Chandigarh: Medical Negligence Case

Upholding the decision of the state commission, the National Consumer Disputes Redressal Commission held PGIMER guilty for medical negligence, directing it to pay Rs 6.6 lakh to the family of a deceased patient.

Case Details

The case is that of a 55-year-old patient, since deceased (hereinafter referred to as ‘the patient’), a known case of Restrictive Cardiomyopathy having diastolic heart failure, raised JVP with tender hepatomegaly. The patient was admitted to the emergency of Advance Eye Care Centre in Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh with eye problems and other health issues, like fever, difficulty in breathing with pain in abdomen, backache, and diarrhea. The on-duty resident doctor treated her and kept her overnight. At about 10:00 a.m. on 24.1.2008, even though the patient’s condition had not improved, she was discharged from the Eye Centre with advice to take antibiotics. Her BP was 70/50 mm of Hg. The complainant alleged that the patient, instead of being discharged, should have been referred to Cardiac emergency.

On the same day at 10:30 a.m., the complainant took his wife to Medical OPD at PGI, who referred her to Cardiac OPD. The Senior Resident (SR), Dr. Ashish/OP-2 at Cardiac OPD examined her and prescribed her ORS and Ciplox TZ tablets. However, Dr. Ashish/OP-2 did not consult any senior Cardiologist; he ignored the extremely low BP and serious condition of the patient. The complainant took her back home but again, the next day, he brought her to Advanced Eye Centre for further check-up. Dr. Usha Singh examined her and advised her to take ENT consultation. Accordingly, the patient visited ENT OPD. As per the complainant, despite her sick condition and diastolic failure with low BP, the doctor did not advise the patient to get admitted to the hospital. The doctors failed to realize the seriousness and did not admit her either in ICU or CCU; but sent her home without proper advice.

Thereafter, on 30.1.2008, the complainant took the patient to PGI in a more deteriorated condition. She was treated in the medical emergency ward by junior doctors. The complainant added that for 24 hours, no doctor either from cardiology or medicine attended her. At 4:30 p.m., due to her critical condition, one tube was inserted in her trachea and she was put on Ambubag. The complainant had made several requests to the doctors to shift the patient to ICU/CCU, but till her death, she was not shifted to ICU; ultimately, the patient died on 3.2.2008. It was alleged that the death was due to medical negligence and deficiency in service on the part of doctors at OP/PGI.

State Commission's Decision

In response to the complaint with the state commission, the hospital responded that there was no negligence on the part of the doctors. The state commission, after going through submissions, held the hospital guilty and directed the PGI to pay a total amount of Rs.6,60,000/- along with litigation costs of Rs.10,000/- to the complainant.

PGIMER's Appeal to NCDRC

This decision was challenged by PGIMER, which approached NCDRC stating that the State Commission proceeded on surmises and conjectures, ignoring the expert opinion given by Government Medical College. There was no evidence to prove that the patient was required to be shifted to ICU or CCU. The patient was under treatment of a team of expert doctors. Moreover, the Medical emergency ward was perfectly well equipped to deal with such emergency situations. Every case does not require ICU or CCU admission. The patient’s death was due to her deteriorated health condition because of Acute Renal Failure. During hospitalization, many Senior and Junior residents were monitoring the patient. The patient was given treatment in accordance with the standard guidelines of “Surviving Sepsis Campaign”. The counsel further submitted that, without any direction from State Commission, the complainant had produced an expert opinion from a private Cardiologist i.e. Dr. Anil Grover; the opinion is not authentic.

The State Commission erroneously accepted the opinion from the independent doctor, whereas rejected the expert opinion submitted by the Government Hospital, Chandigarh.

Expert Opinions

During the proceedings, the State Commission had sought an expert opinion from the Government Medical College and Hospital, Chandigarh. The Committee of Medical Experts headed by Dr. Atul Sachdev opined that the treatment given on 24.1.2008 was correct and the use of antibiotics for the deceased's eye infection was proper. The Committee also endorsed the fact that there was no worsening of the patient’s Restrictive Cardiomyopathy. The advice of ORS and antibiotic (Ciplox TZ) was correct for the management of dehydration of the deceased patient. Per contra to the aforesaid expert opinion, the complainant on his own, without seeking any direction from State Commission, had produced another opinion from Dr. Anil Grover. According to the PGI council, the State Commission ignored the reliable expert opinion from the Government Institute but accepted the entire opinion of a private expert.

NCDRC, after going through the submissions, held PGIMER guilty of negligence.

NCDRC's Observations

It is amply clear that there were many lapses on the part of treating doctors in various departments at PGI, namely, Ophthalmology, ENT, Medicine, and Cardiology. It was institutional negligence. Therefore, we hold the institute vicariously liable for the acts of their doctors. It was not a standard of care to the emergency patient. Considering the patient’s deteriorated health condition, hospitalization was needed, but she was discharged and was subjected to OPD follow-up, which is not justified in the instant case.

Expert Opinions on Record

On the issue of the expert opinions which are on the record filed by both parties, the court stated:

• The complainant had filed an opinion of Dr. Anil Grover, a Private Consultant, Cardiologist. According to him, there was a deficiency in service during the treatment of the patient. He opined that the Ophthalmologist at Advanced Eye Centre, after treating the eye complaint, had properly advised the patient to take follow-up in Medical/Cardiac emergency. According to Dr. Grover, there is a lot of difference in examining the patient in emergency OPD/Ward and in Cardiology OPD. Also, the examination of the patient by Consultant or Junior or Senior Resident (SR) has a lot of difference. The SR from internal medicine, after seeing the patient in emergency, can admit the patient under the Cardiology department. Under such circumstances, the patient was not seen by any Consultant or Cardiology for detailed examination. Even there were no verbal instructions to the SR about the treatment aspects. Thus, it was the fundamental mistake amounting to criminal negligence. Dr. Grover also submitted that one does not send the patient home, who was perceived to be “sick, septicemic” and has systolic BP of 80 mmHg with raised JVP.
• The opinion from Government Hospital, Chandigarh had not commented about the need for hospitalization of the patient, who was very sick; whereas Dr. Anil Grover clearly opined that the patient’s condition was very sick and she was in diastolic failure, her admission in the hospital was necessary. Moreover, the OP/hospital and doctors have not clarified as to why the patient was not admitted in ICU or CCU despite knowing that her BP was persistently low. The OP/Hospital also has not clarified whether the ICU beds were available or not? The patient was discharged and sent home twice in sick condition, which further caused deterioration of her health. It is transpired from the medical record that on 30.1.2008, even after admission in the emergency OPD ward, the patient was not attended by any senior doctor or consultant for more than 24 hours. Therefore, we agree with the well-reasoned opinion given by Dr. Anil Grover. It is justified.

NCDRC's Final Decision

Based on the above observations, NCDRC upheld the decision of the state commission with the following modifications:

The allegations of medical negligence leveled in the consumer complaint, thus, stand proved. In so far as the award of compensation is concerned, the State Commission directed the Institute as well as the two doctors, arrayed as parties in the consumer complaint, to pay the compensation of Rs.6,60,000/- along with other compensation to the complainant. We, however, deem it appropriate to modify the said order and direct that since the OP/PGI is vicariously liable for the negligence of their doctors, the OP, PGI shall pay the amount awarded to the complainant in the first instance. However, the OP, PGI shall be at liberty to conduct their internal disciplinary proceedings in the matter in order to fix responsibility for the lapse and then to recover the amount from the erring doctors, if considered appropriate.