No evidence justifying dialysis on patient with cardiac complications: Consumer court orders hospital, cardiologist to pay Rs 99 lakh compensation

"...the complaint is partly allowed, by directing the Opposite Parties jointly and severally to pay Rs.99,00,000/- (Rupees ninety nine lakhs only). Out of the compensation amount of Rs.99,00,000/-, a sum of Rs.50,00,000/- shall be apportioned to the 2nd complainant/minor daughter. The said amount shall be deposited in a fixed deposit in any Bank in the name of the minor till she attains majority. The 1st complainant, being the natural guardian, shall be entitled to withdraw the accrued interest periodically for the welfare, education and maintenance of the minor. The principal amount shall not be withdrawn, encumbered or pledged until the minor attains majority, except with prior permission of this Commission. The complainants are also entitled to the cost of the complaint at Rs.10,000/- (Rupees ten thousand only). Time for compliance is 45 days from the date of order, failing which the awarded amounts will carry interest at 9% per annum, then onwards," ordered the Commission.

Background: 

The case history goes back to February 28th, 2025, when the complainant's husband was admitted to the treating hospital for treatment. It was alleged that the patient was initially stable. However, the treating hospital and doctor allegedly failed to properly diagnose his condition. 

It was also alleged that the treating doctors administered improper treatment, including dialysis despite the patient suffering from serious cardiac complications. Due to this, his condition worsened, and he ultimately passed away on 02.03.2025.

Apart from these allegations, the complainant also claimed that the hospital and doctor issued false and manipulated medical reports, failed to provide a proper explanation regarding the deteriorating condition of the patient, and they allegedly gave evasive replies when questioned regarding the negligent treatment.

Submitting that the patient was an earning member of the family and how his death resulted in irreparable mental agony, financial hardship, and loss of dependency for the family, the complainant sought Rs 99 lakh as compensation, Rs 3 lakh paid to the hospital and Rs 10,000 towards costs of litigation.

On the other hand, the treating hospital and doctor (cardiologist) denied all the allegations of negligence and deficiency in service and argued that the patient was admitted in a critical condition with serious co-morbidities including uncontrolled diabetes, renal complications and cardiac issues. According to them, all treatment was rendered in accordance with accepted medical protocol and with due care and caution.

They further contended that the deceased had a prior medical history and his condition deteriorated naturally due to complications associated with his illness. It was specifically pleaded that dialysis was medically indicated and administered under expert supervision.

Other allegations regarding false reports, wrongful treatment, coercion for money or suppression of facts were also denied. They further contended that the complainant failed to produce any expert medical opinion to establish negligence. They relied on several judgments including- Jacob Mathew v. State of Punjab, Kusum Sharma v. Batra Hospital, Martin F. D'Souza v. Mohd. Ishfaq, and Dr. Neeraj Sood v. Jaswinder Singh to contend that mere death of a patient does not amount to negligence and that courts should not substitute medical wisdom with hindsight analysis.

Observations by Consumer Court: 

After perusing the documents, the Commission observed that the document records the diagnosis as "Acute AWMI with Severe LVD", showing that the patient was suffering from serious cardiac complications.

The Commission also noted that the complete case sheet of the patient was admittedly not produced before the Commission, as categorically admitted by the hospital and doctor's own witness during cross-examination. "The progress notes and nursing notes are only part of the hospital record. The complete case sheet would ordinarily include admission notes, ICU chart, dialysis requisition, nephrology consultation, cardiology consultation, investigation reports, informed consent, dialysis order sheet, dialysis monitoring chart, medication chart, treatment protocol, discharge/death records," the DCDRC clarified at the outset.

Further, the Commission observed that even though the hospital and doctor argued that the treatment was administered according to accepted medical standards and that the patient had serious co-morbid conditions, the evidence on record revealed that they themselves issued an ECG report pertaining to a period prior to admission of the deceased into the hospital.

"No convincing explanation was offered as to why reliance was placed on such pre-admission report instead of contemporaneous cardiac evaluation during hospitalization. This circumstance creates serious doubt regarding the adequacy of assessment prior to administering critical treatment," observed the District Consumer court, further noting the witness examined on behalf of the hospital and doctor admitted during cross-examination that in case of a heart stroke, dialysis should not be given as per ICMR norms. He further admitted that dialysis was nevertheless administered twice to the deceased patient.

The court also referred to the argument that the hospital conducted the dialysis of the patient without the advice of the treating nephrologist. Even though the witness denied it, the witness admitted to not filing any document advising dialysis on 28.02.2025 by the said nephrologist.

Taking note of multiple contradictions in the witness testimony, the Commission further observed,

"Once their own witness admitted that dialysis is ordinarily contraindicated in such cardiac condition, the burden shifted upon the Opposite Parties to establish through cogent expert evidence and treatment protocol that the dialysis administered in the present case was medically justified despite the cardiac condition. No such independent expert evidence or convincing nephrology/cardiology opinion was produced by the Opposite Parties."

"The Commission is conscious that medical negligence cannot be presumed merely because a patient died during treatment. Equally, once the complainants establish circumstances giving rise to a reasonable inference of negligence and the relevant medical records remain exclusively in the custody of the hospital, the burden shifts upon the hospital to satisfactorily explain the course of treatment adopted. In the present case, the Opposite Parties failed to discharge that burden by producing the treating nephrologist, the dialysis requisition, the complete case sheet or any contemporaneous expert opinion justifying dialysis in a patient suffering from Acute AWMI with Severe LVD," it further observed.

