Rs 44 lakh relief to SGPGI, paediatric, immunology doctors in cancer treatment negligence case, Rs 6 lakh slapped for not filing records
No Medical Negligence
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated Sanjay Gandhi Postgraduate Institute of Medical Sciences, SGPGI and its four doctors from charges of medical negligence in the care of a blood cancer patient, who died during the treatment.
Earlier, the State Commission had directed the hospital and the doctors to pay Rs 30 lakhs to the deceased patient's family for mental agony and torture, and Rs 14 lakhs towards compensation. Challenging this order, the hospital and its doctors from the Paediatric and Immunology departments filed the appeal before the Apex Consumer Court.
However, the Apex Consumer Court set aside the State Commission's order after noting factual discrepancies in the observations made by the SCDRC. Even though the NCDRC exonerated the hospital and its doctors from charges of medical negligence, it directed the hospital to pay Rs 5 lakh to the patient's family as compensatory damage for not providing the entire documents and the hospital sheets indicating the step-wise treatment of the child. Further, the institute was also imposed with Rs 1 lakh cost.
Before the Apex Consumer Court, the complainant alleged that he lost his only son, who was suffering from blood cancer, because of the mismanaged and negligent treatment given to his son by SGPGI Lucknow and its doctors. He urged that at no stage of the treatment, either consent was taken for conducting bone marrow test, administration of Chemotherapy or even carrying out a small surgery in the patient's Trachea.
Apart from this, it was also alleged by the complainant that the patient was admitted to the General Ward of the Institute instead of the specific Department of Immunology or Hematology, where such treatments are supposed to be carried out. The father claimed that the treatment was given without any proper attendance in the General Hospital, which was neither equipped with facilities or with doctors to take care of a patient of blood cancer.
He urged that such a careless approach in treating the child resulted in his ultimate death, for which the hospital and the Appellants were solely responsible. He also relied on certain information received under the Right to Information Act, as well as some documents of the Hospital to urge that his child was shifted to an Isolation Ward, where there were no facilities, and no permission was taken for administering anaesthesia also contributed to the adverse condition of the patient, resulting in his failure to revive himself.
Further, the complainant also raised questions regarding the functioning of the hospital and the treatment procedure. It was also alleged that the Junior doctors assisting the treating doctors did not supervise the shifting of the patient or the treatment procedure and it added to the negligence of the Appellants and their mismanagement.
The complainant also pointed out that two death certificates were issued. While the first death certificate noted the cause of death as septic shock, the subsequent certificate indicated the cause as leukemia.
He claimed that the medical negligence was also evident from the facts on record and the treating hospital and doctors grossly erred by not filing the entire records from 1992 when the child was earlier admitted. Based on the directions received from the Commission, they ultimately filed medical records of only 22 days that too even with regard to his admission and treatment in the second round from 9.5.1994 till 31.5.1994.
On the other hand, the counsel for the hospital and doctors argued that the patient was duly treated for Leukemia and the treatment then available was duly administered timely, promptly, and with due manner. He also submitted that it was not the case of the hospital that the doctors attending on him were unqualified. It was contended that the submission about shifting the patient from the ward to the Isolation Ward to ensure that he gets the best of attendance, as it was beside the nursing chambers.
It was further urged that in spite of the all the best medical protocols having been pressed into service, the child could not survive on account of serious nature of his ailment, which was a terminal ailment.
However, the counsel pointed out that the State Commission's order proceeded based on the downloaded material regarding the treatment, diagnosis of such patient which was neither an evidence led by the Complainant nor were the Appellants confronted with the same. This material was never subject matter of arguments or discussion and consequently placing reliance on such material was a misdirected approach of the State Commission, argued the Counsel.
Regarding the observations made about the child not being taken to the Hematology Department, the counsel termed it 'misplaced' as there was no Haematology Department in the Institution when the child was admitted and treated in 1994.
Addressing the State Commission's order, it was also contended by the Counsel that the findings recorded by the State Commission were without any substance. He claimed that based on their own conclusions, the State Commission proceeded to rely on material which has been extensively quoted to explain the treatment of blood cancer and then to arrive at a conclusion which has no nexus at all to the treatment already carried out for the patient.
After taking note of the submissions, the NCDRC bench noted that the State Commission members referred to the understanding of the medical terminology as 'Acute Lymphoblastic Leukaemia in Children'. The Apex Consumer Court also took note of the facts recorded by the State Commission in the order.
Observations by NCDRC:
Observing that the entire order by the State Commission referred to theoretical material downloaded from the internet and utilised it seemingly as expert opinion. It opinied that the procedure adopted, therefore, was not in conformity with law, the Commission noted,
"...we find that the State Commission has padded up the entire impugned order with theoretical material in all probability downloaded from internet. This material was neither cited by the complainant nor did the hospital or the doctors have had any opportunity to test its correctness as they were not confronted by it. The material has been utilized seemingly as expert opinion upon being downloaded from the internet. We find this procedure to be in violation of principles of natural justice inasmuch as in the field of medical science, particularly in the field of medicine, there might be a lot of other material which could have been brought on record by the hospital and the doctor. Had they been given any opportunity to meet the said material which was not part of the pleadings or even the evidence. The procedure, therefore, adopted does not seem to be in conformity with law."
Apart from this, the top consumer court also noted that certain information was sought by the Complainant under the Right to Information Act and an application was moved before the State Commission, along with her compilation of the documents. At this outset, NCDRC observed, "The Complainant had alleged that he had moved an application for summoning the records from the Hospital which the Appellant had failed to provide but later on, filed the documents only pertaining to the treatment of the patient in the year 1994. The documents pertaining to the treatment in the year 1992 had not been provided and were withheld by the Appellant. We, therefore, find that the State Commission had entertained certain documents filed on behalf of the Complainant that have been referred to in the impugned order."
