Hospital vicariously liable for acts of doctor: NCDRC upholds medical negligence, orders Rs 18 lakh compensation

Dr Inderjit Singh, Presiding Member of NCDRC clarified that they found no error apparent or illegality or infirmity in the findings of State Commission calling for any interference by the apex consumer body; and upheld the findings of State Commission with respect to negligence on the part of the Hospital and the treating doctor as well as fixing of liability on the part of Hospital. It further agreed with the quantum of compensation pronounced by the State Commission.

The case concerns a patient who visited Anusha Critical Care with a complaint of a heart stroke, where he was advised to undergo bypass surgery. Accordingly, he underwent bypass surgery at the Global hospital, performed by its doctor. However, during the surgery, there was irregular and improper supply of oxygen, resulting in blood clotting in the vessels that carry blood to the brain. As a consequence, the brain suffered dysfunction, and the deceased fell into unconsciousness/coma right in the operation theatre. To support his breathing, the deceased was put on a ventilator. Ultimately, the patient died.

Thereafter, the deceased patient's wife and son filed consumer complaint before the State Commission alleging deficiency of service/medical negligence on the part of hospital and the doctor and seeking compensation of Rs.40.00 lakhs.

It was the case of complainants before the State Commission that on account of callousness and gross negligence on the part of the doctor in performing the operation and not taking care of the patient, the patient went unconscious resulting in his death and this happened in the process of performing surgery by the doctor. While the patient was taken with complaint of cardiac problem, he died due to brain hemorrhage. The failure of brain functions and the resultant death of the patient was due to negligence on the part of the doctor and his associates who were expected to keep the supply of oxygen to the brain intact and show vigil during the course of conducting the surgery, it was alleged.

It was also the case of complainants that on persistent enquiries, the doctor hesitatingly revealed that during the course of conducting surgery, there must have been disruption in the supply of oxygen to the brain and for such non-supply or improper supply, there could be clotting of blood in the brain, for which the patient is in unconscious state and in coma. The Hospital and the doctor did not furnish the CD recordings of surgery in the theatre.

Subsequently, the State Commission allowed the complaint and directed the Hospital to pay compensation of Rs.18,00,000/- to the complainants together with costs of Rs. 5,000/-. While complaint against the doctor was dismissed.

However, the order of the State Commission was challenged by the Hospital on certain grounds before the apex consumer commission. It said that the State Commission failed to acknowledge that the patient suffered a stroke, which is a well-known and inherent risk associated with bypass surgery. The risk of stroke was adequately explained to the patient and their family, and all necessary and medically feasible measures were taken by them to prevent such an occurrence. The occurrence of the stroke was a result of a clot formed due to the presence of plaque, fat material, or debris, leading to the blockage of blood vessels supplying the brain. It was not due to insufficient oxygen supply, as wrongly alleged by the complainant.

The Complainants on the other hand contended that the state commission correctly determined that there was a deficiency of service on the part of the hospital. However, it erred in considering the age, status, and income of the deceased. It contended that the petitioner was entitled to a higher compensation. The portion of the impugned judgment related to the determination of compensation was in violation of the law.

They contended that the patient was conscious, coherent and without any clots at the pre-surgery stage. During surgery, on account of medical negligence, whether of the anesthetist or of others, there was hypoxia due to lack of oxygen supply to the brain, due to which the patient went to coma. The scanning reports state that there was no proper supply of blood to the brain in Thalamic. It further contended- "It is the duty of anesthetist during the course of surgery to watch and ascertain proper supply of blood and oxygen to the brain. Adverse inference as to negligence during operation is required to be drawn due to non-supply of operation CD by the hospital. The gross material contradiction between pleadings of the hospital, contents of the medical record and statements made in cross examination by the hospital’s own witnesses regarding condition of the patient clearly show that hospital was guilty of medical negligence. There is no explanation on part of hospital as to how clotting in brain took place despite administration of anti-coagulants. The hospital has failed to discharge the onus of explaining as to how the patient slipped into coma despite claims of successful surgery. There was gross negligence in post-operating care of patient. MRI scan was conducted 4 days later, manner of taking the comatose patient for MRI scan was not appropriate."

They further contended that;

"Carotid Doppler Test was not done despite it being a high risk category and despite Neurologist recommendation. EEG was not done at post-operative stage despite recommendation of Neurologist. Operation Notes do not show any monitoring of blood flow to the brain despite it being a high risk category operation, heart functioning level came down after the operation, there was no adequate surveillance by senior medical staff after operation. Pre-operative NTG Report showed significant residual visible myocardium, hence here was significant chance of recovery of patient."

