Every failure in diagnosis cannot be considered medical negligence: Delhi Consumer Court Exonerates Max Balaji Hospital, Cardiologists

New Delhi: The State Consumer Disputes Redressal Commission, Delhi, recently exonerated Max Balaji Hospital and its doctors from charges of medical negligence while providing treatment to a patient suffering from repeated palpitations. 

Although the patient claimed that the doctors and the hospital could not diagnose the reason for palpitations or suggest implanting an AICD machine, the consumer court held that the hospital and the doctors provided a standard level of services and medical care to the patient.

The history of the case goes back to 2010 when the patient was admitted to Max Balaji Hospital and was put under constant cardiac monitoring and medicare. After examining the patient, the treating doctor, the Director of Electrophysiology and arrhythmia Services HOD, advised ECHO test on day one of admission. 

The ECHO report showed that the patient had a 35% Ejection Fraction from the Left Ventricle and his ECGs were abnormal. The final ECHO done on 01 May 2010 showed 65% EVF with early diastolic dysfunctions. The diagnosis was given as Idiopathic Ventricular Tachycardia. After stabilizing, he was discharged under stable condition on 3rd May with medicines and proper follow-up. He had been advised for Holter monitoring after 2 months.

However, after discharge, the complainant had episodes of tachycardia and so he visited several doctors. After being treated at Medanta Hospital, the patient was discharged on 10/06/2010 and the discharge summary showed that the patient was admitted for stabilizing and management. Again he developed palpitations and due to repeated tachycardia, AICD machine was implanted to control the palpitations.

As per the complainant, the treating hospital i.e. Max Balaji Hospital and its doctors were negligent for not diagnosing the cause of Palpitations. Claiming that the treatment cost Rs 18.50 Lac, he demanded the amount with 24% interest along with Rs 55000 for litigation charges.

On the other hand, the hospital and doctors denied all allegations and submitted that the patient was admitted for palpitations and fatigue which existed for over two weeks. At the hospital, he was monitored by a panel of cardiac specialists. The VT had different morphology and low ejection fraction. All other parameters were normal. Due to repeated occurrences of VT under roper cardiac medications, heart rhythm was not stable. All required tests were done but the final diagnosis was not certain for repeated palpitations even after standard line of treatment for VT. Therefore, the diagnosis of Idiopathic Ventricular Tachycardia was given. 

Later his EVF was 65% checked by 2D ECHO tests, heart condition was stable. So, the patient was discharged with proper medicines and follow-up. The hospital further stated that tests including CAG, EPS were advised but neither the complainant consented nor reported for follow-up.

After considering the arguments, the District Consumer Court had dismissed the complaint noting that the Complainant had failed to prove his allegations against the hospital either by medical opinion or by any concrete evidence of deficiency and negligence in the diagnosis and treatment in managing Tachycardia/palpitations.

Challenging the District Commission's order, the complainant approached the State Consumer Court. It was submitted by the complainant that he was suffering from Sarcoidosis and Tuberculosis, and the hospital failed to diagnose these diseases which cannot be contracted overnight. Further the complainant submitted that nowhere in the discharge summary or the hospital records, it was mentioned that the cause of Ventricular Tachycardia was Sarcoidosis, or to treat Ventricular Tachycardia, an AICD needed to be implanted. 

He also claimed that he was not suffering from Idiopathic Ventricular Tachycardia as claimed by the hospital but Ventricular Tachycardia was triggered due to Cardiac Sarcoidosis. The complainant claimed that despite being super specialists, the hospital and doctors miserably failed to even say a word about the cause of Ventricular Tachycardia and also failed to diagnose Tuberculosis and Sarcoidosis disease. 

While considering the matter, the State Commission observed that the term "negligence" has no defined boundaries and if any medical negligence is alleged, whether it pertains to pre or post-operative medical care or to the follow-up care at any point in time at the hands of the treating doctors, it is always apposite to take note of the constituents of negligence.

At this outset, the Commission relied on the Apex Court's order in the case of Jacob Mathew v. State of Punjab and Anr and noted, "What is to be gleaned from the aforesaid decision is that 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."

The Consumer Court observed that the patient was put under constant cardiac monitoring and medical care and the treating doctor had advised ECHO test on day one of the admission. The diagnosis was given as Idiopathic-ventricular Tachycardia. After stabilizing, the Appellant/patient was discharged under stable condition on 03.05.2010 with medicines and proper follow up and was advised for Holter monitoring after 2 months.

"Therefore, there is no cloud of doubt that the Appellant was provided with the standard line of treatment," the consumer court noted at this outset.

Exonerating the hospital and doctors, the Commission further observed, 

"Here, it is noteworthy that the entire case of the Appellant boils down to the contention that the Respondents failed to diagnose the root cause of Tachycardia and the infection in the lungs of the Appellant. It is pertinent to mention here that a claim for negligence calls for a treatment with a difference. However, in the present case the record divulges that the treatment advanced to the patient was according to standard medical protocol. It is to be noted that a doctor can only be expected to provide a reasonable and standard level of care and a mere failure to diagnose the root cause of a disease cannot be termed as medical negligence. It is enough for the Respondent to show that the standard of care and the skill attained was that of the ordinary competent medical practitioner exercising an ordinary degree of professional skill and the treatment never fell below the generally accepted level/standard of care. The fact that the Respondent charged with negligence acted in accordance with the general and approved practice is enough to clear him of the charge."

Further referring to other legal precedents set by the Supreme Court, the Commission observed that the Appellant had led no evidence of experts to prove the alleged medical negligence except his own affidavits. 

"The experts could have proved if any of the Respondent-doctors/hospital providing treatment to the patient were deficient or negligent in service. Furthermore, the Appellant has not placed on record any relevant medical documents to prove that the treatment given by Respondent-doctors/hospital was contrary to diagnosis and was not required. A perusal of the medical record produced does not show any omission in the manner of treatment," observed the Commission.

It also held that the principle of res ipsa loquitor would not be applicable in this case as for the application of this maxim, no less important a requirement is that the res must not only bespeak negligence, but pin it on the Respondent. Noting that the experts of different specialities and super-specialities of medicine were available to treat and guide the patient's course of treatment, the Commission further highlighted that "The doctors are expected to take reasonable care but none of the professionals can assure that the patient would overcome the ailments in all probability."

Therefore, opining that the hospital and the doctors provided standard level of services and medical care, the Commission dismissed the complaint and noted,

  "The Respondent-hospital and the doctor exercised sufficient care in treating the patient in all circumstances. However, in an unfortunate case, diagnosis may or may not precisely identify the root cause of the disease. Here, It is necessary to remark that sufficient material or medical evidence should be made available before an adjudicating authority to arrive at the conclusion that the disease exacerbated due to medical negligence. Every failure in diagnosis of a patient cannot on the face of it be considered to be medical negligence."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-scdrc-no-medical-negligence-243974.pdf

Also Read: No Medical Negligence! Doctor only performed Excisional Biopsy to confirm cancer: NCDRC grants Rs 75 lakh relief to doctor