Negligence in treating cancer patient: Woodlands Hospital, Oncologist, Anaesthetist slapped Rs 60 lakh compensation

New Delhi: Holding medical negligence during the treatment of a cancer patient, the National Consumer Disputes Redressal Commission (NCDRC) has directed Kolkata-based Woodlands hospital, its oncologist, and anesthetist to pay Rs 60 lakh compensation to the family of the patient, who died during treatment.

"The entire amount shall be paid within six weeks from today, failing which the concerned opposite parties shall be liable to pay 8% p.a. interest till its realization. In addition, the hospital shall pay Rs. 2 lac towards litigation charges," the NCDRC bench of Dr. SM Kantikar mentioned in the order.

The NCDRC bench slapped compensation on the doctors and the hospital after it noted that the Oncologist did not follow the instructions prescribed by Tata Memorial Hospital for chemotherapy. Further, the Oncologist allegedly remained absent during Chemotherapy and the Anesthetist blindly administered Vincristine intrathecally.

Apart from this, the Commission also referred to glaring deficiencies on the part of the hospital and noted, "It should be borne in mind that the hospital had displayed its infrastructure, facilities, name of specialist, departments and other facilities etc. through the brochures, website and advertisements. Therefore, the hospital apart from vicarious liability, is also liable for deficiency, failure of duty of care and unfair trade practices."

"...I conclusively determine ‘deficiency’ as well as ‘unfair trade practice’ on the part of the hospital - OP-1, a multispecialty tertiary care hospital of which the highest standard of essential infrastructure and patient’s care, protocols and management was expected but which it failed to provide. The medical negligence is conclusively attributable to both the doctors (OP-2 & 3), however the negligence of Anaesthetist (OP-3) is writ large," read the NCDRC order.

The wife and minor son of the deceased patient had approached the NCDRC bench seeking a compensation of Rs 3.1 crore as they alleged medical negligence in the treatment.

Back in 2008, the patient was diagnosed with Stage IIB Non-Hodgkin’s Diffuse large B-cell lymphoma (NHL- DLBCL) at Tata Memorial Hospital (TMH), Mumbai. After being advised Chemotherapy for treatment, the patient was airlifted to Kolkata for Chemo under consultation of Dr. Jindel, the Medical Oncologist, who had advised the patient to get admitted in Woodlands Medical Centre, Kolkata.

Three chemo cycles were completed till 11.06.2008 and the patient tolerated all three cycles, without any adverse reaction and he gained around 10 to 12 kg of weight.

For the B2 cycle, the patient had consulted Dr, Jindel and got admitted at Woodlands on June 18, 2008. However, allegedly, the Anesthetist Dr. Sanjay Patwari had administered Chemo. He allegedly injected Vincristine Intrathecally (IT) instead of Intravenously (IV). As a result of wrong administration of Vincristine intrathecally, the patient’s condition alarmingly deteriorated.

On June 20, realizing the precarious condition of the patient, and allegedly in order to wash off their hands from willful negligence, the patient was discharged by the hospital and the doctor referred him to TMH, Mumbai for emergency management.

Following this, the patient was admitted under Dr. Nair in TMH, with symptoms of fever, weakness of lower limb and urinary retention. Dr. Reena Nair counseled the family members of the patient about very slim chances of survival because of progressive deteriorating condition. Thereafter, the patient was shifted at Belle Vue Clinic, Kolkata on June 24, 2008. Ultimately, the patient, unfortunately, passed away on July 9, 2008.

Meanwhile, a complaint was filed before West Bengal Medical Council (WBMC) by the family of the patient against Woodlands Hospital and its doctors for willful negligence. Another consumer complaint was filed before the NCDRC bench and the wife and minor son of the deceased demanded Rs 3.1 crore as compensation for the untimely death of the 37 years old patient, who was the sole earning member of the family.

Responding to the complaint, Woodlands Hospital submitted that even though the death of the patient was admittedly an act of negligence by the Oncologist and Anesthetist, both the doctors were not associated directly with Woodlands Hospital and therefore, the management of the hospital cannot be held liable especially when there were no allegations of any administrative negligence or failure to provide basic infrastructure to the patient.

The hospital further provided details about the fateful day when the negligence allegedly happened. It was submitted that after knowing Vincristine was wrongly injected, the Oncologist and Anesthetist returned to the patient and took corrective steps by withdrawing CSF and gave injection hydrocortisone intrathecally. However, both the doctors allegedly did not report the implication of the said error to the hospital or the authority. Further, the hospital submitted that it did not get any opportunity to deal with the patient further as the patient was already discharged and sent to TMH.

Following this, the hospital examined the medical record and noted that the doctors had not disclosed the mistakenly administered injection and about no neurology reference made though neurological complication occurred. The hospital allegedly initiated internal inquiry of the said incident and prepared Sentinel Event Report on July 2, 2009. Besides, a Departmental inquiry was conducted and it was attended by the Oncologist and the attending nurse. The inquiry was done by WBMC at the Woodlands Hospital.

The treating Oncologist, Dr. Jindel denied negligence on his part and submitted that the wrong administration of injection was conducted by the treating Anesthetist who allegedly injected the medicine without consulting Dr. Jindel. Immediately knowing after the mistake, remedial steps were taken and the patient was shifted to TMH, Mumbai. He made his sincere endeavor to overcome the effects of inadvertently injected injection intrathecally, he further submitted.

