NCDRC Slaps Rs 16 Lakh Compensation on Maha Hospital for Negligence leading to minor's death

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held a Thane-based Hospital liable for medical negligence while providing treatment to a minor patient, who died after developing acute renal failure.

Accordingly, the Apex Consumer Court directed the Tarapur Atomic Power Station Hospital to pay Rs 16 lakh as compensation and Rs 1 lakh as litigation cost to the parents of the deceased patient.

While considering the complaint, the NCDRC bench opined that the hospital was responsible for the patient's death for not taking into cognizance the reduced urine output on the date on which it was first reported and for not referring the patient to a Super Specialty Hospital soon after it came to know of the reduced urine output in the circumstances of the case.

The history of the case goes back to 1998 when the complainant couple's son was suffering from a high fever and was admitted to TAPS Hospital, under the C.H.S facility. Accordingly, the duty doctor checked the patient, and blood and urine samples were taken for investigation.

It was alleged that noticing that there was no improvement in the patient's condition, the complainants started requesting the treating doctor at the hospital as well as the Hospital Superintendent to refer the patient to BARC Trombay Hospital. However, the requests were refused, even though the patient was struggling for life.

After conducting the Sonoraphy test and noting that the patient had started becoming weak, Dr. Vachcharajani referred the patient on 16.07.1998 to BARC Hospital. On the same day at 4 pm, the complainants admitted the patient to BARC Trombay Hospital, where, after examining the patient, the doctors found that the kidneys of the patient had stopped functioning and there was an acute respiratory problem. However, due to the non-availability of the facilities, the patient was referred to Jaslok Hospital for specialized treatment. On the same day i.e. 16.07.1998 at around 7.30 pm, the Complainants shifted the patient to Jaslok Hospital, where at about 6.10 am on 17.07.1998, the patient ultimately died.

Alleging gross medical negligence resulting in the death of their only son, the Complainants filed a complaint before the State Commission seeking a compensation of Rs 16 lakh with interest at the rate of 18% p.a. from the date of filing of the complaint.

On the other hand, the TAPS Hospital and its doctors denied the allegations of negligence levelled against them during the patient's treatment. They submitted that the patient was admitted to the Hospital with high-grade fever and body ache and a standard line of treatment was adopted. The patient was attended to by various qualified doctors, who treated the patient with all due required steps till the discharge of the patient from the Hospital on 16.07.1998.

They claimed that necessary blood tests, pathological tests etc. were advised and done and X-ray reports and pathological reports were found to be normal. Consequently, urgent investigations concerning the patient's condition were advised, and the reports of which suggested acute renal failure and impending Septicaemia. Due to this, it was decided to refer the patient to BARC Hospital, Mumbai.

The State Commission dismissed the complaint and following this, challenging the order, the complainants approached the Apex Consumer Court. The Appellant's counsel cited expert opinion of Dr Seth, which showed a deficiency on the part of the hospital for not having properly treated the patient, be it in terms of malaria treatment or in terms of monitoring the fluids electrolytes, which would have prevented acute renal failure of the patient.

He further submitted before the NCDRC bench that the State Commission erred in relying upon an expert opinion of Doctors constituted by the NPCIL under whose overall control the hospital functioned. Then he submitted that when the condition was not improving after two days of treatment, the patient should have been referred to a super speciality hospital.

While considering the matter, the top consumer court observed, "Evidently and indisputably, the patient had malaria for which anti-malaria treatment was started by the hospital. It is also a fact that the anti-malarial drug causes vomiting and loose motion. Therefore, the first two to three days are not significant in a sense that the line of treatment was normal in the circumstance of the case and no negligence was shown by the doctors."

However, the Commission noted that the situation changed after the third day when the patient's condition was deteriorating very fast and the patient started developing secondary conditions which the hospital and its Doctors "either failed to notice or totally ignored the same."

"It is also a fact that after two days of hospitalization, the Complainant requested the hospital authorities to refer the patient to BARC Hospital, Mumbai. It is also a fact that TAPS Hospital is more like a big dispensary and it does not have a Critical Care facility. While not taking such decision on second day by TAPS, is understandable, but thereafter, on going through the history and on the record, not taking such decision is an issue which needs to be looked into closely and in my opinion is critical in deciding this Complaint," the NCDRC bench noted.

