NCDRC relief to Medanta Hospital on Rs 7 crore Medical Negligence plea of urologist

The court pronounced that there appeared no nexus between the surgical treatment and death of the patient, who died three years after the Arch replacement, establishing that the Hospital, the treating doctors investigated and treated the patient as per the standard medical practice.

The case concerned a patient from Amritsar, who was a Urologist. He was diagnosed to have an Aneurysm of the arch of the Aorta and was referred to New Delhi, wherein, he got admitted to Medanta for replacement of the Aortic arch. Accordingly, the CT-Angio, ECHO, Carotid Doppler, and Peripheral Doppler studies were done.

However, it was alleged by the patient's wife (who is also a doctor) that the CT contrast material caused the severe allegoric reaction and resulted in hoarseness of voice and bout of blood came from the throat. She added that the diagnosis of rupture of the Aneurysm was totally wrong, and treating doctors decided to perform urgent surgery thereafter.

She contended that the doctors did not provide proper information about the nature of the disease and the choice of surgery to be performed. The consent was not informed consent, as both of them (the patient and his wife) were surgeons and would have preferred the endoscopic (closed) method of surgery as it was suggested by one cardiac surgeon, but the doctors allegedly performed open surgery.

It was further alleged that due to unhygienic conditions in the operation theatre the two surgical wounds (one in the groin and one on the chest) became infected and started oozing pus. For its treatment, the doctors allegedly advised further operations on both the sites, but the patient did not agree and he protested that it was against the established surgical principles.

However, the surgery was allegedly forcibly done under General Anaesthesia (GA). After four days, the doctor allegedly performed another operation for the wound on the chest at the lower end of the sternum, which was done under intravenous sedation and not under GA.

The patient was soon discharged, however, it has been alleged that the discharge summary was silent about the paralysis of the right hand, which the patient suffered during treatment. The patient was once again admitted to the hospital and this time also the admission record and the clinical findings were allegedly silent about the paralysis and it was recorded as 'NONE' for the neurological and musculoskeletal system.

Three years after being discharged for a second time, the patient subsequently passed away and the chest wound remained unhealed till his death.

Aggrieved by the alleged negligent acts of the hospital and the treating doctors, the deceased urologist's wife filed a consumer complaint before the Commission to claim compensation to the tune of Rs. 7.87 Crore jointly and severally.

However, the hospitals and the doctors filed their written version and denied deficiency of service or any negligence during the treatment of the patient. They contended;

"On admission, the patient was presented with ruptured Aneurysm and he was in a highly toxic state, around 95-100% risk to life. The patient was treated at OP-1 hospital as per medical standards. The patient survived for almost 3 years after treatment. The patient during Psychiatric consultation, himself admitted that for the past 5-6 years he was a habitual user of the drug Pentazocine and Midzolam."

They further submitted that based on the condition of the patient, " Since the Aortic aneurysm had ruptured, the 'Endo-Vascular' and/or 'Hybrid' procedure were not possible. The only option available to perform surgery was by "Open Procedure". After taking the patient's informed consent, the hospital and the doctors have performed surgery under Deep Hypothermic Circulatory Arrest ("DHCA") and replaced the infected Aneurysmal Arch with '24 mm Dacron branched Arch Graft'.

"The patient was discharged without any signs of paralysis of the right upper limb and was advised physiotherapy and follow-up," the hospital added in its submission.

Examining the case, the Commission noted that the patient was obese (108 kg), hypertensive with dysglycemia, peripheral vascular disease and presented with expanded Aneurysm of the arch of the Aorta. Also noted multiple scars on both arms, which is apparent from photographs of the patient taken at the time of his admission to the hospital, which was indicative of drug addiction by himself. It noted;

"Prior to the surgery, the patient was put on higher antibiotics viz Inj. Tazact, Inj. Amikacin, and Inj. Oflox. Thus it was a proper treatment. The patient was started antitubercular drugs as per medical literature anti-tubercular drugs are also given in the immuno-compromised patient."

It was further noted that during hospitalization the patient was examined by the Psychiatrist and the patient himself admitted that he was a self-administering and a habitual user of Pentazocine and Midzolam for 5-6 years. As per the medical literature Pentazocine is known as the 'poor man's heroine', a derivative of opium, and Midzolam is a sedative. Both drugs cause addiction. Such drug abuse persons are predisposed to risk of mycotic aneurysm, perioperative neuropathy, as noted in the instant case the weakness of Right upper limb.

Opining on the expert opinion submitted by the complainant that stated that the patient suffered Erb's paralysis due to possible mechanical injury to the Brachial plexus occurred during the hospitalization or during surgery, the Commission did not agree with the same and observed that the chances of Brachial plexus injury due to surgery was ruled out.

"In the instant case, we do not find any procedural fault or mechanical trauma to cause the Brachial plexus injury. Moreover, the expert has not commented and was silent on the Aortic arch replacement surgery and other ingredients of medical negligence that has nexus to the cause of death of the patient," Th Commission noted.

Referring to earlier orders by the Supreme Court that held that a doctor or surgeon cannot assure that the outcome of any surgery would be beneficial. Moreover, in the case of Hucks V/s. Cole, it was observed by the apex court that: "a medical practitioner was not be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference of another. A medical practitioner would be held liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field."

Subsequently, the Commission dismissed the complaint stating that deficiency/negligence cannot be conclusively established on the treating doctors/hospital. It noted;

"In the facts and specificities of the present case, in our considered view, the Complainants, though being well-qualified doctors, concealed that the Complainant No.1 was addicted to drugs. At the OP-1 Hospital, the treating doctors investigated and treated the patient as per the standard medical practice."

"We do not find deficiency/negligence in conducting the surgery for replacement of the infected Aneurysm of the arch of Aorta with '24 mm Dacron branched Arch Graft' or in the post-operative wound care and follow-up, " it added.

To access the official judgment, click on the link below-