No medical negligence in COVID-19 hypoxemia case- Consumer Court clears hospital, doctors, sets aside Rs 5 lakh compensation order

Even though earlier, the District Consumer Court had directed them to pay Rs 5 lakh compensation to the patient's family, the State Consumer Court set aside the order and held, "...we are of the opinion that a medical practitioner or hospital would be liable only where their conduct fell below the standards of a reasonably competent practitioner in their field. As such, we are of the considered opinion that no negligence can be attributed to the said doctors as well as the hospital as the doctors have performed their duties with reasonable skill and knowledge. Accordingly, we find force in the contentions raised by the appellants/OPs No.1 to 3 and the impugned order of the District Commission is liable to be set aside."

The history of the case goes back to 2021, when the complainant's wife was admitted to Guru Nanak Mission Hospital, where her treatment was carried on for 4-5 days, and she was referred to Dayanand Medical College & Hospital for better treatment. At the time of admission, she was fully conscious, and during her indoor treatment at the hospital, she recovered fast, and on 26.02.2021 she was shifted from the emergency ward to the General Ward by two doctors from the Medicine Department of the Hospital. However, the next day, the patient felt severe pain in the abdomen. 

Allegedly, despite being informed about this, no one attended to her for about 12 hours. Thereafter, when the complainant and his relatives raised their concern in writing, after about 7 pm, a CT scan was conducted, and following this, the treating doctors informed the complainant that she had to undergo an operation, for which he gave his consent.

It was submitted that after a lapse of 6 hours since conducting the CT scan, the patient was taken to the operating theatre. Allegedly, after the surgery, the patient's condition worsened, a blood unit had to be transfused, BP crashed, and she expired on 28.02.2021.

Filing the consumer complaint, the complainant claimed that the hospital refused to refund the excess amount collected from him, and the patient did not receive proper medical attention for hours. Alleging deficiency in service as well as medical negligence on the part of the hospital and treating doctors, the complainant sought Rs 10 lakh compensation for negligent, deficient, poor and substandard services, Rs 7 lakh for physical harassment, and Rs 3 lakh as the cost of litigation.

On the other hand, the hospital and the treating doctors submitted that the patient was admitted as a known case of Chronic Obstructive Airway disease with Obesity and she was referred from the first hospital as a case of fever and shortness of breath since 14.02.2021 with possibility of tuberculosis and covid-19. They claimed that at the time of admission, the patient had Hypoxemia. She was put on oxygen support immediately, as such, her oxygen saturation was improved and it came to 92%. In view of covid-19 pandemic, possibility of bilateral pneumonia was there and Rapid Antigen Test was conducted, which was found positive. Her RT-PCR Test was also conducted and the same was also found positive. She was immediately shifted to Isolated Covid Intensive Care Unit (Level-III) and managed according to the standard protocol of medical norms and guidelines of the government.

Further referring to the treatment record, they claimed that on 27.02.2021, the patient suddenly started complaining of pain in abdomen and as per pain assessment chart, she was immediately evaluated, and according to the symptoms, tests were conducted and based on the reports, she was managed conservatively with antispasmodics, analgesics and other supportive measures. The second possibility of Mesenteric Ischemia was kept for which her CT Scan abdomen was ordered immediately and the report suggested a Hematoma in abdomen with active leak from left inferior epigastric artery for which an urgent interventional radiology consultation and obstetrics and gynecology consultation was taken. Interventional Radiologist advised Angioembolization.

However, before taking up the patient for Angioembolization, suddenly her blood pressure became un-recordable at 10 PM and accordingly she was resuscitated with IV fluids. Finally, she was shifted inside the Operation Theatre for Angioembolization and under all aseptic precautions, ultrasound-guided puncture of the Right Common Femoral Artery (CFA) was done. On 28.02.2021, the patient suddenly had bradycardia and accordingly, the attendants of the patient were informed telephonically about the bradycardia. Allegedly, they refused for the CPR and after suffering a sudden cardiac arrest, the patient was declared dead. Denying all allegations, they prayed for the dismissal of the complaint.

