Hurried Hysterectomy, Contaminated Blood Transfusion Leads to Patient's Death: NCDRC slaps Rs 25 Lakh Compensation on Doctor, Nursing Home for Medical Negligence

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently slapped Rs 25 Lakh Compensation on a Kolkata-based doctor and private nursing home for medical negligence while conducting a Hysterectomy on a patient, who died after undergoing the procedure.

It was observed by the Apex consumer court that the patient was subjected to surgery without ascertaining the other options and also without following the preoperative stage and the process of blood transfusion.

Further, the NCDRC bench noted that the blood that was given to the patient was contaminated and was the highly probable cause of symptoms that were developed by the patient.

Although the Apex Consumer Court upheld the opinion of the State Medical Commission regarding the medical negligence, it increased the amount of compensation and directed the doctor to pay Rs 15 lakh and the hospital to pay Rs 10 lakh as compensation to the complainant, the husband of the deceased.

The history of the case goes back to 2010 when the complainant and his wife visited the treating doctor to get the patient examined for severe gynecological problems. The doctor prescribed pathological tests and ultrasonography of the lower abdomen.

After assessing the report, the patient was advised to undergo hysterectomy. The treating doctor performed the same through laparoscopic method (TLH) on 23.04.2010. Post-operative, the patient's condition deteriorated and she became unconscious on 25.04.2010 and was shifted to Apollo Hospital, Kolkata, where she expired the next day.

The cause of death indicated in the death certificate was distributive shock and Disseminated Intravascular Coagulation (blood clotting) in a case of TLH (total laparoscopic hysterectomy).

Approaching the State Commission, the complainant alleged that the very attempt and advice of hysterectomy was against the usual norms without attempting any alternative medicinal treatment. Further, the complainant submitted that the advice for surgery was hasty and was performed hurriedly.

Apart from this, the complainant also contended that the patient had low haemoglobin and hypertension, yet the surgery was undertaken by the doctor casually without exercising due diligence. Further, it was submitted that in spire of pathological and other clinical reports indicating a high blood pressure of 140/100 mg and very low haemoglobin percentage of 6% mg/dl, the same was overlooked and the doctor went ahead with the surgery which was another aspect of negligence.

The complainant also alleged that one bottle of blood was transfused to the patient on 25.04.2010 which had been carelessly stored in the ward refrigerator and was severely infected. The patient allegedly collapsed immediately on the transfusion of this contaminated blood and it was the final nail in the coffin.

To prove his allegations, the complainant relied on the evidence and also filed documents to support the submissions and also relied on the medical expert opinion reports brought on record to demonstrate that finally, the patient's death occurred because of contaminated blood apart from other deficiencies.

On the other hand, the doctor and the hospital submitted that all due care was taken and the medicines were prescribed to control high blood pressure. The haemoglobin according to the defence was 9.0 mg/dl as per the blood report dated 24.04.2010 and was 11.3 mg/ dl on 25.04.2010. Therefore, even post-operative, the haemoglobin level of the patient was normal and was not alarming.

After assessing the documents on record, the State Commission concluded that there was clear negligence on the part of the doctor and the hospital in transfusing blood that was stored in a routine hospital fridge and reliance was also placed on the West Bengal Medical Council report dated 24.11.2017 to record medical negligence resulting in deficiency on that count. The State Commission allowed the complaint by directing the doctor to pay Rs 8 lakh as compensation with a further liability of Rs 4 lakh on the hospital on the same count.

The order of the State Commission was challenged by both the parties. While the complainant prayed for an enhancement of the compensation, the doctor and the hospital pointed out that the West Bengal Medical Council's report was bereft of an assessment without records and it cannot be accepted as reliable. They submitted that the State Commission commission committed an error in accepting the report and recording negligence against them. Therefore, they prayed for the dismissal of the complaint.

Contending the appeal before NCDRC, the counsel for the doctor and the hospital submitted that the inquiry, which was conducted on 28.09.2011 by four Doctors of the District Hospital, did not indicate any negligence, nor was there any conclusive report of negligence by the expert team of Medical College of Kolkata consisting of three doctors. Further, the counsel argued that the WBMC concluded that the doctor only deserved to be warned and therefore, there was no gross negligence as found by the State Commission. He further submitted that the 5th bottle of blood, which was stored in the refrigerator of the Hospital, was kept under permissible temperature conditions for storing blood and therefore, there was no error in maintaining the protocol. He further submitted that the other bottles of blood had also been kept in the same refrigerator from where they were transfused time and again from 23.04.2010 to 25.04.2010.

While considering the question of whether the decision to undertake a surgery was appropriate or hasty, the Apex Consumer court took note of the Statement of the Experts, which was deposed before the Ethics Committee of WBMC.

