CMC Vellore slapped Rs 25 lakh compensation for delay in treatment over Rs 1850 unpaid dues

The case concerned a patient with a history of pain in his left arm after engaging in strenuous activity. He was also a patient of diabetes and hypertension. In 2009, the patient visited the hospital after experiencing pain in his left arm on exertion. s. His Treadmill Test (TMT) done elsewhere was positive and he informed the same to the doctors at CMC He was diagnosed with Coronary Artery Disease and suggested an Angioplasty. On further examination (angiography), he was recommended a Coronary Arterial By-pass Graft (CABG) surgery to avoid multiple stenting.

Due to long waiting list, the patient's CABG was not possible within 15 days and therefore no specific date was fixed for CABG. After a few days, Dr. Sujit discontinued medicines Ecospirin and Clopidogrel, and started Heparin 5000 units 6 hourly. It was alleged that Heparin was started without any laboratory investigations or monitoring protocol

Two days later, the patient complained to the hospital authorities of bleeding and disorientation, however, this was allegedly ignored. It was stated that the doctors continued administering the drug which was the cause of the bleeding (Heparin), only to be informed later that he had suffered a stroke and there was an immediate need for a CT scan, however, the doctor allegedly did not do stroke evaluation.  It was further alleged that around 11.00 AM the patient was transferred to the Thoracic surgery unit in Semi-ICU i.e. 3 ½ hours after the onset of stroke. At around 11:15 AM the neurologist came for primary evaluation of the patient and suggested 'CT BrainPlain study', but the CT scan was delayed till 12.30 PM. The staff told the 2 nd complainant to remit and get a receipt of Rs. 1850/- for the CT Scan, though they have already deposited Rs. 150000/- as an advance. The doctor in thoracic surgery told the complainant that now it became neurology problem and thence the neurology dept. will look after the patient. Due to such condition of patient the CABG was deferred. The Neurosurgeon after seeing brain CT Scan report informed the complainants that as the patient already progressed into coma, nothing more could be done. Finally, doctors suggested the family that they should accept the inevitable event and instead of wasting money allow them to withdraw ventilator support

Subsequently, the patient suffered stroke and passed away.

Aggrieved, the deceased's kin moved a complaint with the forum alleging that the delay caused for stroke management was fatal and it was due to lapses in the hospital and demanding compensation of  of Rs. 2,01,44,000/

The complainant's counsel argued;

"The doctors at CMC were fully aware of the risk of initiation of Heparin and it was incumbent on them to outline risk when there was no urgency of CABG and the date for CABG was not fixed. The blood thinners commonly should be stopped 3-5 days prior to CABG. It was also doubtful how the OP without doing any blood test presumed the patient has no bleeding tendency. After the initiation of heparin, the APTT test was not conducted. The mere talk/discussion between the doctor and the patient were no way the implied consent and the doctors failed to take the patient's consent before administration of Heparin."

Pointing out at the delay in CT scan for over 3 hours citing Rs 1,850 in unpaid dues, despite the complainants' prior deposit of Rs 1,50,000, the counsel further added;

"by clinical examination, only Intra-cranial hemorrhage (ICH) cannot be differentiated between ischemic stroke and other causes. No medical intervention could be initiated unless the nature and location of the stroke was ascertained. Thus C.T. Scan of the brain was to be done immediately as early as possible."

Responding to the allegation, the hospital submitted that the complaint was based on a suppression of facts that could not be adequately adjudicated in a Consumer Redressal Forum. They disputed the day of his admission into the hospital and claimed that consent was not normally required before administering heparin. They also contended that he opted for a CABG over an angioplasty.

Denying the remaining allegations being baseless, misconceived and misleading, the hospital contended;

"When the blood thinner like heparin is used, there will be a risk. The risk has been taken into account considering the patient was above 50 years, hypertensive, and on medicines. As per the current trend of practice, the mere history of mild hypertension is not a contraindication to use heparin. Thus it was no a violation of protocol. The OP further contended that the blood test APTT was conducted to know the level of blood thinner. This test was always done after the drug is initiated and to tailor the dose for a given patient. It was further argued that the patient's attendants were explained about the result of patient's brain CT scan and the poor prognosis."

Examining the case, a Bench of members of Dr SM Kantikar and Dinesh Singh found that the administration of Heparin was not improper according to established medical practice, but held the hospital was negligent for the inordinate delay in treatment after the patient suffered a stroke.

Further, the Heparin administration was not stopped despite the stroke the patient suffered, nor was an antidote used.

Discussing the delay in obtaining a CT scan because of the hospital's insistence on payments, the Commission pointed out;

"Although the patient was in most urgent need of the diagnostic CT scan it was delayed for getting a receipt of Rs. 1850/- towards CT scan charges. The hospital was aware that the complainants had already deposited 150000/- in advance. … It seems at that relevant time the rigid protocols prevailed over the medical ethics, which amounts to a failure of duty of care."

"Hospital has every right to insist (on) the payment but it was also a prime duty to care (for) the emergency patient.," the commission emphasized.

Subsequently, the commission accepted the complainant's arguments ruling that the deficiency and medical negligence were conclusively demonstrated. Therefore, to compensate for the doctors' negligence, an amount of "Rs 25 lakh, with interest at 8 percent per annum from the date of the death of the patient till its realization," was granted to the deceased's spouse.

The Commission held;

"... deficiency/negligence is conclusively established. In our considered view, in the facts and specificities of the instant case, compensation of Rs. 25 lakh with interest at the rate of 8% per annum from the date of the death of the patient appears just and equitable ..."