Patient declared dead after 16-hour continuous Surgery: Hospital, Cardiothoracic Surgeon held guilty of medical negligence, told to pay Rs 15 lakh compensation

Hyderabad: Holding Hyderabad-based Star Hospitals and its Cardiothoracic Surgeon guilty of medical negligence, the District Consumer Disputes Redressal Commission III, Hyderabad directed them to pay Rs 15 lakh compensation to the family of a patient, who died while undergoing Minimal Invasive Cardiac Surgery (MICS).

Apart from the lump sum compensation, the Commission has also directed the hospital and the doctor to pay Rs 25,000 as litigation costs to the complainant.

"Keeping the deceased patient for 14 hrs on operation bed without explaining the progress of surgeries to the attendant’s, not providing medical record of patient, not investigating the reasons for LV failure after Mitral valve replacement, assuring success of MICS and collecting more expensive fee for the same but going to less expensive open heart surgery, not explaining the abnormal delay in the surgical procedure which has taken 16 Hrs instead of scheduled surgical period of 3-4 Hrs amounts to medical negligence and deficiency in service by opposite parties," the Commission observed.

The history of the case goes back to 2019 when the husband of the complainant was suffering from breathlessness, mild fever, and dry cough. After a primary check-up by a doctor, the patient was referred to a Cardiologist. Following this, he was shifted to a private hospital for treatment and got admitted in the ICU. After commencement of the treatment, the condition of the patient improved.

The patient was further informed that there were some blockades noticed in the mitral valve of the heart and there were chances of recurrence of the problem. At that time, the doctor had further advised the patient to go for a heart surgery. However, it was mentioned that the surgery was not of immediate urgency.

After being discharged, the family of the patient consulted a doctor at Sunshine Hospital in Hyderabad on February 19, 2019. After conducting tests, the treating doctor suggested for open heart surgery for replacing the mitral valve. The hospital offered the total package cost for open heart surgery at Rs 5 lakhs.

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Looking for a second opinion, the family of the patient approached Star Hospitals in Banjara Hills. They met Dr Gopichand Mannam, a cardiothoracic surgeon. After going through the test reports, the doctor informed the family that heart surgery was necessary for replacing the mitral valve. The doctor allegedly further informed hat besides the conventional methods for speedy recovery, there is a method called Minimal Invasive Surgery and it would cost Rs 10.50 lakhs.

Allegedly, the doctor assured the patient that it was a safe method for performing the surgery and the success rate was about 98%. Relying in this assurance, the patient preferred to go for MIC even though the cost was double when compared to the offer by Sunshine Hospital for open heart surgery.

Consequently, the patient got admitted to Star Hospitals on February 27, 2019. The next day, after preparation, the patient got shifted into the operation theatre for surgery. Even though the family of the patient had been informed that the operation procedure would last for three hours, even after two hours of the scheduled time, there was no information regarding the progress of the surgery. 

In the evening, Dr. Mannam informed the family of the patient that some complications had developed during the surgery and they were trying to overcome the same. Finally, at around midnight, they were informed that the surgery had failed and the patient was declared dead. Except for informing that the patient died, there were no other details about why the complications occurred during the surgery.

Aggrieved by this, the family of the patient alleged medical negligence against the doctor and the hospital. Filing a complaint before the District Consumer Court, they demanded compensation of Rs 2 crores for the tragic death of the patient.

On the other hand, the doctor and the hospital denied any negligence on their part. It was submitted that the patient was suffering from chronic Rheumatic heart disease with severe mitral regurgitation, moderate mitral stenosis and moderate tricuspid regurgitation, normal LV function, who underwent closed mitral valvotomy in the year 1988.

It was further submitted that all the pre-operative parameters indicated that the patient had advance heart disease and therefore, he had been suggested Minimally invasive surgery, which allows the surgeon to use techniques that limit the size and number of cuts, or incisions, that they need to make. It’s considered safer than open heart surgery and the patient usually recovers more quickly; spend less time in the hospital.

During the surgery, the patient could not be weaned off cardiopulmonary bypass after MICS-MVR initially. Tran esophageal echo cardiogram showed significant LV (left Ventricular) dysfunction with ECG changes. Therefore, midline sternotomy was done and coronary bypass vein grafts were placed to obtuse marginal branch, posterior descending artery and posterolateral branches. Subsequently, the patient was tried to come off bypass and could not be weaned off cardiopulmonary bypass even with high inotropic support and intraaortic balloon pump support. Inspite of stiff inotropes and IABP support patient could be weaned off bypass and the patient was declared dead, submitted the doctor and the hospital.

Taking note of the submissions by both the parties, perusing the medical record and relying on the relevant medical literature, the Commission noted that "Though opposite party No.2 Doctor wanted to go with MICS that limit the size and number of cuts, or incisions, that they need to make, but they had to again do midline sternomoty as the patient was tried to come off bypass and could not be weaned off as per the death summary of patient."

"Conversion of a MIC-AVR to full sternotomy is not only a defeat for the surgeon and the team, but also creates trauma to the patient," opined the consumer court bench.

The commission further observed,

"Taking these into consideration and the manner in which the surgery was conducted for 16 Hours continuously without updating the health condition of the patient, and not explaining the reason for failure of surgery is the point of gross negligence and deficiency of service, for which the opposite parties are liable to compensate."

Addressing the allegation that the doctor and the hospital did not provide the patient's family with the medical record, the Commission observed, "The opposite parties violated the regulation (1.3) of MCI who failed to supply patient’s medical record."

Opining that the hospital and the doctor were negligent in providing treatment to the patient, the Commission observed,

"Keeping the deceased patient for 14 hrs on operation bed without explaining the progress of surgeries to the attendant’s, not providing medical record of patient, not investigating the reasons for LV failure after Mitral valve replacement, assuring success of MICS and collecting more expensive fee for the same but going to less expensive open heart surgery, not explaining the abnormal delay in the surgical procedure which has taken 16 Hrs instead of scheduled surgical period of 3-4 Hrs amounts to medical negligence and deficiency in service by opposite parties, hence the complainant is entitled for compensation and cost of litigation."

"Although, the loss suffered by the complainant due to deficiency in service and medical negligence of Opposite parties cannot be compensated in terms of money, yet in view of law laid down by the Hon'ble Supreme Court in above referred authority, age of the patient, and the totality of facts and circumstances of the case, we award lump sum compensation of Rs.15,00,000/- (Rupees Fifteen Lacs only) to the complainant, due to deficiency in service, medical negligence on the part of Opposite parties for causing mental agony, harassment, to the complainant," the order further stated.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/hyderabad-consumer-court-medical-negligence-208838.pdf

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