Patient dies of cardiac arrest during DSE Test: Max Hospital Dehradun directed Rs 10 lakh compensation
compensation
Dehradun: Holding Dehradun-based Max Super Speciality Hospital and its cardiologist liable for deficiency in service and medical negligence, the State Consumer Disputes Redressal Commission has directed the hospital to pay Rs 10 lakh compensation to the son of the patient, who died after a cardiac arrest during the Dobutamine Stress Echo (DSE) Test. The Commission found that the hospital and its doctor failed to obtain consent from the patient for the said test.
Dr. Rana, who directly conducted the DSE test, was primarily responsible for the negligence, while the hospital was held vicariously liable for the actions of its doctor. Consequently, the hospital was directed to pay Rs. 10 lakh as compensation, including medical expenses and litigation costs.
On the other hand, the consulting doctors were exonerated. Dr. Singh, a neurosurgeon and Director of Max Institute of Neurosciences, MIND, Dehradun, had only reviewed the case and advised for preoperative investigations. Dr. Preeti Sharma and Dr. Sadana, both senior cardiologists, had consulted on the patient but did not participate in conducting the DSE test. The Commission found no evidence of independent negligence on their part and, therefore, they were not held liable for any deficiency in service.
The history of the case goes back to 2014, when the complainant's mother, who was experiencing pain on the left side of her face, visited Max Super Speciality Hospital, Dehradun, for consultation. After examination and review of her previous medical records, the doctor at the hospital advised that she required surgery and also prescribed certain medicines.
Seeking a second opinion, the complainant consulted Dr. Singh, the Director of Max Institute of Neurosciences, MIND, Dehradun. After reviewing the records, the doctor advised for an MRI scan and certain other tests. After perusing the reports, Dr. Singh informed the complainant about the date of surgery and also instructed the Cardiac cleareance tests to be carried out prior to the surgery. The complainant was advised to take his mother to Dr. Sharma, Senior Cardiologist of the Hospital.
Dr. Sharma, along with another senior cardiologist, Dr. Sadana, examined the patient, reviewed her medical reports and advised for a Dobutamine Stress Echo (DSE) Test. During the course of the said test, after administration of the peak doses, the patient suffered a cardiac arrest and became unresponsive, hypotensive and was immediately shifted to ICU. She remained in a vegetative and unconscious state from 12.04.2014 onwards.
It was alleged by the complainant that Dr. Rana from the hospital failed to take necessary precautions during the procedure, and he also did not explain the nature and risk before, and did not properly monitor the administration of the Dobutamine injection and the rate of its infusion, as required under standard medical procedure.
Therefore, the complainant alleged that the conduct of the said doctor, fell below the standard of a reasonable competent medical practitioner. It was also alleged that despite being a super specialty hospital, the facility lacked essential and adequate equipment to effectively handle the emergency situation. Further, the complainant stated that at the time of admission, he was informed total cost of treatment would be approximately Rs. 1,65,000. However, he was shocked to receive a bill of Rs 5,61,000, which he was compelled to deposit. Thereafter, the patient was forcibly discharged from the Hospital. Subsequently, the complainant admitted his mother to Nirmal Ashram Hospital, Rishikesh where she passed away on 13.05.2014. Filing the consumer complaint, the complainant sought compensation for the loss of his mother's life and damages suffered.
On the other hand, the hospital and the doctors denied the allegations made by the complainant and contended that considering the fact that the patient was restricted physical activity for the past 15 years, she was advised to undergo a Dobutamine Stress Echo (DSE) test for pre-operative cardiac evaluation. It was further stated that informed consent for the said test was also obtained. During consent, both the patient and her attendant were informed about the risk of sudden cardiac emergency during the procedure. After due deliberation and understanding of the associated risks, the patient and her attendant consented to undergo the DSE test.
It was further submitted that immediately after the cardiac arrest, the hospital declared the Code Blue and in accordance with Advanced Cardio Life Support (ACLS) protocol, immediate Cardio Pulmonary Resuscitation (CPR) was initiated by the team of qualified and experienced doctors. The patient was immediately shifted to ICU for further emergency. Considering the patient's known history of hypertension, obesity and restricted mobility, she was advised ECG and Dobutamine Stress Echo by the Cardiologist before any surgical intervention.
They also submitted that the hospital is fully equipped with all the necessary medical instruments and infrastructure required to handle any emergency situation, and the hospital and its doctors are well-trained and competent to manage all types of medical emergencies. They claimed that all the patients, including the complainant's mother, received superspecialty treatment at the hospital.
The counsel for the hospital and doctors argued that the DSE test was conducted specifically as per medical protocol under expert supervision and Cardiac Arrest was a known risk, and did not happen due to negligence. The counsel further asserted that the informed consent was duly obtained after explaining all risks, including cardiac arrest.
After considering the arguments and perusing the records, the State Consumer Court observed that the primary issue was whether the treating hospital and the doctors were negligent in conducting the DSE test and deficient in providing appropriate medical care during and after the procedure and whether the complainant should get relief.
Noting that there was no informed consent on record, the Commission observed,
"Upon perusal of the record, it is evident that the opposite party Nos. 1 to 5 have not produced any material to establish that a consent was obtained from the patient or her attendants prior to undertaking DSE test. There is no specific consent form showing details of nature of the procedure, its risks, complications nor there is any record demonstrating that such information was ever explained to the patient or her attendants. The requirement of obtaining consent prior to conducting the DSE test was necessary as was confirmed by Dr. Preeti Sharma – Opposite party No. 3, who was present during the hearing. The absence of such consent amounts to deficiency in service and constitute negligence on the part of the opposite party No. 5."
"As the DSE test was actually conducted by Dr. **Rana – opposite party No. 5, the primary responsibility for the negligence was with opposite party No. 5. However, the opposite party No. 1 being Hospital where the negligent act occurred is vicariously liable for the negligence committed by its doctor (opposite party No. 5 during the course of employment). The opposite party Nos. 2, 3 & 4 were merely a referring and consulting doctors, who did not participate in conducting DSE test. There is no evidence on record of any independent negligence on the part of the opposite party Nos. 2, (director of Max institute of neurosciences) 3, & 4 (cardiologists). Accordingly, they cannot be held liable for any medical negligence," it observed.
The Commission referred to the Supreme Court judgment dated 16.12.2019 in the case of Maharaja Agrasen Hospital & Ors. vs. Master Rishabh Sharma & Ors, where the top court bench had held that medical negligence constitutes a legal duty to exercise due care on the part of the medical professional, failure to inform the patient of the risks involved, the patient suffering damages as a consequence of the undisclosed risk by the medical professional, breach of duty of disclosing the risk etc.
In this case, the Apex Court had also held that a hospital is vicariously liable for the acts of negligence committed by the doctors engaged or empaneled to provide medical care.
"The above cited case law is fully applicable to the case in hand," noted the State Consumer Court.
Accordingly, the Consumer Court held the hospital and doctor jointly and severally liable for medical negligence and directed the hospital to pay Rs 10 lakh as compensation.
"In view of the above, we are of the opinion that the opposite party No. 1 – Hospital and opposite party No. 5 – Dr. Rana be held liable, jointly or severally, for medical negligence and deficiency in service. We find that the opposite party Nos. 1 & 5 failed to exercise the reasonable duty of care expected from medical professionals. Accordingly, opposite party No. 1 – Hospital is held liable to pay compensation of Rs. 10 Lakh including medical expenses of Rs. 5,84,201.67 (as per paper No. 234) incurred in the medical treatment of deceased under the principle of vicarious liability," ordered the consumer court.
It further mentioned, "Accordingly, the consumer complaint is partly allowed. Opposite party Nos. 2, 3 & 4 are exonerated from any liability. The opposite party No. 1 - Hospital is hereby directed to pay a sum of Rs. 10 Lakh to the complainant and proforma defendant Nos. 6 to 10 in equal proportion alongwith litigation expenses of Rs. 50,000/- together with simple interest @ 6% per annum from the date of institution of this complaint, i.e. 22.07.2014 till the date of actual payment within a month from the date of this Judgment and Order."
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/uk-state-consumer-court-311203.pdf
