H1N1 test not promptly conducted on symptomatic patient: Consumer Court finds Fortis Hospital, Nephrologist guilty of negligence
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held Fortis Hospital and its Nephrologist guilty of not conducting an H1N1 test promptly while treating a patient having a history of Kidney transplantation.
After being admitted to Fortis Hospital, the patient was later shifted to Government designated hospital after being tested positive for Swine Flu. The NCDRC bench took note of the signs and symptoms of the patient as mentioned in the medical record.
Further referring to the Government Guidelines for treating patients with Flu-like symptoms, the NCDRC bench noted that the patient was certainly covered under Category A and Category B patients during his 1st hospitalisation.
Additionally, when the patient was readmitted a couple of days later, he not only had a cough with sputum with a mild fever over two weeks but was also complaining of breathlessness, and on physical examination also he was found to be "breathless".
"This symptom of “breathlessness” is the additional component included in the Guidelines pertaining to Category ‘C’ apart from the other symptoms of Category ‘A’ & ‘B’ i.e. cough with sputum and fever etc. Consequently, he was required to undergo testing, immediate hospitalisation and treatment, although no tests for H1N1 in the case of Category ‘A’ & ‘B’ were required in terms of the Govt. Guidelines," opined the top consumer court.
With this observation, the NCDRC bench held Fortis Hospital and its treating doctor guilty of medical negligence and upheld the order of the District Forum in this regard.
The matter concerned the complainant's father, who previously underwent kidney transplantation operation twice. However, on 07.12.2009, the patient was experiencing cough and fever and was consequently admitted to the Fortis Hospital Noida under the supervision of the treating Nephrologist Dr Singhal. After a few days, the patient was discharged but was again admitted in the Hospital on 18.12.2009 as he was facing difficulty in breathing. He again was under the treatment of Dr. Singhal.
When the patient was diagnosed with Swine Flu, he was shifted to another hospital as Fortis Hospital informed that they would not treat the patient for Swine Flu. It was alleged by the Complainant that even though the doctor and hospital took steps to transfer the deceased to another hospital. However, they failed to examine and treat the patient properly, thoroughly, and on time.
After being shifted to Apollo Hospital, the patient expired on 28.12.2009. The Complainants contended that if the h1N1 tests had been conducted in time along with other necessary examinations then the life of the deceased could have been saved.
They further contended that the doctor and the hospital were negligent and careless and they did not treat the patient seriously. They also alleged that Dr. Singhal stopped the medicines for kidneys essential for the transplanted kidneys due to which those kidney failed completely and the deceased patient fell back on dialysis due to which Blood Pressure decreased and it ultimately resulted in his death. Therefore, filing complaint before the District Forum, the complainants alleged deficiency in services by Fortis Hospital and its nephrologist and sought a compensation of Rs 16,30,000 for negligence and Rs 3,14,075 as treatment expenses.
On the other hand, the doctor and the hospital denied all the allegations and any kind of deficiency in service on their part. They contended that the patient was provided with the best medical treatment and he was critical at the time of admission. However, his condition got stable during treatment at Fortis Hospital and therefore he was discharged on 13.12.2009.
Confirming that the patient was readmitted a few days later, the hospital and doctor submitted that the patient was treated with Antibiotics and other support systems.
They also referred to the Guidelines of the Ministry of Health and submitted that in view of the ongoing Swine Flu pandemic at that time, the patient's sample was sent for testing to a Government approved Hospital. Since the test result came out positive, the doctor and hospital immediately referred the patient to a centre authorised by the Governent for treatment of patients having H1N1 Flu.
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It was contended that the Government of India had strictly directed Hospitals to refer patients suffering from Swine Flu to the designated hospital. They also submitted that among the list of designated hospitals, the patient chose Apollo Hospital and accordingly appropriate arrangements were made by the Fortis Hospital to transfer the patient.
While considering the matter, the District Forum observed that the Fortis Hospital and its doctor never considered the patient for Swine Flu and the Forum further opined that if the test for Swine Flu would have been done then a proper treatment could have been initiated.
Further taking note of the fact that Fortis Hospital knowingly disobeyed the directions of the Health Department, the District Forum opined that the treatment was given in a negligent manner and the level of treatment was very poor. Therefore, the hospital and the doctor were directed to Rs 3,64,075 to the Complainants.
However, the order of the District Forum was challenged before the State Commission, which set aside the previous order. This was challenged by the complainants before the NCDRC bench.
After perusing the medical records of the patient, the Apex Consumer Court took note of the Discharge Summary of the diseased for the first and second time of hospitalisation. The Discharge summary mentioned details about the diagnosis, procedure, chief complaints and physical examination.
Apart from this, the Apex Consumer Court also noted that the Government Guidelines on categorisation of Influenza A H1N1 cases revised on 5.10.2009. The Directorate General of Health Services, Emergency Medical Relief of the Union Government on 28.10.2009 had categorised individuals seeking consultations for Flu like symptoms in three categories "A, B and C".
The Guidelines for Category A patients stated, “Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting will be categorized as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.”
In respect of the Category B patients, the Guidelines stated that in addition to all the signs and symptoms mentioned under Category-A, "if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir", and individuals having one or more of the high risk conditions such as children with mild illness but with predisposing risk factors, pregnant women, persons aged 65 years or older, patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS, patients on long term cortisone therapy- shall be treated with Oseltamivir.
Referring to the Category 'C' patients, the Guidelines stated that a patient will require testing and immediate hospitalisation and treatment if in addition to the signs and symptoms of Category A and B, he/she has symptoms such as breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails, if the patient is a child with influenza like illness who had a severe disease as manifested by the red flags signs, and if the patient is discovered with worsening of underlying chronic conditions.
Referring to the Discharge Summaries issued by the Fortis Hospital for the first and second hospitalisation of the patient, the NCDRC bench noted that "the deceased was having the complaints of cough with sputum, breathlessness and mild fever for two weeks and the symptoms had aggravated for 2-3 days prior to such date of admission."
Therefore the Commission opined that the patient was certainly covered under Category 'A' and 'B' of the Government Guidelines till that time. However, the Commission observed that when the patient was readmitted a few days later, he not only had cough with sputum with mild fever over two weeks but was also complaining of breathlessness and on physical examination also he was found to be "breathless".
"This symptom of “breathlessness” is the additional component included in the Guidelines pertaining to Category ‘C’ apart from the other symptoms of Category ‘A’ & ‘B’ i.e. cough with sputum and fever etc. Consequently, he was required to undergo testing, immediate hospitalisation and treatment, although no tests for H1N1 in the case of Category ‘A’ & ‘B’ were required in terms of the Govt. Guidelines," opined the top consumer court.
Therefore, the NCDRC bench held Fortis Hospital negligent for not conducting the H1N1 test promptly and noted,
"The omission on the part of the Hospital therefore to have the patient tested for H1N1 promptly would certainly be contrary to the requirements under the aforesaid Guidelines, and therefore does constitute actionable “medical negligence”."
With this observation, the Apex Consumer Court set aside the order of the State Commission and upheld the District Forum's order.
"The Ld. State Commission had therefore acted erroneously in not considering the applicability of the guidelines pertaining to the category ’C’ individuals, which were clearly applicable to the father of Complainant No. 1, and had thus acted with material irregularity in setting aside the well-reasoned decision of the Ld. District Forum," the NCDRC bench mentioned in the order.
Restoring the order of the District Consumer Court, the NCDRC bench directed the Fortis Hospital and its treating Nephrologist to comply with the directions of the District Forum within a month from the date of the order.
The bench mentioned in the order, "The Respondents/Opposite parties are accordingly directed to comply with the directions of the District Forum within a month from this date failing which any outstanding payments shall attract interest @ 12% p.a."
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ncdrc-fortis-hospital-negligence-220385.pdf
