Mumbai: Failure to diagnose Gall Bladder stone by conducting a second sonography proved negligence on the part of Mumbai-based Godrej Memorial Hospital, its CEO and doctor, who have been asked to pay Rs 2.5 lakh as compensation to the son of the deceased patient.
The Additional Mumbai Suburban District Consumer Disputes Redressal Commission held the hospital and its doctors guilty as it noted that despite continuous complaint from the patient regarding acute abdomen pain, they did not attempt to conduct another sonography to find out the cause of the problem.
"It is not disputed that there was increase in Bilirubin levels of the patient progressively during the treatment at the Hospital-Opponent No. 1, where Opponent No. 4 was treating the patient. The Opponents 1, 2 and 4 acted very casually to provide treatment to the patient when the patient was claiming acute pain in abdomen," stated the Consumer court as it held the doctors and the hospital guilty.
The history of the case goes back to 2013 when the complainant's mother, the deceased was admitted at Godrej Memorial Hospital for fever and vomiting. The CEO of the Hospital, Dr. Suhas Gangurde, Dr. Meghraj Ingale and Dr. Deepesh J. Palan were providing treatment to the patient.
Although the hospital carried out sonography for finding out the problem, the test reports did not show anything. Meanwhile the patient kept complaining about acute pain in the abdomen and kept vomiting. However the patient was eventually discharged and despite the requests from the Complainant Dr. Palan did not carry out sonography and the hospital and doctors failed to provide further treatment to the patient. Following this, the hospital and doctors consulted M. D. in Gastro International Disease who in turn asked for liver biopsy, which could have endangered for her life, alleged the complainant.
Ultimately, on the request of the complainant, the patient was discharged and consequently the patient was admitted to Bombay Hospital for treatment. The second hospital advised complete blood count and sonography and they noticed Tiny Bladder Polyps with terminal Calculus with Associated Dilated CRD and mildly dilated IHBR and same was due to implicated dilated CBD Calculus of the size of 1-1- 2 cms.
It has been alleged by the complainant that the Godrej Hospital did not carry out the test at their hospital and as a result, the condition of the patient worsened. Claiming that the patient would have survived longer, the complainant alleged that the negligence on the part of Godrej memorial hospital and its doctors contributed to the death of the patient.
Therefore, holding the hospital and its doctors guilty of unfair trade practice the complainants approached the District Consumer Court and claimed compensation, refund of medical expenditure etc.
On the other hand, the Hospital and the doctors contested the claims made in the complaint and submitted that admitting, treating and discharging the patient was done on the sole discretion of consultants at the Hospital. The treating doctor submitted that missing of stone in CBD on sonography rising hyper luminaria was attributed to sepsis and on recovery from sepsis. The doctor further claimed that the report showed that the condition of the patient was improving.
Dr. Palan submitted before the consumer court that the complainant did not disclose the earlier disease of diabetes. The doctor further denied getting any requests for further sonography and submitted that the patient was not harmed by the delay in diagnosis even at Bombay Hospital.
After considering the complaints and going through the medical record and other pieces of evidence, the consumer court noted that as per the record, the Bilirubin level of the patient was increasing day by day during the treatment at the Godrej Hospital. The court also noted that sonography and several other tests had been carried out at the hospital. However even though the patient was complaining of acute pain in the abdomen, no further sonography was conducted despite several requests by the patient when the level of Bilirubin was increasing day by day causing serious health problem to the patient.
The hospital and the doctors claimed that the onus to prove medical negligence lies largely on the complainant and that this onus can be discharged by leading cogent evidence. A mere averment in a complaint by no stretch of imagination, be said to be evidence by which the case of the complainant can be said to be proved, they argued.
At this outset, the Consumer Court noted, "It cannot be denied that a doctor owes certain duties, namely, a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, and a duty of care in the administration of that treatment. A breach of any of these duties gives a right of action of negligence against him. There can never a be dispute that the medical practitioner has a discretion in choosing the treatment which he proposes to give to the patient and such discretion is wider in cases of emergency, but he must bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care according to the circumstances of each case."
"It is true that there is ample scope for genuine difference of opinion and a doctor is not negligent merely because his conclusion differs from that of other professional men," further noted the bench.
Referring to the medical record, the court noted, "It seems from the record that the Ultrasonography of abdomen and pelvis was conducted to identify obstruction as cause of rising Bilirubin. The Opponents 1, 2 and 4 should have repeat the sonography to find out the cause of pain. It also seems from the record that the Opponents 1, 2 and 4 consulted M. D. in Gastro intestinal disease who in turn asked for liver biopsy. The Opponents 1, 2 and 4 kept conducting the test for detecting infection as a cause of increase of Bilirubin, day to day in patient system but they have not carried out further sonography to identify the exact cause of pain in abdomen."
Taking note of the fact that the patient was taken to the Bombay Hospital, the bench observed, "The patient was taken to Bombay Hospital where Doctor examined the patient and advised blood count and sonography. It seems from report that on examination it was noticed that there were Tiny Gall Bladder Polyps with Terminal Calculus with associated dilated CBD and Mildly Dilated IHBR and the same was due to implicated dilated CBD Calculus of the size of 1-1-2 cms. This position was diagnosed and determined the ailment of the patient. The same examination could have been done by the Opponents 1, 2 and 4. But they have not carried out further sonography on the patient or other test as carried out at Bombay Hospital."
Holding the hospital and doctors guilty, the Court noted, "It is not disputed that there was increase in Bilirubin levels of the patient progressively during the treatment at the Hospital-Opponent No. 1, where Opponent No. 4 was treating the patient. The Opponents 1, 2 and 4 acted very casually to provide treatment to the patient when the patient was claiming acute pain in abdomen. The Bombay Hospital at first instance after examination and sonography noticed stones of the size mentioned above. Opponents did not prudently examine the patient health as required by medical practitioner. A Doctor is not guilty of negligence only if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular subject."
"In the treatment there is ample scope for genuine difference of opinion and a doctor is not negligent merely because his conclusion differs from that of other professional men. All the above facts prima facie indicates negligence on the part of the Opponents 1, 2 and 4 while treating the patient," further noted the Court.
Even though the Court denied that the death of the patient was caused by the treatment by Doctors and Hospital, the Commission held, "However, there is no direct evidence to show that the death of the patient caused due to treatment at Opponents No. 1. But the facts remain that there was negligence on the part of Opponents 1, 2 and 4 for treating the patient at their hospital."
"So far as Opponents No. 3 is concerned there is no evidence that any treatment has been given by him to the patient. The facts on record made it clear that his opinion was sought by Opponent No. 4 over the cause of the issue. Therefore, he cannot be made liable for medical negligence. However, Opponent No.1 being Hospital and Opponent No. 2 being the CEO of Opponent No. 1 and Opponent No. 4 attached to Opponent No. 1 treated the patient are liable for medical negligence and they are liable jointly or severally," further read the order.
The commission also noted that there was no specific pleadings and evidence regarding the expenditure at the hospital and stated in the order, "There is no specific pleadings and evidence with reference to the pleadings about expenditure incurred at both the Hospitals. It can be gathered from the facts on record that the patient and the complainant is sufferer of mental agony, harassment and costs. The complainant would also be entitled to get the compensation from the Opponents 1,2 and 4. Considering the facts on record and the material available on record, we quantified the amount of Rs. 1,00,000/- towards the costs of the treatment, Rs. 1,00,000/- towards the compensation and costs of Rs. 50000/- towards the litigation. The liability of Opponent No. 1 is vicarious. The liability of Opponent No. 1, 2 and 4 is joint or several."
Therefore the doctors and the hospital have been directed to pay Rs 2.5 lakh jointly or severally to the complainant within three months from the date of order.
To read the order of the Commission, click on the link below.
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