Patient dies during Appendicitis surgery: Consumer court holds surgeon, 2 Anaesthesiologists, hospital guilty of negligence, directs Rs 40 lakh compensation

Visakhapatnam: The State Consumer Disputes Redressal Commission of Andhra Pradesh directed a Visakhapatnam based Private hospital and its 3 doctors including a surgeon and 2 Anaesthesiologists, to pay Rs 40 lakh as compensation to the family of a patient, who died after undergoing surgery for Appendicitis.

Referring to the medical records, the Consumer court noted that the records did not contain details regarding what happened within the operation theatre before, during and after the surgery.

The State commission also noted that the inquiry report of K.G Hospital Visakhapatnam indicated that the patient went into a critical condition because of the administration of general anesthesia and therefore, the consumer court opined that the "burden is on the opposite parties to contradict the Same by way of evidence."

The case concerned the death of a patient suffering from acute appendicitis. He had been admitted to Visakhapatnam based Queen's NRI Hospital, where he had been advised to undergo surgery. However, after the operation, the patient did not regain consciousness, and his family members were kept in dark about his condition. Consequently, the patient's condition worsened, he went into coma and was put on ventilator. However, the hospital did not disclose the details of the treatment provided to the patient, who ultimately died on 12.10.2013.

It was alleged by the complainants, the parents of the deceased, that before his death, the Neuro physician, Dr. Babu examined the patient and advised brain scan. On the same day, another doctor had informed the family that the patient had gone into coma due to high dosage of anaesthesia and he was being taken care by Dr. Babu.

The matter reached police and press and the family of the deceased alleged that there was inordinate delay in handing over the case sheet either to the police or the complainants. The case-sheet allegedly showed that the patient suffered severe hypoxic injury resulting in brain death and consequent death.

When the hospital and the concerned treating doctors failed to give a proper explanation for the cause of the patient's death, the complainants approached various authorities including the AP Medical Council and Human Rights Commission. 

Independent authorities allegedly informed the complainant that it was a clear case of negligence and death occurred on account of lapses by the Anesthetist and overlooked by the surgeon and other attending doctors. The complainants were further informed that severe hypoxia occurred during surgery and as a result of it, the patient went into coma and later suffered cardiac arrest.

While probing the issue, the AP Medical Council also found negligence against the doctors and more particularly the anesthetist and imposed punishment of removing her name from the medical register of the State Medical Council for six months. Meanwhile, the Human Rights Commission also got the issue inquired by a team of doctors of KGH Visakhapatnam and they also confirmed negligence against the doctors and especially the Anesthetist.

Submitting that the deceased was working as an Officer of HDFC Bank and drawing a salary of Rs 30,000 per month, the complainants demanded compensation of Rs 99,99,000 as compensation.

However, the hospital denied any negligence on their part and submitted that the patient got admitted to the hospital on emergency basis after a delay of two days. It was contended by the hospital that as opposed to planned admission, emergency admission followed by surgery would involve higher possibility of something going wrong.

The hospital also claimed that the surgery had been conducted while following all the protocols and the family of the patient had been informed about the medical condition of the patient and the treatment procedure at every stage. It was also submitted that the anesthetist had given spinal anesthesia as per standard dose. However, spinal anesthesia was converted into general anesthesia, which was a totally acceptable course of action. The hospital further argued that delayed hypotension is a possible consequence if general anesthetic drugs and sometimes the patients go into hypoxia/coma depending on a number of factors including the bodily susceptibility of the patient.

After considering the submission made by all the parties, the consumer court noted that there was no denial of the fact that the patient had not regained consciousness after the surgery. Further, the timing of the administering general anesthesia was not noted in the clinical notes relating to the surgery. The court also noted that even though the hospital referred to the Specialist senior cardiologist and Neurologist for providing best possible treatment, their names were not revealed and they did not give their evidence affidavit regarding the absence of medical negligence.

Referring to the inquiry report of K.G Hospital Visakhapatnam, the State Commission noted,

"This report indicated that the patient went into a critical condition because of administering. of general anesthesia, the burden is on the opposite parties to contradict the Same by way of evidence. It is clearly stated in Ex.A-9 that the case sheet does not-contain the record of events from time to time during surgery and immediate post OP period, The 3rd opposite party has filed some medical literature regarding the incidence and causes of failed spinal anesthesia and conversion of spinal anesthesia into general anesthesia, But as already stated, in the absence of evidence contrary to-Ex.A-9 and the penalty imposed on opposite party-No.3 on a finding that she was negligent in administering anesthesia, the literature cannot come to the rescue of opposite party."

At this outset, the bench also referred to the Supreme Court order in Jacob Matthew's case and noted,

"Even as per judgment in Jacob Matthew's case, liability arises if the doctor did not give treatment with reasonable competence in a given case when he possesses the skill. It was also observed in Jacob Matthew's case that simple lack of care, an error of judgment is not proof of negligence on the part of the medical professional."

In the context of the death of the patient in the present case, the consumer court observed,

"...what happened within the operation theatre before, during and after surgery is not clearly from the records as noted in Ex. A-9. The explanation put forth by the opposite parties 1 to 4 practically says that death was the inevitable consequence when there are complications after the spinal anesthesia fails."

The commission added,

"If such explanations were to be accepted, without proper details as to what had happened after the spinal anesthesia failed with regard to the patient concerned in this case, it would amount to accepting that there could be no accountability. Therefore, we hold that there is negligence on the part of opposite parties 1 to 4."

While deciding on the amount of compensation, the State consumer court referred to the NCDRC judgments in the case of Samad Hospital & Another Vs. S. Muhammed Basheers & Others and Supreme Court order in the case of Arun Kumar Manglik and Lata Wadhwa. 

Referring to these orders, the State Commission decided Rs 40 lakh as the amount of compensation. The order stated, "Therefore, considering the absence of denial regarding the income of the deceased but his age and qualification, an amount of Rs 40,00,000 is granted as compensation to the complainants."

Apart from Rs 40 lakh as compensation, the Consumer court also allowed Rs 25,000 as funeral charges and Rs 25,000 towards costs. The hospital and its doctors have been directed to pay the amount within two months from the date of order.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ap-state-commission-188451.pdf

Also Read: No medical negligence in treating Hirschprung Disease yet HC orders state to pay Rs 5 lakh compensation