Urinary Catheterization death case: Consumer court junks Rs 18 lakh deficiency claim against Delhi's Hospital, surgeon

In October 2015, the patient visited the treating hospital, where he was examined by Dr. Aggarwal, who collected urine and blood samples for investigation and instructed the deceased to refrain from passing urine for two hours. Later, the patient's mother and wife were informed that a catheter pipe would be inserted through the urethra.

After a lapse of two hours, the treating doctor called the deceased into the examination room for the said catheter insertion. Allegedly, the patient was heard crying out loudly from inside the room.

It was alleged that shortly thereafter, the doctors came from the room and informed the family that the patient had expired. It was further alleged by the patient's family that even though a request for a post-mortem was made, the treating doctor informed them that conducting a post-mortem would not serve any purpose.

The complainant (patient's son) also alleged that the treating hospital did not have rudimentary facilities/techniques like an ICU. Filing the consumer complaint, the complainant prayed for Rs 18 lakh as compensation and Rs 35,000 as litigation costs.

On the other hand, the treating hospital and doctor submitted that the patient was brought to the hospital with the primary complaint of urinary difficulty. In this regard, the deceased showed the urinary report and the prescription of the first treating Nursing Home, as well as a six-month old ultrasound report.

It was submitted that the said ultrasound report clearly recorded a significant post-void residual urinary volume, indicative of urinary retention. As the symptoms continued to persist, a provisional diagnosis of urethral stricture was made, and the treatment plan was formulated accordingly.

The hospital and doctor submitted that after examining the patient, an injection 'Dynapar' for pain relief and injection 'Mikacin'; a urinary antiseptic was given to the patient. The patient was also given water to drink to enable him to pass urine. However, the patient failed to pass urine in the next two hours. It was submitted that the failure to pass urine and the resulting pain in the urinary tract is acute on chronic retention of urine and there is a probable diagnosis of Urethral Stricture. It is medical emergency and the standard treatment in such cases is emptying of bladder with a catheter.

Accordingly, the said procedure of Urethral Catheterization Procedure was attempted to empty the bladder and give relief to the patient. The treating surgeon himself used a thin 8F Foley's Catheter Tube with liberal use of lubricant.

While the procedure was being conducted, the patient complained of pain, and hence the procedure was immediately aborted. It was submitted that the patient immediately showed signs of unconsciousness, followed by acute generalised tonic clonic convulsions and development of cerebral anoxia. Immediate emergency measures were taken, which included maintaining the airway, providing oxygen inhalation, followed by ambu-bag ventilation and oronasal suction. Since the patient was gasping for breath and pulse rate was low, cardiac massage was also done and intracardiac injection. Adrenaline was also given. However, the patient died despite all efforts.

They also denied that the patient's family had asked for MLC/post mortem. According to them, the family members of the deceased only asked for the certificate declaring that the deceased had died. Further, they argued that I.C.U is not a mandatory facility and small medical establishments usually function without an I.C.U. However, the treating doctor was maintaining all necessary equipment like pulse oximeter, oxygen cylinder, ambu-bag ventilation, suction machine, etc.

The Commission sent the documents to LNJP Hospital for expert medical opinion, and a report was sent from the said hospital. In the expert opinion, the LNJP Hospital panel mentioned, "Exact cause of Convulsions cannot be ascertained without proper history, examination and relevant investigations. According to the documents produced patient had sudden onset of Convulsions (GTCS type) which were not controlled by Inj. Midazolam and then patient went into Cardio Respiratory Arrest. In spite of CPR patient could not be revived."

While considering the matter, the Consumer Court took note of medical literature regarding Dysuria and Urethral Stricture. It also considered the Supreme Court order in the case of Dr.(Mrs.) Chanda Rani Akhouri and others Vs Dr. M.A. Menthusethupathi and others, and noted, "The complainant was treated for Dysurea in Patliputra Nursing Home on 08.10.2015. The complainant visited OP on 09.12.2015 regarding anal pain. There was a provisional diagnosis of Urethral Stricture. The complainant died on the same day during catheterization procedure."

Accordingly, dismissing the consumer complaint, the District Consumer Court held, "The expert opinion from medical board of Lok Nayak Hospital states that the convulsions were unlikely to be a complication of urinary catheterization procedure. The medical literature also revealed that catheterization is one of the treatment options. Hence, there is no deficiency on the part of OPs in providing medical treatment. The complaint is dismissed with no Order as to costs. Copy of Order be sent to parties free of cost and file be consigned to record room."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-dcdrc-no-medical-negligence-318224.pdf

Also Read: Rs 1.55 crore relief to 2 Delhi Hospitals, laparoscopic surgeon, doctors in intestinal surgery death case