Hospital, Doctors slapped Rs 10 lakh compensation for medical negligence in treating Acute Pancreatitis

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held a Ranchi-based private hospital and its doctors negligent while providing treatment to a patient suffering from Acute Pancreatitis. For this, the Commission has directed the doctors and the hospital to pay Rs 10 lakh compensation along with litigation cost of Rs 35,000 to the family of the patient, who ultimately died.

The Apex Consumer Court noted that the treating doctors overlooked the patient's experience of acute abdominal pain and medical reports indicating the presence of large stones in the urinary bladder and ureter. Further, the Commission observed that even though the ultrasound report hinted at acute pancreatitis, no treatment was administered for this ailment.

The matter goes back to 2003 when the complainant's son was admitted to the treating hospital due to abdominal pain and vomiting. Initially, the patient was treated by Dr. Nath on the advice of Dr Mohan, who prescribed medications over the phone. However, despite taking the prescribed medicines, the condition of the patient did not improve.

Allegedly, Dr. Mohan examined the patient the next day and advised an ultrasound. However, the doctor allegedly ignored a crucial part of the ultrasound report indicating "Ascites minimal plural effusion is present (Right)", which confirmed that the patient had Pancreatitis.

It was alleged by the complainant that despite this diagnosis, no treatment for Pancreatitis was administered and later that day, the patient was shifted to the ICCU due to acute pain, but life-saving medical care was still not provided. Ultimately, the patient passed away and the death certificate cited Acute Pancreatitis as the cause of death.

Although the District Commission allowed the complaint, the order was challenged by the doctors and the private hospital. While considering the matter, the State Commission allowed the appeal and set aside the order passed by the District Commission. This was again challenged by the complainants before the NCDRC bench.

It was argued by the counsel for the complainants that Dr. Nath admitted the deceased for the treatment of abdominal pain. However, the progress sheet clearly reflected that no physical examination was conducted and only medications were prescribed and the recommended tests were significantly delayed, taking over 13 hours post-admission.

Apart from these, the counsel for the complainants also alleged that there was not timely availability of reports to specialist doctors. Issues like the diagnosis of Acute Pancreatitis by the hospital proprietor, admission of the patient without recording any initial medical history, delayed recommendation of tests, and allegation of the USG report not being reviewed properly were also highlighted.

Further, the counsel for the complainants emphasized on the two expert opinions, one by Dr. G.S. Vats and another one by Dr Samir Rai, who cited critical deficiencies in the medical documentation. These include the absence of a detailed patient history and a lack of notes at the time of admission, which represented a substantial shortcoming in the medical care provided.

Further, Dr. Vats pointed out a delay in conducting a thorough clinical examination of the patient, with the first medical being recorded about one and a half hours after hospitalization. Referring to this delay, it was argued that it indicated a lapse in the delivery of proper medical care. The Expert, Dr Vats also criticized the inclusion of "Chronic Renal Failure" in the death certificate when there was no supporting evidence for such a condition. Additionally, the doctors failed to recognize the severity of the patient's pain and distension, which should have immediately raised suspicion of acute peritonitis associated with acute pancreatitis.

It was opined by the expert that the treating doctors neglected to order vital tests such as Serum Calcium level estimation and a CT Scan, which could have led to a more accurate diagnosis. Although a Serum Calcium test was ordered, it was not conducted and it represented a significant lapse in the diagnostic measures. Further, Dr Vats pointed out how the negligence extended to the interpretation of an ultrasound report and noted that the ulrasound report was illegible, and the doctors failed to act promptly to obtain a proper report. Moreover, the findings from the report, including the presence of Ascites and Minimal Pleural Effusion, were not incorporated into the patient's progress notes.

Similar opinions were expressed by another expert Dr. Rai who emphasised that the missed tests could have provided a more accurate assessment and monitoring of the patient's condition. These tests include Serum Calcium level estimation, a CT Scan, and Serum Electrolytes Measurement. Ultimately, the opinions of the experts suggested that the medical treatment was deficient and negligent and the lack of proper documentation, timely tests, and monitoring were pivotal shortcomings in the care provided to the patient leading to a missed diagnosis of acute pancreatitis and ultimately contributing to the patient's tragic demise.

On the other hand, the counsel for the hospital argued that the attending medical officer promptly examined the patient in the emergency ward, a diagnosis of ureteric colic was made, and necessary treatment was initiated. Eventually, the patient was admitted after stabilization and the nursing staff played a crucial role in executing these instructions. It was further claimed that a record-keeping system was in place to ensure the treatment's consistency.

It was further submitted that the patient's diagnosis of acute pancreatitis came after comprehensive tests and examinations and after identifying this condition, the medical staff acted promptly, confirming with additional tests. It was alleged that despite life-saving efforts, the condition of the patient deteriorated, ultimately leading to his demise. They further alleged that the medical records and the expert opinions did not indicate any departure from professional standards or a misalignment in the treatment plan. Therefore, they denied any negligence on their part.

While considering the matter, the top consumer court observed that since the filing of the complaint, the case has been dealt with by the district Forum twice, the State Commission thrice and the National Commission thrice. 

Previously, the State Commission twice directed the doctors and the hospital to pay Rs 10 lakh compensation. However, the matter was remanded back to the District Commission by NCDRC and in the 2016 order, the District Commission held the doctors and the hospital negligent and ordered Rs 10 lakh compensation. However, when this was again challenged before the State Commission, which allowed the appeal and exonerated the doctors and the hospital. 

