No medical negligence: Rs 2.78 crore relief to Medanta Hospital, Cardiologist

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently reiterated the Supreme Court's observations that while an action for negligence can certainly be maintained, there should be no harassment of doctors merely because their treatment was unsuccessful. With this observation, the Apex Consumer Court exonerated Medanta Hospital and its Cardiologist from the allegations of medical negligence during Pacemaker Implantation.

The history of the case goes back to 2016 when the patient was admitted at Medanta, The Medicity for planned and Elective Procedure of Pacemaker implantation. A detailed examination was conducted. However, the doctor and duty nurse did not find any abnormality in the patient.

As per the complainant who is a cardiologist by profession, the patient was a high-risk case for the development of a stroke and she was on Pradaxa 150 mg twice per day. It was alleged that this was informed to the treating doctor- Dr. Singh, the cardiologist at Medanta. Considering this, the doctor kept the patient off Pradaxa for 48 hours.

Thereafter on 05.07.2016, the patient underwent Pacemaker Implantation at the hospital and the next day, it was informed to the Complainant that the patient was under medical supervision in the Cardiology ICU and would be discharged on the same day after the bills were cleared.

It was further alleged that when the complainant arrived at the hospital, he was denied access to the Cardiology ICU to see his wife unless he cleared the bills first. Hours later, when he finally was granted entry, he found his wife in the ICU- unconscious and unattended, suffering from a life-threatening stroke.

Being a Cardiologist himself, the complainant had to intervene to provide emergency care instructions. He alleged that the delay in treatment due to the negligence resulted in severe consequences for his wife, including paralysis. Further, it was alleged that the hospital's failure to restart the patient's medication i.e. Pradaxa much earlier after surgery and irresponsible conduct of the hospital and the doctor towards the patient further aggravated the situation due to which, the patient suffered a stroke leading to paralysis.

On 08.07.2016, the patient was ultimately discharged. Despite the complaints to the Hospital administration, no satisfactory response was received. It was then alleged that due to unhygienic conditions in the hospital, the patient developed a pacemaker infection on 29.07.2016. The complainant claimed that the hospital denied negligence on the part of their Doctors or Hospital. Thereafter, alleging negligence causing stroke and untimely paralysis to the patient, the complainants filed the Consumer Complaint seeking total compensation of Rs 2,78,24,904 with interest at the rate of 12% p.a. from the date of Complaint till realisation.

The complainant's counsel argued that there was a deficiency on the hospital and Cardiologist's part as the Tab Pradaxa was not given to the patient after the pacemaker implantation on 05.07.2016 and the medicine was only given the next day by which the patient had suffered a stroke, resulting in the patient suffering from Vascular Parkinsonism & Pseudobulbar Palsy and Bulbar Palsy.

Apart from this, the counsel argued that there was no proper care in the concerned ICU of the hospital as it was the patient's husband, who being a Doctor, had found that the patient suffered cardiac arrest in the ICU.

On the other hand, the hospital and doctor denied negligence and stated that the patient was provided for as per her clinical needs and in accordance with the standard of care and protocol. The patient was treated by a team of expert doctors including the treating doctor Dr. Singh. It was stated that the stroke suffered by the patient on 06.07.2016 was the fourth stroke suffered by the patient, which was attended to very swiftly and the damage caused to the patient was not due to the stroke.

It was further submitted that since the Complainant was a Cardiologist himself, a detailed discussion was conducted regarding the pacemaker implantation including the management of Pradaxa. It was also informed to the Complainants that the patient was a known case of recurrent strike, Tab. Pradaxa would be temporarily discontinued and would be started after 24 hours of the conduct of the procedure.

They also informed the consumer court that on the date of pacemaker implantation, pre-operative relevant blood investigations were conducted which reported that the patient was fit and normal to undergo the implantation. Dr. Singh conducted the Single Chamber Pacemaker implantation, which was uncomplicated. The post-operative protocol was followed to manage the patient. Chest X-ray and ECG were conducted, which showed normal reports post-surgery. The patient was conscious on the morning of 06.07.2016 and she was examined and showed expected improvements.