The Commission also perused the death summary report of Jaslok Hospital and Research Centre where the patient was admitted in the late evening of 16.07.1998 and was declared dead in the early hours of 17.07.1998. 

Relying on this report, the Commission observed, "The Jaslok report is significant because it has correctly noted in an impartial manner the sequence of events and thus more reliable. The significant observation has been that the Complainant was admitted in the hospital for five days with complaints of fever, chills and decreased output for three days. The third day would start definitely of 14/15.07.1998. When this has been noticed by the Doctor, from the hospital record, it is seen that they have totally ignored it and have continued with treatment for conditions other than this problem. I notice that on the one hand, IV fluid has been given and subsequently lasix has been given. These are the procedures to be adopted in a normal course. However, such procedure cannot be undertaken when it is observed that the urine output has either reduced or totally stopped on 15.07.1998."

The Commission noted that the reduced urine output in a malarial situation was a clear indication of serious kidney problems. It opined that the "Hospital should have shown promptness for the patient to be referred to a Super Specialty Hospital for further treatment where facility of dialysis / ventilator in an appropriate Nephrology ICU would have been available."

"Reduced output of urine is a sign of the patient having renal failure. Eventually when on 15.07.1998 the blood tests were conducted, it was found that the parameters indicating renal failures had already been on a very high side, including the level of creatinine and the reduction of platelets. Not having referred the patient even as late as 15.07.1998 was definitely a most negligent step taken by the Doctors and the Hospital as there would have been a possibility that if the patient had been put on a ventilatory support with dialysis, he would have recovered. It has to be borne in mind that the patient was very young and that he had no history of any disease whatsoever. Reduced urine output is a clear indication of a renal stress and should not have been allowed to have been handled by a hospital with limited facilities and no specialist Doctors," the Commission further observed.

NCDRC noted that the problem of not diagnosing the seriousness of the reduction in urine output was further compounded by the fact that even when the patient was referred to BARC Hospital, Mumbai, it should have been known by the Doctors in TAPS Hospital, being a sister concern, that facility for treatment of renal failure does not exist in BARC Hospital.

Opining that there was a lack of concern on the part of the treating hospital, the Commission further noted,

"It would have been the primary responsibility of the Superintendent of the Hospital to have taken this minimum precaution and care to find out where should the patient be referred to after coming to know about the renal failure. This shows that the hospital authority did not exercise due care in referring the patient to the proper hospital. In case of renal failure, time becomes an essence and therefore, this shows the lack of concern on the part of the hospital authorities."

The top consumer court opined that the State Commission had ignored these factors. It also expressed its shock over the report of the expert Committee, which was headed by a Chief Engineer, NPCIL.

"For reduced urine flow even a Doctor with a normal competence would have understood the gravity of the situation. Administration of Lasix and IV fluid is not a solution when urine output is getting progressively reduced and creatinine level jumping. This should have been seen in the backdrop of the patient having the condition of malaria since last four days and who had not responded with all the multi malarial drugs and the drugs for reducing vomiting and loose motion including administration of powerful antibiotics," noted the Commission.

"For not understanding this simple medical condition, in my opinion, is nothing short of serious medical negligence. It is not my contention that the Doctors should have given some other treatment, it is my contention that this hospital was just not equipped to handle such situation. The State Commission has missed the critical point. By the time the patient was referred to BARC Hospital on the evening of 16.07.1998, the patient had already crossed the stage of any recovery. The Expert Opinion of the Respondents is in my opinion, nothing more than covering up the mistake committed by TAPS hospital and its administration," it further observed.

The Apex Consumer Court opined that it was collective negligence on the part of the hospital represented by its medical superintendent. The hospital was held responsible for medical negligence and for the death of the patient for not taking into cognizance the reduced urine output on the date on which it was first reported and for not referring the patient to a Super Specialty Hospital soon after it came to know of the reduced urine output in the circumstances of the case.

Accordingly, setting aside the State Commission's order, the NCDRC bench ordered, "The Respondent No. 1 is directed to pay an amount of Rs. 16 lakhs along with interest @ 9% per annum from the date of death of the patient till realization to the Complainants within six weeks of this Order, failing which, the rate of interest shall be 12% per annum for the same period. Further, the Respondent No. 1 shall pay Rs. 1 lakh as cost of litigation to the Complainants within six weeks, failing which interest @ 9% per annum shall be paid from the date of this Order till realisation."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-order-239270.pdf

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