Patient Dies of Cerebral Hypoxia: NCDRC directs Army Hospital to pay Rs 25 lakh

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) has recently directed the Army Hospital R&R, Delhi Cantt. to pay Rs 25 lakh compensation to the parents, wife and daughter of an Army Commissioner Officer for their negligence while treating the patient who had been admitted in there after facing a major road accident.

After considering the medical record and the case sheet it was held by the top consumer court that the patient suffered hypoxia due to failure in duty of care in the ICU.

It noted, "As discussed supra (para 25) the doctors at AHRR failed in their duty of care towards the accident victim. Though it was major accident, patient suffered facio-maxillay injuries but, there was no evidence of head injury which was confirmed by CT scan and MRI. Thus, the root cause of hypoxia failure in duty of care in the ICU. As discussed above the medical records are not convincing about reasonable standard of care exercised by the doctors and staff at AHRR. The records at places revealed tampering. The entirety attributes medical negligence of Opposite party No.1. The patient remained under treatment and hospitalisation for long period due to vegetative state." 

The history of the case goes back to 2004 when the patient, who was working as a Commissioner Officer in the Air Force Hospital, met with a major road accident and suffered injuries on face and chest. After receiving first-aid treatment at the local hospitals including SMS Hospital, Jaipur, he had been airlifted to AHRR at Delhi Cantt and got admitted in ICU under Dangerously Ill List and was put on ventilator. There, the doctors had instructed for "Care of ET tube (endortrachial tube) connecting ventilator, and Regular Suction of ET (for clearing airways).

The doctors at AHRR noted that the patient had Maxillo Facial Injury, multiple rib fracture and undisplaced fracture C-2. Therefore, a doctor at the hospital had advised to maintain SPO2 and watch for respiratory distress. On the same night, the patient was found to be in distress and restless and the SPO2 decreased to 40%.

In the complaint, several allegations had been made against Dr Chaturvedi who allegedly supressed the real facts of the patient and falsely created the theory of "self extubation" for the purpose of eye wash of gross medical negligence committed in the AHRR.

The complaint further alleged that the AHRR case record was tampered at many placed to cover up their gross negligence. It also pointed out that the entries of doctors at SMS Hospital and RR Hospital did not match. Referring to the diagnostic notes, the complainants claimed that the false insertion of 'head injury' in the hospital records was made by the Army Hospital.

Besides, the complaint referred to several other instances of negligence on the part of the hospital including administering expired medicine IV Astymin, wrong blood transfusion resulting in allergic reaction, negligence of staff resulting in the fall of patient from the bed and resulting in fracture of right arm and shoulder with severe bruises on back.

Following this, the patient had been prematurely transferred to Army Hospital at Hindon despite the fact that it had no Neurologist, no qualified physiotherapist or no special attendant. Therefore, the physiotherapy stopped and the patient's body became stiff. Due to lack of physiotherapy patient's right leg became weak and got paralyzed.

Consequently, the patient had been taken to AIIMS but the Orthopaedic doctor in there suggested "No Ortho intervention is required" and referred the patient to PMR, discharged from AIIMS and consequently sent him back to Air Force Hospital. It was alleged that even though the USG done at Army Hospital showed renal stones, no treatment had been prescribed and later the patient had to undergo surgery for stones in PSRI through AHRR, Delhi Cantt.

Alleging negligence against the three hospitals- AHRR, Air Force Hospital and AIIMS, the complainant sought Rs 2,04,05,000 as compensation.

On the other hand, the hospitals denied any negligence on their part and questioned the maintainability of the complaint a well. The Army Hospital submitted that AHRR was doing one of the soverign functions of the State. It argued that AHRR was not for commercial activity and therefore the complainant was not a consumer.

Air Force Hospital Hindon denied that untrained physiotherapist had fractured patient's hip bone. It was further submitted that patient's management of kidney stone was done as per standard treatment protocols.

Meanwhile, AIIMS submitted that the complainant was not a consumer under provisions of the Act, 1986 since AIIMS does not levy any charge or receive consideration for the professional services. It was further submitted the allegations made against AIIMS and the treating doctors, are wholly wild, vague, mischievous/scandalous, and unspecified.

Reiterating the events, the father of the patient informed the Consumer Court that they had been informed that the patient pulled out the ET tube and as a result he oxygen supply was cut off and therefore, suffered cardiac arrest. There was a gap of 20 minutes for resuscitation, which was long enough to develop cerebral hypoxia due to damage to the brain cells. Thereafter, the patient's condition started deteriorating, pulse rate and blood pressure were fluctuating, he showed more myoclonic jerks. After prolonged treatment for 2 months his vital parameters were under control but he did not regain consciousness.

