Patient acting in contravention of follow-up advice amounts to contributory negligence- Consumer Court absolves St Stephen Hospital Delhi
No Medical Negligence
New Delhi: The State Consumer Disputes Redressal Commission, New Delhi, recently exonerated a Delhi-based St Stephen hospital from charges of medical negligence while treating a patient, who underwent cholecystectomy at the hospital.
The patient claimed that she had to face post-operative complications due to the hospital not administering medicines to her to control her blood sugar level and the Commission, after taking note of the Expert Medical Opinion found that there was no medical negligence on the hospital's part.
Instead, the hospital held the patient guilty of contributory negligence for not reporting to the hospital for a follow-up.
"In view of the aforesaid, it is clear that the patient’s act of acting in contravention of follow-up advice amounts to contributory negligence," observed the Commission.
The history of the case goes back to 2007, when the patient/complainant, who had a history of diabetes, underwent an open cholecystectomy at the treating hospital. It was alleged that the patient was arbitrarily discharged from the hospital despite explicit protest from the complainant's attendant due to quick pus formation.
After going home, the patient's condition worsened, and she was readmitted and was administered insulin injections four times a day to control her sugar level.
Filing the consumer complaint, the patient alleged that the hospital failed to take precautionary measures before and during the surgery and also did not take post-operative care. Due to this, she had to suffer both physically and financially.
Based on the hospital's application, the matter was moved to a Panel of Expert Doctors to seek their Expert medical Opinion regarding the allegations of medical negligence. The complaint was referred to the Hindu Rao Hospital, Delhi, for the expert medical opinion of the Medical Board constituted under the instructions of the hospital's Medical Superintendent.
The Medical Board opined that the procedures carried out at the treating hospital were justified for the complainant and she was discharged from the hospital on 09.07.2007, but the Discharge Summary did not mention any treatment for Diabetes Mellitus. It further opined that the surgical site wound infection is not uncommon in post-operative cases and its incidence increases in diabetic patients.
After considering the matter, the District Commission in its March 2018 order held that the medical facility was negligent and directed the hospital to pay Rs 1,08,000 as compensation. This amount included the billed amount, medical charges, litigation costs, and compensation for physical pain and mental trauma.
Aggrieved by the order, the hospital appealed before the State Commission and submitted that the District Commission had ignored the Expert Opinion given by the Hindu Rao Hospital, and it also failed to appreciate that the surgical site infection was caused due to the hospital's failure in reporting to the surgical OPD on 13.07.2007 and the failure to maintain hygiene of the surgical site. Thirdly, it is submitted that the District Commission ignored the Evidence Affidavit filed by the Treating Doctor.
Apart from this, the hospital also submitted that the District Commission went beyond the pleadings in the Complaint, and the order was based on no evidence. According to the hospital, regarding the issue of insulin administration, insulin is not administered repeatedly or at will and is only given as and when required.
On the other hand, the complainant argued that the hospital ignored the fact that she suffered from acute diabetes. It was alleged that the complainant was prematurely discharged despite protest and expert opinion found that discharge summary does not mention about any treatment for diabetes mellitus. It was the complainant's case that she developed a surgical site infection after her discharge as she was not administered with medicines to control her diabetes before and after the surgery.
The State Commission pursued the expert opinion given by the Hindu Rao Hospital and noted, "A perusal of the aforesaid medical opinion reflects that the Medical Board has opined that the patient was treated with ERCP with Sphirctontomy followed by Cholecystectomy, which is the standard treatment for the condition of Cholelithis/Choledochial Cyst and the patient was discharged on 08.08.2007 in satisfactory condition. However, the Respondent has submitted that the Board has further opined that the Discharge Slip does not mention about any treatment for Diabetic Mellitus."
"In this regard, it is to be noted that the treatment record reflects that the Respondent's blood sugar was monitored 4 times a day viz. 6:00 A.M., 10:00 A.M, 2:00 P.M. and 10:00 P.M., throughout her admission. Here, it is to be noted that though the Discharge Summary does not mention the treatment of Diabetes Mellitus, the treatment record makes it clear that the blood sugar parameters of the patient were closely monitored. Furthermore, the Appellant has submitted that the readings were not such as required infusion of insulin and patient was administered insulin as and when required in the opinion of the treating doctors. Here, it is pertinent to remark that the patient was discharged in a satisfactory condition and the surgery was uneventful. Therefore, in view of the aforesaid findings, it cannot be said that the Appellant-hospital or the treating doctors were negligent in their conduct," further noted the Commission.
However, the Commission also noted that the "doctors and the Appellant hospital have prima-facie erred in record keeping in so much so that the Discharge Summary does not mention of any treatment pertaining to Diabetes Mellitus, and the same, in the thoughtful opinion of this Commission, amounts to professional misconduct."
It was further observed by the Commission that the record reflected that the patient was advised to visit the treating hospital on 13.07.2007, however, the patient failed to do so and did not report on the said date. It also took note of the hospital's argument that the pus formation in the surgical site was not on account of medicine for controlling blood sugar not being administered, but due to poor hygiene and the result of the complainant's failure to report to the hospital on the concerned date.
"Here, it is to be noted that the Expert Opinion categorically mentions that higher incidence of surgical site infections are known to occur in diabetes especially following open procedures. Keeping the same in mind, the Treating Doctors had advised the Respondent for a follow-up on 13.07.2007 which was disregarded by the patient and the patient returned to the Appellant hospital on 15.07.2007 with a surgical site infection," noted the Commission.
Accordingly, it held the patient guilty of contributory negligence and held,
"In such circumstances, it cannot be conclusively said as to what caused the surgical site infection; whether the infection was caused by the Treating Doctor’s negligence or owing to the patient’s failure in maintaining hygiene or failure in reporting to the hospital, or as a natural consequence to the patient’s diabetic status."
Holding that there was no medical negligence on the part of the treating hospital, the Commission observed,
"Therefore, in the absence of any conclusive proof to establish that the patient suffered surgical site infection on account of the Appellant’s negligence and keeping in view the observation of the Expert Medical Board, no negligence can be carved out on the part of the Appellant. However, the Appellanthospital and treating doctors are further directed to ensure proper record keeping in the future in so much so that the treatment of diabetes mellitus did not find mention in the Discharge Sheet and the Discharge sheet was wrongly dated."
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/fa-273-2018-hamida-khatoon-final-299587.pdf
