PGDCC Holder treats Myocardial Infarction: Hospital, Doctors slapped Rs 5 lakh compensation

Jalandhar: Holding that there was clear-cut misrepresentation of doctors' designations, the District Consumer Disputes Redressal Commission, Jalandhar, recently directed a Super Speciality Hospital, its three doctors to pay Rs 5 lakh compensation to the family of a patient who died while undergoing treatment for Acute Inferior Wall Myocardial Infarction.

While considering the complaint, the Commission observed that in the absence of the lead Cardiologist, Dr. Chawla, two other doctors attended the patient, despite lacking the required qualification. Further, the Commission noted that there was a delay in conducting the angioplasty procedure. 

The history of the case goes back to 2019 when the patient was admitted to the treating hospital, Caremax Super Speciality Hospital, with the complaint of chest pain. She remained admitted in the hospital for the next three days, after which she was declared dead. The complainants alleged that they were rendered deficient and negligent medical services.

The medical records revealed that the patient was suffering from a massive heart attack, i.e. Acute Coronary Syndrome, Acute Inferior Wall Myocardial Infarction, which had to be managed with primary Angioplasty as soon as possible. However, since the main cardiologist i.e. Dr. Chawla, was not present, another doctor- Dr. Sharma (MBBS, PGDCC, FNIC and labelled as consultant cardiologist) managed the patient.

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As per the complainants, Dr. Chawla reached the hospital two days later, took the patient for Angipgraphy and explained to the complainants that there was a blockage of 99% on one Coronary Artery and two blockages in other arteries.

The complainants claimed that there was a delay in conducting the angiopplasty and angiography. They further claimed that the lead cardiologist was not present and another doctor, who lacked proper competence to treat such a patient with severe cardiac problem, started the treatment. Further, they alleged there was a delay in administering the Cathlyse injection. Ultimately, their submission was that the delay in treatment deteriorated the patient's condition, ultimately leading to her death.

Further, the complainants argued that when the main cardiologist was not present, the hospital was bound to inform the complainant about this and was also duty-bound to call another cardiologist to treat such a serious patient, or, as a last option, they could have referred the patient to any other cardiac center. However, allegedly, the hospital neither performed angioplasty nor called any other specialist doctor to treat the patient.

Relying on the NCDRC order in the case of Goyal Hospital and Research Centre pvt. Ltd. Jodhpur Vs. Kishan Shukla, the complainants argued that lacking the required competence, Dr. Sharma was not entitled to even touch the patient of such severity. However, on the contrary, he started treatment of the complainant's mother, who was suffering from Acute Coronary Syndrome and Acute Inferior Wall Myocardial Infarction.

There were also allegations against the hospital for not providing the medical records within 72 hours, not providing the complainants with the CCTV footage etc.

On the other hand, the hospital and the doctors opposed the complaint and submitted that the complainant failed to submit any report from any medical board in support of his alleged claim of medical negligence concerning the treatment of the patient. The counsel for the hospital and doctors submitted that Dr. Sharma was an emergency and critical ICU Expert at the hospital and was on duty being in charge of ICU/Emergency and Dr. Thaploo, a Senior Cardiologist, was also present there. They claimed that Dr. Thaploo attended the patient immediately along with his team and due procedure was done when the patient was admitted to the hospital.

Further, it was submitted that the decision to do primary angiography/angioplasty or give Thrombolytic therapy is multifocal or multi-faceted and the treating cardiologist did this after taking into consideration all the factors. The counsel also submitted that the complainants gave consent to give thrombolytic therapy after ruling out all contradictions. He also relied upon the consent and submitted that after receiving the immediate treatment, the patient responded well, and her condition improved. She remained stable after thrombolytic therapy, and the next day, she started having intermittent chest pain. Since she started spontaneous isolic pain as per bed head ticket, there was an indication of angiography, which was done after the attendants were explained about the need of angiography multiple times. Ultimately, the angiography was done only after receiving consent.

After conducting the angiography, the results were explained to the complainants, and again, angioplasty was advised, but again the patient's attendant took time in giving consent for angioplasty plus stenting. Ultimately, the procedure commenced after receiving the consent, and there was no delay in conducting the procedure and giving the treatment to the deceased. Further, the counsel submitted that an enquiry was conducted by the Civil Surgeon after constituting a Medical Board.

The counsel also argued that Dr. Thaploo was a well-qualified cardiologist and was competent to treat the cardiac patient. For this, the counsel relied upon the documents relating to the education and qualification of Dr. Thaploo.

While considering the matter, the consumer court referred to the Supreme Court order in the case of Jacob Mathew vs State of Punjab, where the Apex Court noted that any task which is required to be performed with a special skill would generally be admitted or undertaken to be performed only if the person possessed the requisite sill for performing the task. Therefore, if the doctor possessed adequate qualifications and was capable and authorized for the treatment acceptable to the medical profession of that day, he could not be held liable for medical negligence. The top court bench had also observed that a simple lack of care and an error of judgment or an accident was no proof of negligence. 

In this case, the Consumer Court noted that Dr. Chawla, whose competence was not disputed, was not present in the hospital. However, Dr. Sharma, who is not a cardiologist, allegedly attended to the patient. However, the hospital has submitted that Dr. Sharma was working as a Senior Cardiologist at the said hospital and was designated as the Emergency and ICU in charge at the hospital. 

The Commission further noted that as per the opinion of the Review Committee of Medical Board, the degree of Dr. Sharma was relevant as he was carrying out the order of Dr. Thaploo, the senior cardiologist. The Commission noted that Dr. Sharma had a PG Diploma degree in Clinical Cardiology from Indira Gandhi National Open University. 

Further, the Commission noted that the proceedings of the erstwhile Medical Council of India depicted the decision regarding the recognition of the PGDCC Programme offered by IGNOU, which was not allowed and recommended for inclusion in the first schedule of the IMC Act 1956 for the batches admitted from the 2006 to 2013 admission cycle. Dr. Sharma passed the diploma in 2011. The Civil Surgeon of Jalandhar held that Dr. Sharma was eligible and permitted to conduct ecocardiography only and not Ultrasonography. 

Regarding Dr. Thaploo, the Commission noted that he was not registered with the Punjab Medical Council but with the Jammu and Kashmir Medical Council, where his additional qualification registered with the Council was MD Medicine.

At this outset, the Commission referred to the NCDRC order in the case of Goel Hospital Vs. Krishan Gopal Shukla to note that undergoing several trainings, attending workshops in cardiology did not confer the qualification of cardiologist unless and until the same was recognised by MCI. Further, the Apex Consumer court had noted in the judgment that persons who are misrepresenting and posing as specialists or super specialists without any approved qualification by the statute or controlling authority were actually practising quackery by treating the patient in the absence of a valid degree.

"So, from the discussion and law laid down by Hon'ble Supreme Court and the documents, it is proved that Dr Sharma is not a qualified as a cardiologist. He is having diploma of Cardiology, which is not recognized by the IMC, therefore, cannot be considered to be a cardiologist or specialist as discussed by the Hon'ble National Commission," the consumer court noted.

"So, Dr. *** Sharma did not possess the required and adequate qualification to treat the cardiac patient Smt. ***, who was admitted on 08.07.2019. Similarly, Dr. *** Thaploo was never registered either with IMCA nor with PMC at the relevant time... he has pursued the prescribed course of Post Graduate training and is Diploma holder for the practice of cardiology....Thus, as per the law laid down by the Hon'ble National Commission... he did not possess requisite qualification or degree on 08.07.2019and as per the law laid down by the Hon'ble Supreme Court in a case, titled as "Jacob Mathew Vs. State of Punjab and Anr." in 2005 (6) SCC 1, he was not competent to treat," the Commission further noted.

Regarding the allegation that the complainants took time to give consent for the procedure, the Commission noted that there was nothing on record to suggest that. Referring to the Supreme Court order in the case of "Parmanand Katara Vs. Union of India & Ors', the Commission noted, "It mandated that both public and private hospitals and doctors must provide immediate medical aid in emergency cases. It has been observed that no legal formalities are required in emergency cases. In the present case, the consent of angiography and angioplasty both was given vide Ex.OP1/D and during the procedure of angiography, it was obligatory upon the doctors to perform angioplasty, if it was required. They should not have waited for further consent. It is not the case of the OP that at the time of performing angiography, angioplasty was not required immediately."

"There is no explanation why there was delay in performing the angioplasty," noted the Commission.

Accordingly, the Commission observed-

"it is a clear cut case of misrepresentation as both the doctors, who were available in the hospital, at the time of admission and initial treatment, were not eligible for practicing cardiology acceptable to medical profession of that day as they did not have required qualifications. It is also proved that Dr. ***Chawla was not there. This shows that in the absence of expert Cardiologist, Dr. ***Chawla, the two available doctors had to rely on Thrombolytic procedure and as per record only the Thrombolytic procedure was discussed with the attendants of the patients and consent was also obtained from them with that regard only. Had there been no misrepresentation in the designation of Dr. *** Thaploo and Dr.*** Sharma as Cardiologist and had it been clear to the patient's family that in the absence of Dr. ***Chawla, Cardiologist, there is no available Cardiologist in the hospital, the family members might have decided to take the patient to some other hospital, where a cardiologist was available at the time."

"Thus, in view of the judgments passed by the Hon'ble Supreme Court, Hon'ble National Commission and Hon'ble State Commission, it is concluded that there was misrepresentation and misleading information in relation to the services rendered by the OPs No. 1 to 3 and 7 as per Section 2(28) of the Consumer Protection Act, 2019 while treating Smt. Varsha Goel and they were negligent in providing services to Smt. *** (patient)," further noted the Consumer Court.

With this observation, the Commission directed the hospital and the doctors to pay Rs 5 lakh compensation to the complainants jointly or severally. "In view of the above detailed discussion, the OPs No.1 to 3 and 7 are held negligent in providing services to Smt. ***. Deficiency in service and unfair trade practice has been proved. In such circumstances, the OPs No. 1 to 3 and 7 are jointly and severally directed to pay Rs. 5,00,000/- to the complaint,"ordered the Commission.

To view the order, click on the link below:

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