Standard protocol not followed! Hyderabad Hospital, cardiologists Slapped Rs 10 Lakh Compensation
New Delhi: The District Consumer Disputes Redressal Commission-III, Hyderabad recently directed a hospital, and two associated doctors to jointly compensate Rs 10 lakh to a complainant for negligence leading to the death of his mother.
The District Consumer Court granted compensation to the complainant after concluding that the treating doctors and hospital acted 'hastily and negligently' in treating his mother/patient with multiple procedures at one go, despite being aware of the fact that the patient was not prepared for the subsequent procedure of Angioplasty with stenting except for the Angiogram which was originally planned.
Further, the Commission noted that the hospital and doctors did not follow proper protocol in conducting the said procedures as there were no sufficient reports submitted to substantiate that they had followed the standard protocol.
Additionally, the treating hospital- Vasavi Medical & Research Centre did not follow due procedure in issuing the case sheet and necessary documents to the Complainant in spite of receiving multiple requests which amounts to deficiency in service, noted the consumer court.
The history of the case goes back to 2020 when the complainant's mother was suffering from breathlessness, and increased chest discomfort on exertion. After she approached the treating hospital, she was advised for an Angiogram. After one hour, the treating doctors informed the complainant that the patient was diagnosed with "two heart blocks" as per Angiogram status and therefore, they advised to get stent application at the same time to avoid repetition of the procedure for a better outcome.
However, the doctors allegedly did not inform about any risks and complications involved in the stent application, but only assured the better life of the patient after the stent application. After the complainant agreed to the stent application procedure, the treating doctors informed that the patient developed complications during the surgery and chances of survival were less. Thereafter, the treating doctors declared that the patient had died due to sudden cardiac arrest.
When he asked the treating doctors why his mother, who was very active till she got into the Operation theatre had died all of a sudden, the treating doctors informed him that after the CAG, the patient was diagnosed with two vessel disease i.e. LAD and LCX and that the patient underwent PTCA and LCX and suffered sudden Cardio Respiratory Arrest. It was further submitted that in spite of intubation and temporary pace maker and CPR, the patient could not be saved and was declared dead.
Further, the complainant alleged that when he requested the hospital and doctors to furnish the Case Sheet, they informed that it was a property of the hospital and it could not be furnished to any individual without direction from the competent authorities.
Filing the consumer complaint, it was averred that the hospital and doctors' nonperforming CAG + PTCA properly, and failing in managing the complications arising out of it, not only amounts to gross negligence but also amounts to deficiency in service. He further averred that had the hospital and doctors not performed the PTCA, the complainant's mother would have survived for several more years.
On the other hand, the treating hospital and doctors submitted that only after thorough investigation according to standard protocol, pre-diagnosis test and considering the patient's condition, and fitness and after consulting the opinion of other team of doctors, it was opined that the his mother should undergo the mentioned procedure as advised.
Apart from this, they also claimed that the complainant and other attendants were explained of all the consequences, risks like existing trauma and post-trauma, monetary involvement and course of action to be taken by the treating doctors and hospital during the treatment and the procedure that was to be followed during the surgery and even before and after the surgery.
They also claimed to have adopted an acceptable medical profession while treating the patient and submitted that due care, skill and diligence were taken. Further, it was submitted that despite taking up various investigations before the procedure, the patient might have been suffering from some ailments on account of her age factor and not due to the procedure or treatment of the hospital and doctors. Therefore, they argued that they could not be made liable for medical negligence.
While considering the matter, the Consumer Court perused the medical records and also took note of the response given by the hospital, denying the complainant access to medical records.
The Commission noted that if an Angiogram is being performed on a patient under General Anaesthesia, the patient is advised not to eat or drink anything after midnight and only to have clear liquids for breakfast on the day of the procedure.
"Coronary angioplasty and stent placement are emergency treatments for heart attack and if a nonemergency procedure is scheduled, the cardiologist has to follow certain preparatory steps like, conducting all the required medical tests to find out other conditions of the patient that may increase the risk of complications, and advise to adjust or stop taking certain medicines before angioplasty, not to eat or drink several hours before the procedure, and to take approved medicines with small sips of water on the morning of the procedure. Medical literature further reveals that Ischemic complications of percutaneous coronary intervention (PCI) are infrequent but prognostically important. Whereas, in the instant case, as admitted by the Complainant in his evidence affidavit, his mother took breakfast and tea before the said procedure which evidences that the Opposite parties neither given any instructions in this regard nor prepared the patient for further procedure, if required," the Commission noted at this outset.
"In the absence of Opposite parties’ denial on the same, it is evident that the Complainant’s mother/Patient had breakfast before the procedure and as such, she was not prepared for any further medical procedures other than the angiogram. As per the evidence affidavit of the Opposite party no.2, he has explained to the Complainant and other attendants all the consequences and risks involved and the course of action to be taken by them during the procedure. If such is the case, it is evident that knowing that the Complainant’s mother/patient is not prepared for the any further procedure, if required, other than angiogram, he has proceeded for further procedure of angioplasty and stenting," it further observed.
The Commission noted that even though the treating doctor argued that they had posted the angioplasty on a fixed date, in reality, the he forgot the fact that "the angioplasty/procedure was not posted to a fixed date as he mentioned but carried out the additional procedure as an extension of angiogram without any specific preparation of the patient, just to avoid carrying out the procedure once again."
Apart from this, the Commission also noted that there were no reports filed to substantiate that the said tests were duly conducted on the complainant's mother before commencing the procedure and to conclude that the patient was fit to undergo the said procedure and any additional procedures also at one go, if needed, having diagnosed the acute coronary syndrome by the treating doctor. Further, the Commission noted that the ER Assessment form that was filed by another doctor was without his signature.
"In addition to these observations there are few more observations that proves that the Case sheet is not properly maintained and the necessary precautions were not duly carried out by the Opposite parties before conducting the dual procedure of Angiogram and Angioplasty with stenting on an elderly patient who is a K/C/O of HTN and K/C/O CVA," the consumer court observed.
Accordingly, the Commission concluded, "
With the given observations, it is evident that the Opposite parties have acted hastily and negligently in treating the Complainant’s mother/patient with multiple procedures at one go knowing very well that she is not prepared for the subsequent procedure of Angioplasty with stenting except for the Angiogram which was originally planned. It is also proved that they have not followed proper protocol in conducting the said procedures as there are no sufficient reports submitted to substantiate that they have followed the standard protocol. Additionally, the Opposite party no.1 hospital did not follow due procedure in issuing the case sheet and necessary documents to the Complainant inspite of receiving multiple requests which amounts to deficiency in service."
Therefore, the Commission directed the treating hospital and doctor to pay Rs 10 lakh as compensation and Rs 10,000 as the cost of litigation.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/hyderabad-dcdrc-263655.pdf
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