Urologist, MS Surgeon, Chhattisgarh Hospital cleared of medical negligence charges in Benign Prostatic Hypertrophy patient death case

The crux of the matter lied in the conflicting opinions presented. A medical board stressed the importance of pre-operative assessments, medical fitness checks, and a comprehensive medical history, which were allegedly not conducted. They suggested that these omissions significantly impacted the patient's outcome. However, the State Commission argued that the medical board overlooked certain notations in the medical records that indicated proper monitoring and care during and after the operation.

However, Justice A P Sahi, President of NCDRC, presiding over the case, supported the State Commission's findings, emphasizing that no grounds were established to prove medical negligence on the part of the hospital or doctors.

The case involved a complaint filed by the complainant against Suyash Hospital and a Urologist along with a doctor (MS Surgery) associated to the facility. The instant appeal was filed against the order dated April 2, 2011, by the State Commission of Chhattisgarh in response to a medical negligence claim.

The complaint originated from the treatment provided to the complainant's husband,  who was suffering from a condition known as Benign Prostatic Hypertrophy, commonly referred to as a prostate problem. The patient sought medical help from the Urologist at Suyash Hospital, Raipur, Chhattisgarh, and was advised to undergo surgery. The surgery took place on November 4, 2006 and he was discharged from the hospital with a specific direction to follow the treatment by reporting at the hospital after 07 days.

However, the patient developed some problems and he telephonically sought some advice but due to a hemorrhage, he got himself admitted in a local hospital, namely Paliwal Nursing Home, Korba, Chhattisgarh. On being contacted on phone, he was advised by the urologist to go to Raipur, which is about 225 kilometers away. As per the hospital staff, the patient's family claimed that he rode a scooter for 20-25 kilometers a few days before being admitted to the nursing home on November 24, 2006.

The patient then went to Bilaspur to see another doctor named Dr Neeraj Sharma. Dr Sharma also recommended going to Raipur. However, the man spent the night at Dr Bhargava's Nursing Home. On November 25, 2006, at 10:00 a.m., he was taken to Suyash Hospital in Raipur under the care of the urologist. A surgery was performed because of the bleeding caused by a clot. However, post surgery, the patient had trouble breathing, he lost consciousness and eventually passed away around midnight.

Aggrieved, the deceased patient's wife moved a complaint with the State Commission alleging gross negligence on the part of the hospital and the doctors claiming that they failed to conduct essential pre-operative investigations and ignored standard protocols for assessing the patient's condition before surgery.

According to the complainant, the patient's post-surgery health deteriorated due to a lack of proper care. This claim led to an investigation by the State Commission of Chhattisgarh, which eventually dismissed the complaint on April 2, 2011. Following this dismissal, the complainant appealed to the National Consumer Disputes Redressal Commission (NCDRC).

During the appeal, a medical board was constituted by the State Commission to assess the case. The medical board's report dated August 23, 2010, emphasized the importance of pre-operative assessments and medical fitness checkups that were not conducted in this case. The report concluded that these omissions were critical factors in the patient's outcome.

The board opinioned that the patient did not seem to follow the post-operative instructions. He visited multiple doctors before consulting the urologist when complications arose. "The urologist's treatment approach was standard and suitable for the situation. The patient's death appears to have been the result of respiratory distress and ventricular arrhythmias. Proper preoperative medical fitness checks, including ECGs and chest X-rays, were crucial but seemingly were not conducted. A comprehensive medical history and examination were necessary in this case," it added.

However, the State Commission did not accept all the findings in the medical board's report, noting that the patient's ECG and cardiac status were continuously monitored during the operation and afterwards, suggesting that all required precautions had been taken. The State Commission pointed out that the medical board might have overlooked these important notations.

Eventually, the State Commission concluded that no negligence on the part of the hospital or doctors was established. Therefore, it upheld the dismissal of the complaint.

Challenging the State Commission's order, the complainant moved the apex consumer body. The appellant's counsel argued that the State Commission's interpretation of the evidence and the medical board's report was erroneous. They claimed that pre-operative steps were not taken as required and that the patient's death was a direct result of negligence.

The hospital and the doctors' counsel, on the other hand, emphasized that the patient's failure to adhere to post-operative instructions and the delay in seeking medical attention likely contributed to the complications that arose.

Deliberating the issue, the Commission found no grounds to establish negligence on the part of the hospital or doctors. As opined by the expert board, NCDRC took into consideration that the patient failed to turn up as advised after seven days. It further noted;

"What the expert body opined was about lack of preoperative steps that were imperative. The said notings have not been mentioned or noticed specifically in the medical expert opinion while commenting that preoperative tests have not been observed. The State Commission found that the expert body overlooked the notings on record, particularly that of Dr. Jayesh Parmar who is stated to be also a critical care expert, that is contained and endorsed on the order sheet at 4.40 p.m. on the same day. This noting, even though post operative, records and confirms the preoperative care taken as noted above and also notes the monitoring of continuous ECG recording, the B.P. and pulse that is evident on a perusal of the same. No reference to the same appears to have been made in the expert opinion report. The finding of the State Commission therefore cannot be faulted with as it does appear that the expert body did not refer to it or had not noticed the same."

"The patient appears to have not adhered to the advice rendered earlier for check up after 07 days and appears to have aggravated the situation by riding a two wheeler resulting in the condition in which he was admitted again for surgery. The precautions appear to have been taken and the post operative condition indicated his general condition as stable. The respiratory problems developed late at night and according to the expert opinion, all protocols were observed as per standard practice."

Subsequently, the NCDRC dismissed the appeal, supporting the State Commission's findings that the medical experts' report did not adequately consider the crucial notations in the medical records. It held;

"Accordingly no ground is made out to establish any infirmity in the line of treatment or any negligence on the part of the opposite parties. The findings of the State Commission indicate no scope for interference in this appeal which is hereby dismissed."

To view the original order, click on the link below: