Cardiologist, hospital asked to pay Rs 12 lakh compensation on after patient death

The case goes back to the year 2012 when the 69 Years old patient was admitted to the Nashik based referral hospital with complaints of heaviness in the chest. As per the report of the angiography a day before the admission, it was diagnosed as Single vessel disease, the patient was treated with angioplasty (PTCA for LAD) the next day in which stent was passed in Left Anterior Descending Artery, which was performed by the Cardiologist.

After the angioplasty, the patient's health started deteriorating with a rapid drop in the blood pressure (hypotension) and other vital parameters for which the treating doctors tried to investigate by abdominal sonography to find out the source of bleeding inside the body to find out the reason for the drop in blood pressure, intensive care treatment was given, Cardiothoracic Surgeon was consulted. But despite all possible efforts to treat the patient, he succumbed and died on 2 days later.

Aggrieved by the death of the patient, the wife of the deceased and son, filed a complaint at the State Consumer Disputes Redressal Commission alleging negligence in the treatment. Whereas the hospital and the doctor opposed the complaint by filing written statements and evidence, medical literature along with expert opinions.

During the hearing, the counsel on behalf of the deceased patient's kin submitted that, during the angioplasty, when the catheter was inserted in the femoral artery, which was ruptured and there was dissection of the artery leading to continuous bleeding lead to formation of retroperitoneal haematoma. This was the cause of constant hypotension, drop in blood pressure, further lead to critical condition and since this was not diagnosed in time and the investigations like CT Scan was not done immediately, the patient died as no timely surgical exploration could be done and thus saving of life of the deceased was not possible.

It was also submitted that a renowned cardiologist from Aurangabad, who suggested that the CT Scan of the abdomen should have been done at the earliest. Thus, valuable time was lost and the most essential test of CT Scan of the abdomen to diagnose the cause of bleeding was not performed in time and thus there was a delay in diagnosis and treatment.

It was further submitted that another Cardiologist was telephonically consulted by the treating doctor and the cardiologist had advised to do CT Scan. Since this advice was neglected by the hospital, there was a delay in diagnosing as well as treating the patient, he allaged adding that there was non-availability of battery back up due to which there was delay in taking patient to CT Scan. Additionally, when the CT Scan of the abdomen was done over at 10 pm on that day, the patient was operated on next day indicating the negligence of the hospital.

However, the counsel for the hospital and the doctor averred that these were fabricated reports and the abdominal CT Scan was never advised, instead, it was wrongly informed that Sonography was performed.

Maintaining their stance, the doctor and the hospital presented a few expert opinions in support of their contentions which were however not considered by the court.

The relevant are as follows:

A Cardiothoracic Surgeon from Nashik, with 6 years of experience, stated that the treating doctor has adopted best possible treatment and is in line with the academic books and any  reputed doctor would have acted on the same line considering the situation. At the end he has also mentioned that, "as patient‟s coagulation profile and renal parameters were deranged ,patient was taken up for surgery after stabilization." 

Another expert opinion was by a doctor of DNB Cardiology, with 6 years of experience as Cardiologist, mentioned as the treating doctor has treated the patient according to the academic books. This opinion is replica of the opinion given by the cardiothoracic surgeon. Both the opinions presented by the petitioners do not explain the delay in advising CT Scan and then delay in performing the exploration operation of the patient, it was stated.

Considering the rival contentions of both parties, submissions made, the bench perused the records presented before it and reviewed the concept and settled principles in deciding the negligence by highly skilled medical professionals. It observed:

The concept of medical negligence is being dealt with settled principles of the law that govern it. Reasonable degree of care and skill means that the degree of care and competence that an "ordinary competent member of the profession who professes to have those skills would exercise in the circumstance in question." The burden of proof is correspondingly greater on the person who alleges negligence against a doctor than a charge of negligence against the driver of motor car.

Believing that the doctor is not liable for every injury suffered by the patient, the bench said;

The liability of a doctor arises not when the patient has suffered any injury, when he is treated in good faith but when the injury has resulted due to the conduct of the doctor, which has fallen below that of reasonable care. Thus, the doctor is not liable for every injury suffered by a patient. He is liable for only those that are a consequence of a breach of his duty. Hence, once the existence of a duty has been established, the complainant must still prove the breach of duty and the causation. In case there is no breach, or the breach did not cause the damage, the doctor will not be liable. To show the breach of duty, the burden on the complainant would be to first show what is considered as reasonable under those circumstances and then that the conduct of the doctor was below this degree.

Reaching its verdict, the bench relied on several observations made by the Supreme Court on the skill of a doctor and the brevity of medical negligence. Relevant is as follows

the skill of a medical practitioner differs from doctor to doctor and it is incumbent upon the Complainant to prove that a doctor was negligent in the line of treatment that resulted in the life of the patient. It is for the Complainant to prove the negligence or deficiency in service by adducing expert evidence or opinion and this fact is to be proved beyond all reasonable doubts.

A simple lack of care, an error of judgment or an accident is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed. When it comes to the failure of taking precautions what has to be seen is whether those precautions were taken which the ordinary experience of men has found to be sufficient; a failure to use special or extraordinary precautions which might have prevented the particular happening cannot be the standard for judging the alleged negligence. So also, the standard of care, while assessing the practice as adopted, is judged in the light of knowledge available at the time of the incident, and not at the date of trial. Similarly, when the charge of negligence arises out of failure to use some particular equipment, the charge would fail if the equipment was not generally available at that particular time (that is, the time of the incident) at which it is suggested it should have been used.

Taking all the submissions, discussions and the record into account, the bench noted:

The hospital, the treating cardiologist, after performing the angioplasty, did not come to the conclusion about the source of bleeding inside the human body and thus went on doing investigations that weren‟t necessary. Also, he neglected the advice given by the senior Cardiologist. He advised the CT Scan of Abdomen very late on the post-angioplasty day, on 8th May 2014, by late evening. The CT scan was not possible as there was no battery backup to shift the patient down in the hospital where the CT Scan Department was situated. After the diagnosis of the bleeding source on CT Scan, the patient was not operated immediately in the night but next day, the reason given was the operation theatre was not ready for the operation for various reasons. We are of the opinion that, the OP no.2 was liable due to act of omission, while the OP no.1 the Regional Referral Centre, Nashik and the OP no.3 State Government were liable again for act of omission, not providing the facility necessary for emergency lifesaving treatment, even when the service to provide emergency treatment was charged; thus more responsible than the treating doctor himself. Thus, there was negligence in providing the emergency treatment and identifying as well as treating the complication of angioplasty, injury to the femoral artery by the sheath and catheter while introducing the same into the artery.

The bench held that there were acts of omission by the treating cardiologist, hospital and sate and thus liable for the loss of life, that could have been avoided by vigilant and timely action by them.

The doctor was liable for not taking proper steps to diagnose early the reason for unresponsive hypotension that the patient suffered from and the hospital and state were vicariously responsible for the act of omission of the hospital as well as the inadequate infrastructure of the hospital, in spite of the hospital being tertiary care hospital.

Considering the prior health of the deceased, the loss of life, loss of the pension income to the family and the mental agony-harassment associated, the bench ordered the hospital and the doctor to pay Rs 12 lakh compensation along with other costs to the patient and concluded on the case.