Referring to the RTI reply filed mentioned by the State Commission in its order, the NCDRC observed how the SCDRC concluded that the treatment of the patient was being done in the Immunology Department of the Institute and it could have only been done by the expert doctors of the Haematology Department and none others.
The apex consumer court also took note of the other arguments made by the State Commission and ultimately concluding that the treating doctors were negligent at each and every step and how careless post-operative care was given.
NCDRC referred to the arguments made by the complainant and the hospital and doctors and also the observations made by the State Commission and concluded that,
"The State Commission has, therefore, mixed up all these factual issues and has reproduced the material that was neither provided by the complainant nor was made known to the Appellant and seemed to have been on the basis of the same opinion gathered by the doctors themselves. In all probability the majority of the opinion founded in the order appears to have been downloaded from the internet and pasted therein without any opportunity to either of the parties."
In respect to the case, the NCDRC bench took note of the treatment extended to the child, the issue of consent, the child being treated in the isolation ward and also the State Commission's observations and noted,
"We have examined and produced the records as well as the evidence referred to in addition. We find that a mere suspicion cannot take place of proof and a doubt is not conclusive evidence of an alleged negligence. The facts indicate that the child was suffering from severe leukaemia and, therefore, the treatment then available, including chemotherapy, had been administered to the child. It is not the case of the Complainant that proper medicines had not been administered or an adequate dose. The complaint appears to be that the attendants of the patient were negligent. We are unable to agree to this inasmuch as had the doctors been negligent, there would have been no treatment that was undertaken. The disease was diagnosed and treated and, therefore, merely because the patient was kept in the general ward or shifted to isolation ward does not reflect upon medical negligence per se."
Regarding the issue of patient management, the Apex Consumer Court observed that "the complaint was not about wrong hospitalization nor the facts alleged were pleaded in a manner so as to construe a case regarding medical negligence," further adding that
"No expert evidence was led except for the downloaded material that has been pasted by the State Commission in the impugned order...To hold the Paediatrician to be responsible is also not founded on the ground that the treatment was wrong or had not been consulted and referred to doctors dealing with the subject matter. The inferences drawn by the State Commission in the paragraphs also quoted above are, therefore, not based on relevant evidence and the findings have been arrived at on irrelevant considerations."
Accordingly, the NCDRC bench concluded that the State Commission's order cannot be sustained. It observed the following:
"The impugned order which has proceeded to award Rs.30 Lakhs for mental agony and torture and Rs. 14 Lakhs towards compensation does not demonstrate any proportionate consideration under the heads for which the compensation has been awarded. We, therefore find that this calculation also is bereft of any appropriate logic and, therefore, the impugned order does not seem to be sustainable."
"The State Commission has recorded the theory of consent and has recorded that proper consent had not been taken. We do not agree with the 5th finding of the State Commission, inasmuch as from a perusal of the hospital sheets and the other documents on record the treatment and the steps taken for attending on the child cannot be said to be against any medical protocols. Merely because the consent form did not have the signature of the guardian, the same would not amount to an absence of informed consent...The State Commission seems to have been influenced by the medical literature that was reproduced in the order and in effect the State Commission did not choose to obtain any expert opinion to clear its doubts nor did the complainant lead any such expert evidence to find medical negligence in the treatment of the child," it further observed.
Even though the NCDRC bench sympathized with the complainant for losing his only son at such a tender age, it also observed that there was no "clinching and convincing evidence" to hold the hospital or the doctors negligent for the treatment of the child to hold them responsible for medical negligence.
While the Commission held that there was no evidence to indicate medical negligence, it noted that the hospital did not submit any of the documents regarding the medical records in the written statement which was filed and the evidence affidavit. Accordingly, the Commission held the hospital liable for failing to ensure availability of records and the issue of record keeping.
It observed, "This was possibly because the complaint itself and the evidence affidavit of the complainant were all very sketchy. However, the hospital was under a duty and an obligation to have disclosed the entire material on its own. It is the State Commission which seems to have called upon the hospital to provide the documents, some of which came to be filed by the complainant before the State Commission later on. That was received after making request through the Right to Information Act. This procedure of not providing the documents and then catering to it only after the Right to Information Act is resorted to cannot be appreciated as the institute is a fairly well established institute and we therefore find that it ought to have provided documents to the complainant which was not done. We find the appellant no.1 therefore to be partly responsible and negligent on this aspect,"
Therefore, even though the Commission exonerated the treating doctors from the charges of medical negligence in the treatment of the hospital, it held the hospital liable for failure to keep the records and produce them without being asked. For this, the Commission slapped a Rs 5 lakh compensation on the hospital and ordered,
"We therefore allow the appeal and set aside the impugned order dated 02.03.2022 insofar as it relates to the appellants no. 2 to 5 and set aside the findings recorded in respect of medical negligence. At the same time, we hold the appellant no. 1/Institute to be liable for the deficiency of not providing the entire documents and the hospital sheets indicating the step-wise treatment of the child which itself is a deficiency and we therefore find it expedient to award a Compensatory damage of Rs.5.00 Lakhs on the appellant no.l/lnstitute to be paid to the respondent complainant within two months from today. The compensation imposed .and relief awarded while allowing the complaint are set aside. A cost of Rs. 1.00 Lakh is imposed on the appellant no. 1/Institute to be paid as a litigation cost to the respondent complainant. With the said modifications, the impugned order stands substituted accordingly."
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/sgpgi-ncdrc-313711.pdf