With regard to their appeal for enhancement of compensation, the complainants contended that at the time of death, patient was about 48 years of age, was working as Senior Assistant in Judicial Department and drawing salary of Rs.25,831/- p.m., had also been selected to the post of Category-II Superintendent and was temporarily promoted as Superintendent. The amount paid to hospital was Rs.3.40 lakhs although the demand was for Rs.8.0 lakh, which was subsequently scaled down to Rs.6,12,990/-. Apart from this payment, they also incurred subsequent hospitalization fee and other expenses. Out of Rs.18.00 lakh granted by State Commission, after taking care of various expenses, actual compensation comes only to Rs.12,70,061/- which is inadequate and not in consonance with either the age, income or status of the deceased. They relied upon various judgments of Hon’ble Supreme Court and this Commission in support of their demand for higher compensation and contended that even if multiplied method prescribed for Motor Accident Cases in Sarla Verma Vs. DTC (2009) 6 SCC 121 is taken into account, the compensation would be about Rs.40 lakhs.

After hearing the submissions, NCDRC went through the State Commission's order that concluded that;

"There was negligence/deficiency in service on the part of Hospital. As payments have been made to Hospital, there was an agreement of hiring of services of hospital, hence Hospital was held liable. There was no privity of contract about hiring of the doctor, hence the doctor was not held liable. State Commission after considering the evidence of DW1 (Dr. K. Prashant, CPO of Hospital) has concluded that there was improper supply of oxygen to the patient, which amounts to negligence and deficiency in service on the part of Hospital authorities. State Commission has also observed that in the instant case due precautions and responsibilities for pre-operative and post-operative were not taken.

It remarked that;

"State Commission has also observed that OPs failed to give any explanation as regards clotting of blood in the brain. As the OPs failed to inform the resultant condition of the patient and as there was no progress in the physical condition of the patient, it is quite natural, the complainants took the patient out from OP Hospital. DW1 doctor in his evidence before the State Commission stated that in this case, there is no supply of oxygen along with blood to parts of brain. It is the duty of the anesthesiologist during the course of surgery to watch and ascertain proper supply of blood to the brain and the proper supply of oxygen to the brain. State Commission has also taken note of some discrepancies in the consent forms."

It further held that;

"State Commission has further observed/concluded that it was imperative on the part of the doctor attending the patient to ensure proper supply of oxygen, which in the instant case, they failed to, which amount to negligence and deficiency in service. The relationship of OP-1 Hospital and OP-2 operating doctor being that of master and servant, for the acts of servant, master is equally liable under vicarious liability. The OPs failed to exercise reasonable care while treating the patient, which resulted in the death of patient. We are of the considered view that State Commission while coming to finding of negligence on the part of OPs have considered all the relevant facts, evidence produced before it and taken note of all the documents as well as rival contentions of the parties and case laws relied upon by them. We find no error apparent or illegality or infirmity in the findings of State Commission calling for any interference by this Commission at Appeal stage. We endorse the findings of State Commission with respect to negligence on the part of the OPs as well as fixing of liability on the part of Hospital. As regards quantum of compensation also, considering the age, status and income of the deceased, the State Commission has fixed the compensation at Rs.18.0 Lakhs as against Rs.40.0 lakhs claimed by the complainants. We are in agreement with the quantum of compensation arrived at by the State Commission."

However, as the time for compliance of State Commission’s order was one month, NCDRC held that;

"Compensation of Rs.18.00 lakh awarded by the State Commission shall be payable with simple interest @9% p.a. from 04.12.2016 (date of order of State Commission plus one month) till the date of actual payment by the Appellant Hospital herein. Further, the cost of Rs.5,000/- awarded by State Commission in favour of complainants is enhanced to Rs.30,000/-. The entire compensation of Rs.18.00 Lakhs as awarded by the State Commission, along with interest @9% p.a. w.e.f. 04.12.2016 and costs awarded as per this order shall be paid within one month of this order, failing which the total amount due as per this order, on the expiry of one month, shall carry simple interest @12% p.a. till the date of actual payment. Order of State Commission stand modified to that extent. Both the appeals stand disposed of accordingly."

To view the original order, click on the link below: