NCDRC slaps Rs 25 lakh compensation on Safdarjung Hospital, 2 cardiologists

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently upheld the Delhi State Consumer Court's order to hold Safdarjung Hospital and its two Cardiologists liable for medical negligence and directed them to pay Rs 25 lakh compensation to the wife of the patient, who died during the treatment.

In its order, the NCDRC held, "the standard of care and medical protocol required the administering of Inj. Nirmin which was not available in the Hospital. The State Commission’s finding that this amounted to negligence is based on its view that an essential injection such as this was to have been available in a hospital such as the appellant hospital. There is no evidence led to prove that the alternative of Inj. Albumin was the alternative prescribed under the protocol for treatment. No medical records as mandated under the Medical Council of India Regulations (MCI) 2002 were also made available."

"In the absence of these records, the conclusion of the State Commission cannot be faulted," noted the Apex Consumer Court, while upholding Rs 25 lakh compensation order passed by the State Consumer Court.

The case concerns a patient who was suffering from COPD, Lower Respiratory tract infection, cardiomyopathy with poor heart function with leaking heart valves when he was admitted to Safdarjung Hospital on 12.01.2017.

As per the complainant, the patient was administered the injection Albumin which continued for a few hours without informing the family members of the patient. Further, it was claimed that the treating doctor, Sr resident cardiologist, administered the injection Albumin acting on the advice of the HoD of the cardiology department, when the patient's pulse rate was 67 and BP was 110/78. This injection was administered as an alternative since injection Nirmin was not available. Consequently, the patient became unconscious.

Despite the resuscitation measures applied by the treating doctor on duty, the patient could not be revived. The complainant alleged that no records were supplied by the appellant hospital and doctors to prove that injection Nirmin was not available in the hospital and therefore injection Albumin was administered. It was contended that both injections of Nirmin and Albumin were administered.

Alleging an overdose of medicine, the wife of the deceased patient filed a consumer complaint before the Delhi State Consumer Court and demanded compensation for the alleged medical negligence, mental pain, and trauma.

While considering the matter, the State Consumer Disputes Redressal Commission Delhi, had held the treating hospital and its doctors liable for medical negligence and directed them to pay Rs 25 lakh as compensation. It had noted, "It is shocking that injection Nirmin was not available in a big hospital like Safdarjung Hospital in Delhi. There is no reason why said injection was not available in the hospital. There is nothing to show that since when the said injection was not available in the hospital and what efforts were done by the hospital to procure that injection."

The state commission had further observed, "The OPs have not denied in answer to para-4 of the complaint that they did not conduct any test before jumping to unlogical, unauthentic and astonishing conclusion that the patient has been suffering from alleged disease. This is per se negligence... The second important factor is that OPs have not denied that initially they proposed to administer Nirmin injection. They have admitted that they gave injection IV Albumin. Now the only controversy is whether the injection was given simultaneously or Albumin was given in place of Nirmin. The OPs have not denied that administrating both the injections simultaneously is not permissible or is not medical negligence. So the contention of the complainant that two other Senior Cardiologist advised her that it was a case of medical negligence, is strengthened."

However, the hospital and the doctors challenged the State Consumer Court's order on the grounds that the State Commission erred in arriving at the finding of medical negligence without obtaining an independent/ expert opinion in the absence of any proof to establish that the treatment provided was contrary to the medical protocol.

They submitted that the deceased patient was admitted to the CCU Unit II and was diagnosed with a case of CAD, COPD, Global LV Hypokinesia, moderate Mitral/ Tricuspid regurgitation, EF 15-20 with left ventricular failure. Allegedly, the patient was brought to the hospital after being treated for 7 days in a private hospital for pneumonia and he was a known case of dilated Cardiomyopathy who had eluded all treatment against the doctor's advice for the last two years. Tests, including 2D Echo, were done in the hospital and the family members were apprised of the seriousness of the illness. HRCT Chest finding suggested severely damaged lungs.

The hospital and the doctors further submitted that the deceased patient's heart was working at only 1/6th capacity and that his Ejection Fraction (EF) was 15%, and given the leaking valve, the effective ejection fraction was less than 10%. They claimed that the patient was treated as per the standard guidelines and the proof of the same was improvement in condition, which was also admitted by them in the complaint before the State Commission.

However, the patient became unconscious due to cardiac arrest as a result of Ventricular Tachycardia with hemodynamic collapse which, according to the hospital and the doctors, is a common cause of sudden death in patients with dilated cardiomyopathy with severe left ventricular systolic dysfunction. They stated that the doctor on duty provided cardiopulmonary resuscitation and certain injections. However, the patient could not be reviewed.

They argued that the State Commission failed to consider that a substitute medicine can be administered to a patient and this alone does not result in harm or casualty. It was also submitted that there was no record to show that the death was due to an overdose of medicine as had been argued by the complainant.

Meanwhile, the counsel for the complainant contended that the hospital, despite the directions by the State Commission, failed to produce the original medical records of the patient which itself is an act of negligence. It was also contended that the State Consumer Court had noted manipulation and interpolation of records by the treating doctors and hospital, which, as per settled law, amounts to negligence and deficiency in service.

It was also argued that the hospital was negligent on account of the non-availability of Nirmin injection and that such a lack of availability of essential drugs also amounted to negligent and deficient service.

Referring to the medical record provided under the RTI Act by the hospital to the complainant's son, it was argued that they had adopted a totally wrong and illegal line of medical treatment which was rightly observed by the State Commission. It was also contended that the hospital and doctors had distorted the facts of the deceased's past medical history and previous hospitalisation without producing any documents to establish either the treatment of the previous two years or even the name of the private hospital where the patient had allegedly been admitted for a week prior to admission in the hospital on 12.01.2017.

While considering the matter, the Apex Consumer Court noted,

"Admittedly, the standard of care and medical protocol required the administering of Inj. Nirmin which was not available in the Hospital. The State Commission’s finding that this amounted to negligence is based on its view that an essential injection such as this was to have been available in a hospital such as the appellant hospital. There is no evidence led to prove that the alternative of Inj. Albumin was the alternative prescribed under the protocol for treatment. No medical records as mandated under the Medical Council of India Regulations (MCI) 2002 were also made available."

The NCDRC bench also referred to Regulation 1.3 of MCI Regulations, 2002 which states that "If any request is made for medical records either by the patients/ authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued with the period of 72 hours."

NCDRC observed that the complainant claimed that the patient's medical records were not made available despite being asked for. It further noted-

"No details of tests at the time of admission of the deceased patient have been brought on record by the appellant (the hospital and the doctors) in support of its contentions that he was suffering from multiple medical issues. It has been specifically contended by the respondent that no tests were conducted."

Highlighting the absence of the medical records, the Apex Consumer Court upheld the State Commission's order of granting Rs 25 lakh compensation to the deceased patient's wife and noted, "In the absence of these records, the conclusion of the State Commission cannot be faulted."

"In view of the foregoing discussion, we are unable to find reasons to interfere with the findings and order of the State Commission. The order is liable to be upheld. Accordingly, the appeal is dismissed," it noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-safdarjung-hospital-236978.pdf

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