In a judgement that is going to have far reaching implications for the medical world, a Supreme Court judgment has clearly implied that Hospitals/Nursing Homes that do not have ICU facility at their Institute cannot perform surgeries, and any discrepancy arising out the same would amount to negligence.
The precedence for this judgment comes in the form a case where a nursing home in Bengal performed Hysterectomy on a patient, but could not provide ICU facilities when complications arose. The patient to be then shifted twice and she finally succumbed to her injuries at SSKM Hospital.
The case goes back to year 1994, when the now deceased patient , with multiple fibroids in her uterus consulted Gynecologist Dr. Bishwanath Das. After five months of treatment, she had severe bleeding and was admitted to Ashutosh Nursing Home for emergency Hysterectomy. She had complaints of High BP and Low Hb ( 7gm%) which were partially corrected before the surgery. However, after the surgery she did not regain consciousness and since the Nursing Home did not have the ICU facility, she was shifted, and she later died at SSKM Hospital.
In his complaint with the state Consumer commission, the deceased’s husband put forward two contentions
- The decision to perform surgery without first controlling blood pressure and hemoglobin amounted to medical negligence. The surgery was not an emergency but a planned one and conducted six months after the disease first surfaced.
- Secondly, having regard to the forceable complications, the decision to perform surgery at a nursing home which did not have the ICU for post operative needs also amounted to medical negligence.
The State Commission, vide order dated 19th September, 2005, held that there was medical negligence as surgery was conducted without controlling the blood pressure and haemoglobin and ordered a compensation of Rs 2 lakhs. The National Commission ( NCDRC) noting the medical literature, the Expert Opinion of Dr Basu concluded that the procedure performed was not elective as the deceased was having severe bleeding and that the doctors was a skilled gynaecologist, competent to do the surgery . NCDRC hence reversed the decision absolving the doctor and hospital of medical negligence.
With an appeal with the apex court, SC analysed the case on two aspects
- Whether the National Commission applied the right test for holding that there was no medical negligence in the decision of the surgeon to perform surgery.
- Whether the choice of nursing home to perform surgery amounted to negligence as requirement of ICU was a clear forcibility and centres with ICU were available nearby.
The court went to quote various past judgements, held one the first account that the National Commission was justified in holding that decision to perform surgery may not by itself be held to be medical negligence. However with regards to the second point the court noted
We however, find that neither the State Commission nor the National Commission have examined the plea of the appellant that the operation should not have been performed at a nursing home which did not have the ICU when it could be reasonably foreseen that without ICU there was post operative risk to the life of the patient.
Finding guilt on this issue and observing that since the matter had been pending for the last 23 years, instead of ordered fresh adjudication, the court ordered, in the interests of justice to direct the doctors and the hospital to pay a sum of Rs.5 lakh to the heirs of the appellant without any interest. The court also provided some guidelines for the consumer courts on speedy disposal of such cases.