Mumbai: The State Consumer Redressal Forum has quashed the judgment given by District Forum and held two treating doctors and a Tertiary Care Hospital negligent and deficient in providing service for diagnosis and treatment of a 73-year old cancer patient. The forum directed them to pay a compensation of Rs 10.25 lakh for the damage caused during the treatment.
The case goes back to 2005 when the elderly lady was admitted at Dr L H Hiranandani Hospital, Powai with complaints of fever with riggers. She was diagnosed with urinary tract infection and was treated by a urologist.
The CT scan revealed that she had Pyelonephritis for which she received treatment. At the time of discharge, she was advised to get a weekly urine routine test and fortnightly urine culture and sensitivity test. And also there was OPD (Out Door Patient) follow up by the patient for 94 days.
The patient was admitted to the hospital again after three months with the complaints of vomiting of blood. A physician Dr Suri attended her for the treatment. During this second stay in the hospital, various investigations, abdominal sonography, CT scan of abdomen and pelvis and other relevant investigations were done.
The patient after a week was shifted to ICU where she was treated by Critical Care specialist for three days. The patient went through multiple organ failure and died.
Two daughters of the deceased lady approached the District Consumer Redressal Forum where their complaint was dismissed. The complainants further approached the State Consumer Disputes Redressal Commission and filed an additional statement of the claim along with the appeal memo for compensation of over 25 lakh.
The court went through the allegations made by the complainants. It was alleged that the patient received empirical antibiotic treatment and so received resistant antibiotics. Further the complainants alleged Failure to diagnose cause of fever as pyelonephritis
Though the deceased patient was clinically better after the first admission there were many deficiencies in the service by the doctors and hospital like without considering the history of patient resistant antibiotics were given, the abdominal sonography performed gave wrong report, during second admission nephrologist did not visit and examine the patient for 6 days, though hospital is NABH (National Accreditation Board for Hospitals under Quality Council of India) accredited there were no nursing notes maintained so poor documentation, the patient received wrong drug tablet Combiflam that should not have been given, hence there was no targeted treatment given to the patient.
It was further alleged that since the sonography of the abdomen did not diagnose pyelonephritis (instead reported hydronephrosis) and also antibiotics were not given as per culture and sensitivity; there was no targeted antibiotic therapy that lead to septicaemia and ultimately death of patient.
It was argued that due to variations in the reports of sonography done on two different days, there was no proper diagnosis regarding the conditions of the kidneys and hence there was negligence in treating the patient.
The hospital and the treating doctors submitted their reply on the matter denying any negligence. They stated as per the University of Pennsylvania Medical Centre guidelines for antibiotic initially broad-spectrum antibiotics should be used and the same was done.
They further mentioned that the patient was of advanced age 73 years, having multiple medical problems like cancer of the breast operated in 1996, known case of diabetes mellitus being treated, who was investigated, diagnosed and properly treated by various specialists indifferent medical disciplines. Hence there was no medical negligence or deficiency in service on the part of opposite parties, hence demanded the dismissal of the complaint.
The forum went through the entire matter and observed that all the facts, evidence placed before, expert opinions from both the sides, all Medical record, medical literature and case laws dealing with medical negligence on part of the antibiotic prescription and delay in diagnosis and treatment
“….during the stay in the hospital from 18th November 2005 to 27thof November 2005, initially deceased patient received antibiotics that were resistant as per previous urine culture and sensitivity report. Injection Monocef was given to the patient on admission and continued for more than 5 days of the indoor treatment…….
….We also observed from the medical record that, on the second day of the admission, on 19th November two more antibiotics were added, injection metrogyl 100 ml intravenous 8 hourly and injection Ciplox 100 ml intravenous BD. The urine and blood was sent for culture and sensitivity only on 4th day, i.e. 21stof November. Advocate for opposite party submitted that as per the University of Pennsylvania Medical Centre guidelines for antibiotic initially broad spectrum antibiotics should be used and the same was done by opposite parties. The said guidelines are not found on record. We are of the opinion that, the patient received antibiotics for more than 5 days out of 9 days in hospital, to which patient was already resistant and culture and sensitivity of urine was not advised at the beginning of the treatment.
It was contended by advocate for appellant (complainant) that since on day 1, 18th November 2005, the report of first abdominal sonography given as a normal study, that may have misled the treating Consultants to believe that apparently renal system appears to be normal. Gastroenterologist Dr.Bhushan Pandit, pointed out in his examination on next day, 19th November 2005, that abdominal sonography should be repeated. Repeat abdominal sonography done by another radiologist gave different picture and reported as “enlarged right kidney with a hypoechoic lesion in the mid pole possibly abscess communicating with the pelvicalyceal system, right hydronephrosis and hydro generator calculus with no evidence of Pericholecystic fluid collection”. After this report, no further investigation was advised such as CT abdomen to confirm the presence of abscess. The team of treating consultants was later joined by, original Urologist Dr.Gupte on 21st November 2005.
On 4th day of admission, the patient was subjected to endoscopic drainage of purse from kidney, the said operation was done in the evening. It was contended by advocate for opposite parties that the patient was quite old, 73 years, already diagnosed case of Cancer breast previously operated, known case of diabetes mellitus been treated and with known kidney Disease in the form of Pyelonephritis, the patient was of high risk and that the response to the treatment was expected to be less since the patient had reduced immunity because of various diseases. On perusal of various reports, mainly DIPA Renogram for knowing bilateral kidney function, on pages 521 and 522 of compilation dated 13th August 2005, report reads as, “both Kidneys weight of normal size, right kidney showed moderate hydronephrosis with mildly dilated upper to 3rd ureter with moderately reduced function, left kidney function was also moderately reduced”. We are of the opinion that with the known previous history of kidney problems and other diseases the patient was having, the team of specialist and super specialist doctors must have been more careful in evaluating and treating the patient.
The forum held the doctors and hospital guilty-
“In our opinion, district forum has not considered the evidence from the actual medical records, speak about use of resistant antibiotics , delay in the diagnosis due to wrong sonography report, delay in diagnosis of pyonephrosis ( pus in Kidney) leading to delay in its drainage operation and the lost chance doctrine.
The court directed that the hospital and the two doctors to pay compensation of Rs 10 lakh and 25 thousand as litigation cost.