Golden hour wasted in acute ischemic stroke treatment: Consumer court slaps Rs 43.36 lakh compensation on Apollo Hospitals Hyderabad
Medical Negligence
Hyderabad: The State Consumer Disputes Redressal Commission, Hyderabad (Additional Bench), Telangana, recently held Apollo Hospitals liable for medical negligence during the treatment of a patient with an acute ischemic stroke and directed it to pay Rs 43.36 Lakh as compensation.
After perusing the medical records, the SCDRC concluded that the hospital had failed to provide timely treatment to the patient and therefore the "golden hour" was lost.
"...it is very clear that the Opposite Parties have wasted the golden hour period in providing treatment to the patient. Added to the same, both parties have suppressed the previous record or without support of any documentary evidence, drawn their own conclusions by assumptions and presumptions. Due to the failure to provide golden hour treatment, it is obvious reason for deterioration of health condition of a patient, when days progressed, more so when the patient is having so many comorbidities," observed the Commission.
Case Background:
The history of the case goes back to 2013, when the patient developed symptoms of a brain stroke with slurred speech and was taken to the Secunderabad branch of the treating hospital between 1:30 PM and 2:00 PM. Allegedly, after being made to wait a long time, a CT Scan and other investigations were carried out, and the patient was found to be suffering from an acute ischemic stroke.
However, due to the non-availability of a neurologist, the patient was shifted to Jubilee Hills Branch. Doctors proceeded to perform Haemodialysis and it went on till 10:00 PM and then shifted to ICU in the mid-night, where the dialysis was conducted and the condition of the patient was reported as stable.
It was alleged that more time was wasted due to the admission procedure, and due to this, the golden-hour treatment could not be administered.
The patient underwent treatment for seven months. During this time, his condition worsened; he slipped into a coma and later passed away.
Several allegations were raised by the complainants, including obtaining consent signatures without disclosing the contents, negligent and improper treatment by doctors and nurses resulting in another stroke, deficiency in service, etc. Complaints were filed before the Human Rights Commission, an FIR was registered, and ultimately a consumer complaint was filed.
Meanwhile, these allegations of negligence were denied by the hospital, which argued that if the family of the patient was not satisfied with the treatment, they should not have continued it in the hospital for 7 months. They also claimed that the dues were not cleared by the complainant.
The hospital maintained that thrombolysis was not administered due to medical contraindications and that treatment was provided by a multidisciplinary team in accordance with accepted medical standards. "on 22.03.2013 at 3:15 PM patient was brought before Apollo Hospital, Secundrabad, as he was having sudden onset of left side weakness and difficulty in speech at 1:30 PM in his house; that he was examined, investigated and found to be suffering from acute ischemic stroke after, excluding haemorrhage by C.T-Scan; that his clinical history suggestive of stroke, and diagnosed as cerebra vascular accident, right middle cerebral artery territory; that thrombolysis was differed for two independent contra indications," it mentioned
Observations by Consumer Court:
While considering the matter, the State Consumer Court observed the timing of the patient's admission to the Secunderabad branch of the hospital mentioned by the complainants and the hospital and also the submission made in this regard before the Human Rights Commission.
"As per Ex.A10 dated 11.06.2013, in H.R. Case No.3202/2013 dated 11.06.2013 given by PW1, goes to show that on 22.03.2013 patient was taken before Apollo Hospital, Secunderabad at 2:30 PM; and due to non-availability of Neuro Doctor they moved us to Apollo Jubilee by 5:30 PM, as we started at 4:30 PM from Secunderabad. It means neither the timing given in the complaint nor in the written version is correct," it observed.
The Commission also took note of the bills issued by the Secunderabad branch and observed that contradictory claims were made by the complainants and the hospital regarding the admission time. The admission records reflected that the patient was admitted on 22.03.2013 at 06:42:24 PM and at the bottom, the patient's attendant signed the date and time as 22.03.2013 at 6:38 PM. However, the documents submitted by the hospital showed contradictory timing, as they showed that the patient was examined by the doctor on 20.03.2013 at 1 PM, while underneath the same page, the date was mentioned as 22.03.
At the outset, the Commission observed, "The ‘Nursing assessment’ at page-9 shows the temperature readings were recorded on 22.03.2013 at 2:00 PM & 6:00pm. By that time, the patient was not even admitted in the Apollo Jubilee because he was admitted at 6:42:24 hours. It is difficult to believe that, even before admission, the Patient was examined and medication started. For the reasons better known to the Opposite Parties, the admission form, the assessment done by the casually Doctor and the other alleged teams of experts etc., is not filed not only relating to Apollo, Secundrabad but also Apollo, Jubilee."
The Commission further noted that even though the patient was taken to Apollo, Secunderabad as an emergency case, he was not subjected to diagnostic tests.
"Normally, if any patient comes to emergency, will be taken inside, Doctor/Doctors will attend and note down the complaints and assess the condition of the patient and will provide first aid or extend the necessary emergency services. Quite surprisingly, in the case on hand, no record of the hospital at Secunderabad is filed to verify the condition of the patient and the timings of the visit. It is not luxury to expect such treatment record, from a hospital which is recognised as “The Global Gold Seal of approval” with JCI accreditation and certification," observed the Commission.
SCDRC observed on the argument that the patient was kept at the hospital under the guise that a Neuro Physician was coming and at last they were advised to go to Apollo Jubilee as the said expert did not turn up.
"It is for the Opposite Party to confirm whether any said Neuro physician was in fact present in the hospital during those days or no such expert was on the rolls of the hospital. Surprisingly, the Opposite Party-1 (hospital) kept silent without answering the same. In other words, the best available evidence is not placed before the commission, which amounts to suppression of a material aspect of the case. If really the emergency record of Apollo, Secundrabad is placed, everything would have been clarified; unfortunately, it was not done," observed the Commission.
Further, the Commission noted that the hospital did not file its original record to establish the time of arrival of the patient and also the treatment that was provided to him during the entire stay in the hospital till his death.
"Except, the photo copies of the documents filed by the Complainants, nothing is there to rely upon, for better appreciation of the facts or contentions and rival contentions of the parties to the complaint. The nursing assessment and clinical chart giving noting’s dated 22.03.2013 only. For the dates 23.03.2013 to 27.03.2013, it is noted “refer to master chart”. The master chart has not seen light of the day..." observed the Commission.
The Consumer Court further took note of the details submitted by the hospital and noted that the record mentioned that the “Patient not thrombolysed as patient beyond window period”. Thereafter, the patient was instructed to shift to the ICU, and as per the drug chart, Clexane injection was given at 6:30 PM. I.V.I.Ns was said to have been administered at 6:00 PM, but it was scored off.
It was observed by the Commission that, except Dolo, nothing was given to the patient up to 10:00 PM, although several names of medication were mentioned on 22.03.2013. Observing that the Golden hour period had lapsed, the Commission noted,
"It means, as per the drug chart, no much treatment was given to the patient on 22.03.2013. In view of the above discussion, we are of the view that, no proper treatment was given to the patient during the Golden hour period. Over and above the same, the corrections or over writings on the dates, manipulations and time, is adding fuel to the fire regarding the delay. When the patient said to had symptoms at his house, Warasiguda on 22.03.2013 at 1:30 PM, not starting any treatment by 6:00 or 6:40 PM, leads to an inference that, the Golden hour period was wasted by the Opposite Parties (hospital, doctors) due to their negligence."
"As per chart the first medication was started on the patient on 22.03.2013 only at 7:13 PM. So, it is very clear that no medication was given to the patient prior to that. Since, the Apollo Hospital, Secundrabad is also comes under the Management of Opposite Party No-1 hospital, the time taken at the Secundrabad Hospital also shall be considered. In a case of “acute ischemic stroke” the crucial period is first 60 minutes and maximum time 4.5 hours. The Opposite Parties cannot retreat themselves from the statement made by the Doctor, at the alleged 6:00 PM on 22.03.2013 in page-13 that window period was lapsed," it further noted.
Addressing the argument by the hospital that the patient had comorbidities and that is why Thrombolysis was not done, the Commission held that it was an afterthought to wriggle out of the allegation made in the complaint regarding the lapse of golden hour.
The Commission also took note of the allegations by the complainants that the patient was not properly attended to after being shifted to the tracheotomy ward. At the outset, the SCDRC noted that "For reasons better known to Opposite Parties, case sheet dated 08.05.2013 is not filed to prove that they were alert in providing services to the patient or disprove the allegation that, nobody attended the patient for about more than half an hour." Further, the Commission criticised the hospital for not filing the treatment records from 28.03.2013 to 17.10.2013 and also took note of the discrepancies in the allegations made in the complaint.
It observed, "In the case on hand, on the face of record, (with the help of available evidence) it is very clear that the Opposite Parties have wasted the golden hour period in providing treatment to the patient. Added to the same, both parties have suppressed the previous record or without support of any documentary evidence, drawn their own conclusions by assumptions and presumptions. Due to the failure to provide golden hour treatment, it is obvious reason for deterioration of health condition of a patient, when days progressed, more so when the patient is having so many comorbidities."
Accordingly, the Commission held the hospital liable for medical negligence. Taking into consideration the age of the patient, his retirement age, patient's previous health conditions, the Commission directed the hospital to pay Rs.40,11,876/- towards medical negligence, Rs.1,00,000/- towards loss of estate, Rs 1 lakh in total as loss of consortium and paternal affection, Rs.1,00,000/- compensation for Shabby maintenance of records, and Rs 25,000 as legal costs.
"In case of default in the payment of Rs.40,11,876/- + Rs.1,00,00/- loss of estate + Rs.1,00,000/- compensation within 30 days as stipulated the amount shall carry interest @ 9% p.a., from the date of default till realization," it ordered. "Out of the compensation of Rs.40,11,876/- + Rs.1 Lakh loss of estate & Rs.1 Lakh compensation & Rs.25,000/- towards costs, the Complainant No.1 is entitled for 50 % and complainant 2 & 3 are entitled for each 25 %," it further said.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/2026/09/10/apollo-hospital-scdrc--474966.pdf
