Unexplained contradictions in medical records: Consumer court upholds negligence, Rs 32.94 lakh compensation against Max Hospital Mohali, Cardiologist

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently upheld the finding of medical negligence and Rs 32.94 lakh compensation slapped on a cardiologist and Mohali-based Max Hospital.

Dismissing the appeals filed by the treating hospital and the cardiologist, the Apex Consumer Court observed that there were no explanations regarding the contradictions in the hospital's medical records, X-ray reports, nursing notes, and billing documents.

"After a thorough reassessment of the entire evidence, we find ourselves in agreement with the conclusion reached by the State Commission and the Hon'ble High Court. The Appellants have failed to provide a cogent and consistent explanation for the contradictions in the medical records and the bill," observed the top consumer court, further noting that the appellants have failed to prove that there was no negligence or deficiency in service on their part.

The NCDRC bench also dismissed the appeal filed by the complainant and held that the compensation of Rs 32.94 lakh, awarded by the State Commission, appeared to be just and reasonable.

It noted, "The State Commission took into account the loss of income, cost of treatment, pain and suffering, and litigation costs. While the loss of a life is invaluable, the compensation awarded is substantial and meets the standard of being "just and proper" under the circumstances. No case for enhancement is made out."

Case Background:

The history of the case goes back to 2013 when the complainant's husband, a 43-year-old patient suffering from severe coronary artery disease, who had undergone Coronary Artery Bypass Graft (CABG) surgery, was admitted to the treating hospital with the complaint of prolonged chest pain.

He was attended to by the treating cardiologist, who advised the implantation of a biventricular (triple chamber) pacemaker. The complainant submitted that a surgery was performed and a double-chamber pacemaker, allegedly costing Rs 45,000, was implanted instead of the recommended biventricular pacemaker.

Since the procedure remained incomplete, a second procedure was carried out after one day for the implantation of the biventricular pacemaker costing Rs 4,47,869. Consequently, the patient was discharged. However, he suffered a severe heart attack and died within 3 days of discharge from the hospital.

The complainant approached the State Consumer Court, Punjab, and demanded compensation of Rs 84.73 lakh, alleging gross medical negligence, deficiency in service, and unfair trade practice.

Earlier, after considering the complaint, the State Consumer Court had held the treating cardiologist guilty of medical negligence, and the hospital had been held vicariously liable. They were directed to pay Rs 32.94 lakh compensation.

Aggrieved by this, the doctor and the hospital filed an appeal before the NCDRC, while the complainant filed a separate appeal seeking an enhancement of the compensation awarded by the State Commission.

The doctor and the hospital argued before the Apex Consumer Court that the implantation of the biventricular pacemaker was carried out in two stages because of the patient's fragile medical condition, which is a standard protocol. No second pacemaker was implanted; only the third lead was placed in the second stage, they submitted.

According to them, the patient had died of a Sudden Cardiac Death (SCD) or Myocardial Infarction due to his pre-existing severe heart condition (Class IV), and not due to the surgery. They relied on the Post-Mortem report, which confirmed the presence of the pacemaker in situ and leads in RA & RV, consistent with a triple chamber device.

Meanwhile, the complainant argued that there were contradictions in the hospital's own records. While the medical notes dated 20 September 2013 recorded that the Cardiac Resynchronisation Therapy (CRT) procedure had already been completed, the X-ray report of the same date showed the pacemaker to be in situ, argued the complainant.

Further, the complainant relied on the hospital bill, which reflected a separate entry for a "Double Chamber Pacemaker" costing Rs 45,000 and contended that the subsequent explanation describing it as a typographical error was an afterthought, and a clear admission of falsification of records. Besides, she also argued that the internal records relating to the placement of the LV lead and the limited video footage of the procedure by the hospital further exposed inconsistencies in the defence.

Observations by NCDRC:

NCDRC perused the entire record, including the State Commission's order, the voluminous medical documents, the bills, the postmortem report, the PGIMER expert opinion, the subsequent judgment of the Hon'ble Punjab & Haryana High Court, and the new documents filed by the Appellants regarding the supply of the pacemaker.

It observed that the State Commission's finding of negligence is primarily based on three key contradictions that emanate from the Appellants' own records. One of these contradictions was the presence of an ECPM (pacemaker/pulse generator) in the X-ray report dated 20.09.2013, versus the doctor's consistent stand that no pacemaker was implanted on that day.

Another contradiction was between the two-stage surgery claim and the internal nursing note dated 20.09.2013 stating "Patient CRT [Cardiac Resynchronization Therapy] done". Further, the bill contained an entry for a "Double Chamber Pacemaker" for Rs. 45,000/- on 20.09.2013, despite the patient having paid for and consented to a biventricular device. This, the appellants claimed, was a typographical error in the procedure charges.

NCDRC held the appellant's contention that the X-ray report showed an 'External Chamber Pacemaker (ECPM) and not the permanent pacemaker, as unpersuasive. "The document itself is titled 'X-Ray Chest AP View' taken post-surgery to check the placement. The radiologist's report notes "ECPM with wires... in situ." In common medical parlance within the context of a permanent pacemaker implantation report, ECPM refers to the implanted pulse generator. The Appellants' attempt to create a distinction between an 'external' and 'implanted' pacemaker in this context is a distinction without a difference and appears to be an afterthought to explain away a damaging piece of evidence," the Commission noted at the outset.

