No relief: NCDRC upholds medical negligence by Delhi hospital for delay in emergency surgery

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently upheld the Delhi State Commission's order directing Delhi Base Hospital and Mata Channan Devi Hospital to pay Rs 10 lakh compensation to an ex-servicemen for failing to provide timely treatment.

After an accident, the complainant was first taken to Base Hospital and later to Mata Channan Devi Hospital, where his legs had to be amputated. 

The history of the case goes back to 2011 when the complainant met with a railway accident and was taken to Base Hospital, Delhi. After providing first aid to the complainant, an ex-serviceman, he was referred to the treating hospital. It was alleged that the Base Hospital had refused to provide Ambulance Service on the ground that the service could not be provided to Ex-servicemen.

In this regard, the complainant argued that the argument that ex-servicemen cannot be treated at Base Hospital were contrary to the guidelines provided in Ex-servicemen Contributory Health Scheme (ECHS).

After reaching the treating hospital- Mata Channan Devi Hospital, the treating doctor- Dr. Jain confirmed that amputation was required for both legs (maximum by one or one and half inches for artificial limbs). The complainant alleged that even though he was admitted on 16.01.2011, the treatment could only start the next day evening and the delay in treatment resulted in amputation of both legs.

After surgery, the complainant's relatives came to know that the doctors had amputated the patient's left leg by around 8 inches and right leg by 11 inches below the knee joint, which was contrary to what was informed earlier and the same could have been avoided by providing timely treatment to the complainant. 

Therefore, the patient alleged that the negligent approach of the doctors of Base Hospital and the treating hospital resulted in the amputation of the legs by more length than it was assured by the doctors earlier. 

Further, he alleged that he was discharged despite having a high fever and this led to inconvenience and unnecessary expenditure due to the negligence on the part of the doctors. Later, when the complainant approached Dr. B P Yadav, he came to know that the doctors of the treating hospital did not perform the operation following the required protocol. As per the X-ray report, the fibula was found longer than Tibia of left leg. Allegedly, Dr. Yadav's opinion was confirmed by Rockland Hospital, Delhi as well. 

On the other hand, the hospital submitted that the patient could only be treated after his sugar level came down to normal and there was no delay in giving treatment to the patient. Further, it was stated that the amputation of the legs was already done at the Base hospital after they were cut in the accident and at this stage, the hospital could do nothing to save the complainant's leg.

Further, it was stated that the hospital went ahead with the operation only after obtaining informed consent and with full knowledge of his clinical reports and all risks and responsibilities. It was also stated that no specification was ever given by the doctors to show how much amputation was required for artificial limbs. The amputation was performed at musculotendinous junction of Gastrosoleus to provide good stump for the fitting of artificial limb and the amputation was essential to save the remaining legs of the patient.

Regarding the fever, the hospital submitted that having fever after operation was very normal and all checkups were done before discharging the complainant from the hospital. They further informed the Commission that the complainant visited the hospital again with infection, which was caused due to carelessness in post-operative care at home.

Therefore, emphasizing that the complainant was given treatment as per the established norms in the line of medical sciences and as per international standards, the treating hospital denied medical negligence and deficiency on their part.

Previously, while considering the complaint, the State Commission had partly allowed it, directing the hospitals- Base Hospital and Mata Channan Devi Hospital to pay equally a compensation of Rs 10 lakh with interest at the rate of 3.5% from the date when the cause of action arose till its realisation.

Challenging this order, the hospital filed an appeal before the Apex Consumer Court. While considering the matter, the NCDRC bench noted that the principles of what constitutes medical negligence is now well established by number of judgments of this commission as also the Hon’ble Supreme Court of India, including Jacob Mathew vs. State of Punjab and in Indian Medical Association Vs V.P.Shantha. One of the principles is that a medical practitioner is expected to bring a reasonable degree of skill and knowledge and must also exercise a reasonable degree of care and caution in treating a patient.

NCDRC noted that even though the hospital argued that the operation was delayed due to high blood sugar of the patient, there is no mention of blood sugar in the medical record, including the discharge summary. "Therefore, in the absence of any evidence, the contention of the learned counsel for the hospital cannot be accepted," it noted.

Regarding the discharge of the complainant while having high fever, the Commission noted that even though the discharge summary dated 20.01.2011 does not mention it, the prescription slip dated 20.01.2011 given by BAMS (Vaid), clearly shows that the complainant was suffering from fever.

"In addition to this, the discharge summary dated 28.02.2011 clearly shows that the patient was admitted on 22.01.2011 and the chief complaint of the complainant was fever for the last two days, meaning thereby that the patient was suffering from fever from 20.01.2011 i.e. from the date of discharge itself. This clearly shows negligent act on the part of the doctors of the hospital," noted NCDRC.

"As regards the remarks of excellence of services provided to the complainant, it is clearly written by handwriting that the ‘doctors in the hospital are careless. This patient was operated after 33 hrs. after post admission in the hospital (admitted at 08.00 hrs. on 16.01.2011 & operated on 17.01.2011 at 1500 hrs.) and the patient was discharged from hospital on 19.01.2011 15.00 hrs.," It further observed.

However, perusing the medical record of the Base Hospital, the Commission noted that it did not appear that the Base hospital had conducted any operation. "It had given only first aid to the complainant. Therefore, the contention of the learned counsel for the hospital that the operation was conducted at Base Hospital is rejected," it noted.

Holding the treating hospital liable for medical negligence, the NCDRC bench noted, "The hospital has not given any plausible reason to explain why the operation was conducted on 17.01.2011 after about 32 hours from the date and time of admission in emergency. The negligence in this case on the part of the appellant hospital is evident from the elapse of time from when the patient was admitted in emergency and the 32 hours that elapsed before he was taken in for surgery. No evidence has been brought on record to explain the reason for delaying the emergency surgery. It is also borne out from the record that the patient was discharged while he had high fever. Even if the Vaid may not be relevant to comment on treatment received, he does have the requisite skill to record temperature of a patient before him. It has been recorded on 20.01.2011 as being 102 Fahrenheit, this being the date on which he was discharged. It is also not in dispute that he was re-admitted with septicaemia in his operated limbs on 22.01.2011."

"As regards the surgery, it has not been disputed by the appellant hospital that the patient was advised and underwent revision surgery on account of his lower end fibia being longer than the tibia, which should be shorter to make the stump conical. The surgery at the appellant hospital did not make his amputation fit to wear an artificial limb, which was the intent of the amputation as per the averments of the appellant hospital. He had to undergo further surgery to correct the situation. The overall treatment and outcome of the patient in the appellant hospital is clearly evident of negligence at all stages. From admission, to outcome of surgery, and a hasty discharge while the patient was suffering from fever," it further noted.

With this observation, the Apex Consumer Court upheld the State Commission's order noting that it passed a "well-reasoned order that warrants no interference."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-upholds-257905.pdf

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