Unsuccessful Treatment or Death of Patient Does not prove Medical Negligence: NCDRC absolves 2 Jaipur hospitals

New Delhi: Exonerating two Jaipur-based hospitals from charges of medical negligence while treating a patient suffering from lung and heart problems, the National Consumer Disputes Redressal Commission (NCDRC) recently stated that with the unsuccessful treatment or death of a patient, it cannot be automatically assumed that the medical professional was negligent.

Even though the State Commission had held those two hospitals guilty of medical negligence, the NCDRC bench opined that the order of the State Commission was erroneous. 

Reiterating the observations made by the Supreme Court in the case of Bombay Hospital and Research Medical Centre vs. Asha Jaiswal & Ors, the top consumer court observed, "Thus, every death of a patient cannot, on the face of it, be considered as death due to medical negligence, unless there is material on record to suggest to that effect."

"In the Jacob Mathew v. State of Punjab[2] case, the Hon’ble Supreme Court laid down the ‘test’ for establishing medical negligence that ‘[It] is clear that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical professional was negligent’," the NCDRC bench further observed.

Also Read: Method of testing, quality of test reagents differs place to place: NCDRC relief to Mathura hospital over wrong HbsAg test report

The history of the case goes back to 2016 when the complainant's husband was hospitalized in the general ward of the Pink City Heart and General Hospital for complaints of severe chest pain and excessive perspiration. The treating doctor Dr. Lath started treatment and ECG and Sonography had been prescribed. Further, the patient had been administered antibiotics and anti-allergic medicines under a presumption of lung infection.

Later the patient was sent to Heart and General Hospital for 'Doppler ECHO study' but the report was allegedly delayed and the condition of the patient deteriorated meanwhile.

The next day, the Pink City Hospital performed an ECG, which revealed "Myocardial Infraction/ Heart Attack" and the patient was referred to Dana Shivam Heart & Super Specialty Hospital. Allegedly, after lapse of 24 hours, Angiography was performed which revealed two blockages and thereafter, angioplasty had been performed.

After Angioplasty, an infection was noted at canulla site in the left leg of the patient. Following this, the patient was taken to Santokba Durlabhji Memorial Hospital (SDMH) in critical condition and admitted in ICU. Unfortunately, the patient died and being aggrieved by the death of the patient due to alleged negligence, the complainants filed Consumer Complaint against all three hospitals before the State Commission.

It was submitted by Pink City Hospital that the patient had been treated immediately, tests had been performed and medicines had also been prescribed. The hospital further submitted that even though the basic facilities for preliminary tests were available hospital, in order to avoid misdiagnosis, ECHO- Doppler study was performed at Heart & General Hospital by an expert. Further, the Pink City Hospital submitted that the patient died 28 days after discharge from the hospital.

While considering the matter, the State Commission placed medical negligence and carelessness on part of Pink City Heart & General Hospital and Dana Shivam Heart & Specialty Hospital and exonerated Heart & General Hospital.

Being aggrieved by the order of the State Commission, those two hospitals approached the NCDRC bench and reiterated their pleadings and evidence. The top consumer court bench perused the entire treatment record from the hospitals.

However, holding that the State Commission's findings were erroneous, the NCDRC bench pointed out,

"The State Commission held against the Pink City Hospital (OP-1) that the patient was treated for lung infection, but not for heart problem. Due to the tablet ‘Lasix’ with ‘Asprin’ there was increased urine flow and blood thinning to the patient. It is pertinent to note that the treating doctor at OP-1 treated the patient as per the standards. It was not the tablet of Lasix but injection of Lasix 20mg was given and Tab. Aspirin was given. In my view, it was the correct line of treatment for LVF to prevent MI. Also, the other medicines were administered for reducing risk of strokes and heart attack etc. The patient was given Deriphyllin injection for wheezing and chronic bronchitis, the inj. Enoxion as anticoagulant helps to prevent acute coronary syndrome (LVF/heart attack), also Dyloop Plus to treat Chronic cardiac failure (LEVF). Sorbitrate is commonly used as coronary dilator for heart failure, oesophageal spasms, and chest pain (angina). It was not negligence from the OP-1, thus the findings of the State Commission against OP-1 were erroneous, and the same are set aside."

Referring to the observations of the State Commission against Dana Shivam Heart & Specialty Hospital, the Commission opined them to be "not acceptable". 

At this outset, the Commission referred to the medical record of the hospital and noted that the patient was kept in Medical Intensive Care Unit at the time of admission and immediately Cardiologist Dr. Sunil Kumar Garssa examined the patient and treatment for Cardiac Stabilization for control of blood sugar had also been initiated. Thus, the Commission opined that "It was the reasonable standard of care at OP-2."

"Admittedly the patient had Coronary Artery Disease (CAD), Acute Coronary Syndrome, Left Ventricular Ejection Fraction (LVEF) / Congestive Heart Failure (CHF). At OP-2 Dr.Garassa made provisional diagnosis of Myocardial Infarction (MI) with Left Ventricular Failure (LVF) and Diabetes Mellitus Type II (DMT2). The patient and the attendants thereof were apprised about the nature of diseases as well as poor prognosis. In the instant case, the Chief Interventional Cardiologist, Dr. Sunil Kumar Garssa performed Angiography as well as Angioplasty access route through the Right Radial Artery Route and not through the Femoral Artery. Therefore, the finding of State Commission is totally erroneous that Angiography and/or Angioplasty were performed through leg (Femoral Artery Route) and the patient's foot developed loss of sensation. It was just presumption of State Commission. I do not find any evidence either to the effect that patient had lost sensation in his foot and/or developed gangrene or would have been required to be amputated if he survived. It was hypothetical and presumptive finding of the State Commission," noted the Apex consumer court.

The NCDRC bench also observed that the State Commission had held that the patient ought to have been referred to a Higher Centre, prior telephonic information was to be given to the referral hospital and also the allegation that Dana Shivam Heart & Specialty Hospital had noted arranged for ambulance while shifting the patient. 

However, in this regard, the NCDRC noted that the patient's attendants desired to get the patient discharged and LAMA had been issued. Referring to this, the apex consumer court noted, "In my view, the acts of OP-2 were neither deficiency nor failure of duty of care."

Perusing the medical record of SDMH, the bench opined, "Thus, I don’t find any lapses during treatment at SDMH also."

The top consumer court referred to the Supreme Court judgment in the case of Bombay Hospital and Research Medical Centre vs. Asha Jaiswal & Ors where the Apex court had clarified that "if the patient was in a critical condition and he could not survive even after surgery, keeping that in mind the blame cannot be passed on to the Hospital and the Doctor who had provided all possible treatment within their means and capacity to diagnose the patient of this illness."

Referring to this, the NCDRC bench held,

"Thus, every death of a patient cannot, on the face of it, be considered as death due to medical negligence, unless there is material on record to suggest to that effect. In the Jacob Mathew v. State of Punjab[2] case, the Hon’ble Supreme Court laid down the ‘test’ for establishing medical negligence that ‘[It] is clear that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical professional was negligent’."

Therefore, the Commission exonerated the hospitals from charges of medical negligence and observed,

"In the instant case, I note that apart from the allegations, the Complainant failed to bring on record the appropriate medical evidence to prove medical negligence. Moreover, as discussed above, the conclusion reached by the State Commission appears to be assumptive without the scientific analysis and lack of supportive medical evidence."

"Based on the discussion above, I find that the findings recorded by the State Commission, holding both the Hospitals guilty of medical negligence, are not sustainable in law. The whole approach of the State Commission is erroneous. Consequently, both the present Appeals are allowed. The order passed by the State Commission is set aside. Consequently the Complaint is dismissed," it added.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-judgment-206741.pdf

Also Read: NCDRC Relief Of Rs 4 Crore Compensation To Mohali Hospital, 4 doctors accused of negligence