Doctors Would Leave Patients Requiring Urgent Medical Attention if Made to Face Unnecessary Litigation- Court relief to doctor, hospital

New Delhi: Exonerating a Delhi-based pulmonologist and hospital from charges of medical negligence while treating a patient diagnosed with Acute Myocardial infraction, the State Consumer Disputes Redressal Commission (SCDRC) observed that if a doctor has to face legal proceedings only for attending a patient in an emergency, then the doctor would feel better advised to leave the patient requiring urgent medical attention.

Although the complainant argued that the patient had died as the doctor was not qualified to treat the patient and had not referred him to any specialist in time, the Commission noted that the patient was taken to the Casualty, where the treating doctor was on duty.

"In our opinion, if a medical practitioner is made to face unnecessary litigation for merely attending to a patient in an emergency situation, then a medical professional would feel better advised to leave a patient in need of urgent medical attention, to his own fate," observed the Commission.

It also highlighted that "every procedure related complication cannot be considered a result of malpractice unless it was caused by medical negligence. To constitute a procedure related injury in a medical facility, the injury must have been the direct result of a medical provider's failure in providing an acceptable level of care."

With this observation, the State Commission set aside the District Consumer Court's order directing the doctor and hospital to pay Rs 6 lakh compensation to the legal heirs of the patient, who died while undergoing treatment.

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The history of the case goes back to 2009 when the complainant's father, an employee of Central Warehousing Corporation, was taken to Jeewan Anmol Hospital with a complaint of chest pain associated with sweating and he was admitted to the hospital under the observation of Dr Sinha. 

After preliminary investigations and ECG, he was diagnosed with Acute Anterior Wall Myocardial infarction. Allegedly, the patient was not given proper treatment and the hospital did not have proper infrastructure, a special ward and other requisite facilities to treat patients suffering from myocardial infarction due to which neither the complainant's father was treated with angioplasty nor any diagnostic tests were done.

It was alleged that the patient was also not referred to another hospital. Consequently, the patient became breathless and he was frothing in his mouth. He was diagnosed with Cardio-respiratory arrest without conducting any necessary diagnosis. Following this, he was declared dead.

The complainant alleged medical negligence and deficiency in service on the part of the hospital and the doctor and prayed for a compensation of Rs 12 lakh towards pecuniary damages for loss of earning and Rs 5 lakh towards pain and suffering along with interest @15% p.m. from the date of filing the complaint till realization.

While considering the matter, the District Commission perused the Case Summary issued by the Doctor to note that Dr. Sinha was only a Bachelor of Medicine and Surgery along with a Diploma in Tuberculosis and Chest Diseases (DTCD). Therefore, he did not possess any post-graduation specialization especially in the field of Cardiology to handle cases of myocardial infarction. 

The Consumer Council also noted that the patient was treated as a case of Acute Coronary syndrome and the treatment started in the Casualty itself. Therefore, the Commission concluded that the doctor was a physician who was well aware of the patient's condition and also of the fact that the situation warranted immediate medical attention of an expert and competent cardiologist.

At this outset, the District Commission had also noted that there was no evidence on record to suggest that after diagnosing the patient to be suffering from Acute Anterior Myocardial Infraction, the doctor had without losing any time called for any cardiologist of the Hospital competent to handle the case for further specialized treatment to meet the medical exigency nor had he taken steps to shift him to the Intensive Coronary Care Unit of the Hospital.

The District Commission had also noted that there was no evidence to show that the hospital had a well-qualified and competent team of Cardiologists and a separate Cardiology Wing fully equipped with all infrastructure and paraphernalia to treat cardiac patients and to meet all types of medical emergencies relating to cardiology.

"On the contrary, he continued to treat the patient and thus, by this conduct he conspired with the Respondent Hospital in its unfair practice of swindling money out of the pockets of the patients on the pretext of giving treatment to them in utter disregard of the precious human lives with which they were playing to satisfy their monetary greed," the District Commission had held while directing the doctor and the hospital to pay altogether Rs 6 lakh compensation to the patient.

Aggrieved by the order, the doctor approached the State Commission and submitted that the District Commission had failed to appreciate the necessity of obtaining an expert medical opinion, given that the core issue pertained to medical negligence which demanded specialized knowledge for arriving at a conclusion.

It was further submitted that only a medical expert or a medical board can adequately determine medical negligence and the Commission should have referred the matter to such board accordingly. It was also submitted that the District Commission disregarded the Bolam Rule, as established in Jacob Mathew's case. Additionally, the doctor submitted that the District Commission failed to observe that the burden to prove negligence lied on the Complainant and the complainant failed to furnish any expert opinion, resultantly failing to prove any negligence. Lastly, the doctor claimed that the treatment provided by them was as per the standard medical protocol and no medical negligence could be carved out on the part of the doctor.

While considering the matter, the State Commission noted that the District Commission arrived at the conclusion that since the doctor was not a cardiologist and the hospital was not a cardiac hospital, the doctor was liable for medical negligence as he did not refer the patient to a cardiologist/hospital with requisite facilities to treat Myocardial Infraction.

However, the State Commission noted that while the District Commission had observed that the patient had been admitted at 4:00 AM and considerable time was wasted by the doctor by not referring the patient, a perusal of the document titled "Admission Record" reflected that the time of admission of the patient was 5:30 A.M.

"A further perusal of the record reflects that when the patient was bought to the Respondent No.2-Hospital, at around 5:30 A.M.in the morning, at that time the Appellant was the duty doctor. In our thoughtful opinion, a doctor owes a duty of care towards the patient and is duty-bound to attend to a patient in medical exigency, and as such, the Appellant-doctor in no manner could have refused to treat the patient," noted the State Commission.

At this outset, the Commission also relied upon the Supreme Court order in the case of Jacob Mathew v. State of Punjab and Anr and noted that "A medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence before a medical practitioner is charged with or proceeded against criminally. A surgeon with shaky hands under fear of legal action cannot perform a successful operation, and a quivering physician cannot administer the end-dose of medicine to his patient."

Referring to the Apex Court's order, the State Commission remarked that the doctor had no choice but to treat the patient presented before him in an acute emergency. Therefore, it opined that if a medical practitioner has to face unnecessary litigation for only attending a patient in an emergency situation, then the doctor "would feel better advised to leave a patient in need of urgent medical attention, to his own fate."

Further relying on the Supreme Court's order in the case of Jacob Mathew, the State Consumer Court, Delhi reiterated, "a simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. To establish a claim for medical negligence, it is imperative to meet the following criterion i.e. firstly, the patient was owed a duty of care. Secondly, that duty was breached by a deviation from accepted standards of care. Thirdly, the patient suffered damages and fourthly, the damages suffered were a direct result of the medical provider's breach of duty."

In respect to the case, the Commission noted that the patient was brought to the hospital at 5:30AM and underwent thrombolysis at approximately 8:15 AM.

"From the extensive reading of medical literature on the subject, it has come to our knowledge that as per the standard medical protocol, thrombolytic therapy is recommended to be started as early as possible in patients with acute myocardial infarction. It has further come to our knowledge that the injection of Streptokinase can be administered by a doctor having MBBS degree. The Appellant being a chest specialist was therefore, competent to administer the said treatment," the State Commission noted at this outset.

Further perusing the medical records, the Commission opined that the "preparedness and commitment to patient well-being through immediate admission, diagnosis, and initiation of treatment in the casualty department. The patient was properly thrombolysed and all appropriate medical procedures were followed during the treatment. Therefore, it is clear that the patient was treated as per standard medical protocol and there was no deviation from the standard medical procedure."

Regarding the argument that the doctor failed to refer the patient to a cardiologist/cardiac facility, the Commission referred to the Supreme Court order in the case of C.P. Sreekumar (Dr.), MS (Ortho) v. S. Ramanujam, where it was held that the Commission ought not to presume that the allegations in the complaint were inviolable truth even though they remained unsupported by any evidence.

Apart from this, the Commission also noted that the complainant had not challenged the treatment provided by the doctor and it was also not the case of the complainant that the doctor had provided wrong treatment to the patient not any specific allegation pointing towards any discrepancy in the treatment or diagnosis of the disease was made by the complainant.

"As regards the contention of the Respondent No.1 that the Appellant failed to refer the patient to a cardiologist/cardiac facility, the Appellant has submitted that the patient has to be kept under observation of a period of 1-2 hours after administration of Streptokinase and transportation/transfer during such period is dangerous. Here, we deem it crucial to remark that shifting a patient without offering him basic/primary treatment or stabilising his condition or confirming the availability of beds or treatment in another hospital can be equally fatal to the life of the patient and can amount to medical negligence," the Commission noted.

Therefore, concluding that there was no medical negligence, the Commission noted,

"A pursual of the medical record produced does not show any omission in the manner of treatment. The patient received appropriate thrombolytic therapy, and all necessary medical protocols related to informed consent were followed throughout the course of treatment. The hospital and the doctors are required to exercise sufficient care in treating the patient in all circumstances. However, in an unfortunate case, death may occur. It is necessary that sufficient material or medical evidence should be available before the adjudicating authority to arrive at the conclusion that death is due to medical negligence. Every death of a patient cannot on the face of it be considered to be medical negligence."

Accordingly, the State Commission set aside the District Commission's order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/dr-anant-kumar-sinha-vs-smt-nidhi-jain-anr-on-26-november-2024-267260.pdf

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