Failure to provide life support ambulance for critical patient: Consumer court slaps Rs 15 lakh compensation on Delhi's hospital

New Delhi: The Delhi State Consumer Disputes Redressal Commission has directed a Delhi-based hospital to pay Rs 15 lakh in compensation for failing to arrange a life-support ambulance and appropriate medical supervision during a patient's transfer to another hospital.

The case concerned a patient diagnosed with rheumatic heart disease, severe mitral stenosis, moderate mitral regurgitation and severe aortic regurgitation. He had undergone dual valve replacement and left atrial appendage ligation surgery at AIIMS on November 25, 2008, and remained under regular follow-up.

On November 13, 2013, the patient developed acute breathing difficulties and was rushed to the emergency department of Metro Hospital & Heart Institute.

An Echo revealed an obstructed aortic prosthesis (mean gradient 61–66 mmHg) with thrombus. Following evaluation, the treating doctor advised admission and administered streptokinase thrombolytic therapy.

However, the patient subsequently suffered a stroke, resulting in speech impairment and weakness on the right side of his body.

According to the complaint, the family was informed that the patient required specialised neurological management and was advised to shift him to another hospital.

The complainant alleged that despite the patient's critical condition, the hospital failed to arrange a fully equipped ambulance or provide an accompanying doctor for the transfer.

The family claimed that nearly five hours were lost before they independently arranged an ambulance from Vimhans Hospital. The patient was subsequently admitted to the intensive care unit at Vimhans on November 15, 2013.

The complainant further alleged that the patient continued to suffer neurological impairments affecting his speech, memory, comprehension and ability to perform daily activities.

Alleging medical negligence and deficiency in service, the patient, represented through his wife, approached the Consumer Commission seeking Rs 35 lakh for medical negligence, harassment and mental agony, Rs 50 lakh towards loss of future earnings and other expenses, and Rs 50,000 in litigation costs.

Contesting the allegations, the Hospital and the doctor maintained that the treatment had been administered according to established medical protocols.

The hospital submitted that high-risk consent had been obtained before administering streptokinase and that possible complications, including bleeding and neurological risks, had been explained to the patient and attendants.

It further argued that the family had been offered the option of transferring the patient to the hospital's Noida facility but had declined. According to the hospital, the patient was subsequently discharged for treatment at Vimhans without delay.

During the proceedings, the Commission examined expert medical opinions from G.B. Pant Hospital, the Delhi Medical Council and appeal before the erstwhile Medical Council of India (now NMC)

The G.B. Pant Hospital expert board observed that "Thrombolytic therapy (Streptokinase) for stuck valve thrombosis is one of the established line of management which was instituted in this patient. High risk consent for the administration of streptokinase (thrombolytic) was taken from the patient before the administration of streptokinase and all the risks were explained as per the consent page attached in records. Dislodgement of thrombus causing stroke is a known complication of the disease i.e. thrombosis of aortic valve."

The Delhi Medical Council also found that no prima facie case of medical negligence was established against the treating doctor. Its decision was subsequently upheld by the MCI.

Taking note of these findings, the Commission concluded that the patient had been treated according to standard medical protocols and that negligence could not be attributed to the treating doctor merely because a recognised complication had occurred.

However, the Commission took a different view regarding the hospital's failure to arrange emergency transportation.

It observed that patients admitted to premier hospitals have a legitimate expectation of receiving appropriate medical care and facilities consistent with the institution's reputation and the charges collected.

The Commission observed:

we deem it appropriate to reiterate that the relationship between a hospital and its patient is founded upon trust, confidence and the legitimate expectation of receiving timely and appropriate medical care. A hospital is not merely a commercial establishment providing medical facilities for consideration; it is an institution entrusted with the onerous responsibility of safeguarding human life. The financial consideration charged by a hospital must necessarily be accompanied by a corresponding degree of accountability, diligence and responsibility in the discharge of its obligations. The provision of basic emergency facilities, including an appropriately equipped ambulance and qualified medical personnel for patient transfer, cannot be treated as an optional or dispensable service. Any failure in this regard, particularly in an emergency, strikes at the very foundation of the trust which a patient places in a medical institution. Such lapses, therefore, warrant serious judicial scrutiny and cannot be viewed lightly.

It further noted that the hospital had failed to make adequate arrangements for transporting the patient at a time when he required immediate medical attention.

Even otherwise, it is a matter of common knowledge that an adequately equipped ambulance constitutes an indispensable component of emergency medical care and plays a pivotal role in preserving the life and safety of a patient, particularly when the patient is in a critical condition. The timely availability of an ambulance, equipped with the requisite life-support facilities and accompanied by appropriately qualified medical personnel, is not a matter of convenience but an essential element of the duty of care owed by a hospital to its patients.

The Commission also found that the hospital had not provided any satisfactory explanation or supporting material to demonstrate that reasonable arrangements had been made for his safe and timely transfer.

Emphasising the hospital's continuing responsibility, the Commission observed:

"The duty of a hospital does not come to an end merely upon providing consultation or administering treatment within its premises."

The Commission held that this responsibility also extends to ensuring the patient's safety, continuity of care and well-being during transfer to another medical facility.

It further observed:

"We further observe that the failure to arrange for an ambulance and appropriate medical supervision during the transportation of a critical patient is not a mere procedural lapse or an inconsequential administrative omission."

The Commission concluded that the hospital's failure to provide an appropriately equipped ambulance and medical supervision amounted to a serious breach of its duty of care and constituted deficiency in service under the Consumer Protection Act, 1986.

Accordingly, the Commission partly allowed the complaint against the hospital and directed it to pay Rs 15 lakh as compensation for the mental agony and distress caused to the patient and his attendants. It also awarded Rs 50,000 towards litigation costs, taking the total amount payable to Rs 15.5 lakh..

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