Patient succumbs to hospital-associated infections Post CABG surgery, NCDRC slaps Rs 10 lakh compensation

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently directed a Hyderabad-based hospital to pay Rs 10 lakh in compensation to the family of a patient, who succumbed to hospital-associated infections after undergoing Coronary Artery Bypass Graft Surgery.

After perusing the medical report and diagnosis test results, the Apex Consumer Court opined that although direct medical negligence of the doctors was not established in the case, there was a deficiency in the services of the hospitals, causing complications arising out of the bacterial and microbiological infections. Such infections ultimately led to the failure of the organs of the patient arising out of severe Septicaemia and his ultimate death.

Finding the hospital deficient in the maintenance of its hygiene and standard protocols to prevent infections, the NCDRC bench directed it to pay Rs 10 lakh compensation with interest @6% from the date of the patient i.e. 22.08.2002 till the date of actual payment. 

The history of the case goes back to 2002 when the concerned patient sought treatment at Hyderabad-based Care Hospital (Quality Care India) for coronary surgery. the treating doctor, Dr Chand- a Cardio Thoracic Surgeon and an anaesthetist Dr Ramulu conducted the surgery. 

It was submitted that even though the planned surgery was conducted successfully, post-operative care and management of the patient undertaken by the hospital and the attending doctors resulted in negligence on their part. This ultimately culminated into the patient getting infected with hospital-associated infections and then succumbing to the said infection due to the absence of following the correct medical protocol by the treating facility.

The counsel for the complainants argued that even though the hospital had advertised and claimed to possess all the best facilities, in reality, the facilities were inadequate which also added and compounded the mismanagement of the treatment. In support of his contentions, the counsel submitted six reports including one from Global Hospital dated 05.08.2002. 

On the other hand, the counsel for the hospital and its doctors referred to the previous medical history of the patient, particularly, his genetic history, indicating diabetic and cardiac disorders that were there in other family members as well. It was submitted that the patient suffered Transient Ischemic Cerebral Attack in 1995 on account of his smoking habits, obesity, drinking alcohol and other symptoms that led to slurred speech and weakness. He also submitted that the surgeries were performed thrice in 1999, one for prostrate, one for intestine and then a third one in the abdominal region. Another surgery for piles was also performed in 1995. Referring to the medical history of the patient, the counsel for the hospital and doctors submitted that the patient was a person of very weak immunity that was severely compromised on account of his habits and his past medical history.

It was argued that this weak constitution reduces the body's immunity to fight various bacteria and viruses. Thereafter, he pointed out that the patient was severely diabetic which further made him susceptible to weaknesses and infections. It was also argued that since he was a heavy smoker and was also known to have drinking habits, the same also increased his risks and infections and illnesses including pneumonia and other respiratory problems, which led to complications, whenever such a patient is subjected to a surgery or such medical treatment.

He further submitted that the patient also suffered from acid peptic disease, which is a group of gastrointestinal disorders caused by alcohol and regular use of medicines like aspirin, inflammatory drugs, chewing tobacco and smoking cigarettes. Therefore, the main argument by the counsel was that the patient was not only weak in constitution but was suffering from very serious deficiencies of immunity and was also carrying a very high risk for infections.

In this regard, the counsel pointed out that the patient had visited Apollo Hospital in Hyderabad and was diagnosed with Acute Coronary Syndrome on 03.06.2002. He was however put on a Holter monitor and at the time of discharge, he was advised for surgery, but he expressed to undertake the same at a later date. 

Meanwhile, the patient travelled abroad and visited King's College Hospital in London, where he was examined by a doctor in the cardiac department, who tendered his medical report dated 11.07.2002, which stated, "This patient has critical three vessel coronary artery disease and despite his recent onset of symptoms, is recommended to undergo early coronary artery surgery with grafting to all three coronary vascular territories."

Although the doctor had referred the patient to another doctor, for undergoing the coronary artery bypass graft surgery at the Cromwell Hospital, due to financial issues, he did not undergo the surgery abroad. After coming back to India, the patient was admitted to the treating hospital and the surgery was done on 31.07.2002. The surgery was allegedly carried out successfully and he was extubated after six hours of ventilation. However, on 02.08.2002, since his breathing was high he was re-intubated. An infection of pneumonia was detected and to find out the cause of the infection, a culture and sensitivity test of fluids was sent for investigation to Global Hospital. 