Regarding the issue of withholding the complete case sheet, the DCDRC noted

"The Opposite Parties, despite being the custodians of these records, withheld the complete case sheet without assigning any satisfactory explanation. This omission assumes considerable significance because the principal defence of the Opposite Parties is that dialysis was medically indicated. The best evidence to establish such medical justification would have been the contemporaneous treatment records... Failure to produce the best available evidence invites an adverse inference under Section 114(g) of the Bharatiya Sakshya Adhiniyam, 2023, namely that had such records been produced, they would have been unfavourable to the Opposite Parties."

Addressing the witness testimony, the Commission noted that the admission of the witness assumes significance not because the witness is a medical expert, but because it constitutes an admission made by the Opposite Parties through the witness chosen by them. Another thing that the Commission noted was that despite such controversy, they failed to examine the treating nephrologist or cardiologist or produce any contemporaneous medical record justifying dialysis.

"The failure to produce the best available medical evidence justifies drawing an adverse inference," the DCDRC noted.

The Commission addressed the Supreme Court judgments relied on by the hospital and doctor and observed, "The above principles represent settled law and are respectfully accepted by this Commission. However, the present case does not fall within the category of cases where negligence is sought to be inferred merely because the patient unfortunately died. The findings recorded herein are founded upon specific documentary and oral evidence available on record."

It observed that despite the diagnosis of Acute AWMI with Severe LVD, indicating a serious cardiac condition, the patient was admittedly administered dialysis on 28.02.2025. It noted that the hospital and doctor failed to produce any contemporaneous nephrology advice recommending dialysis before its administration. Their own witness admitted that no such document had been filed before the Commission. The witness further admitted that the complete case sheet of the patient was not produced before the Commission.

Referring to these, the District Consumer Court observed, "Such admissions considerably diminish the evidentiary value of his testimony in relation to the medical treatment rendered. Most significantly, when the Opposite Parties did not examine the treating nephrologist, the treating cardiologist, the ICU consultant or any independent medical expert to justify the course of treatment adopted."

It noted that once the complainants established circumstances raising a prima facie inference of negligence, namely (i) administration of dialysis despite serious cardiac complications, (ii) absence of contemporaneous nephrology advice, (iii) reliance upon a pre-admission ECG, (iv) non-production of the complete case sheet, (v) failure to examine the treating specialists, the evidentiary burden shifted upon the Opposite Parties to establish that the treatment nevertheless conformed to accepted medical standards but no such evidence has been forthcoming.

"The Opposite Parties merely relied upon general propositions of law without substantiating, by reference to contemporaneous medical records or expert testimony, that the treatment administered in the present case satisfied the standard of care expected of reasonably competent medical professionals. The Supreme Court decisions relied upon by them do not dispense with the obligation of the hospital to explain its treatment where the relevant records are in its exclusive possession," the Commission observed at the outset.

"The present case is materially different. Here, the finding of negligence is not based on hindsight or the unfortunate death of the patient. It is based upon failure to produce the complete treatment records, absence of contemporaneous medical advice justifying dialysis, reliance upon a pre-admission ECG instead of a contemporaneous assessment, failure to examine the treating specialists, admissions elicited during cross-examination, failure to rebut the complainants' evidence with cogent medical material. Therefore, the ratio of the decisions relied upon by the Opposite Parties does not advance their case," it held.

The Commission opined that this case squarely attracts the principles laid down in Achutrao Haribhau Khodwa, Spring Meadows Hospital v. Harjol Ahluwalia, Nizam Institute of Medical Sciences v. Prasanth S. Dhananka, and Balram Prasad v. Dr. Kunal Saha, where the Supreme Court recognised that hospitals are liable where the standard of reasonable medical care is not maintained and such failure results in injury or death.

"Accordingly, this Commission is satisfied that the complainants have proved, on the touchstone of preponderance of probabilities applicable to proceedings under the Consumer Protection Act, 2019, that the Opposite Parties were guilty of deficiency in service and medical negligence," the DCDRC concluded.

Noting that the deceased was earning Rs 90,000 per month, and was 42 years of age, the District Consumer Court calculated, "Applying the multiplier of 14 corresponding to the age of 42 years and considering future prospects, loss of dependency, consortium, medical expenses, mental agony and other consequential losses, though the complainants will be entitled to a total compensation of Rs.1,40,00,000/- (Rupees One Crore Forty Lakhs only) but since the complainants restricted the claim to Rs. 99,00,000/- (Rupees ninety-nine lakhs only) we are inclined to allow only the amount claimed by the complainants."

"Out of the compensation amount of Rs.99,00,000/-, a sum of Rs.50,00,000/- shall be apportioned to the 2nd complainant/minor daughter. The said amount shall be deposited in a Fixed Deposit in any Bank in the name of the minor till she attains majority. The 1st complainant, being the natural guardian, shall be entitled to withdraw the accrued interest periodically for the welfare, education and maintenance of the minor," it ordered.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/2026/08/05/kakinada-dcdrc-363312.pdf

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