Under staffing is one of the serious problems faced by most of the Hospitals in the country. In a recent medico-legal case, while Allegations of Medical Negligence against doctors of Apollo Indraprastha were turned down, but Hospital was held liable for inadequate staff and Doctors and hence directed by National Consumer Disputes Redressal Commission ( NCDRC) to pay compensation to the family of a patient. The Commission however reduced the claim to Rs.2 lakhs from Rs.15 lakhs, which was awarded by the State commission.
Facts in short :
1. Apollo Hospital had filed the appeal against the Order of State Commission which directed the Insurance Co. to pay Rs.5 lakh and further directed the Hospital to pay total Rs.10 lakhs towards punitive damages to the Opponent No.1 – the Complainant in an alleged medical negligence case.
2. The complainant’s, Rajiv Gandotra’s wife, Vandana ( ‘the patient’) was admitted in Apollo Hospital at Sarita Vihar, on 14/07/1997. She delivered a female baby (in 26 weeks) weighing only 680 gms. The baby was shifted to NICU, but unfortunately the baby expired on 17/04/1997.
3. The Complainant made several allegations against the Doctors and Hospitals.viz.
(i) incomplete communication and improper attitude of the Obstetrician, Neonatologist, and Paediatric resident doctor,
(ii) inadequate NICU care provided to the new born baby because of difference of opinion regarding case management between two treating neonatologists,
(iii) professional incompetence,
(iv) under staffing at NICU and
(v) unsympathetic behavior of the hospital administration.
1. The Hospital refuted all the allegations and contented that the Hospital is multi-specialty hospital with 50 disciplines.
2.The baby was extremely premature i.e. delivered at 26 weeks and weighed only 680 gms. After delivery, baby had no spontaneous respiration and had very occasional heartbeat. In the labour room, a tube was inserted in the windpipe of the baby to assist breathing and Endotracheal suction was done under direct vision. Intermittent Positive Pressure Respiration (IPPR) was started and when the heart rate of baby picked up, baby was shifted to NICU and connected to the ventilator. The other supportive measures were also given by the NICU doctors and nurses.
3. The Baby in NICU was monitored by well known Sr. Neonatologist Dr. Anil Gupta.
Expert Committee Observations:
1. The Health Minister of Delhi Government, to investigate the complaint’s allegations appointed the Expert Committee of eminent Doctors from Delhi.
2.The Committee concluded that the medical care given at the hospital was adequate. The cause of death could be a combination of extreme prematurity, intrauterine infection, PPHN, IVH, Sepsis and birth asphyxia. These causes independently could be fatal for the baby.
3. However, On the point of ‘Under staffing of the NICU’ committee opined that, though the labour room and NICU are well equipped with neonatal resuscitation facilities and life support measures but, Patient to Nurse ratio was not satisfactory. The numbers of resident doctors are barely adequate. The Record Keeping was also not upto the mark.
4.The Committee reserved its comments on the financial policies of the hospital and on the allegation of rude behavior of doctors for lack of witnesses.
1. The National Commission after going through the documents, expert committee reports and the arguments advanced by the parties, confirmed the finding of expert committee that the treatment given at the Hospital was as per protocol and adequate.
2. It dismissed the allegations of medical negligence against the Doctors as the chances of survival of baby were very remote and it relied upon the judgements of Hon. Apex Court wherein it was observed that :
“..At times, the professional is confronted with making a choice between the devil and the deep sea and he has to choose the lesser evil. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Which course is more appropriate to follow, would depend on the facts and circumstances of a given case. The usual practice 39 prevalent nowadays is to obtain the consent of the patient or of the person in-charge of the patient if the patient is not be in a position to give consent before adopting a given procedure. So long as it can be found that the procedure which was in fact adopted was one which was acceptable to medical science as on that date, the medical practitioner cannot be held negligent merely because he chose to follow one procedure and not another and the result was a failure.”
3. However, on the point of inadequate staff and Doctors and method of segregating infected babies from others in NICU, it agreed with the Expert Committee report, but reduced the total compensation to Rs.2 lakhs for such inadequacies.
This judgment teaches us in many ways. It again emphasizes importance of proper documentation. The limitations of Medical Science are once again can be seen. The important factor is inadequacy of staff like nurses, doctors. This problem is being faced by all most majority of the Hospitals. As it involves costing. If the ratio of staff, Doctors is to be increased, no doubt indirectly cost of treatment will increase and patients will start protesting. This is vicious circle. The Doctors would agree that its difficult to get trained staff and qualified doctors. How to overcome this situation ?
Thanks and Regards,
Adv. Rohit Erande.
Case Details :
Indraprastha Medical Corp. Ltd., Sarita Viahr, New Delhi. V/s. Rajiv Gandotra & United India Insurance Co. Ltd. First Appeal NO.220/2008, D.O.J. – 15/05/2018.
Dr. S.M. Kantikar – Member.