Upholding an order passed by the state commission, the national consumer disputes redressal commission (NCDRC) directed Mohali-based Max Super Speciality Hospital and three doctors, including a senior cardiologist, to pay a compensation of Rs25 lakh with an interest of 8% to the family for medical negligence leading to the death of the patient.
In
an order last month, the NCDRC bench of Subhash Chandra (presiding member) and Dr Sadhna Shanker (member) says, "We are of the view that the standard of care in a high-risk patient at the pre-operative stage was not provided, as also noted by the medical board. Further, when she was brought back in a critical condition, the hospital should have admitted her and acted as per medical protocol. The lack of standard of care provided on both the occasions in one operation constitutes medical negligence on the part of the hospital and the doctors and the senior cardiologist."
"We are of the opinion that the Punjab state consumer disputes redressal commission has passed a well-reasoned order, which does not require any interference by this Commission. Therefore, both the appeals are dismissed," the order says.
The case is related to Salwinder Kaur, wife of Sham Singh, who underwent knee replacement surgery and then angiography at Max Super Speciality Hospital. Mr Singh alleged that on 19 August 2014, Dr Amit Gupta conducted an echocardiogram (echo) test of Ms Kaur and, as per the report, her left ventricular ejection fraction (LVEF) was recorded to be 35%. As per the medical jurisprudence, the doctors are not supposed to conduct knee replacement surgery on a patient with 35% LVEF; otherwise, the surgery could be fatal for the patient.
However, Mr Singh alleged that "the doctors conducted 2D colour and doppler echocardiography test of Ms Kaur on the same day, which shows LVEF of 60%, which is medically impossible and is wrong being manipulated or doctored by the doctors to conduct the surgery against the health condition of the patient."
However, on 20 August 2014, the bilateral total knee replacement surgery of Ms Kaur was conducted.
Mr Singh alleged that on 19 August 2014, the hospital did an X-ray of the knees and chest of the patient. However, the X-ray report was given only on 21st August and 22 August 2014, one day after the doctors performed the surgery without even perusing the X-ray reports.
On 23 August 2014, when the condition of Ms Kaur deteriorated, she was shifted to the intensive care unit (ICU) and then on 25 August 2014 to SICU, where she was kept on a ventilator till 8 September 2014. On 9 September 2014, she was referred to cardiologist Dr Sudheer Saxena in the CCU. Her angiography was done, and the report came out to be normal but her condition was worsening by the day.
Mr Singh, the husband of the patient, alleged that Ms Kaur was discharged from the hospital. On 11 September 2014, her condition became very critical and the family took her back to Max Super Speciality Hospital. However, the doctors there refused to admit the patient. The family then took her to Fortis Hospital, which also refused to admit her. Then she was taken to SGHS Hospital in Sohana, where she was admitted to the ICU and on 1 October 2014, she died.
Mr Singh alleged that the patient was not taken care of as per medical protocol before and after the surgery, she got an infection or sepsis and remained on an invasive mechanical ventilator for approximately one week. He also alleged that the death summary report also shows that the patient had swelling in both knees.
Alleging medical negligence by the hospital, the doctors, and the senior cardiologist, Mr Singh filed a complaint with the state commission.
The hospital and doctors contested the complaint, stating that Mr Singh's contention that LVEF was only 35% is totally incorrect as 2D colour and Doppler echo done on 19 August 2014 clearly shows that the LVEF of the patient was more than 60% which was within the normal parameters. They further stated that Ms Kaur, the patient, did not have any complaints of breathlessness or chest pain, and there was no medical negligence on the part of the hospital, the doctor, or the senior cardiologist.
While allowing the complaint, on 27 February 2019, the state commission directed the hospital and the doctors to pay Rs25 lakh as compensation with an interest of 8% and Rs33,000 as litigation expenses.
Aggrieved by the state commission order, Max Super Speciality Hospital and the doctors approached NCDRC.
Their counsel argued that the 2D colour and Doppler echocardiography test report showed that the LVEF was 60% and only after confirming that the echo report was normal, was the clearance given for surgery.
He submitted that the echo test was conducted on Ms Kaur on 26 August 2014 but inadvertently, the date in the report was mentioned as 19 August 2014, which stands corrected to 26 August 2014.
