According to NCDRC ruling, Hyderabad-based NIMS and two of its doctors showed deficiency in medical service leading to death of a patient in 2000

National Consumer Disputes Redressal Commission (NCDRC) has hauled up Hyderabad-based Nizam's Institute of Medical Sciences (NIMS) and two of its doctors for lapses in medical services leading to a patient’s death and directed them to pay Rs3 lakh to the victim’s family as compensation.

The victim, Vinayaka Rao, died on 16th December 2000 after he fell down in bathroom a day ago, while he was under going a treatment for acute leukaemia at NIMS. His wife N Shree Mani, along with her three children filed a case in State Consumer Dispute Redressal Commission of Andhra Pradesh against NIMS alleging the hospital and two of its doctor did not provide timely treatment to Mr Rao.

According to the petition Mr Rao was suffering from acute leukaemia. He was consulted at NIMS on 27 November 2000, where the Acute Myeloid Leukaemia was diagnosed and same day he was admitted in the hospital for treatment. On 15th December, the patient developed high fever and was prescribed medicines after check up by a doctor. After few hours, Mr Rao fell in the bathroom but there was no doctor  available at that time to treat him. According to Mrs Shree Mani, the same doctor was reached over phone, who then advised to give another tablet to Mr Rao.

Mrs Mani says that when the patient fells down, a CT scan was required as he was suffering from high fever, hence it “shows lack of reasonable and timely care.”
Defending that there was not any deviation of medical practice in treating the patient, NIMS said, “It is not uncommon for patients to remain in excellent health and suddenly deteriorate while on chemotherapy. As for sudden high fever on 15 December 2000, NIMS stated that, “The spike in fever was due to neutropenic fever. It is not a reflection of the platelet count or hemoglobin.”

Considering medical literatures showing that infection and hemorrhage are primary causes of death in patients with leukemia and fever is sensitive but non-specific sign of infection in neutropenic patients, the Andhra Pradesh Consumer Forum ruled out the case of medical negligence.  

Mrs Mani challenged the decision of state commission and appealed to the NCDRC. As she could not obtain a report from an independent medical expert, the NCDRC sent all the details of the treatment given to Mr Rao to All India Institute of Medical Science (AIMS), New Delhi for assessment.

The committee of AIIMS, in its assessment on the fall of the patient in the bathroom, stated that, “It has been established from the record that the patient had a fall on the 15th day of his treatment, but the details of the fall, injury sustained if any, clinical condition post fall and CT scan are not available. There is a mention of altered sensoriumon on 16th day that may be a part of Intra Cranial event (which may be a neurological manifestation) or Neutropenic shock because of infection.”

The victim’s wife personally argued that there was no treatment record for 15th December 200. The next entry was made on 16th December. The NCDRC said, “This explains why AIIMS have observed in their report that no record of clinical condition of the patient from the afternoon of 15th December till the morning of 16th December is available”

The Commission also noted that “the observation of the expert committee that in the absence of record of the clinical condition of the patient from 15th December afternoon to 16th morning, they (AIIMS) were not in a position to comment whether there was medical negligence or not.”

Considering the observations of the AIIMS expert committee and the records of treatment on 15th December where the hospital decided not to discharge the patient, NCRDC stated that NIMS committed two serious lapses. “While the condition of the patient warranted assessment of the effect of fall in the bathroom (whether by CT scan or any other investigation) it was not done,” the Commission noted.

In its final order, the NCRDC said, “What compounds these two lapses is that the patient was running high temperature. In fact, it was serious enough for the NIMS and the doctors to postpone his discharge fixed for 15 December 2000. Secondly, as per their own evidence, NIMS knew that sudden deterioration in the condition of the patient was a strong possibility. Thirdly, the doctor knew about high fever and had been telephonically informed about the fall. In our considered view, these lapses amount to deficiency of service, within the meaning of Section 2(1) (g) of the Consumer Protection Act 1986.”

The Commission ordered that the allegation of deficiency of service is upheld and lump sum compensation of Rs3 lakh should be given to Mr Rao’s widow and his children, with an interest at 7% from the date of the complaint, within a period of three months.