He also claimed that the doctors at AHRR simply relied upon the CT scan done at SMS Hospital, Jaipur, but did not do MRI scan for such a long-time. Finally the MRI was done after a lot of persuasion and although it did not indicate any major defect in the brain, it indicated subdural hygroma (Water Accumulation) and ventricular dilation, which could be due to prolonged ventilation. He claimed that the Neurology Department did not take any efforts to rehabilitate the patient but openly told that patient had gone into coma due to brain injury and no chances of revival.

After taking note of the submissions, the NCDRC noted that the crux of the case was that at what time the patient suffered hypoxia. Therefore, the top consumer court perused the entire medical record, clinical notes and case sheet. Thereafter NCDRC noted, "The crucial entries of SPO2 values on 15.05.2005 and 16.05.2005 are missing. Most of the entries are erroneous...clearly it shows haphazard maintenance of record. Even the daily progress chart was not properly maintained. The daily progress treatment chart dated 16.05.2004 that (Page 134) wherein the SPO2 values from 8.00 a.m. to 1.00 p.m. are not visible. We would like to quote that 'good medical record is good defence, poor medical record is poor defence and no medical record is no defence'. Thus, the poor record maintenance at AHRR becomes poor defence."

Referring to AHRR medical record, the bench further noted, "The dates in the case sheet are not matching with the sequence of treatment e.g. patient was treated in "2004", but most of the records show entry as "2005", [pg 50A – Part – I / Vol – II]. It creates strong doubt about tampering of record and/or prepared as fresh, afterthought."

Opining that there was medical negligence, the top consumer court noted,

"Therefore, in our considered view, the patient had suffered hypoxia due to extubation for more than 5-10 minutes and it subsequently progressed into coma and patient became vegetative. It is also evident about number of glaring discrepancies in the recording of vital parameters, SPO2 level. Improper and haphazard maintenance of medical record suggests about tampering. The patient kept under sedation and on ventilator support with regular suction. They performed trial extubations / intubations several times, resulted into coma. It is also evident that the patient fell down from the bed on 26.02.2005 and sustained fracture of right arm and shoulder, it further prolonged hospitalisation."

While elaborating on the idea of medical negligence, the NCDRC bench referred to Supreme Court's observations and judgments in the case of Kusum Sharma and others v. Batra Hospital and Medical Research Centre & Others, Dr. Laxman Balakrishna Joshi vs. Dr. Trimbak Bapu Godbole & Anr, and A.S. Mittal vs. State of U.P. that talk about the duty of care expected from the doctors.

Referring to these the bench noted,

"Let us examine the case on hand, whether there was any breach of duty by Opposite Party No. 2. The question remains unanswered how and why self extubation occurred in ICU. The expected duty of care in the ICU is highest one especially at AHRR, which is the tertiary care hospital. Admittedly in the ICU , patient suffered cerebral hypoxia which him led to vegetative stage till his death. It reflects the breach/lack of duty of care from the hospital materially contributed to the damage, that is usually sufficient to attribute negligence. As HBOT treatment (75 runs) at Apollo Hospital, there were signs of improvement, but further treatment was stopped due to lack of funds. For the same reason, the patient could not go for higher treatment to USA also. During hospitalisation the patient sustained fracture of right shoulder and further developed large bedsore."

"As discussed supra (para 25) the doctors at AHRR failed in their duty of care towards the accident victim. Though it was major accident, patient suffered facio-maxillay injuries but, there was no evidence of head injury which was confirmed by CT scan and MRI. Thus, the root cause of hypoxia failure in duty of care in the ICU. As discussed above the medical records are not convincing about reasonable standard of care exercised by the doctors and staff at AHRR. The records at places revealed tampering. The entirety attributes medical negligence of Opposite party No.1. The patient remained under treatment and hospitalisation for long period due to vegetative state," it further noted.

While determining the amount of compensation, the NCDRC bench took note of several factors including the fact that the patient had died at the age of 32 years, had earned several certificates for meritorious services, left behind his parents, wife and a daughter etc. Therefore, the bench noted,

"Based on the discussion above and respectfully following the precedents of Hon'ble Supreme Court, in the ends of justice a lump sum compensation of Rs. 25 lakh is just and fair in the instant case. Accordingly, the Complaint is partly allowed. The Opposite Party No. 1 is directed to pay Rs. 25 lakh with interest @ 9 % per annum from the date of filing of this Complaint till its realisation to the Complainants. The amount awarded shall be shared / devolve among the Legal Heirs as per Hindu Succession (Amendment) Act, 2005."

To read the order, click on the link below.

https://medicaldialogues.in/pdf_upload/medical-negligence-army-hospital-182887.pdf

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