Rs 1.55 crore relief to 2 Delhi Hospitals, laparoscopic surgeon, doctors in intestinal surgery death case
No Medical Negligence
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated Northern Railway Central Hospital, Batra Hospital and Medical Research Centre, and its doctors from allegations of medical negligence during the treatment of a patient, who died after undergoing a surgery.
Even though the Apex Consumer Court sympathised with the patient's family, it held that there was no evidence to establish that the treating facilities and doctors (medical officers and a laparoscopic and general surgeon) were negligent in providing treatment.
"While concluding, we may state that it is indeed, shocking and sad that a young 22-23 year old patient lost her life within a short span of four days of hospitalisation. However, such unfortunate outcome in itself, though agreeably disturbing, shocking and unacceptable for the relatives, cannot in itself amount to negligence of the hospital or treating doctors, and, the allegations of medical negligence nevertheless have to be evaluated dispassionately on the basis of evidence on record in light of the pleadings," observed the NCDRC bench.
"The standard yard-stick on which such evaluation is to be based is whether the Hospital or the treating doctor can be held accountable for any lapse or deviation in following any standard medical protocol or practice or for lack of skill, expertise, care and caution exercised during the diagnosis, investigations, treatment or surgery or while creating respective medical records. No error or fault can be found for error in medical judgment and decision when the course adopted by the doctor is one of the recognised options. No negligence can be found also when the unfortunate outcome is the consequence of the ailment of the patient and complications arising therefrom which complications cannot be wholly avoided," it further noted.
Case Background:
Alleging that her daughter died due to delayed and negligent treatment, the mother of the deceased patient filed the consumer complaint seeking Rs 1,55,60,000 as compensation.
The complainant alleged that back in July 2015, when her daughter was first taken to Northern Railway Central Hospital with a complaint of severe abdominal pain, the casualty medical officer on duty provided symptomatic treatment and tentatively diagnosed appendicitis. It was alleged that despite repeated requests, the patient was not admitted. Thereafter, the patient's family had to shift her to Batra Hospital.
It was submitted that the patient was admitted to the second hospital after a delay of almost 5 hours and the hospital also did not give any emergency treatment to the patient, even though she was suffering from severe abdominal pain. Finally, even after she was admitted, the patient remained unattended for more than 9 hours. Due to this, the patient's condition allegedly kept on deteriorating. Finally, she was referred to a doctor at the hospital, who, after examining the patient, recommended various tests and a CT scan. The patient was taken to the Operating Theatre on 23.07.2015, and after the operation, it was informed that a major operation was done, and the patient's large intestine was removed, and her condition was serious. On 26.07.2015, the patient was declared dead.
In the complaint, the complainant also alleged tampering of medical records, delay in performing diagnostic tests such as CECT, improper ICU access to the family, lack of communication by doctors, etc. It was also alleged that the surgery was misrepresented as a "small operation" despite the later revelation that a major intestine procedure had been performed.
On the other hand, it was argued by Northern Railway Central Hospital that prompt examination was conducted in the casualty and by the surgical department. It was also contended that the patient's vitals were normal, and she was provided and prescribed treatment on the lines of renal stone and was advised to report back, if required, at any time. The hospital submitted that the patient was diagnosed as a case of Renal Stone based on earlier ultrasound findings, and treatment was administered accordingly. Allegedly, soon after consultation in the surgical OPD, the patient left the casualty on her own and did not return for follow-up.
All allegations of negligence were denied by the second treating hospital as well. It was submitted that there was no delay in treatment and the patient was immediately evaluated, admitted, and provided IV antibiotics. CECT abdomen was advised and after receiving findings suggestive of ileocecal tuberculosis with perforation and peritonitis, surgery was conducted after obtaining high-risk informed consent. The hospital also claimed that the patient was managed properly after the surgery and ventilatory support, multidisciplinary ICU care, antibiotics, blood transfusion, and continuous monitoring. Despite this, the patient expired due to multiorgan failure and septicemia.
Observations by NCDRC bench:
While considering the matter, the Apex Consumer Court carefully examined the pleadings, affidavits, and extensive medical records. Regarding the treatment of the patient at Railway Hospital, the Consumer Court found no evidence of any deficient conduct.