"This conclusion is further strengthened by the nursing progress note of the same date (20.09.2013 at 5:52 PM), which states, "Special instructions to handover staff: Patient CRT done." CRT (Cardiac Resynchronization Therapy) is a treatment that specifically uses a biventricular pacemaker. If, as the Appellants claim, only two leads were implanted and the pacemaker was to be installed later, the notation "CRT done" would be factually incorrect and misleading. This inconsistency was rightly seized upon by the State Commission and also highlighted by the Hon'ble High Court," it observed.

According to the Apex Consumer Court, the bill was another significant piece of evidence.

"It unmistakably lists a "Double Chamber Pacemaker" as an item with a cost of Rs. 45,000/-. The Appellants' explanation that it is a typographical error and actually represents the procedure charges for the first stage, supported by a breakup for another patient, is not credible. A hospital's billing software is expected to maintain a standard chart of accounts. If the amount was for 'Procedure Charges', it should have been listed as such. Listing it specifically as a 'Double Chamber Pacemaker' creates a strong presumption that such a device was, in fact, used. This finding is not a technical one but a factual finding based on documentary evidence," it held.

Noting that the appellants had placed on record documents to show that the biventricular pacemaker and its leads were delivered to the hospital on 19.09.2013 and 20.09.2013, the NCDRC observed that "this does not fully resolve the contradictions in the record. If the correct device was available, why does the bill show a cheaper, different device? Why do the medical notes prematurely state "CRT done"? Why does the X-ray report show a pacemaker in situ on 20.09.2013 if only leads were implanted? These documents, provided after the impugned order, seem to raise more questions than they answer and do not erase the glaring inconsistencies in the contemporaneous medical records."

While the Commission agreed that the expert opinion from PGIMER stating that the "procedure was carried out as per protocol," is an important piece of evidence, it also observed, "the value of this opinion is considerably diminished by the fact that the Medical Board itself did not have or did not comment upon the critical inconsistencies in the record."

NCDRC referred to the order of Punjab and Haryana High Court, which, while dismissing the quashing petition, observed, "Interestingly, though the Board assessed the medical record, but did not make out any detailed discussion with regard to the inconsistency in the record... The Board of Doctors remained silent regarding the X-ray reports dated20.09.2013 and22.09.2013..."

"A blanket opinion that the procedure was 'as per protocol’ loses its sanctity when it fails to address specific, contradictory, and contemporaneous documentary evidence from the hospital's own file. The principle laid down in V. Kishan Rao (supra) is that a Consumer Forum is not bound by an expert opinion if the facts on record are clear. In this case, the facts on record are not clear; they are deeply contradictory, and the expert opinion fails to resolve them," observed the NCDRC.

It held that the subsequent judgment of the Punjab and Haryana High Court, dismissing the Appellants' quashing petition and directing them to face trial for offences under Sections 304-A, 420, and 120-B IRC, is a significant development.

"While the findings in a criminal proceeding are not binding on a civil consumer forum, the High Court's detailed analysis of the same set of medical records and its conclusion that a prima facie case of cheating and gross negligence is made out, is highly persuasive. The High Court found the Appellants' stand to be self-contradictory and noted the same discrepancies (Xray showing ECPM, nursing note showing CRT done, bill showing double chamber pacemaker). This strengthens the Complainant's case that the Appellants' version of events is not credible," observed the Commission.

"The doctrine of res ipsa loquitur (the thing speaks for itself) may not be strictly applicable in complex medical negligence cases. However, in this case, the Appellants' own documents create a situation where the events speak loudly of a lack of transparency and probable negligence. A patient was taken for surgery, an X-ray and medical notes indicate the procedure was complete, and the bill shows a cheaper device was used, only to be followed by a second surgery and, tragically, the patient's death. The Appellants have failed to provide a satisfactory, coherent, and consistent explanation for these multiple, glaring discrepancies in their own records. Their shifting explanations and afterthought documents do not inspire confidence. The unexplained contradictions in the hospital's own records are sufficient to draw an adverse inference of deficiency in service," it noted.

According to the Commission, the case is about the unexplained presence of a pacemaker on an X-ray and a cheaper device on a bill, where the doctor claims neither existed.

"This is not a case of an error of judgment during a complex procedure, but one of potential misrepresentation and a fundamental lack of clarity about what was actually done to the patient. The Hon'ble Supreme Court in Jacob Mathew held that a medical professional is not liable for an error of judgment. However, that protection applies when the facts are undisputed, and the only question is the choice of treatment. Here, the facts themselves are hotly disputed and stand contradicted by the hospital's own documents. The protection of Jacob Mathew cannot be extended to cover a situation where the professional's account of the treatment is contradicted by the hospital’s official medical records and billing documents," it observed.

Accordingly, it upheld the decision by the State Commission and the High Court and observed, "Consequently, the finding of the State Commission that OP-3 (Dr. ***) is guilty of medical negligence/deficiency in service and that OP-1 (Max Super Specialty Hospital) is vicariously liable for the acts of its consultant doctor is upheld."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/2026/08/14/ncdrc-mohali-max-hospital-365119.pdf

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