. Dr Kanailal Karmakar, a Nephrology expert, emphasized the importance of Vancomycin usage in certain situations, contradicting the alleged resistance concerns. Opinions from medical experts emphasized the importance of appropriate antibiotic usage based on clinical judgments to avoid potential antibiotic resistance.

Consumer Commission's Verdict

The Commission carefully reviewed all relevant medical records, reports, and expert opinions to reach its conclusions. It perused the salient observations of the Enquiry Committee, wherein, a Medical Board was formed with the Dr. S.K. Guha Roy Medical Officer, Sub-Divisional Hospital Salt Lake, Dr. Partha Pratim Guha, Superintendent, Salt Lake SDH and Dr. Swati Pramanick, ACMOH, Bidhannagar. It acknowledged Sri Guha Roy as a consumer under the Consumer Protection Act, 1986, making his complaint valid for consideration.

The Commission observed that there was indeed a delay in blood transfusion, a critical aspect of the treatment, despite a rapid drop in the patient's haemoglobin levels. This delay was deemed as a breach of duty and a departure from accepted medical protocol. It observed;

"Dr. S. Guha Roy, Medical Officer, Sub-Divisional Hospital, Salt Lake has submitted a ReOpinion on 11/04/2018 regarding Enquiry Report, in his own hand writing, (ANX – R) wherefrom it appears to us that it is again observed that on 24/03/2017 Dr. Sarkar advised 2 units of blood transfusion when the HB% further dropped down to 5.3g%. The said advised was carried out after 4 days ie on 28/03/2017. Hence, there was definitely delay in transfusing blood to the patient in spite of the fact that HB level dropped down rapidly."

The Commission further opined that to reach the conclusion it is necessary to understand the meaning of negligence in order to adjudicate medical negligence. It noted that;

"The definition of negligence includes careless conduct and the breach of duty on the part of doctor/doctors in order to take proper/standard care of the patient. The breach of duty may be occasioned either by not doing something, which a reasonable man, under a given set of circumstances would do, or by doing some act, which a reasonable prudent man would not do."

In pursuant to the discussion above; the Commission observed that;

"Though Dr S Guha Roy has provided an advice for further expert yet being an expert and prudent medical personality Dr. S. Guha Roy has clearly submitted in his opinion that there was definitely delay in transfusing blood to the patient in spite of the fact that HB level dropped down rapidly (it is admitted that the HB level was 9.6 on 31/01/2017, 6.7 on 14/03/2017 and 5.3 on 24/03/2017). Not only that the enquiry report dated 25/09/2017 also speaks for delay in blood transfusion. So far as delay in transfusion of blood is concerned, we can safely decided that the OP No. 1/doctor has failed to follow the accepted medical protocol in pursuant to the Principle of Bolam Test."

However, regarding the use of vancomycin injection, the Consumer body found conflicting arguments and lacked a clear expert opinion. As a result, a definitive decision on this matter was postponed pending further expert evaluation. The Commission said;

"Regarding use of vancomiycin injection there are so many arguments. Some are in favour of the doctor and at the same time some are also against the doctor and at this stage whether it is an omission on the part of Nephrologist/OP No. 1 or not it is not clear to us due to lack of opinion on this particular point/issue. But depending upon the principle of Bolitho Test there is no hesitation to hold that regarding delayed blood transfusion, to some extent medical negligence on the part of OP No.1/doctor attached to the AMRI Hospital has been occurred and in this respect the medical negligence on the part of OP No.1 is proved and the complainant is entitled to get relief/reliefs against the OP No.1only."

Highlighting the need for expert opinions in medical cases, citing the Bolitho Test to ensure a balanced consideration of both medical professionals' and patients' perspectives, the Commission subsequently held that the Nephrologist was partially negligent in adhering to the standard medical protocol, specifically in the timely administration of blood transfusion. The Commission ordered compensation of Rs 5,00,000 to the complainant, along with litigation costs of Rs 20,000. It held;

"Keeping in view of the above observations and for finality of litigation we are constrained to allow the instant consumer case on contest against the OP No.1 / doctor with costs and dismiss the same on contest against the OPs No. 2 to 4 without any order as to costs. Accordingly, it is ordered that OP No.1 is directed to pay compensation amounting to Rs. 5,00,000/- (five lakh ) only to the complainant within 60 days from the date of passing of the order. The OP No.1 is further directed to pay litigation cost of Rs.20,000/- (twenty thousand) only to the complainant within the aforesaid stipulated period of time in default the whole awarded amount ie Rs 5,20,000/- (five lakh twenty thousand) only shall carry interest @ 10% pa from the date of filing of the consumer case (02/07/2018) till full realization."

To view the original order, click on the link below: