NCDRC: Hospitals And Doctors Not At Fault If Critical Patients Cannot Be Saved Despite Appropriate Care

The National Consumer Disputes Redressal Commission (NCDRC) bench comprising Dr. S.M. Kantikar, presiding member held that unsuccessful treatment or a patient's death during surgery does not automatically imply negligence on the part of the medical professional. The NCDRC dealt with the issue of the death of an individual due to the alleged administration of ‘General Anaesthesia’ and ‘Spinal Anaesthesia’ simultaneously. While considering the challenged decision of the State Consumer Dispute Redressal Commission (Kerala), the bench was of the view that even after receiving treatment, the hospital and doctor should not be blamed if they provided appropriate care within their means and capabilities.

Brief Facts:

Mini Philip (“patient”), a 37-year-old patient underwent laparoscopic sterilization at Deen Hospital. As she was suffering from respiratory problems, the surgery took longer than usual. The patient was later transferred to Poyanil Hospital and then to Ananthapuri Hospital, where she passed away the next day. The legal representatives (“Complainants”) filed a complaint in the Kerala Consumer Disputes Redressal Commission (“State Commission”), wherein the State Commission partially allowed the complaint and directed the hospital and doctors to jointly and severally pay Rs. 7 lakhs as compensation to the Complainant, along with a cost of Rs. 10,000. Two of the doctors, who just assisted with the surgery, were held to be not liable. Aggrieved by the order, the Complainant filed an appeal seeking an enhancement of compensation whereas, the hospital and the doctors who performed the surgery filed a separate appeal against the decision of the State Commission.

The Complainants argued that both General Anaesthesia and Spinal Anaesthesia were administered simultaneously, leading to the patient's death. Negligence was attributed to the doctors, who performed the surgery. The Complainants further submitted that brain hypoxia and ARDS occurred due to spinal canal injuries caused by an unqualified doctor. Additionally, the hospital lacked accreditation for the laparoscopic sterilization of females, raising concerns about their competence. The Complainant also noted the surgery was completely unnecessary considering the patient's track record of respiratory distress.

The hospital and the doctors provided a written response stating that the patient received careful management and was promptly transferred to a higher centre. They claimed that all necessary measures were taken in the patient's best interest. The patient and her husband were informed about the sterilization procedure, including its advantages, disadvantages, and anaesthesia risks. The patient underwent the operation at 5:30 pm under general anaesthesia, with thiopentone administered. When the laparoscopic surgery was performed, the patient's condition remained stable with satisfactory oxygen levels. However, after extubation, the patient experienced breathlessness and required immediate reintubation and positive pressure ventilation. The patient developed pulmonary oedema, which was treated with a Lasix injection. The doctors resuscitated the patient, and additional measures like bronchodilators, corticosteroids, and endotracheal suction were performed. Despite these efforts, the patient's oxygen levels remained low. Due to persistent pulmonary oedema, a decision was made to transfer the patient to Poyanil Hospital for ventilator support. On September 26, 2006, the patient was shifted to Ananthapuri Hospital but passed away the same evening.

Observations by the Commission:

The main issue for the commission to decide was whether the patient received general anaesthesia and/or spinal anaesthesia and whether the cause of death was related to spinal anaesthesia.

The NCDRC while referring to the evidence available observed that the doctor did not administer spinal anesthesia to the patient. It was observed that the injection mark itself cannot conclusively establish whether it was for diagnostic or therapeutic purposes. Additionally, Cerebrospinal Fluid (CSF) was not collected for analysis during the post-mortem to determine the nature of the injection given to the patient. The chemical analysis did not reveal the presence of any drugs or poisons. Therefore, the possibility of spinal anaesthesia was ruled out by the NCDRC. Combined administration of general anaesthesia and spinal anaesthesia was also ruled out as the cause of death.

The NCDRC further assessed the qualification of the doctor who administered anaesthesia to the patient. It was clear from the evidence that the doctor had completed a one-year exclusive senior house residency in anaesthesia at a government hospital and had over 25 years of experience in the field. Therefore, in the opinion of the NCDRC, he was competent to administer anaesthesia for minor procedures. 

Moreover, reliance was placed on the Supreme Court case of Jacob Mathew v. State of Punjab (2005) 6 SCC 1, wherein it was held that unsuccessful treatment or a patient's death during surgery does not automatically imply negligence on the part of the medical professional. Thus, the NCDRC was of the view that not every patient's death can be automatically considered medical negligence unless there is evidence to suggest so. Additionally, the NCDRC also referred the Bombay Hospital and Research Medical Centre vs. Asha Jaiswal & Ors 2021 SCC OnLine SC 1149, wherein the Supreme Court stated that if a patient was in critical condition and could not survive even after receiving treatment, the hospital and doctor should not be blamed if they provided appropriate care within their means and capabilities. 

Conclusively, the NCDRC observed that the doctors effectively managed complications and performed resuscitation after the surgery. The patient was timely referred to Poyanil Hospital for ventilator support. Therefore, negligence cannot be attributed to any of the doctors. The appeal filed by the hospital and the doctors was allowed, and the appeal filed by the complainant was dismissed.

Case: Deen Hospital & 2 Ors. Vs Philips Thomas & 4 Ors.

Case No.: FA/662/2013

Counsel for the Petitioner(s): Mr Raghenth Basant

Counsel for the Respondent(s): M/S. Advocates and Solicitors

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