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No Medical Negligence In inserting Central Venous Catheter: Consumer court exonerates Fortis Hospital, Doctors

Barsha MisraWritten by Barsha Misra   |  
No Medical Negligence In inserting Central Venous Catheter: Consumer court exonerates Fortis Hospital, Doctors
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New Delhi: Taking note of the fact that no evidence had been filed to prove the treating doctors guilty, the State Consumer Disputes Redressal Commission (SCDRC) recently exonerated the Fortis Hospital, Delhi, and its doctors from charges of medical negligence while treating a patient suffering from multiple problems including hypertension, chronic kidney disease stage-V, advanced azotemia, bacterial pneumonia, and sepsis.

Although the complainants had challenged the treatment procedure adopted by the doctors in inserting Central Venous Catheter, dismissing the Complaint, the Commission noted, "It is clear from the record that there exists no evidence which would substantiate the claim of the Complainants that the treatment given to the patient by the Opposite Parties was not acceptable or was not used generally at the time when the patient was operated upon. The Complainants have even failed to establish that there was a lack of due care and caution on the part of the Opposite Parties either by oral or by documentary evidence, which are basically the essential requirements/ingredients for constituting a case of Medical Negligence covered under the Consumer Protection Act, 1986. Per contra, the Opposite Party has been diligent enough to prove their bonafide and also the fact that there was no negligence on the part of either of the Opposite Party."

Back in 2012, the patient, the mother of the complainants was suffering from breathlessness, cough and fever and consequently she got admitted to Apollo Hospital in Delhi for proper treatment. The treatment was proving to be successful as the patient was recovering at a good pace. However, since a private room was not available at the hospital, the complainants contacted Fortis Hospital and shifted the patient for the sole purpose of availing a private room.

Also Read: SC says doctors cannot be held negligent because they could not save patient

It was alleged by the Complainants that instead of shifting to a private room, the patient was taken to Intensive Care Unit (ICU) and several 'invasive procedures' had been performed by the doctors even though the complainants had clearly instructed otherwise. Such invasive procedures included 'Central Venous Catheter', which allegedly led to swelling around the patient's neck and also caused breathing difficulty.

They also claimed that even though the Blood Pressure of the patient started falling, the doctors did not try to investigate if the patient had developed intrathoracic bleedings secondary to multiple attempts for cannulation through her neck.

Ultimately, the patient was put on dialysis and she started complaining of extreme pain in chest. Following this, the ICU doctor, Dr. Prasant informed the complainants that the patient will need Ryles Tube also known as Nasogastric Tube. However, the complainants denied this and condition of the patient started deteriorating and ultimately she died.
Alleging that the death of the patient had happened due to inappropriate and wrong treatment given by the doctors, the complainants approached the Delhi State Commission and filed the complaint.
On the other hand, the Hospital and its doctors submitted before the Commission that the deceased was a patient of hypertension, chronic kidney disease stage-V, advanced azotemia, bacterial pneumonia, sepsis and was already undergoing treatment at Indraprastha Apollo Hospital. Further pointing out that the shifting of the patient from Apollo Hospital had been done on the sole will of the complainants, the Hospital and its doctors informed the Commission that at the time of admission at Fortis Hospital, the patient was already suffering with multiple organ failure and extensive infection in her body.
They also submitted that even though the relatives of the patient wanted to admit the patient in the private room, the condition of the patient did not allow the same. Therefore, the patient was admitted directly in the ICU as the patient required hemodynamic and respiratory monitoring. They also denied the accusation that contention that the condition of the patient deteriorated after attempting central line caused due to heamothorax.
After considering the submissions of both the parties and perusing the medical record, the State Commission noted that the Complainants did not alleged that the doctors operating upon the patient were not having the requisite skill or competence or were not qualified to operate upon the patient. The Complainants had complained about insertion of 'Central Venous Catheter', renewal of 'Femoral Venous' access etc.
However, the doctors and the hospital submitted in their written affidavit that the Complainants were reluctant of any measure that was being taken for the benefit of the patient. They also submitted that the patient underwent CT scan of Chest, which did not show any haemo/pneumothorax as well as Ultrasound Sonography (USG) of the abdomen in the same evening, which also did not show any trace of bleeding from the procedure site.
At this outset, the Commission noted, "It is a well laid down principle that the doctor diagnosing upon a patient is the best judge of the treatment which is to be undertaken for that specific patient. There may be multiple approaches with which the patient may be treated upon, however, the doctor is expected to choose the most appropriate one in the given facts and circumstances. Hence, a higher degree of reliance is placed upon the concerned doctor, that whatever option he/she exercises will be for the benefit and interest of the patient. It is also a settled law that simply for the reason that one option or a specific mode of treatment was chosen over the other will not itself be a ground for holding the doctors liable for negligence."
"In the present case, what has actually transpired is that there was unwillingness on the part of the Complainants on every step of the treatment, whether, it may be of admission in the ICU instead of the private room or the insertion of Reyles Tube and so on. The progress note sheets, filed with the Written Statement/Reply, proved through Evidence by way of Affidavit, which has not been rebutted by the Complainants, clearly establish that whenever certain suggestions were made by the operating doctors, the Complainants would deny the permission and even get into argument sometimes," it noted further.
The State Commission also referred to the NCDRC order in the case of Indu Sharma vs. Indraprastha Apollo Hospital and Ors. and Supreme Court order in the case of Malay Kumar Ganguly vs. Dr. Sukumar Mukherjee & Ors., where it had been clarified by the bench that it was the bounden duty of the doctor to decide, the correct line of treatment; doctor wouldn't just blindly obey the wishes of the patient.
Referring to these, the Commission observed, "From the aforesaid dicta, it is further clear that the wishes of the patient and in the present case, of the relatives, alone are not to be blindly obeyed, and the law puts the duty upon the operating doctor to choose the best method, which, is acceptable generally at the given period."
The Commission also relied upon the law laid down by the Apex Court in the case of Jacob Mathew v. State of Punjab and Anr and noted, "Following the aforesaid principle, it is to be noted that it is not the case of the Complainants that the insertion of the Arterial Line, Nasogastric Tube were not the acceptable modes when the patient was being operated. However, what has been contended is that the moment the steps were taken by the doctors to cannulate through the neck, the condition of the patient deteriorated, and the doctors did not feel the need to check for intrathoracic bleeding."
"On perusal of the record and as has been rightly contended by the Opposite Parties, we find that on 20.01.2012, the patient underwent two examinations, one being CT scan and the other being USG of the abdomen, and none of them revealed any bleeding from the procedure site as has been alleged by the Complainants," the bench further noted.
Taking note of the fact that no Expert Evidence had been submitted by the Complainants, the Commission noted, "Furthermore, even though the Complainants have not spared a word against the operating doctors in their complaint and have challenged each and every step which was being taken for the treatment of the patient, they have failed to bring on record any substantial evidence, oral or documentary, in support of their contentions. The Complainants have even failed to examine any Expert Witness in support of their case. This Commission cannot presume that the allegations in the complaint are inviolable truth even though they remained unsupported by any evidence."
The Commission referred to several other judgments including the top court order in the case of Harish Kumar Khurana vs. Joginder Singh and Ors, Martin F. D'Souza v. Mohd. Ishfaq, and C.P. Sreekumar (Dr.), MS (Ortho) v. S. Ramanujam.
Referring to these, the bench noted, "From the aforesaid dicta of the Hon'ble Apex Court, it is clear that only the failure of the treatment is not prima facie a ground for Medical Negligence and in order to attract the principle of res ipsa loquitur, Negligence i.e. the breach of a duty exercised by omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do, should be clearly evident from the record."
"It is clear from the record that there exists no evidence which would substantiate the claim of the Complainants that the treatment given to the patient by the Opposite Parties was not acceptable or was not used generally at the time when the patient was operated upon. The Complainants have even failed to establish that there was a lack of due care and caution on the part of the Opposite Parties either by oral or by documentary evidence, which are basically the essential requirements/ingredients for constituting a case of Medical Negligence covered under the Consumer Protection Act, 1986. Per contra, the Opposite Party has been diligent enough to prove their bonafide and also the fact that there was no negligence on the part of either of the Opposite Party," it added.
"Consequently, we are of the view that there exists no Negligence on the part of the Opposite Parties, hence, the Complaint stands dismissed," further read the order.
To read the Delhi State Commission order, click on the link below
central venous catheterDelhi State consumer disputes redressal CommissionSCDRCstate consumer dispute redressal commissionno medical negligenceFortis hospitalApollo Hospital
Barsha Misra
Barsha Misra

Barsha completed her Master's in English from the University of Burdwan, West Bengal in 2018. Having a knack for Journalism she joined Medical Dialogues back in 2020. She mainly covers news about medico legal cases, NMC/DCI updates, medical education issues including the latest updates about medical and dental colleges in India. She can be contacted at editorial@medicaldialogues.in.

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