No Negligence in treating patient who suffered high velocity trauma: NCDRC relief of Rs 2.9 crore to Fortis Hospital Delhi

The Presiding Member of the Commission, Dr S M Kantikar rejected a complaint filed against the hospital by a patient (through his guardian) who sought compensation of Rs 2.9 crore alleging that his life was ruined as his brain was damaged due to gross negligence of the hospital.

The 23-year-old patient met with a road accident in 2013 and suffered a head injury, fracture right leg, hand and his right eye. He was taken to Rohtak Medical College. The x-ray, USG abdomen and CT Head was done and it was informed that except for fracture of right arm and femur, the USG and CT was normal. On the next day, he was shifted to Fortis Hospital (OP) and kept under the supervision of two doctors of the Orthopedic Department.

The patient was completely conscious, his Glasgow Coma Scale (GCS) was E4V5M6. He suffered sudden breathlessness with tachycardia and de-saturation in the ICU and he was put on a ventilator. Further, his health deteriorated day by day. It was alleged that CT Head and NCCT was performed, but the same was not reviewed by Neurologist. MRI brain was not advised. The patient was in unconscious condition with GCS-E2M3V1, but no Neurologist or Neurosurgeon visited the patient despite advice of Anesthesia and critical care team. At the first time, a doctor visited the patient and advised MRI brain. The MRI was reported as "extensive confluent area of cytotoxic edema with extensive petechial haemorrhages involving the bilateral fronto-occipital-parietal periventricular white matter, corpus callosum, cerebellar white matter and internal capsule". Since the condition of the patient was not improving, the attendants decided to shift the patient to PGIMS, Rohtak.

However, his condition deteriorated and he was unable to sit or lie down, he was unable to eat by himself. It was alleged that his life was ruined due to negligence of the Fortis Hospital and due to gross negligence, his brain damaged. Eventually, the patient was discharged from Medical College Rohtak, however, his treatment and physiotherapy was still going at home.

Aggrieved, the patient's guardian moved the Commission.

In response, the hospital filed the reply through the facility Director, Jasdeep Singh, who submitted that the Complaint was frivolous only misconceived and vague. The complainant failed to prove an act of omission on the part of hospital. He further submitted that after the road accident, the patient was admitted at PGIMS, Rohtak and treated for one day. He took LAMA discharge and brought to Fortis Hospital, where he was examined in the emergency room and had history of transient unconsciousness at the time of accident and then he became conscious.

He further submitted that due to multiple fracture of long bones, it predisposes to ARDS and diffused axonal injury. He was transported from Rohtak to New Delhi, which was pre-disposing factor for fat embolism. The facility further added that the patient suffered Fat Embolism syndrome (FES). He relied upon the textbook - Rockwood and Green's Fractures in Adults, Finks Textbook of Critical Care. He further submitted that, "The patient was given proper treatment, therefore, survived from the life threatening complication of trauma because of timely intervention. The CT chest confirmed ARDS and MRI were suggestive of diffuse axonal injury and fat embolism. Such injuries carry high mortality and morbidity as described in the textbooks and literatures."

After hearing the contentions and perusing the medical record, the Commission clarified that the patient suffered high velocity trauma and initially, took a treatment at Civil Hospital, Jhajjar; and Medical College, Rohtak. He took LAMA discharge from Medical College, Rohtak and got admitted in Fortis Hospital as an emergency. After relevant investigations, he was diagnosed as acute axonal injury. The patient further suffered respiratory distress, he was intubated and treated in the ICU throughout the hospitalisation from 11.11.2013 to 20.11.2013. "Thus, the allegation of the Complainant that he was taken to Fortis Hospital for correction of fracture is not sustainable," the apex consumer body noted.

Considering the entirety, NCDRC observed that;

"Due to high velocity trauma, the Complainant suffered deceleration injury i.e. axonal injury to the brain. Due to high inflammatory mediators in the long bone fracture he developed ARDS. However, due to sedation, the initial CT scan of brain showed normal result which remains for few hours to few days. In fact, the efforts of Fortis Hospital saved the life of the patient from the serious complications of the injury, however thereafter the Complainant raised such unwanted allegations. The patient was being weaned from ventilator and he chose to go back to Rohtak, Medical College, but for natural course of disease he tried to put blame on the Fortis hospital. It is also evident from the medical record that the patient was treated in ICU and provided the alpha bed to prevent bedsores. The Fortis Hospital ICU Care was as per the standards, which did not show any deficiency in patient's management."

Relying on the law on medical negligence through various judgments in Supreme Court, the Commission dismissed the complaint and held;

"It should be borne in mind that 'no cure is no negligence'. The doctors and the treating team at the OP-Hospital have treated the patient with reasonable standard of practice. The doctors made all the efforts to save the patient and treated him in the ICU throughout the hospitalisation. The patient took LAMA discharge and again got admitted in Medical College, Rohtak for further management. Thus, conclusively, there was neither failure of duty of care nor medical negligence attributable to the Hospital and the Doctors."

To view the original judgement, click on the link below: