No Negligence but Lack of Consent: Indraprastha Apollo told to pay Rs 5 lakh compensation

Delhi: The State Consumer Disputes Redressal Commission has ordered Indraprastha Apollo hospitals in Saritavihar, to compensate an amount of Rs 5 lakh to the family of a deceased patient.

The hospital had been accused of transfusing blood to the patient when the patient didn’t need it and also it was alleged by the petitioner that the hospital authorities did the procedure only to make money.

The case relates to the patient, Anupama who suffered from diarrhoea and was taken to a family doctor initially. After a treatment of four days, the patient felt no relief whatsoever, further to which, she was taken to Indraprastha Apollo hospitals in Sarita Vihar. At the hospital, she was diagnosed with Systemic Lupus Erythematosus (SLE). Haemoglobin levels were found low in Anupama's body, accordingly, she underwent the blood transfusion. Soon after the procedure, she got a psychosis attack.

The complainant, Harish Kr Chadha, Anupama’s father, contended that one doctor examined the patient and declared her fit for discharge. But later Harish was told that the patient is not fit for discharge.

The court noted the complaint of the patient's father as follows,

“Complainant opposed the proposition and suggested that the haemoglobin could be improved by a healthy diet. He wanted the patient to be discharged on that very day. He also did not have a blood donor. The grievance of the complainant is that despite good condition of the patient, two units of blood were transfused by Dr Sahani. A double dose of steroid was given. It rocked the brain of the patient.”

The patient was soon shifted to ICU. She was put on a ventilator and no movement was observed in her body.

 The complainant made severe allegations adding that the hospital and the treating doctor did this only to grab money. ICU charges were Rs.70,000/- per day. On 02.08.2004 he was asked to deposit Rs. 1 lakh. Harish expressed his incapacity to pay the same and informed that Rs.70,000/- was deposited only one day before. Upon this ventilator, oxygen and other facilities were withdrawn by the hospital administration. It was alleged that the death of the patient was concealed initially and only informed to the attendants the next day.

The hospital and the doctors clearly denied all the allegations. In their defence, they informed that the patient was admitted to  Hospital on 22.07.2004 with complaint of vomiting 5-6 times daily for the last 10-12 days. She had loose stools, 6-8 times a day. She was having fever for the last 10 days. She disclosed the history of Reynolds Phenomenon in winter. Towards past history, it was informed that at the age of 13 years, she had developed skin rashes along with fever and ulceration.The same was resolved with treatment but no records were available. Thereafter the patient had recurring episodes of skin disorder, Bullous Lesions which were associated with generalized Lymphadenopathy. These episodes occurred 2-3 times a year and resolved with treatment. Doctors submitted that the patient was diagnosed as suffering from Systemic Lupus Erythematosus(SLE) with Coomb’spositive hemolytic anemia.

They contended  that it was a complicated disease and could not have an on spot diagnosis without referring to a stringent battery of tests. Patient had multiple Lymphnodes (cervical)of the size from 0.5 to 2 cms in neck.There was no contra indication to blood transfusion. Deceased had presented with low hemoglobin. Her condition warranted life savingmeasures. Steroids needed to be given. Fever was not a contraindication in such a situation. Cause of fever could be infective or non-infective due to an auto-immune disease like SLP. In non-infective fever such as in auto- immune disease, there was no contraindication to steroids. Steroids were given in a standard dose

The case was earlier presented in front of the District Forum which relied upon the Experts’ opinion dated 23.05.2006 given by Medical Council of Delhi.

All the records show that the OP-1 Hospital and the treating doctor did not obtain the consent of the patient’s attendants in giving treatment. No record shows if the patient or her attendants were disclosed information relating to the diagnosis of the disease SLE, nature of the proposed treatment, potential risk of the treatment and the consequences of the patient refusing the suggested line of treatment. All these things were fundamental requirement of law.

Coming to the case in hand the disease SLE had several risks including the risk of death. It ought have been explained to the patient or her attendants (depending upon the situation that disclosure to the patient was not advisable).

As discussed above there is no ‘informed consent’ or any such disclosure in black and white in the whole of therecord before this Commission. There is no consent obtained while transfusing blood. Similarly there is no ‘consent’ while transfusing plasma (plasmapherosis). Experts while giving their opinion have held that the OP-1 Hospital was guilty on that count

The judges held that a disclosure to the attendants could have prepared them mentally to undergo the treatment and face the risks associated with it. Attendants could have exercised their option not to undergo the treatment in question or they could have opted for some alternative treatment in other therapies. In its absence, they suffered mental agony for which they are required to be compensated.

Holding it negligence on part of the hospital and the treating doctor, the court held,

“Compensation to the tune of Rs.5 lac would meet the ends of justice. The appeal is accordingly partly allowed. OP-1 Hospital and the treating doctor are directed to pay an amount of Rs. 5 lakhs jointly and severally to the Complainant within a period of 30 days from today failing which it shall carry interest @12% per annum.”