MD Medicine Doctors Competent to Treat ICU Patients Without Additional Intensive Care Training: NCDRC

New Delhi: While considering an appeal alleging medical negligence in treatment, the National Consumer Disputes Redressal Commission (NCDRC) recently held that MD Medicine doctors are sufficiently qualified to treat ICU patients without the requirement of extra intensive care training.

"Every MD Medicine is competent to treat patient in ICU," held the Apex Consumer Court bench, presided by Justice Ram Surat Maurya and Mr. Bharatkumar Pandya, while dismissing the complaint of medical negligence.

The history of the case goes back to 2009 when the complainant's wife was admitted to the Intensive Care Unit (ICU) ward of Akshaya Hospital with complaints of uneasiness. 

It was alleged that despite the fact that the hospital was a speciality hospital, no senior doctors examined the patient, who was treated by a junior MBBS doctor and two homeopathy assistants. 

The complainant further alleged numerous irregularities, including inadequate monitoring, inappropriate medication use, lack of informed consent, potential manipulation of medical records etc. and the patient passed away reportedly due to a sudden heart attack. In the death certificate, the cause of death was mentioned as 'Acute Coronary Syndrome, Cardiac Arrest, Cardiac Pulmonary Arrest'. 

However, the complainant argued that the diagnosis was contradictory to the earlier test results and ECG findings. Therefore, alleging medical negligence and lack of appropriate care, the complainant filed a complaint before the Madhya Pradesh State Commission, which dismissed the appeal. Following this, they approached the NCDRC bench.

On the other hand, the hospital argued that the patient was attended by a Senior Doctor -Dr Singh who had an MD Medicine degree. The doctor pursued his MD from Gandhi Medical College, Bhopal in 2007 and thereafter worked as a Senior Resident Doctor in Hamidia Hospital, Cardiology Department, Bhopal.

Further, the hospital submitted that the patient was subjected to all preliminary check-ups. Contrary to the complainant's claim, the hospital argued that nitroglycerine (NTG) was administered along with other medicines. The hospital also denied the existence of a junior doctor and claimed that all its staff, including doctors were adequately involved. 

Referring to the medical records, the hospital claimed that a second ECG showed that the patient's condition had stabilized before she experienced cardiac arrest, even though the medical team promptly took all the resuscitation efforts. As per the hospital, the patient suffered sudden cardiac arrest as she had a history of uncontrolled diabetes and hypertension. 

Denying the claim that the patient never had symptoms of heart attack, the hospital emphasized that sudden cardiac arrest was due to a well-known complication of Acute Coronary Syndrome, which refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (Stemi) to presentation found in non-ST-segment elevation myocardial infarction (NSTEMIN) or in unstable angina. ACS is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery, submitted the hospital. Relying on the medical records, they denied all the allegations of deficiency in service. 

While considering the issue, the top consumer court was considering the question of whether Dr. Singh, MD Medicine was competent for ICU duty in the hospital. 

A Medical Board was set up based on the orders of the State Commission and it comprised Dr. T.N. Dubey, Dr. B.S. Yadav, and Dr. Ajay Sharma. Dr. Dubey, the Chairman of the Medical Board, in cross-examination, stated that in the ICU, the treating doctor present should be MD Medicine.

Referring to this opinion the NCDRC bench held that Dr. Singh was competent for ICU duty and noted,

  "Medical Council of India did not prescribe that MD doctor present in ICU should have intensive course. Every MD Medicine is competent to treat patient in ICU. It is true that Homeopath doctors are not trained in allopathic medicine and for this reason a Homeopath cannot treat a patient by himself with allopathic medicine but they can supervise the vitals of the patient like any other paramedical staff. The appellants have not produced any contrary guidelines of Medical Council of India. From above evidence, it is proved that Dr. Singh, MD (Medicine) was In-charge of ICU of the hospital at the time of admission of the patient in hospital on 31.03.2009 at 21:15 hours."

"Dr. Singh, MD (Medicine) attended the patient, advised investigation and treatment of the patient. Homeopaths merely noted the vitals of the patient. All these facts were in the knowledge of V.C. Rawat. Dr. Singh, MD (Medicine) was competent to treat the patient in ICU," the bench further noted.

Regarding the allegations regarding infusion of NTG, the Commission noted that NTG was given through a PVC conduit (bottle & IV set) which absorbs NTG, making the effective NTG dose much less than what was going on with additional security attached namely Dial-O-Flow, which is standard practice in the hospital to infuse NTG and other sensitive drugs.

"Last recorded BP of the patient at 2:00 hours on 01.04.2009 was 118/70. The patient was already on Betaloc and Betablockers, NGT could not be withdrawn suddenly as it may precipitate heart attack. Lomorin was not given to the patient. It was Lomorin-a low molecular weight heparin, a standard treatment for Acute Coronary Syndrome was given. The patient never went into hypotension. NTG cannot produce hypotension and death within a span of 10 minutes," noted the Commission.

Therefore, the top Consumer Court concluded that the hospital provided proper care and there was no deficiency of service on the part of the hospital. 

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-order-246330.pdf

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