Death after Anaesthesia administration during implant removal :Bengaluru Hospital, Doctors to Pay Rs 38 Lakh Compensation

Bengaluru: The Karnataka State Consumer Disputes Redressal Commission recently directed a Bengaluru based hospital and its consultant Orthopaedician and Anesthesiologist to pay Rs 38 lakh as compensation and litigation expenses to the family of a patient who died while undergoing treatment for implants removal procedure.

Although the complainants alleged that the patient collapsed because of wrongful administration of anesthesia, the hospital and the doctors claimed that no sedatives/anaestheisa was given to the patient. 

However, after considering the expert opinion the Consumer Court noted, "...the OP doctors had administered anaesthetic drugs to the deceased Lakshmi when patient complained of acute chest discomfort with ECG changes and it was not a life saving surgical procedure. In view of the above discussions we are of the considered opinion that, the OP - Doctors have committed medical negligence by administering anesthetic drugs to the deceased Lakshmi before going to the procedure of removal of 04 implants which resulted in to her death..."

Therefore, relying on the expert opinion given by Dr. Varghese, the State Commission concluded that the treating doctors had administered anaesthetic drugs to the deceased when the patient complained of acute chest discomfort with ECG changes and it was not a life saving surgical procedure.

The matter goes back to 2007 when the complainant's wife met with an accident and sustained crash injuries and fractures on her left arm from shoulder to wrist. She was shifted to Hosmat Hospital and was admitted as an in-patient.  Dr. Kumar was the consultant orthopedician at Hosmat Hospital and he performed operations and 4 implants were made to the fractured bones to the patient's left arm and after operation and treatment she recovered a lot and consequently got discharged.

Following the advice, she used to go to Hosmat Hospital for dressing. Dr. Kumar advised the patient to get admitted at Jaimaruthi Hospital for removal of implants stating that he is also working in the concerned hospital and accordingly the patient got admitted to the hospital.

Allegedly, during admission to Hosmat Hospital, the patient's health condition was good. The Director of the Hospital and Dr. Raja, the Anesthesiologist, advised conducting some examination before operation to removal of implants.

As per the complainant, in the operation theatre, the patient was given anesthesia and immediately the Director of the Hospital came out and informed that the patient had collapsed completely and was struggling for survival of her life. When the complainant questioned about this to the Director, he was informed that it happened due to improper administration of anaesthesia. Further, the Director expressed the inability to conduct the operation and advised to shift the patient to Panecia Hospital to put her in ventilators and same was not available in the treating hospital. Immediately, she was shifted to Panecia Hospital by ambulance where they declared she was dead. 

The complainant alleged that they were shocked to find that in the post mortem report the patient was declared dead due to cardiac arrest. They alleged that there was no complaint of cardiac problem at any point of time. There were no symptoms regarding cardiac problems during the course of tests conducted in Hosmat Hospital also, alleged the complainant.

It was alleged by the complainants that the patient died due to administration of anaesthesia and it was a negligence on the part of the doctors at Jaimaruthi Hospital. They further alleged that the doctors who performed the post-mortem in Victoria Hospital were close friends of the treating doctor and managed to give a report stating that the patient had a cardiac arrest.

On the other hand, the hospital and the doctors submitted that the patient was admitted at Hosmat Hospital and she underwent required surgery like wound debridement, radial artery and nerve repair with excision arthoroplasty, left elbow with elbow spanning external fixator. She was on regular follow-up and she was advised to consult the treating doctor for removal of external fixation after three months. 

Since the treating doctor Dr. Kumar was at Jai Maruthi Hospital at that point of time, he called the patient to visit the said hospital for removal of external fixation. Accordingly, the patient visited the said hospital and at this point of time, Dr. Nagesh, the director of the Hospital and Dr. Kumar examined the patient. Allegedly, the patient and her husband insisted to conduct the procedure under anaesthesia and both the doctors explained in detail about the pros and cons of anaesthesia administration, particularly, focusing on the general risks and complications involved in such procedure. 

When the complainant and the patient requested for anaesthesia administration, Dr. Raja, the consulting Anaesthesiologist was called to monitor anaesthesia care and to assist the treating doctor in the said procedure. The patient allegedly informed that she had diabetes and she previously underwent Mastectomy and also abdomen surgery. Her ECG showed inferior wall Ischemia. Allegedly, Dr. Raja wanted to inform her husband, who was unavailable at the time and had gone out to buy medicines. In the meantime, the doctors were getting ready for the procedure and suddenly the patient started sweating and complained chest discomfort with drop in saturation and heart rate and the doctors tried resuscitation and once she was feeling better, they decided to shift her to a nearby hospital for ICU care. Accordingly after obtaining consent from her husband patient was shifted to Panacea Hospital and she was accompanied by the above said doctors and two nursing staff along with oxygen, monitors and emergency kit. At the said hospital she was immediately taken to ICU and put on ventilator. Despite all their efforts the patient could not be saved and she passed away on the same day around 02.45 PM.

It was submitted by the doctors and the hospital that since the patient was feeling tensed and nervous she was given injection MIDAZOLAM 1mg and Glyopyrolate 0.2 mg and decided to wait till she feels fine and comfortable and then commence the procedure. They claimed that these medicines are not given for sedative purpose and MIDAZOLAM is given for the purpose of reducing anxiety, tension which is used to avoid any cardiac problem and Glyopyrolate is a pre-anaesthia drug which is given to reduce oral secretions.

Addressing the allegations, they submitted that the question of improper anesthesia does not arise at all since only pre-anaesthetic drugs were given and no sedative/anaesthesia was given to the patient. Further referring to the post-mortem report, they denied any deficiency or negligence on their part and prayed for the dismissal of the complaint. One Dr. Rajendra.P. Manjrekar, an expert on behalf of opposite parties filed his affidavit evidence.

The commission, before admission of the case, suo-moto had referred the matter to RMO of St. John's Medical College, Bangalore, seeking expert opinion along with the required documents, for which one Dr. Varghese. P.S. Professor & Head of Forensic Medicine, Medico Legal Consultant- Emergency Medicine, R.M.O, St. Johns Medical College Hospital, Bangalore submitted his expert opinion dated: 23.04.2010 before the commission. After obtaining the said expert opinion the above case got admitted before the commission.

While considering the matter, the complainant perused the complaint, versions, affidavit evidence, interrogatories, and answers to the interrogatories filed on behalf of both parties along with the expert opinion and documents placed before the Commission. The expert on behalf of the hospital and the doctors, Dr. Manjrekar stated that the doctors had administered only "monitored anaesthesia care" which is used for monitoring the vital signs like BP, Pulse and Oxygen saturation for doing a procedure and unfortunately the patient developed signs of circulatory collapse independent of the drugs given to her. It can be attributed to her pre-existing IHD, Diabetic, and Autonomic Neuropathy, opined the expert.

At this outset, the Consumer Court noted that the hospital and the doctors never disclosed in their version about the fact that the doctors had administered only "monitored anaesthesia care" instead of this they contended that, no sedative/anaesthesia was given to the patient and only pre-anaesthetic drugs i.e. injections MIDAZOLAM 1mh and Glyopyrolate 0.2 mg were only given.

Taking note of this, the Commission observed, "...the expert evidence of Dr. Rajendra P. Manjrekar filed on behalf of Ops does not corroborate the contentions raised by the OPs."

The Commission also perused the opinion of the Expert Dr. Varghese, to whom the consumer court had referred the matter. Dr. Varghese in the last line under the heading of 'Brief History of the case' stated that, "cause of death is not available in the available records."

Further, the expert report mentioned that "Mrs. Lakshmi for external fixator removal goes to Jaimaruthi hospital; preoperative review (before giving anaesthesia and surgical procedure), Lakshmi gave history acute chest discomfort before Anaesthetic was administered and acute chest discomfort worsens after administration of Anaesthetic drugs, general condition of Lakshmi worsens doctors try to resuscitate the patient for about 2 hours, then decide to shift to higher centre and no surgical procedure was undertaken."

In the 'Remarks Column', the report stated that, "on perusal of medical records, I am of the opinion that, anaesthetist should not have administered anaesthetic drugs when patient Lakshmi complained of acute chest discomfort with ECG changes suggestive of infero lateral wall ischemia, before administration of anaesthetic drugs and also it was not a life saving surgical procedure."

Therefore, relying on the expert opinion given by Dr. Varghese, the State Commission concluded that the treating doctors had administered anaesthetic drugs to the deceased when the patient complained of acute chest discomfort with ECG changes and it was not a life saving surgical procedure.

Opining that there was medical negligence on the part of the doctors, the Commission further noted, "In view of the above discussions we are of the considered opinion that, the OP - Doctors have committed medical negligence by administering anesthetic drugs to the deceased Lakshmi before going to the procedure of removal of 04 implants which resulted in to her death and it is evident that, before consulting these OP – doctors she was heal and healthy and there is no sign of cardiac disease symptoms. Due to the said act of the Ops the death of wife of complainant No.1 was happened, for which complainant No.1 being husband of deceased Lakshmi and complainant Nos.2 & 3 being children of deceased Lakshmi have suffered lot of mental trauma."

With this observation, the Commission directed the doctors and the hospital to pay Rs 36 lakh towards compensation, Rs 1 lakh towards loss of consortium, loss of estate, loss of love and affection and another Rs 1 lakh towards litigation expenses.

"The Ops are jointly and severally directed to pay a total sum of Rs.38,00,000/- along with interest at 6% per annum from the date of the accident till realization. The Ops are directed make compliance within 45 days from the date of the order," ordered the consumer court.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/karnataka-state-commission-rs-38-lakh-compensation-228737.pdf

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