The NCDRC bench perused the observations previously made by different Consumer Courts in respect of this case. Further, the top consumer court also referred to several orders issued by the Supreme Court including in the case of Jacob Mathew v. State Of Punjab & Anr.

After carefully going through the observations of the previous consumer courts and taking note of the Supreme Court orders, the NCDRC bench observed that the State Commission's focus was primarily on the experience and expertise of the treating doctors, rather than closely examining the course of treatment and the care provided to the patient.

"It is not within our purview or expertise to make medical diagnoses. However, our duty is to assess whether the treating physician took the necessary precautions and provided appropriate care to alleviate the patient's pain and suffering. Furthermore, we must scrutinize the remedial measures taken by the OPs," the NCDRC bench observed at this outset.

As per the NCDRC bench, the doctors appeared to have not made adequate efforts to monitor the patient's deteriorating condition, even when the patient was in the ICU. The bench noted that the USG report revealed findings of ascites and minimal pleural effusion on the right side. However, these findings were not documented in the progress notes.

The consumer court further referred to the expert opinions provided by Dr Vats, who expressed that the presence of ascites and minimal pleural effusion strongly indicated the development of acute pancreatitis.

Referring to this, the bench noted,

"We consider the omission to acknowledge these findings as a clear instance of negligence in the patient's treatment on the part of the OPs. The argument presented by the OPs, suggesting that the initial treatment for ureteric colic and acute pancreatitis is the same, does not exonerate them from demonstrating the absence of negligence in their provision of treatment to the patient."

NCDRC also referred to the opinions expressed by the other expert Dr Rai, who indicated that the medical presentation strongly suggested acute pancreatitis and noted, "...yet this possibility was not considered, and the diagnosis was overlooked."

The bench also noted the evaluation of Dr Vats opining that the treating doctors did not adequately consider the possibility of acute pancreatitis. Dr. Vats also opined that the doctors should have immediately conducted crucial tests such as estimating the serum calcium level and a CT scan. At this outset, the bench observed,

"Deplorably, these critical tests were not carried out. It is noteworthy that the idea of conducting a serum calcium test only arose at 8:25 PM, approximately an hour before the patient's demise. However, it appears that this test was ultimately not performed. Even if it is assumed that the treatment provided to the patient would have been the same for both ureteric colic and pancreatitis, there is no justification for omitting any mention of pancreatitis in the progress notes, particularly after reviewing the ultrasonography report. This omission appears to be another instance of negligence on the part of the OPs."

Noting that the treatment of the patient was based on telephonic advice from Dr. Mohan, the consumer court opined it to be another instance of negligence in treatment and noted,

"The argument made by the OPs, asserting that Dr. J. Nath was a competent doctor, does not absolve the OPs, especially considering that Dr. J. Nath simply followed the directions provided by Dr. D. Mohan (OP-3) over the phone. If OP-3 had personally examined the patient earlier, there might have been a possibility of early detection of the complication of pancreatitis. In light of the discussions and findings outlined above, we are of the considered view that there was negligence and a deficiency in service on the part of the OPs in providing treatment to the deceased patient..."

Holding the doctors and the hospital negligent, the Consumer Court observed,

"For the reasons stated hereinabove, and after giving a thoughtful consideration to the entire facts and circumstances of the case, various pleas raised by the learned Counsel for the Parties, we are of the considered view that State Commission went wrong in concluding that there was no fault on the part of doctors, treatments given were all in good faith, ... We are not in agreement with these conclusions of the State Commission and are of the view that there was material irregularity in the order of the State Commission in this regard."

"The State Commission's order contains errors as it overlooked significant facts and circumstances in the case. These facts include the patient's experience of acute abdominal pain and medical reports indicating the presence of large stones in the urinary bladder and ureter. The ultrasound report also hinted at acute pancreatitis, yet no treatment was administered for this ailment," it further noted.

Referring to several instances of negligence, the Commission set aside the State Commission's order and noted,

"The State Commission failed to recognize that expert medical opinions obtained by the OPs did not align with the facts and records maintained by the hospital. These reports omitted crucial information regarding treatment after the pancreatitis diagnosis and did not address actions taken between 3:30 pm and 9:45 pm on 07.03.2003. In contrast, reports from Dr. G.S. Vats and Dr. Samir Rai, obtained by the complainants, were meticulously based on thorough reviews of the hospital's medical records. These reports challenged the accuracy of the patient's diagnosis and criticized the lack of proper treatment for the severity of his condition, given the ultrasound findings."

"We tend to agree with the findings of District Forum in its order dated 28.11.2016 that ultrasound report submitted by the complainant before the District Forum revealed ascites and minimal pleural effusion on the right side, which were crucial signs of acute pancreatitis. Regrettably, these findings were not recorded in the patient's progress notes, highlighting negligence on the part of the OPs. The OPs' argument that the initial treatment for both ureteric colic and acute pancreatitis is the same doesn't absolve them from negligence in care," further noted the Commission.

With this observation, the top consumer court directed the doctors and the hospital to pay Rs 10 lakh compensation with simple Interest @ 9% p.a. w.e.f. 28.01.2017, along with litigation cost of Rs.35,000/- (including the litigation cost of Rs.15,000/- awarded by the District Forum) within 2 months.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-rs-10-lakh-compensation-226146.pdf

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