"After perusal of the evidence, we are unable to find any alarmingly or even reasonably deficient conduct in the treatment on the basis of mere allegations in the complaint and the pleadings and evidence on record as above. We find no merit in the allegations that despite request by the patient’s relatives and despite alleged continuing distress and pain suffered by the patient, the incharge doctors did not admit the patient in the hospital. The fact that the patient went home and returned only next day morning for SOPD consultation, and the fact that the SOPD consultations also brought in no new line of treatment would indicate that the doctors, in their best wisdom, judgment and skill, in the circumstances, took an expert medical opinion of treatment as suggested and necessitated by medical history and clinical condition, which in our opinion, cannot be faulted in the absence of contrary expert opinion or palpable negligence or misconduct, neither of which is brought out by any credible evidence on record," observed the Commission.
"The generalised and unsubstantiated allegations that the patient was not admitted in hospital despite the patient being in sever pain and despite the insistence for admission by the relatives cannot and do not persuade or lead us to any adverse findings of any negligence. The condition of the patient at this moment, in retrospect, and after noticing subsequent events as unfolded, can be surmised or felt to have perhaps required a more comprehensive investigation and even hospitalisation, but the medical decision of the treating doctors has to be evaluated on the yardstick of evidenced medical condition when the decision was taken uninfluenced by the subsequent events," it further noted.
Further noting that the patient did not come back for the review and observing that the patient's condition was stable upon arrival at the second hospital, the consumer court decided that there was no lapse, infirmity, violation of any medical protocol or negligence in the treatment provided by Railway Hospital.
The NCDRC bench also took note of the medical records by the second hospital. Addressing the issue of delayed treatment, the Commission observed, "...we conclude that the patient reached Batra Hospital casualty at 11 pm only. Therefore there is no merit in the allegations of lack of urgency and treatment as mentioned in para 9 of the complaint. The factual unsubstantiated averment of the complainant that the patient was brought at 330-4 pm is false and misleading and appears to us to have been made solely with a view to provide gravity to the allegation of delay in providing the treatment."
Further, the Commission declined to accept the allegations of tampering with BP readings and treatment sheets, and held, "There appears to be some overwriting which may perhaps indicate the subsequent changes made in the records. Equally, it could be in the ordinary course. After scanning through the complete medical records, we are unable to infer any foul play by the Hospital or the doctor."
The Consumer Court concluded that there was no medical expert opinion to hold medical negligence in the treatment. It held,
"There is no medical expert opinion or any authentic medical literature placed on record by the complainant to persuade us to hold that the delay of nearly 12 hours in carrying out CECT and absence of other investigations, which led to the belated diagnosis of perforation and need for urgent surgery, was compulsively indicated by the clinical condition of the patient upon admission at 1 pm. Without such scientific and medical basis placed on record by the complainant to arrive at such conclusion, we are unable to arrive at any conclusion of medical negligence on the part of the OPs in this behalf. There is merit in the explanation of the OP for the “delay” in as much as firstly the patient was getting stabilised upon admission and secondly various possible causes for the condition of patient needed to be weighed and evaluated which is medical and clinical expert judgment of the experts which we are afraid we can not put to the test of propriety in the absence of another expert medical opinion."
Observing that there was no evidence to establish medical negligence during the treatment at the second hospital, the Commission observed,
"There is no serious allegation qua the conduct of the surgery or post-surgery management of the patient. As such, otherwise also, the perusal of the medical record of detailed progress notes, investigation reports and nursing notes filed with the complaint is indicative of multiple consultations and monitoring, diagnostic and management efforts and treatment rendered by the hospital, which unfortunately still could not succeed in saving the patient. As the literature placed on record by the OPs would show, the post-surgery mortality rate in intestinal perforation cases is very high to the extent of 17%, and it is unfortunate that the patient fell within that 17%. The intestinal perforation occurring due to long standing untreated Koch’s resulted into fecal material leaked into the abdominal cavity, which, progressively and despite medical management, resulted into infections, septicemia multiorgan failure and cardiac arrest. The high risk and other consents were duly obtained and are on record. The surgical and anesthetic notes are also very much available in the record filed by the complainant. Thus, we are unable to find any deficiency or medical negligence so as to make the OPs liable."
Accordingly, the Commission exonerated the treating hospitals and doctors and dismissed the complaint.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ncdrc-no-med-neg-313005.pdf
