Operating under Nephropathy: Doctor, Hospital told to pay compensation

Kolkata: Holding that the due to medical negligence on the part of the doctor and the hospital, a patient had died; the West Bengal State Commission has directed them to pay Rs 2 lakh as compensation along with litigation costs to the deceased patient’s kin.

The case goes back to the year 2013 when the complainant’s mother, a 74-year-old patient was admitted to the Nabajiban Hospital for an orthopedic operation on advice of the doctor.

The complainant had moved the district forum alleging that even when the blood investigation reports, Bio-chemistry and Haematology reports revealed that the patient was not clinically fit for operation but in spite of that she was operated on by the doctor without optimising compromised Renal Function of the patient and the undue risk was taken without keeping in mind the best interest of the patient. Hence, immediately after operation blood urine and a creatinine level of the patient began to increase rapidly and Renal function of the patient failed totally and ultimately the patient died. As per Death Certificate, the death was due to Pneumonia for 7 days, Sepsis for 13 days, Nephropathy for 21 days, a postoperative 8 day of the fractured shaft of femur. It was contended that the doctor and the hospital had failed to exercise proper care and caution to the patient and acted in a rash and negligent manner endangering human life only for commercial objectives.

In response, the doctor submitted that he had only advised the patient to be admitted for operation but never suggested name of any institution where the patient was to be admitted and the complainant took the decision independently about where to admit the patient.

The doctor further stated that prior to operation proper measures were taken including consultation of Nephrologists. He explained that as the patient was totally bedridden and was unable to make any movement whatsoever and her organs were deteriorating day by day and the only way she could have recovered was to restore her movement in some way and that was the only reason for which surgery was suggested.

The hospital authorities also denied any medical negligence from their part.

On the basis of all the submissions, the District forum allowed the complainant’s plea and directed compensation to her declaring lack of care by the hospital and the doctor.

Aggrieved with the forum’s order, the doctor moved the commission and prayed for relief.

It was submitted by the counsel appearing for the doctor that the District forum had failed to appreciate the fact that the doctor after considering the Nephrologists review had advised not to operate further but it was the complainant who wanted patient to get operated.

The counsel on behalf of the complainant then submitted before the court that prior to operation the consent of the patient party was not obtained by giving adequate information concerning the nature of the treatment procedure. He further contended that the patient was infected by a lot of Nosocomial i.e. hospital-acquired infection like Klebsiala etc. which appears form urine culture, sensitivity reports indicated that the hospital authority has failed to exercise proper care of the patient and acted in a negligent manner resulting the death of the patient.

After going through the contentions and reasonings made by both the parties, the Commission’s bench comprising Presiding member, SP Chowdhury and Dipa Sen as a member; made its observations.

On the part where the doctor contended that he never suggested the name of the institution where the patient was to be admitted and the complainant took the decision for admission of the victim independently, the bench observed:

Such a statement appears to be incorrect because the prescription dated 19.04.2013 issued by the appellant clearly speaks that he advised admission in Nabajiban Hospital for operation by writing. Therefore, it is at the instruction of the appellant, the patient party admitted the victim in the respondent No. 2 hospital.

The court noted that on the stand that prior to operation all necessary tests were done and Nephrologists were consulted to ascertain whether OT can be done or not; the treatment sheets of Nabajiban Hospital do not justify the same.

In the treatment sheet dated 22.04.2013 it has been mentioned about Nephrology consultation but there is no assertion as to who were those Nephrologists and what kind of advice given by them relating to operation of the victim. Apparently, the victim had been suffering from renal problem and without mitigating the said renal problem, the appellant took the risk of operation of a women, who was 74 years old which did not exercise by consultant of SSKM Hospital about 5 years back.

The bench observed that prior to operation the doctor being an expert in the medical field should have consulted the Nephrologists, more particularly, when the victim had really been suffering from Kidney problem.

On the date of operation a consent appears to be obtained but in reality it was obtained on dotted line without disclosing the fact that at the age of 74years and further considering the level of Blood Urea or Creatinine there might be complications. It is true if a patient suffers from some complication which is an inherent risk of treatment, it is not always considered as negligence, provided the complication did not arise because of negligence of the treating doctor. However, it is mandatory that the treating doctor must disclose the inherent risk of any procedure to the patient in writing and take a valid consent before commencing with the treatment. In the instant case the appellant has mentioned high risk patient for surgery but unfortunately he did not take minimum care required from a surgeon

Reaching its decision, the commission upheld the District forum’s order;

it is evident that knowing fully well the patient is an old aged person, who earlier treated at SSKM Hospital, Kolkata but the hospital authority did not take venture to operate him and after 5 years from the date of such treatment, the appellant advised for operation knowing fully well that the patient had been suffering from Nephrological problem. The Ld. District Forum has rightly observed that the OP (appellant) ventured the operation of the patient without explaining the nature and procedure of the treatment and its purpose to the patient party or to the patient herself and the bed head ticket (BHT) speaks that after operation the patient could not move or even sit due to severe pain in the operated leg and no check up x-ray was done by the attending doctor after operation. All these are unexpected from a reasonable man far less to speak of a doctor. Therefore, it is palpably clear that there was an intentional act or omission or failure on the part of the appellant in administering treatment to the victim.

The respondent No. 2 hospital should also be blamed as the victim was infected by lot of Nosocomial i.e. hospital acquired infection like Klebsiala etc as it appears from Uren culture and sensitivity reports dated 20.05.2013.

The bench held that due to lack of care/negligence on the part of the doctor and the hospital, the complainant had to lost her mother and had there been proper treatment with care and attention, she might have remained alive and directed them to pay the compensation to the complainant:

we find that the amount of compensation awarded by the Ld. District Forum amounting to Rs. 2,00,000/- apart from litigation cost of Rs.10,000/- is not excessive.