Endoscopy conducted without considering Scoliosis, Belching: Yashoda Hospital slapped Rs 15 lakh compensation

Hyderabad: Holding that the hospital administration and the doctors "utterly failed to anticipate adverse Pros and Consequences and considering the Radiology Report of a patient prior to the commencement of the Endoscopy procedure", a District Consumer Disputes Redressal Forum in Hyderabad has slapped a fine of Rs 15 lakh on Yashoda Hospital following the death of a patient.

The forum directed the hospital and its medical administrator, and two of its doctors to pay the compensatory amount following a complaint moved by the deceased's kin alleging medical negligence that led to the death of the patient.

The case concerned a 28-year old physically challenged patient suffering from Neurofibromatosis since her birth with severe narrowing of Esophagus (Food Pipe) and Trachea (Wind Pipe). Later she developed "Dysphasia/ Belching". 

On 5th April 2011, the patient was taken to Yashoda Hospital after the problem aggravated. The treating doctor advised for a Blood test, CT scan of the neck, and upper GI endoscopy test for investigation and further treatment.  Accordingly, the CT scan was conducted and the reports clearly mentioned that the patient was suffering from the displacement of the windpipe and food pipe.

However, the complainant alleged that the doctor without considering the findings of the radiologist report casually directed the patient for endoscopy test that lead to the serious consequences.

Soon after the endoscopy, the patient became unconscious and was put on ventilator support. Subsequently, she succumbed a day after being discharged from the hospital.

The complainants contended that the patient died due to caused due to carelessness and negligent act of doctors. Alleging gross medical negligence, they further submitted that without ascertaining the health condition and without verifying the CT scan report of the patient, the doctor negligently advised for endoscopy test.

"If doctors would have verified radiologist report and its findings, which was clearly mentioned that the Trachea (windpipe) and Esophagus (food pipe) were dislocated. The doctors should have applied their mind and avoided the test," their complaint stated, Pointing to the loss of daughter and mental agony, the complainants-parents of deceased demanded Rs 19 lakh compensation. 

Responding to the contentions the hospital administration and the doctors disputed the claim that the patient was suffering from belching and submitted that the endoscopy was conducted only after the written consent.

"When the patient came to the opposite party hospital, she was suffering from severe Dysphagia (unable to swallow food). When she came to the hospital as an outpatient, she was unable to swallow even small quantities of food and if she was to continue like that, she would have landed in severe malnutrition status. Having regard to the condition of the patient, the doctors of the hospital advised for CT scan of neck and thereafter in view of CT scan, all the findings were discussed with the radiologist, " their reply stated

Since there was no other test which can clearly delineate the problem, made the patient to undergo Endoscopy which was only the option left, the reply added

The hospital administration and the doctors stated that they had explained the pros & cons of the Endoscopy to the patient as well as to the parents of the patient and also clearly informed and explained to them about the alternate tests and their disadvantages. The attendants of the patient and the patient had given written consent only after understanding and accepting the procedure of Endoscopy to be conducted on the patient by the hospital administration and the doctors,

The Opposite parties  further stated that during the Endoscopic procedure, the doctors hadtaken utmost care in view of the critical condition of the patient. One anesthesiologist was also present during the endoscopy procedure and has taken utmost precaution and proper care, anticipating problems during the Endoscopy. The allegation of the complainant that there was evidence of tracheal injury is absolutely false and not true. In fact if tracheal injury was to be there, it would have caused immediate fatality. 

The doctors further stated that till now no case has been reported in the medical literature that endoscopy causes tracheal injury. Post procedure, the patient developed hypoxia (reduced oxygenation) because of severe Tracheal stenosis and immediately the patient was intubated and oxygen was given.

During the post procedure period and during the stay in the hospital the Opposite parties have taken utmost care of the patient and the patient showed signs of improvement. On the next day the patient was taken off the ventilator and put on oxygen therapy. In-spite of improvement in the health condition of the patient the attendants of the patient wanted to take the patient to their native place at their own risk even after the advice by the doctors not to move the patient. Thus in-spite of repeated efforts by the opposite party doctors to convince the attendants of the patient regarding the continuation of treatment and the risks involved in shifting the patient, the attendants of the patient did not listen to the advice of the opposite party doctors. They shifted the patient much against the medical advice of the doctors. If the patient was to continue in the hospital of the opposite party and continued the treatment, she could have improved her health condition and could have survived in fact. The parents of the patient have given in writing stating as Left against Medical Advice, while leaving the hospital. Thus, the death of the patient was due to the acts of the Complainants i.e., (parents of the patient who were the attendants of the patient at that time) but not due to the negligence on the part of the doctors and the hopsital

After hearing the contentions and persuing the documents submitted by the parties, President V Narasimha Rao, and members- VT R Jawahar Babu and R S Rajasree observed that the hospital administration and the doctors "utterly failed to anticipate adverse Pros and Consequences and they conducted the procedure of Endoscopy, without considering the physical appearance i.e. Scoliosis and Belching. "

The doctors of the opposite party state that till now no case has been reported in the medical literature that endoscopy causes tracheal injury. Post procedure, the patient developed hypoxia (reduced oxygenation) because of severe Tracheal stenosis and immediately the patient was intubated and oxygen was given. Tracheal stenosis means narrowing of wind pipe that can occur after radiation therapy, prolonged usage of breathing tube or other procedures. It can be caused by an injury or a Birth defect. But the Opp. Parties No. 1 to 3 failed to explain the reasoning as to why hypoxia is developed and why the opposite parties proceeded with the procedure of Endoscopy as the patient is a known case of Tracheal Stenosis. 

The forum noted that the doctor had also not submitted the findings of the endoscopy procedure

The opposite parties have not furnished the findings of the Endoscopy procedure to prove the reasons for occurrence of mishap. They are simply denying the commensurate of Tracheal injury but failed to explain the reasons for development of hypoxia (reduced oxygenation). The opposite parties utterly failed to anticipate adverse Pros and Consequences and they conducted the procedure of Endoscopy, without considering the physical appearance i.e. Scoliosis and Belching. Accordingly, we answered this point in favor of thecomplainant

The forum finally noted Due to negligence and ignorant acts of the hospital administration and the doctors and directed them to pay a compensation of Rs 15 lakh. The forum held;

"It is very clearly established that the Opposite parties No. 1 to 3 failed to consider the Radiology Report under Ex. A-3 prior to commencement of Endoscopy procedure. Nowhere it was noted or proved that on considering the findings of Ex. A-3 Radiologist report only the procedure of Endoscopy is being commensurated."  

The forum added;

"The physical appearance of the deceased daughter of the complainants itself speaks that she has got physical deformity which it termed as "Belching" legally considered as maxim of "Res-ipsa Loquitor". Without considering the maxim under the res-ipsa Loquitor the opposite parties No. 1 to 3 has conducted the procedure of Endoscopy very negligently under the pretext of ascertaining the root cause of the decease, it amounts to deficiency in treating the patient and also adoption of unfair trade practice under the factor of corporate treatment."

You can read the full order by clicking on the following link