NCDRC relief to St Stephens Hospital, dismisses appeal alleging medical negligence

New Delhi: Finding no medical negligence on part of the Delhi based St Stephen Hospital; the National Consumer forum has dismissed a complaint against it which alleged that deficiency in service and negligence by the hospital resulted in the death of the patient.

The case goes back to the year 2007, when the patient, the wife of the complainant, was taken to the hospital with complaints of severe abdominal pain. Chest X-ray, ultrasound, CT scan and various other tests were conducted.

In his the complaint, the husband of the patient submitted that after the patient was shifted to surgical female ward, the Ryle's tube was forcibly inserted through her nose by an unskilled nurse and no qualified doctor was present at that time.

Such the procedure should be carried out in the presence of a competent and qualified doctor, he alleged. Therefore, the patient was put to unwarranted risk. She was shifted to Surgical (SICU) as she developed pneumonia and was not properly treated for the ailments she was suffering from. A week later into treatment, the patient was declared dead, the complaint submitted.

Being aggrieved, the complainant filed a complaint before the Delhi State Consumer Disputes Redressal Commission alleging that deficiency in service and negligence on the part of St Stephen's Hospital resulted in the death of his wife. The hospital did not issue medical record despite several requests.

In response, the hospital authorities denied all the allegations and negligence during treatment. They averred that the complaint was based upon the gross misconception and the treatment was given as per clinical signs and the symptoms of the patient. It was denied that the unskilled nurse inserted the Ryle's tube.

During the proceedings before the State Commission, it had sought an expert opinion from Safdarjung Hospital. The expert opinion stated (relevant portions)

"The patient was admitted to the said hospital on 19.11.2007 with complaints of ever, pain abdomen and vomiting and during her stay in the hospital a diagnosis of hydarid cyst of live with sepsis with multi organ dysfunction and acute respiratory distress syndrome was made. She was shifted to the ICU on 22 Nov., where her condition worsened.
This is nothing in the submitted reasons to suggest that due diligence and care was not taken by the attending doctor and specialist while treating her.

All necessary ventilator strategies were adopted, necessary investigations done, antibiotics, fluids; vasopressors were administered according to necessity and according to accepted guidelines.

According to records, the patients' relatives were informed of her deteriorating condition, off and on."

The Commission after hearing the parties, considering the evidence and expert board report, dismissed the complaint being devoid of merit.

Thereafter, challenging this decision, the complainant filed the first appeal before National Consumer Disputes Redressal Commission. The facts and its affidavit of evidence pertaining to the whole case were reiterated before the bench of Dr SM Kantikar as Presiding Member and Dinesh Singh as Member.

The counsel for the complainant submitted that the expert opinion was not as per the prescribed standard, but it was just a general report issued based on the medical record. If the patient was suffering from hydatid disease of liver then why the treatment of pneumonia was given; it was pointed. He further submitted that the Ryle's tube was not properly placed, it invaded the lungs, and thus it was the negligence on the part of the hospital.

After perusing the medical record and the expert opinion received from Safdarjung hospital; the NCDRC bench observed:

From the medical record, the diagnosis was clear that the patient was suffering from hydatid disease of the liver with sepsis and multi organ dysfunction syndrome (MODS) with acute respiratory disease syndrome (ARDS). Under such condition, it was necessary to aspirate gastric contents through Ryle's tube. We do not find that the Ryle's tube was wrongly placed in the lung or there was any perforation of the esophagus.

The medical record clearly depicts that the treating doctors have performed all necessary investigations and arrived at the diagnosis of hydatids disease of the liver. The patient further suffered MODS and ARDS which was treated as an emergency in the ICU with antibiotics, IV fluids and the vasopressors proper ventilatory support.

The bench found the State Commission's impugned Order to be well-appraised and well-reasoned Order and deemed the expert opinion as apt while dismissing the appeal.

Concluding on the case, the bench stated that it did not find there was any deficiency from the hospital and the treating doctors therein during the care and treatment of the patient. The patient was critical, but despite every possible efforts, the patient could not survive.

"..we find neither deficiency nor negligence on the part of the O.P. hospital. The first appeal is dismissed."
"it is not feasible to attribute negligence / deficiency on the respondent hospital, it is difficult to conclusively establish medical negligence / deficiency in service on the respondent hospital."

Attached is the detailed judgment below: