Patient dies of organ failure: NCDRC upholds order against doctor, Amritsar hospital to pay Rs 10 lakh compensation

Presiding Member of the Commission, Dr S M Kantikar further pronounced the act of ‘Omission’ in duty of care", and consequently, dismissed the revision petitions filed by the hospital, doctor and the complainant.

The brief facts of the case are that on July 2, 2011 a patient, Rupesh Bhandari was admitted to Parvati Devi Hospital in Amritsar. He was examined by the concerned doctor and made a provisional diagnosis of Acute Viral Hepatitis. Accordingly, conservative treatment was started for Hepatitis (type A, B, C and E).

After a couple of days, for a second opinion, the Gastroenterologist, examined the patient and the correctness of the treatment given by the concerned doctor. The test reports revealed positive for Hepatitis A. A day later, the patient developed symptoms of irritability, which was a sign of hepatic encephalopathy led to fulminant hepatic failure.

The doctor advised and shifted the patient to Fortis Escorts Hospital. It was alleged that the doctor administered more medicines and failed to diagnose renal failure. The patient remained in the hospital and died after 39 days, on August 13, 2011. Being aggrieved by the alleged negligent treatment of doctor and the hospital, the patient's son filed the consumer complaint before the District Consumer Disputes Redressal Commission Forum, Amritsar.

In response, the hospital and the doctor filed their written version and submitted that the patient was treated with due care and diligence. They submitted that;

"The patient was treated with consultation of an expert Gastroenterologist. The vitals of the patient were monitored consistently on every 2 hours. On 01.07.2011 and 04.07.2011 the necessary lab investigations were done in the lab of complainant. On 06.07.2011, patient showed irritability, it was sign of hepatic encephalopathy, therefore the concerned doctor advised to shift the patient to the higher center as he would require facilities for ventilator support, dialysis and even liver transplant. However, initially the complainant was reluctant to shift the patient owing to the high costs involved. Thereafter, the petitioner contacted Dr. H. P. Singh, Director of Fortis Escorts Hospital and apprised him of the status of the patient who suggested to contact center in Delhi and finally the patient was shifted to Fortis Escorts Hospital, Amritsar along with all original medical records."

However, the District Forum on appraisal of evidence partly allowed the complaint and passed the order as;

“Keeping in view all these facts, we allow the complaint with costs and the doctor and the hospital are directed to pay compensation to the tune of Rs.10 lacs (Rs Ten Lakhs) i.e. Rs 5 lacs each in equal share, to the complainant as compensation. However, the doctor and the hospital can claim this amount from their respective insurers, as per the terms and conditions of the policy. The hospital and the doctor are also directed to pay Rs.5,000/- to the complainant as costs of litigation. Copies of the order be furnished to the parties free of cost.”

Being aggrieved, the doctor and the hospital; and the Complainant filed first appeals before the State Commission. The F.A. NO.1000/2015 filed by hospital and F.A. NO.1001/2015 filed by the doctor for dismissal of the complaint, whereas the F.A. NO.1004/2015 filed by the patient's father (complainant) for the enhancement of compensation.

The State Commission dismissed the appeals filed by the hospital and the doctor, and allowed the appeal filed by complainant. The compensation was enhanced to Rs 17,27,036/- to be paid jointly and severally by the hospital and the doctor.

Being aggrieved the instant four revision petitions were filed before the Commission.

After hearing the arguments from the learned counsel for the parties, the Commission perused the medical record, inter alia Orders of District and State Commission and observed;

"It is pertinent to note that on July 2, 2011, on admission the doctor diagnosed it as a case of acute fulminant hepatitis. The Gastroenterologist Dr. H. P. Singh, DM visited the hospital on 3rd and 4th July, 2011. The test report HAV Positive and HBE Negative. Therefore, Dr. H. P. Singh recommended no treatment. It is pertinent to note that the doctor did not consult Nephrologist and kidney function tests were not advised to rule out acute renal injury. It is also not evident that the ICU was functioning, and the patient was shifted to Fortis Hospital. The investigations done there revealed deranged liver function test (LFT) and LDH, prothrombin time, INR were high. Therefore, diagnosis was made as Hepatitis A, Hepatic-encephalopathy and acute renal failure. Subsequently, the death of patient occurred after 39 days of hospitalization due to multi-organ failure."

"Adverting to the consent form, it appears to be signature on dotted lines. It was a printed consent form which neither was signed by the patient nor by the doctor. It shows number of blank spaces, other clinical details were not mentioned. Thus the instant consent does not fulfil the ingredients of ‘informed consent’ as held by the Hon’ble Supreme Court in Samira Kohli vs. Dr. Prabha Manchanda and others case. NCDRC in the case of Vinod Khanna vs. R. G. Stone Urology and Laparoscopy Hospital & Ors has held the hospital liable for lack of valid informed consent. In my view, using printed consent form is not a negligence, but the printed contents should satisfy the ingredients of valid informed consent laid down in Samira Kohli’s Case. It should not be a generalized, but it should be subject specific for the diagnosis, treatment and procedure etc. The key is to make sure that the consent was informed, i.e. advising the patient of risks, informing their freedom choice and where possible discuss alternatives. In my view, the patient’s signature on dotted lines goes a long way towards mitigating legal problems of doctor. In my view, it was not a valid informed consent. It bears no signature of patient though he was in conscious state, but of patient’s father signature seen in the column of patient’s relative. It is pertinent to note that it was the case of fulminant hepatitis which further causes renal involvement. The doctor failed advise KFT or seek opinion of Nephrologist for the Acute renal failure. From the medical record it is evident that KFT was advised at delayed stage- on 5.8.2011, the monitoring of fluid Intake/Output was not proper. This was the act of ‘Omission’ in duty of care."

It further observed;

"The doctor was qualified as MD, Medicine and in my view physicians are competent to treat Hepatitis. In addition he took an opinion of Gastroenterologist Dr. Harpreet Singh. However, the doctor himself claiming Gastroenterologist was against the Regulation [7.2] of MCI(Medical Council of India). Also the doctor and the hospital violated the Regulation [1.3] of MCI who failed to supply patient’s medical record. The ICU of the hospital was not functional on 6.7.2011. The patient was referred in the evening to Fortis Escorts Hospital, Amritsar for further management."

Noting that the instant Revision Petitions are devoid of merit, the Commission dismissed the petitions and held;

"At present the Complainant is about 70 years of age and unfortunately lost his young son who left behind his wife and two minor daughters in severe stress and agony. The Hon’ble Supreme Court in the cases viz ‘Rubi (Chandra) Dutta Vs. M/s United India Insurance Co. Ltd. and ‘Sunil Kumar Maity vs. State Bank of India & Anr.’ held that the scope of Revision Petition is limited. The concurrent findings of facts as held by both the Fora below, thus within the meaning and scope of section 21(b) of the Consumer Protection Act, 1986. I don’t find any jurisdictional error, or a legal principle ignored, or miscarriage of justice, as may necessitate interference in the exercise of the revisional jurisdiction from this Commission."

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