Faulty intubation during anaesthesia: SC slaps Rs 10 lakh compensation on Manipal Hospital

New Delhi: The Supreme Court recently directed Manipal Hospital to pay Rs 10 lakh compensation to the widow of a patient who developed hoarseness in his voice as a result of faulty insertion of a double lumen tube while administering anaesthesia.

While the District Consumer Court had granted Rs 5 lakh Compensation and the National Consumer Disputes Redressal Commission (NCDRC) upheld the same, the Supreme Court bench comprising Justices Hima Kohli and Ahsanuddin Amanullah enhanced the amount of compensation to Rs 10 lakhs.

"Having regard to the fact that the appellant expired during the pendency of the proceedings before the NCDRC, no useful purpose would be served in remanding the matter back for reappreciation of the evidence to arrive at a just and fair compensation. Instead, it is deemed appropriate to direct that the compensation awarded by the District Forum be doubled from ₹5,00,000/- (Rupees Five lakhs only) to ₹10,00,000/- (Rupees Ten lakhs only) with simple interest calculated @ 10% per annum from the date of filing of the claim petition till the amount is paid, subject to the adjustment of the amounts already released in favour of the deceased - appellant," the Apex Court bench ordered.

The appellant approached the Supreme Court bench being aggrieved by the NCDRC order, which upheld the Karnataka State Commission order that confirmed the ruling of the District Consumer Court, Bangalore directing the hospital to pay Rs 5 lakh as compensation and Rs 5,000 as litigation expenses. However, the complaint against the concerned doctors was dismissed.

It was submitted by the counsel for the appellants that despite the deficiency of services being proved against the hospital and the deceased patient having claimed Rs 18 lakh as compensation with interest, the District Forum had suo moto arrived at a rough and ready figure of Rs 5 lakh payable as compensation without furnishing any reasons for arriving at the said figure.

The matter goes back to 2003 when the patient had undergone surgery on the left lung and after the surgery, he developed hoarseness in his voice. Even though the operating surgeon had assured the patient that the hoarseness could be due to the operation involving the complete removal of the tumor along with lymphnodes around the Recurrent Laryngeal Nerve and assured that the patient could regain his voice within 6-8 months with nebulization and voice therapy, the patient's voice was not restored and remained hoarse all through. 

Subsequently, the appellant took opinions from two other expert doctors in the field and both doctors opined that there was subluxation of the left arytenoid process, which happened due to wrong intubation during the anaesthesia procedure at the hospital.

The appellant's counsel argued that it is not in dispute that the surgery relating to cancer of the lung is a specialized surgery and requires a specialized anaesthetist. It was contended that even though the Head of the Department of Anaesthesia was to administer anaesthesia to the deceased patient, the same was administered by a doctor who was qualified but was a trainee anaesthetist in the Cardiac Anaesthesia Department.

While considering the matter, the NCDRC bench frowned on the delegation of such a critical duty on a trainee anaesthetist and treated the same as a breach of duty of care. After perusing the material on record, the NCDRC bench observed that the dislocation of the left Arytenoid was on account of the trauma caused leading to the paralysis of the vocal cord of the deceased-appellant and that the RLN injury does not cause dislocation of Arytenoid. The top consumer court opined that the paralysis of the left vocal cord of the deceased-appellant was attributed to the faulty insertion of the Double Lumen Tube in the course of administering anaesthesia to him for undergoing the surgery.

Meanwhile, the counsel for the hospital submitted that the District Forum erred in discarding the evidence of the doctors who stated that there was nothing wrong in giving anaesthesia through a double-lumen tube. He also sought to question the reliance placed by the District Forum on the testimony of two expert doctors produced by the deceased-appellant during the course of evidence.

However, the records revealed that the Hospital did not object to the said expert doctors deposing in the case, nor did the Hospital file an application for an expert appointed by the District Forum for giving an opinion in the instant case, argued the hospital's counsel.

"Mere reliance on medical literature would not be sufficient to exonerate the Hospital from its duty of ensuring that the Head of the Department, Anaesthesia ought to have inserted the Double Lumen Tube. Instead, he was not available and the task was delegated to a trainee anaesthetist," noted the bench.

Further, the Court also took note of the submission made by the appellant's counsel that the deceased was working as an Area Sales Manager in the private sector and his career nosedived due to the hoarseness of his voice. The counsel submitted that the patient had virtually lost his voice and continued on the same post from the year 2023 onwards without promotion till he expired at the end of 2015. He was working on the same salary that was being paid to him at the time of his initial engagement i.e. Rs 30,000. per month.

Taking note of these facts, the Supreme Court bench observed, "...we are of the opinion that the District Forum ought to have taken all the aforesaid aspects into consideration for arriving at a rightful compensation payable to the deceased which in the instant case, has not been done."

Therefore, the bench enhanced the amount of compensation from Rs 5 lakh to Rs 10 lakh and ordered, "As requested by learned counsel for the appellants, the amount awarded as above be released by the Hospital in favour of the widow of the deceased complainant ... within a period of four weeks from today."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/supreme-court-rs-10-lakh-compensation-232650.pdf

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