He further argued that another echo test and DL scopy were done and Ms Kaur was extubated on 8 August 2018 and later shifted to the cardiology department due to ECG atrial fibrillation and bigemini changes. "On 9 September 2014, an angiography was conducted on her and the report was found to be normal and Ms Salwinder Kaur was discharged on 10 September 2014 when she was fully conscious, oriented, thermodynamically stable afebrile, TLC (WBC) count within normal unit."
He further argued that on 11 September 2014, Ms Kaur was brought to the hospital in an emergency but her condition was found to be normal, therefore, she was not admitted.
The counsel for Mr Singh contended that the echo test of Ms Kaur conducted by Dr Gupta on 19 August 2024 shows LVEF as 35% and, as per medical protocol, no surgery could be done and if done, it could be fatal to the life of the patient. He further argued that the 2D colour and Doppler echocardiography report is forged, and no 2D colour and Doppler echocardiography was conducted.
"The doctors conducted the surgery on 20 August 2014 without waiting for the report of the X-ray knee and X-ray chest, which amounted to medical negligence on the part of the hospital and doctors. At the time of discharge, Ms Salwinder Kaur was not well, but the doctors forcibly discharged her. When the patient came in emergency on the next day, the hospital and doctors refused to admit and treat her, which amounted to deficiency in service on the part of the hospital and doctors," he submitted.
After hearing both sides and perusing the documents available on record, the NCDRC bench observed that the main question in this case was whether there was medical negligence on the part of the hospital and the doctors.
It says, "In so far as the contention that the wrong date has been mentioned in the echo test report, from a perusal of the echo report, it is seen that the report was prepared by Dr Amit Gupta on 19 August 2014. The perusal of the log on page 499 makes it clear that on 19 August 2014, the hospital issued two requisitions bearing Nos254126 and 254127 and the requisition no254126 relates to echo while requisition no254127 relates to PFT or spirometry test. The dates mentioned in the requisition and the echo test report are the same, i.e. 19 August 2014. Therefore, it cannot be said that a wrong date has been mentioned in the echo report."
"Further, the bill issued by the hospital on page 501 shows that the hospital has charged Rs1,100 for conducting echo test, which was conducted on 20 August 2014. The hospital has further charged Rs1,100 for another echo bedside, which was conducted on 23 August 2014. The hospital and the doctor had not produced any credible evidence to show that the Echo test was conducted on 26 August 2014 as mentioned by them. Therefore, their contention that the wrong date has been mentioned is rejected and it is clear that the ECHO report of 19 August 2014 shows LVEF as 35% is the correct one," the bench says.
In the case of whether the report of 2D colour and Doppler echocardiography is fabricated or forged, NCDRC observed that the hospital and the doctors have failed to produce any requisition or any bill to show that the said test was conducted. "Therefore, the report of 2D colour and Doppler echocardiography cannot be accepted."
The bench also noted from the perusal of the X-ray of knee and chest reports that the reports were prepared on 21 August 2014 and 22 August 2014 while the surgery happened on 20 August 2014. Therefore, it says it is apparent that the surgery was conducted without seeing the reports and no evidence has been brought on record to substantiate the claim that the reports were shared with the surgeon prior to the operation.
Referring to an expert opinion dated 17 March 2016 from the medical board constituted by the medical superintendent of PGIMER in Chandigarh, NCDRC says the expert opinion states that the patient was a high-risk case for any major surgery and detailed pre-operative evaluation and risk stratification was required.
"It is clear that the same was not done, as no evidence of the same is on record. It is also to be noted that when the patient comes to the hospital in an emergency, she should be admitted, evaluated and managed per the hospital protocol. The version of the hospital that the patient was found to be normal when she came to the hospital in an emergency cannot be accepted because immediately after that, the patient was admitted to ICU in Sohana and ultimately died," the bench says.
Dr Anurag Sharma, in his appeal, argued that he is a cardiologist and had nothing to do with the pre-operative assessment or the surgery done on Ms Kaur, and he should not be held liable.
However, NCDRC observed that the patient had LVEF of 35%, a cardiac risk. "Further, when after surgery, the patient's condition deteriorated, she was shifted to the cardiology department on 9 September 2014 and she was discharged from there on 10 September 2014. In view of the same, as the patient was under the direct care of the cardiology department post operation for nine days, Dr Sharma cannot claim that he has no liability."
While disposing of the appeals, NCDRC directed Max Super Speciality Hospital and the three doctors to pay Rs25 lakh compensation with an interest of 8% to the family of Ms Kaur.
(First Appeal No1785 of 2019 Date: 31 May 2024)
