Delay in administering reteplase injection: Cardiologist told to pay Rs 6 Lakh compensation for patient death
Hyderabad: Observing a delay in administering life-saving Reteplace injection to a patient who was in a serious condition of heart attack, the District Consumer Disputes Redressal Commission has directed an interventional cardiologist to pay a compensation of Rs 6 lakh for negligence and deficiency in service resulting in the death of the patient.
The direction came following a compliant moved with the Consumer Commission by the deceased patient's husband alleging that the cardiologist was negligent in treating the patient leading to her death.
The case goes back to August 26, 2016, when a 56-year-old patient was brought to the Nalgonda-based cardiology hospital, owned by the cardiologist- with reported chest pain and uneasiness. The cardiologist conducted ECG and 2D Echo on the patient apart from several tests and medication that amounted a bill of Rs.47, 300/-.
It was alleged that while the procedures were being conducted on the patient, the Doctor was not present and had left for his house, leaving the patient in serious condition. The patient had been kept in the hospital for over five hours, but her condition did not improve. Soon after, the patient passed away.
Mentioning that the hospital lacked the adequate infrastructure necessary for the treatment of the patient, the complainant further alleged that the cardiologist, "feigned to treat the patient" with a malafide intention to usurp exorbitant money from them, adding that the doctor neither discharged his professional duties nor did he refer the patient to a better hospital.
Thereafter, a legal notice was sent to the cardiologist in November 2017 claiming claimed an amount of Rs.47,300/- towards medical expenses, Rs.16,700/- towards gold ring finger (that was allegedly stolen by the hospital staff from the patient's finger), Rs.3,36,000/- towards mental agony and Rs.6,00,000/- towards compensation, total Rs.10,00,000/-.but was unanswered.
Aggrieved, the complainant moved the Consumer Commission.
During cross-examination, the cardiologist denied all allegations and submitted that after conducting initial treatment and tests (including blood pressure check, ECG, and 2D Echo) the doctor had arrived upon the conclusion that the patient had been suffering from serious heart attack. Following this, the complainant has explained the risk and consequences of a heart attack including the sudden death that may happen to the patient.
He added that after understanding the complications involved in the procedure during the heart attack, the complainant admitted his wife for treatment and consulted for the treatment and signed in the consent letter out of his free will and consent without any pressure from the side of the cardiologist or the staff of the hospital.
The cardiologist has also clarified before the commission that he administrated RETEPLASE injection which had to be given within 30 minutes of heart attack as early as possible according to the protocol followed in the cases of a heart attack. After giving the injection, the patient showed signs of improvement and it was also reflected in the second ECG.
It was further submitted that after coming to a conclusion that the patient should undergo an angiogram, the doctor advised the complainant to take the patient to the higher cardiac center where the angiogram facility would be available; and maintained that he issued a referral letter to the complainant.
While addressing the legal notice sent by the complainant on 15/09/2019, the cardiologist argued that he had replied to the notice on 10/10/2017 and it had been served to the complainant on 13/10/2017. He further stated that the Complainant, without waiting for the reply from him, lodged this complaint to corner and blackmail him. He further alleged that the complaint had been lodged with an intention to grab money from the hospital at the cost of his reputation.
After hearing both the parties, the Commission observed that during cross-examination about the referral letter and consent letter filed by the Cardiologist, he had admitted that "the complications happened before shifting the patient to the higher center so he did not give any referral letter, but he gave death summary."
The Commission noted that the Case sheet lacked the necessary details such as identification column, the details of the patient's condition (blockage of the valves and the percentage of the blockage). The case sheet had been written in the form of a story and it hadn't contained visiting time or the details of the treatment given. The Opposite Party accepted all these flaws in the case sheet. The Commission also found contradictions in the statements of the Opposite Party, as the Discharge Summary stated that "referred to higher centre for Coronary Angiogram", but the Opposite Party, during his cross-examination, had stated that "there is no need of angiogram facility to this injection."
Further, after verifying the documents, the Commission referred to the previous judgment by the Supreme Court reported in IV (2004) CPJ 40 (SC). It mentions, "the doctrine of res ipsa loquitur apply the onus lay on the hospital authority to prove that there had been no negligence on its part or on the part of anyone for whose acts or omissions it was liable and that onus has not been discharged. Once an allegation is made by the patient was admitted in a particular hospital and the evidence is produced to satisfy that he died because of lack of proper care and negligence, then the burden lies on the hospital to justify that there was no negligence on the part of the treating doctor or hospital. Therefore, the hospital which is in better position to disclose what care was taken or what medicine was administered to the patient. It is the duty of the hospital to satisfy that there was no lack of care or diligence. The hospitals are institutions, people expect better and efficient service."
The apex court judgment further mentioned, "In the opinion of this court before forming an opinion that expert opinion is necessary, the Fora under the Act must come to a conclusion that the case is complicated enough to require an opinion of the expert or that the facts of the case as such that it cannot be resolved by the Members of the Fora without the assistance of an expert opinion."
The Commission further referred that in the decision reported in I (2020) CPJ 3 (SC) between Maharaja Agrasen Hospitals and others Vs. Master Rishabh Sharma and others, it had been observed that "Medical Negligence – Expert evidence – Court is not bound by evidence of an expert, which is advisory nature – Court must derive its own conclusions after carefully sifting through medical records, and whether the standard protocol was followed in the treatment of the patient."
The Commission observed,
"Though the Opposite Party knew that the patient was suffering from a serious heart attack had failed to refer the patient to higher center for better treatment with the equipment available. The Opposite Party failed to perform his professional duty in treating the patient due to his negligence and carelessness."
It added,
"The deceased is 56 years old woman, the Complainant lost his wife's love and affection due to the untimely death in the hospital of the Opposite Party who would have survived if the Opposite Party would have given proper treatment, i.e. administering the Reteplese injection within 30 minutes which has been admitted by the Cardiologist."
Subsequently, the Commission noted;
"There is negligence and deficiency in service on the part of the Opposite Party in giving treatment to the Complainant's wife and her the fundamental right to life has been curtailed due to the negligent treatment given to the patient. The Opposite Party has failed to prove a valid informed consent obtained from the Complainant before subjecting his wife for the treatment. The Opposite Party had himself admitted that there was a delay of two hours in administering Reteplace injection to the patient who was in serious condition of heart attack and delayed the treatment which caused the death of the patient, as the principal of res ipsa loquitor applies."
On the basis of these findings, the Commission directed the Cardiologist to pay "An amount of Rs.6,00,000/- [Rupees Six Lakhs only] towards compensation, Rs.1,00,000/- [Rupees One Lakh only] towards mental agony, Rs.47,300/- [Rupees Forty-Seven Thousand and Three Hundred only] towards medical expenses with interest @ 9% p.a. from the date of filing of the complaint till realization along with costs of Rs.10,000/- [Rupees Ten Thousand only] within 45 days from the date of receipt of this order."
To view the original court order, click on the link below:
