Disability due to medical negligence- Hospital, Doctors slapped Rs 20 lakh compensation
Medical Negligence
New Delhi: Holding Guwahati-based Hospital and its doctors liable for medical negligence, the National Consumer Disputes Redressal Commission (NCDRC) recently granted Rs 20 lakh compensation to the patient, who suffered permanent damage to the vocal organs after undergoing treatment at the Hospital.
Apart from the Rs 20 lakh compensation, the Apex Consumer Court has further granted Rs 50,000 as legal costs.
The history of the case goes back to 2013, when after meeting with an accident in Arunachal Pradesh, the complainant was rushed to the General Hospital in Naharlagun for his initial treatment. Thereafter, the complainant was referred to the treating hospital- GNRC Medical Hospital, Guwahati. After being treated there, the patient was discharged with a tracheostomy tube in place. The patient had undergone two tracheostomy procedures while undergoing treatment at GNRC Hospital.
After returning home, the patient faced severe discomfort, which included extreme coughing and expulsion of food through the tracheostomy tube. His condition deteriorated due to significant damage to his vocal organs, and because of this, he was rushed to a nearby hospital.
The attending physician at the hospital referred him to CMC Vellore for advanced care and after the commencement of procedures, it was revealed that the surgical intervention performed at GNRC Hospital had resulted in severing of both the food pipe nd the windpipe, leading to permanent damage to the complainant's vocal organs. Thereafter, the complainant filed a complaint with the National Consumer Disputes Redressal Commission (NCDRC) praying for appropriate compensation.
Highlighting the unfair trade practices and significant lapses on the part of the treating hospital, the complainant submitted that despite a lack of significant improvement, the patient was detained in the hospital, leading to an escalation of medical expenses.
It was contended that the complainant was put in a super-speciality hospital for an excessive period, and despite this, he did not receive any ENT consultation to restore his voice. The complainant claimed that the postoperative pain and complications that he suffered were due to a lack of proper care and monitoring by the treating hospital.
Further, the complainant argued that no neurosurgical specialist evaluated him for six days despite serious injuries to the head. This, according to the complainant, constituted 'deficiency of service'.
Citing medical standards that indicate that prolonged intubation beyond 10 days can pose a risk to the windpipe, thus necessitating tracheostomy, the complainant argued that there was a failure to perform tracheostomy after 10 days of intubation, and it constituted another serious 'deficiency in service'.
The complainant also highlighted poor documentation on the part of the hospital and claimed that consent forms for tracheostomy procedures lacked the necessary doctor's identification, and no formal surgical records were maintained for either of the two tracheostomy operations. It was alleged that informed consent was also not taken for the surgeries, and the doctors also did not sign the consent forms.
On the other hand, the hospital and the doctors at the hospital denied the allegations of medical negligence and contended that there was no specific timeframe prescribed in standard medical literature regarding the time when a tracheostomy needed to be performed.
Further, they argued that three neurosurgeons daily took rounds and monitored the complainant, and an independent expert opinion was also relied upon by the hospital to argue that both vocal cords of the complainant were symmetrical and approximated well.
Regarding the allegations of documentation practice, it was submitted that a similar practice was followed at AIIMS. Further, it was argued that the complainant's condition had worsened due to the delay in reporting to CMC Vellore and therefore, the GNRC hospital and its doctors could not be held liable for it. They further claimed that all the procedures were explained to the patient's attendants, and informed consent was taken.
While considering the matter, the NCDRC bench perused the case record and noted that even though the complainant's airway was found normal in a CT scan dated 12.07.2013, an accidental extubation occurred on 11.07.2013. The bench opined that it was a serious lapse, suggesting a lack of ICU supervision.
Further, it was observed that the doctor who treated the complainant did not have any signatures in the complainant's clinical notes. The consumer court also noted that when the complainant was taken to CMC Vellore, it was confirmed that the trachea and oesophagus were surgically compromised during the second tracheostomy performed at GNRC Hospital.
Referring to the medical records provided by the treating hospital, the NCDRC bench observed that the records lacked the names, qualifications, and registration numbers of the doctors. It was also observed that in violation of the erstwhile Medical Council of India regulations, the name of the referring or operating surgeon was never recorded.
Addressing the issue of informed consent, the bench noted that
"As regards the material issue whether before undergoing surgery, the patient or her parents were informed about the possible risks and complications and their informed consent was taken, it is true that every operation, as small as it may be, carries wide range of risks from the most insignificant to the most serious, may lead to fatal complications. Discussing all complications with patient and attending relatives is a necessity, so that she may make up her mind for surgery."
At the outset, the Apex Consumer Court placed reliance on the decisions of the Supreme Court in the case of Samira Kohli Vs. Dr. Prabha Manchanda & Anr, where while discussing the concept of informed consent, it was held that a patient had an inviolable right in regard to his body and therefore he had the right to decide whether or not he should undergo a particular treatment.
"Breach of any of these duties gives right of action for negligence to the patient. This means that when a medical professional, who possesses a certain degree of skill and knowledge, decides to treat a patient, he is duty bound to treat him/her with a reasonable degree of skill, care, and knowledge. Failure to act in accordance with the medical standards in vogue and failure to exercise due care and diligence are generally deemed to constitute medical negligence," the NCDRC bench observed
Referring to the case details, the bench noted,
"As regards tracheostomy performed at GNRC, the document for obtaining „Consent for Operation, Anaesthesia and Other Medical Services‟ obtained from the complainant for surgery performed on the complainant on 22.07.2013 is placed on record. This document is undisputed. Perusal of the same reveals that, it is in a printed format wherein the patient is stating the explanation given, understanding he had and associated issues with respect to surgery that is to be performed. This consent form has been signed by the complainant himself, parent/ guardian as well as a witness. It has no reference to actual details of the surgery other than „tracheostomy‟ or its implications. It is even more intriguing to note that it does not contain any detail as to who is the doctor who has given the information, explanations, options and cautions to the complainant. It also has no signature of any medical person on the consent form. Therefore, such consent recorded and relied upon by OPs is clearly untenable in law."
Addressing the issue of duty of medical care, the NCDRC bench relied on the order by the Supreme Court that observed that when a medical professional, who possesses a certain degree of skill and knowledge, decides to treat a patient, he is duty-bound to treat him/her with a reasonable degree of care. Failure to act in accordance with medical standards in vogue is generally considered as medical negligence.
Relying on judicial precedence including the Supreme Court order in the case of Jacob Mathew vs State of Punjab, the top consumer court observed,
"In view of the foregoing the negligence in providing medical treatment to the complainant by both the OPs is manifest in the form of compliance with obtaining informed consent, providing medical treatment of requisite standards, providing necessary information, guidance and support to the complainant. These failures on the part of OPs resulted in adverse impact in the condition of the complainant who has been rendered with significant disability and that he cannot speak normally and has a tube in his neck for time to come."
"After due consideration of the entire facts and circumstance of the case, including the trauma and suffering of the complainant, the expenditures that were incurred for his treatment at various hospitals including at VMC, Vellore and the present condition he is in, he needs to be compensated," opined the Commission.
However, regarding the claim for compensation of Rs 12,40,19,000, the NCDRC bench held that the amount was unsupported by necessary evidence and was evidently disproportionate.
"Clearly, he incurred substantial expenditures towards Treatment, moving from Arunachal to Tamil Nadu for treatment for a long time and also was under constant treatment and medication, in addition to pain and suffering. Therefore, after due consideration of all these, including the sufferings and the condition he needed to cope up in future also, we consider it appropriate to award a lumpsum amount of Rs.20,00,000 as compensation to be to jointly and severely paid by all the three OPs, within one month from the date of this order. In the event of delay, the OPs are liable to pay simple interest @ 12% per annum for such delayed period till final payment," ordered the NCDRC bench.
"The OPs are also directed to pay Rs.50,000 as costs to the complainant," it further directed.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ncdrc-order-medical-negligence-286699.pdf
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