Meanwhile, the Anesthetist submitted that Dr. Jindel requested him over telephone to administer intrathecal Chemotherapy session to the patient. Further, he submitted that on all previous cycles, the injections had been transported from Pharmacy by the designated personnel of the hospital and intrathecal drugs were not packed separately to the Ward in the designated container. 

The Anesthetist further claimed that the hospital had not followed the international recommendation and there were procedural lapses on the part of the hospital and treating Oncologist. He also alleged that the hospital and the Oncologist did not implement specific guidelines in Chemotherapy instruction sheet as provided by TMH and they kept the Anesthetist in dark about such instructions.

While considering the matter, the top consumer court noted that the WBMC had held the treating Oncologist Dr. Jindel guilty of infamous conduct in professional respect and removed his name from Register of WBMC for period of one year.

When the doctor challenged the order and approached the Principal Secretary of West Bengal Health Department, he was exonerated from all charges and the Anesthetist was held guilty for wrongful administration of the drug.

The NCDRC bench further noted that TMH had issued specific Chemotherapy instruction sheet specifying that "All chemotherapy should be administered only by qualified/trained Medical Oncologist”.

After perusing the entire medical record, and going through the medical literature on NHL treatment, and Chemo protocol, the Commission observed, "Admittedly, the medical negligence in administration of Vincristine wrongly was proved."

"In my view, now there is no need to dissect more to prove the negligence of the OPs. The “things speak on its own” the principle of “Res Ipsa Loquitor” squarely applicable to the case on hand. There is no need go to great lengths to prove the negligence. In the instant case, upon hearing the arguments form OPs, it seems the OPs are shirking way from each of their responsibility, but they are trying to shift the blame on one and another," further noted the bench.

Referring to the medical literature on Vincristine and the top court order in the case of Jacob Matthew and other judgments, the NCDRC bench opined, "In the instant case, the OP-1 hospital is vicariously liable for the act of OP-2 and 3, who treated the patient negligently."

"Thus, as per the law laid down (supra) in my view the OP-2 and 3 are responsible for not adhering to MCP- 842 Protocol, thus they can’t escape from the liability. The role of nurse was limited. As per chemotherapy protocol the chemo dose was to be prepared and drawn by the Oncologist. There was no allegation of any infrastructure or other lapse on the part of OP1 hospital where the patient has been successfully administered treatment on previous occasions. It is also an admitted fact that OP2 was incharge of the treatment which was to be done as per Protocol MCP-842 and if not followed, both doctors are liable for the consequences. However, even though the OP1 had no role to play in the entire treatment aspect, is vicariously liable here," it further observed.

Explaining the role of the hospital, the bench noted,

"The management of a hospital not only involves providing services of doctor or other staff, but also to ensure that proper treatment is provided to the patient. In the present case, nothing is on record that the nurse was not a trained or not for Chemotherapy. It is not evident the hospital has system checks or Standard Operating Procedures (SOP) for Chemotherapy and to prevent such incidents."

"The hospital (OP-1) cannot escape its vicarious liability for the medical negligence that has been meted out in the present case. Thus, I am of the opinion that the hospital is required to compensate for the medical negligence that has happened in the hospital," it added.

In the order, the top consumer court listed down the glaring deficiencies on the part of the hospital and noted,

"There are glaring deficiencies visible from the hospital (OP-1). There are no safety guidelines for treatment of cancer patients and about Chemotherapy. No documentation, no Standard SOPs for the Care of the patient receiving Cytotoxic or Biologic Agents. The hospital has not maintained records properly. For Intrathecal Chemotherapy only staff who have been appropriately trained and accredited, and whose names appear in the appropriate register are permitted to have involvement in the prescribing, dispensing, issue, checking and/or administration of intrathecal chemotherapy appropriate to their role and training. There are several procedural lapses on the part of OP-1. The Intrathecal drugs were not packaged separately for delivery to the ward in designated containers and clearly labeled on the outer container “For intrathecal use" as is required as per International recommendations. The hospital and the treating doctors are expected to be aware of unexpected errors. The specific guidelines provided in the Chemotherapy Instruction Sheet provided by Tata Memorial, Hospital, Mumbai were not followed strictly, just acted casually. Thus, the hospital OP-1 is held liable for those deficiencies in services and patient care."

The consumer court also held the doctors liable for medical negligence and held that

"Having regard to the observation on ‘ Duty of Care’ I find the hospital (OP-1) and two treating doctors failed in their duty of care. The doctors OP-2 and 3 were equally responsible for failure of duty of care. The OP-2 as a Medical Oncologist did not follow the Instructions prescribed by the TMH for Chemotherapy. He was not present during chemotherapy, which was against the mandatory protocol. And secondly, the OP-3 blindly administered Vincristine intrathecally; it was utter failure, carelessness and dereliction in the duty of care."

"Accordingly, the total amount of Rs.60 lakh as compensation awarded to the Complainants. Out of it, the Woodlands Medical Centre Ltd (OP-1) shall pay Rs. 30 lakh, the Medical Oncologist Dr.Rajesh Jindel (OP-2) shall pay Rs.10 lakh and the Anesthetist Dr.Sanjay Patwari (OP-3) shall pay Rs.20 lakh," ordered the NCDRC bench.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/woodlands-hospital-medical-negligence-207386.pdf

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