Consequently, the patient was examined by Dr. Talluri, who recorded Sepsis (HA Pneumonia). Accordingly, the treatment for Sepsis was started. It was submitted by the counsel for the hospital and doctors that every step of precaution at every stage was being taken by the attending doctors and there was not even an iota of negligence in taking care of the patient.

The top consumer court noted that another allegation of the complainants was regarding the use of medicine known as Xigris. Although the complainants questioned the use of this medicine highlighting that it was withdrawn in 2011, the NCDRC bench noted that when the medicine was prescribed to the patient, the same was an approved drug for severe sepsis and therefore its withdrawal in 2011 cannot in any way impact its prescription way back in 2002.

While considering the matter, the top consumer court perused all the medical and test reports. It also took note of the opinions expressed by the experts submitted by the complainant. After assessing the affidavits of evidence of the complainant, hospital and the doctors, the top consumer court noted,

"...the fact of a Hospital Associated Infection is corroborated by the pathological and microbiological tests indicated above. They pointedly direct towards the infections having entered through the catheter. The measures adopted by the treating doctor by changing catheters also demonstrate that in all probability the infections had entered through such contaminated equipments which were the source of infections. The scientific tests therefore carried out do indicate that the infections were caused in the hospital on account of contaminated equipments that were used during the treatment of the deceased. The diagnosis and the prescription of medicines also indicates that the medicines had to be prescribed in order to counter the said infections, the source whereof related to the catheters and other respiratory equipments used by the hospital. It is therefore clear that the Hospital Associated Infections were caused in every probability on account of the lapses and unhygienic conditions of the hospital."

"There is no explanation worth the name by the hospital nor any evidence adduced and in all probability it is for this reason that the same was not reflected in the cause of death in the death summary or the medical certificate. The said infections can tend to be fatal and this is what appears to have happened in this case. There is no convincing explanation, argument or evidence to contradict this conclusion," it further noted.

Noting the argument of the hospital's counsel that the patient had a very weak immunity which resulted in his condition, the NCDRC bench observed,

"It is probably correct that the patient was having a long symptomatic history of getting treated for various medical complications and his own lifestyle and habits also contributed towards his weak constitution. However, these facts were all known to the opposite parties even before they proceeded to perform the surgery. The patient was suffering from a chronic disease and was also susceptible to complications on account of his weak constitution but at the same time what aggravated the same is the hospital associated infections that seems to have compounded the worsening situation of the patient. It is quite possible and probable that had he not suffered these infections, he would have possibly survived as the coronary bypass surgery was reportedly successful."

Although the hospital's counsel blamed the patient's smoking habits, the top consumer court opined that "There is no material to establish that smoking by itself would invite hospital associated infections."

"The same may be a reason for the lack of immunity of a particular patient but insofar as the present case is concerned, it is evident that the hospital associated infections had set in and this onset continued successively from 02.08.2002 till 17.08.2002 and even thereafter, virtually adding to the worsening health condition of the deceased patient," it further noted.

The consumer court noted that the evidence on record and clinical and pathological investigations establish that the patient's condition after the operation from 02.08.2002 onwards deteriorated due to the hospital-associated infections, opining it to be a "clear deficiency on the part of the hospital contributing to the patient’s death."

It ordered,

"The question of a direct medical negligence on the doctors, therefore, does not seem to be established but the deficiency in the services of the hospital, as noted above, causing complications arising out of the bacterial and microbiological infections have in all probability led to the failure of the organs of the patient arising out of severe Septicaemia and his ultimate death. The hospital, therefore, is liable for damages on account of the aforesaid deficiency in service."

Directing the hospital to pay Rs 10 lakh compensation to the deceased's family, the consumer court ordered, "The hospital however has been found to be deficient in maintenance of its hygiene and standard protocols in order to prevent infections and, consequently, in the light of the findings above and the observations, it would be appropriate to award a sum of Rs.10,00,000/- together with interest @ 6% from the date of death of the patient i.e. 22.08.2002 till the date of actual payment, which shall be done within a period of three months from today. In the event of any nonpayment, the same shall carry enhanced rate of interest of 9%."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-compensation-236491.pdf

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