Earlier, while considering the matter, the District Commission allowed the complaint. Holding the hospital and treating doctors liable, the District Consumer Court had directed them to pay Rs 5 lakh compensation for medical negligence, Rs 10,000 as compensation for mental harassment, and Rs 10,000 as litigation costs.

Challenging this, the hospital and the doctors approached the State Consumer Court and they argued that the District Commission failed to consider that the complainants did not come with clean hands and concealed the material facts to the effect that the patient was covid-19 positive and treatment to her was rendered in a specialized Isolated Emergency ICU (Level-III) according to the guidelines issued by the government for the treatment of covid-19 positive patients. They also submitted that the District Commission ignored the fact that the complainant himself refused for resuscitation of his wife inspite of explaining its need again and again.

They also pointed out that no expert opinion or medical literature has been placed on record by the complainants to substantiate their false allegations of medical negligence. In the absence of any expert opinion/medical literature, the bald allegations of the complainants are not ipsi-dixit sufficient to prove the case of medical negligence.

While considering the matter, the State Consumer Court perused the medical records and observed, "Accordingly, it has been duly established on record, that apart from the ailments already suffered by the wife of the complainant at the time of admission in the OP’s Hospital, she was also suffering from severe Covid-19 and the said fact has not been disclosed by the complainants in their complaint. It is not in dispute that the patient developed abdomen pain on 27.02.2021. However, as per version of the appellants/OPs, the same was caused due to ‘Hematoma in abdomen with active leak from left inferior epigastric artery’, for which Interventional Radiologist advised Angioembolization."

The Commission also took note of a case report namely Splenic Infarction and Spontaneous rectus sheath hematomas in Covid19 patient and another case report regarding Spontaneous giant rectus sheath hematoma in patients with Covid-19.

At this outset, the Commission observed, "It is pertinent to mention here that as per medical terms, available on internet, an ‘abdominal hematoma with an active leak from the left inferior epigastric artery’ is a serious medical condition known as a ‘Rectus Sheath Hematoma’ (RSH). This can cause a large, painful accumulation of blood in the abdominal wall and, if bleeding is significant, can lead to life-threatening complications. Further, as per version of the appellants and case reports relied upon by them(supra), the said disease is a known complication in patients with covid-19."

"The above said version of the appellants has been duly corroborated in the medical record placed on record by the appellants as Ex.OP2/6(Colly), especially the details of procedure taken by the appellants are duly written in the patient notes dated 27.02.2021 and consent was also taken from complainant No.1 for performing ‘Angioembolization’ after explaining the condition of the patient to her husband in vernacular language. The appellants, have duly established on record that the said complication i.e. ematoma in abdomen with active leak from left inferior epigastric artery’ was caused to the patient due to covid-19 and they treated the same as per standard medical procedure. It is not the case of the complainants that the appellants/OPs No.1 to 3 have not performed the said procedure of ‘Angioembolization’ as per the standard medical protocol. Rather, they alleged that the appellants have not performed any operation/procedure despite receiving the amount for the same, which according to us is bald and baseless as they failed to establish the same by leading any cogent evidence in the shape of an expert opinion or otherwise. Negligence is an essential ingredient of the offence and if needs to be established, then it must be culpable or gross and not the negligence merely based upon an error of judgment," it further noted.

Referring to the Supreme Court order in the case of Jacob Mathew Vs State of Punjab and Anr., the Commission observed that in this case, neither there is any error nor any specific allegation that the procedure adopted by the doctors was not as per medical protocol.

"The appellants put their all to give proper treatment to the wife of respondent No.1/complainant and to cure her. As such, we are of the considered opinion that there is no medical negligence on the part of the appellants/OPs No.1 to 3 while giving treatment to the patient for the ailments suffered by her," it noted.

"...we are of the considered opinion that the appellants/OPs No.1 to 3 had duly attended the patient and gave proper treatment as per standard medical protocol. The District Commission has overlooked the said aspect and has wrongly allowed the complaint in favour of the complainants," the State Consumer Court further observed. Accordingly, the State Commission set aside the District Consumer Court's order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/punjab-scdrc-no-med-negligence-307486.pdf

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