As per the protocol, the Tab Pradaxa, which was on hold for 24 hours of the procedure was administered at 1.00 pm. However, at around 3.10 pm, when the discharge formalities were completed, the patient suffered a sudden stroke. In response to the situation, CT Brain Plain and CT Angio Brain and Neck were conducted on an urgent basis, the findings of which revealed that the stroke to the patient in 2014 and January 2016 had caused damage to the brain. It was also suggestive of the fact that the patient was prone to atherosclerosis and such significant stenosis at such an aggressive rate could not be solely due to temporary discontinuation of Tab. Pradaxa for a very limited period.

As per the doctor and the hospital, the complainant gave consent for the procedure of endovascular mechanical thrombectomy on the patient to prevent a major infarct. Thereafter, the patient underwent a successful procedure and was shifted to ICU for continued monitoring. Tab. Pradaxa was advised to start. The next day, the patient was conscious and oriented and therefore, after getting the required examination, the patient was shifted to a room and she completely recovered from the stroke. Finally, the patient was discharged from the Hospital in a stable condition with follow-up advice. However, the complainants allegedly did not turn up for further follow-up except on 14.07.2016.

While considering the matter, the consumer court took note of the opinion given by AIIMS, which concluded that there was no medical negligence on the part of the hospital and the treating team. The Medical Board opined that there was no delay in administering Pradaxa after the pacemaker implantation. Further, the Board opined that according to the available hospital records and timelines, the response of the ICU staff and the treating team was optimal.

Relying on the Medical Board's opinion, the Commission noted,

"Considering that the main argument of the learned Counsel for the Complainants that the administration of Pradaxa or rather non-administration and the same not having been found to be relevant leading to the unfortunate stroke suffered by the patient as per the Expert Report, I do not see any further observation by me in this regard and therefore to this extent, the argument of the Complainants fails."

Referring to the allegations regarding poor post-operative care in the ICU, the Commission noted,

"I understand the anxiety of the Complainant No. 1, who is the husband of the Complainant No. 2 and who himself is a Cardiologist. On reading the Complaint, it becomes very evident and at times he could not control himself from giving directions to the hospital staff / doctors. It is not the case of the Complainant No. 1 that the Doctors at the hospital were really incompetent as he himself had chosen the hospital after due care and the patient had even earlier been admitted in the hospital for certain interventions, which was done to the satisfaction of the Complainant No. 1."

"It has to be kept in mind that once the patient is admitted to the hospital, it should be left to the treating doctors to decide on the process and procedure of treatment and also give certain space to them in performing their duties. No doubt, the Complainant No. 1 is a Cardiologist, however, interfering with the treatment and casting doubt on the treating doctors, in my opinion, after going through the record is not warranted and appears to be an over-reaction. It is unfortunate that the patient suffered a cardiac stroke and had to suffer thereafter. However, there is no proof or co-relation shown in the Complaint or argued that the cardiac arrest was the result of the implantation of the pacemaker. Since the patient was a chronic heart patient and having gone through various interventions in the past, the probability of such stroke cannot be ruled out. It is to the credit of the hospital that prompt action post-stroke was taken and the patient survived," it further noted.

At this outset, the Commission relied on the Supreme Court order in the case of Jacob Mathew, where the Apex Court had observed that

'so long as it can be found that the procedure which was in fact adopted was one which was acceptable to medical science as on that date, the medical practitioner cannot be held negligent merely because he chose to follow one procedure and not another and the result was a failure.'

Reliance was also placed on the Supreme Court order in the case of Kusum Sharma & Ors. Vs. Batra Hospital & Medical Research Centre & Ors, the judgment of Vinod Jain vs. Santokba Durlabhji Memorial Hospital and the top court order in the case of Bijoy Sinha Roy vs. Biswanath Das & Ors. In the case of Bijoy Sinha Roy, the Apex Court had observed, "While action for negligence can certainly be maintained, there should be no harassment of doctors merely because their treatment was unsuccessful."

Reiterating this observation and relying on these previous legal precedences, the top consumer court dismissed the consumer complaint against Medanta and its Cardiologist and noted,

"In view of the aforesaid discussion, I do not find any medical negligence on the part of the Opposite Parties. Accordingly, the Complaint is dismissed."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-medanta-hospital-239989.pdf

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