Medical negligence attributed to non-involvement of Specialists: Hospital, Doctors directed to pay Rs 10 lakh compensation
West Bengal: The Asansol bench of West Bengal State Consumer Dispute Redressal Commission has recently directed a hospital and its treating doctors including a Critical care consultant and orthopedic surgeon to pay Rs 10 lakh as compensation to a petitioner who alleged that her husband passed away due to medical negligence of the doctors and the hospital. In pronouncing the order,, the commission held negligence on part of the doctors for not involving specialists while treating a trauma patient who was suffering from multiple issues.
In particular, the court noted that the doctor in the ICU, a critical care specialist ordered various set of procedures without the involvement of specialists of the domain
The case was filed by the petitioner alleging further that the doctors did not take note of the CT scan and other reports and due to the deficient service of the hospital and the doctors the patient passed away during dialysis.
It was alleged that no pulmonologist or other specialists were consulted to tend to the patient and dialysis was performed without nephrologist involvement though there was no such kidney problem. Alleging medical negligence, the petitioner approached the WB Consumer court for redressal.
The patient was a 55-year-old accident victim whose car collided with a tanker after which he was admitted to the hospital. A C.T. scan was done for the whole abdomen revealing all the organs of the abdomen normal but it was alleged that the treating doctor noted that the patient was suffering from acute pancreatitis, which was allegedly contradictory to the C.T. Scan report.
Moreover, the consultant noted that the patient's lung condition was poor, but no pulmonologist was consulted to clinically examine the lung. It was further submitted that no kidney abnormality was noted, yet the patient was sent for dialysis without taking any informed consent from the complainant. The patient had later died.
The Counsel appearing for the petitioner alleged that the patient party was not informed of the deteriorating condition of the patient and instructed accordingly, which is a serious lack of vicarious responsibility of the hospital. Further, the counsel added that the doctors should not neglect the patient nor mislead the patient party in as much as the patient died in the process of dialysis but there was no noting in the program report as to the failure of kidney, nor it is reflected in the Death Certificate of the patient.
The hospital and the doctors denied the allegations and stated the petitioner has intentionally concealed certain parts of the medical records. The counsel for the hospital and the doctors submitted that the patient was diagnosed with bilateral lung contusion, mild liver laceration and ABG – Respiratory Acidosis other than certain bone fractures. In the Emergency Department, the patient was urgently intubated and ventilated. For rib fracture CTVS opinion was sought. Bilateral intercostal drainage was given and blood transfusion was also done yet hypotension persisted.
Thereafter, the patient was shifted to the Intensive Care Unit (SICU) with a working diagnosis of RTA with Polytrauma and the doctors submitted that there was an increase in Lipase/Amylase along with persisting pain in the abdomen, which was suggestive of acute pancreatitis. The ORIF of the right acetabulum was done and medication was also duly administered but the patient had gone into intractable hypotension and on 18.12.2016 and the patient had a sudden cardio arrest. Active resuscitation was done but he could not be revived and was finally declared clinically dead, they submitted.
It was stated that the cause of death was primarily due to septic shock, acute pancreatitis in a case of RTA with Polytrauma and despite every sincere effort on the part of treating doctor and such other staffs of the hospital, the life of the patient, since deceased, could not be saved. It was submitted that there was no breach of duty towards the patient, and there was no failure on the part of the hospital or the doctors to attend the standard of care, and the damage incurred was not connected.
After considering the submission of both the parties, the commission observed that the service rendered by such doctors and hospitals undoubtedly falls within the ambit of Section 2(1) (0) of the Act and the cause of action has fallen within the jurisdiction of this Commission. As far as the issue of medical negligence is concerned, the commission stated
Medical negligence is defined as lack of reasonable care and skill or wilful negligence on the part of a doctor in respect to acceptance of a patient, history taking, examination, diagnosis, investigation, treatment – medical or surgical etc. resulting any injury or damage to the patient. The terms 'damage' means physical, mental or financial injuries to the patient. In the instant case, principle resipsa liquitor is applicable. The maxim applies in a case in which certain facts proved by the plaintiff, by itself, would call for an explanation from the defendant without having to allege and prove any specific act or omission of the defendant.
The court noted that in the current case, all the organs of the abdomen being normal, the treating doctor surprisingly noted that patient was suffering from acute pancreatitis which is opposed to C.T. Scan Report. " Blood investigation showed increase in Lipase/Analyse along with severe persisting pain abdomen which was clinically perhaps confirmative of pancreatitis which itself is serious of life threatening. But no gastroenterologist was consulted", the commission further observed.
The poor condition of lung and pancreatitis of the patient as per the Report of the hospital could not be considered unstable enough for the operation, the commission observed also stating that the scan report also revealed that the kidney was normal. The commission partcicularly noted lack of consultation from specialists. It added.
But we find that the patient was planned for dialysis on 18.12.2016. Surprisingly enough the patient was not referred to any nephrologist or the opinion of any nephrologist before planning for Dialysis. Post Mortem Report and Death Certificate reveals that the patient died due to septic shock and it was also noted that tracheostomy was done on but no ENT Specialist was consulted or called at the time of such tracheostomy.
The court further added,
" Septic Shock is a life-threatening condition caused by a severe localised or system-wide infection that requires immediate medical attention. We also find that there was high lipase, amylase was also high but ..... no opinion of gastroenterologist was obtained or the deceased was not referred to any medicine specialist or gastroenterologist."
Referring to the supreme court's verdict clarifying that " The Hospital would be held hospital responsible for nosocomal infection, The patient is admitted in Hospital, it is the responsibility of the hospital to provide the service and to satisfy that all possible care was taken and no negligence was involved in attending the patient in the hospital/nursing home", the court stated, " there was negligence, latches or deficiency" on the part of the accused hospital as it failed to maintain hygiene sterility and immunity of environment to combat infection and it also did not consider any alternative management when the patient was not responding to medication suggestion.
It is palpable that complainant's husband died due to no diagnosis or wrong diagnosis resulting into irrational therapy or procedure coupled with lack of caution and care constituting collective negligence.
The court finally stated,
We find the element of breach of duty, negligence, absence of due care, wrong prognosis in the treatment of the deceased by the OPs. Accordingly, we come to hold that OPs are guilty of medical negligence. The maxim of res ipsa loquitar is applicable to medical negligence and in this case also. The maxim is applicable when the negligence is evident. It is a law of torts but it is practically a rule of evidence. Res ipsa loquitur is a doctrine that infers negligence from the very nature of an accident or injury in the absence of direct evidence or how any OP behaved. We find the element of breach of duty, negligence in the treatment of the deceased by the OPs. Accordingly, we come to hold that OPs are vicariously guilty of medical negligence. The expression res ipsa loquitor is not a doctrine but "a mode of inferential reasoning" and applies only to accidents of unknown cause. Negligence on the part of the OPs in the treatment of the deceased is palpable and established beyond all reasonable doubt.
However, the complainant claimed Rs. 99,39,946/- as compensation, but the commission considered that the Complainant has also submitted during her argument before this Commission that she has filed a claim case before Motor Accident Tribunal which is pending. The court also added, though the patient was badly injured,
" it cannot be said also with certainty that the patient might have survived or his life would have been saved had he been referred t doctor of medicine, gastroenterologist, nephrologist or ENT Specialist."
Hence, after considering the whole scenario, the commission order
OPs are directed jointly and severally in equal proportion to pay an amount of Rs. 10,00,000/- (Rupees Ten Lakh only) to the complainant towards compensation apart from litigation cost of Rs. 25,000/- for medical negligence and deficiency in service within 60 days from the date of this judgements failing which the complainant will be at liberty to put the decree into execution U/S. 27 of the C.P. Act 1986.
To view the judgment, click on the link below
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