The expert opined that the patient had not been managed according to medical norms and there was nothing to indicate that the patient was having bleeding at the time of admission to assume an urgent need for surgery. The medical norms were not followed by not waiting for 24 hours after blood transfusion to ascertain the oxygen-carrying capacity of the blood. The patient should have been evaluated by a Cardiologist and Anesthetist at the preoperative stage. The statement categorically records that there were no evidences of fibroid uterus or other pathology requiring urgent hysterectomy, opined the expert report.

Referring to this report, the Apex Consumer Court noted,

"From the above opinion of the expert, it is evident that the patient was subjected to surgery without ascertaining the other options and also not following the appropriate protocol of preoperative stage and the process of blood transfusion."

Further, the NCDRC bench noted that at the initial stage, a team of four Doctors from the District Hospital of District 24 Paragana submitted a preliminary report on 28.09.2011 stating that since there were no complete documents available, it was not possible to give any firm opinion and the matter should be referred for an inquiry by a more experienced team of Gynecologists and Hematologists from any teaching institute of Kolkata.

In terms of the above report dated 28.09.2011, an Enquiry Committee of three Doctors of the Medical College Kolkata was constituted and they submitted a report on 20.10.2014.

Referring to the report of the Enquiry Committee of the three Doctors of the Medical College Kolkata, the Commission noted, "The said report even though did not give a final opinion but recorded its doubts with regard to the blood transfusion and the surgery being conducted at low levels of hemoglobin and symptoms of cardiomegaly."

Following the submission of this report, the Ethics Committee of WBMC tendered its report to the Medical Council and opined that the treating doctor acted irresponsibly in two manners- enough or conservative treatment had not been tried for the sake of surgery (LAH) in haste, the decision of surgery was hasty and without enough or prior conservative treatment, and transfusion of overnight stored blood, which was the prima-facie cause of death of the patient.

After considering the matter and duly questioning the complainant and the respondent doctor, the Council unanimously found the charged medical practitioner guilty of infamous conduct in a professional respect. Therefore, the Council unanimously decided that the concerned doctor was "warned".

Referring to the proceedings of the Council, the top consumer Court noted,

"It is, thus, evident from the aforesaid facts that apart from professional conduct, there were lapses clearly indicated therein which are sufficient to conclude that the Doctor was negligent."

In respect of the issue of blood contamination, the Commission referred to the deposition of the treating doctor before the Ethics Committee, where he stated that the patient was probably a victim of transfusion-related acute lung injury which is characterized by sudden onset of fever with chills tachycardia, breathlessness and rapidly progressing hypoxaemia and DIC usually starting 1 to 6 Hrs following transfusion and is one of the leading causes of posttransfusion mortality.

At this outset, the NCDRC bench noted, "It is, thus, evident that the blood was contaminated." The Commission also noted that the Nursing Home sought a report of the Blood Bag containing the blood that was transfused. Referring to the report from the pathology centre of the hospital itself, the Commission noted,

"This microbiology report confirms the manner in which the blood was contaminated and were the highly probable causes of symptoms that were developed by the patient that have been confirmed in the experts’ depositions and the evidence as discussed hereinabove."

Further, the NCDRC bench referred to the RTI application filed by the complainant seeking information regarding storage permission for blood by nursing home. Responding to the query, the State Public Information Officer stated that "Nursing Homes are prohibited from the permission of setting up of Blood Storage Unit for storing of blood."

Referring to this, the Apex Consumer Court noted, "It categorically states that all Nursing Homes are prohibited from setting up any blood storage unit for storing blood. It is, thus, evident that the blood which was kept for 3 days in the ward refrigerator of the Hospital was apparently in violation of the aforesaid Government instructions."

Therefore, holding the doctor and the hospital negligent, the top consumer court observed,

"It is, thus, evident from all the aforesaid facts on record that there was gross negligence having accumulative effect right from the stage of the planning of the surgery till the culminating of entire episode with the allegations arising out of the contaminated blood transfusion resulting in the death of the patient."

While considering the prayer for an enhancement of the compensation, the NCDRC bench noted, "In the instant case, the deceased was a post graduate in commerce and was also in possession of a Certificate from the Institute of Cost Work Accounts. This aspect does not seem to have been appropriately addressed by the State Commission and it has been decided on the ground that the said assertions were not supported by any cogent documentary evidence."

Therefore, the Commission opined that "award of ₹8 Lakhs against the Doctor and ₹4 Lakhs against the Hospital seems to be on the lower side."

Enhancing the amount of compensation, the Commission ordered,

"The facts and the manner in which the patient was handled clearly indicate gross medical negligence on the part of the Doctor as well as on the part of the Hospital administration in the manner in which the events and incident of blood transfusion compounded the worsening situation of the patient. Thus, a sum of ₹15 Lakhs against the Doctor and ₹10 Lakhs against the Hospital deserve to be imposed in the background above which would be just compensation."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/rs-25-lakh-compensation-ncdrc-230756.pdf

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