The Bench comprising Smt. Meena Ramanathan (Presiding Officer–Non-Judicial Member), Sri K. Ranga Rao (Judicial Member), and Sri V.V. Seshubabu (Judicial Member) found that the delay in initiating treatment contributed to the deterioration of the patient's condition and also criticized the hospital for maintaining medical records in a "shabbiest manner."

Facts

The complaint was filed by the wife, son and daughter of late N. Devender Rao, a government teacher, seeking ₹1 crore compensation for alleged medical negligence and deficiency in service by Apollo Hospitals and its doctors.

According to the complainants, Rao developed symptoms of a stroke, including slurred speech, on March 22, 2013, and was taken to Apollo Hospital, Secunderabad. Despite the emergency nature of his condition, diagnostic procedures were delayed and the family was later informed that no neurologist was available. He was thereafter shifted to Apollo Hospital, Jubilee Hills, where he was admitted and subsequently underwent haemodialysis.

The family alleged that the delay in treatment at both hospitals deprived the patient of timely stroke management during the crucial "golden hour." They further claimed that doctors failed to adequately explain the treatment being administered, did not properly disclose developments in the patient's condition, and obtained consent without providing complete information.

Although the patient initially showed signs of improvement, his condition later deteriorated during his prolonged hospitalization. The complainants alleged inadequate monitoring, understaffing and lapses in care. Rao eventually died on October 19, 2013, after several months of treatment.

Hospital's Defence

Apollo Hospitals denied all allegations of negligence, contending that the patient suffered from multiple serious pre-existing conditions, including chronic kidney disease, diabetes, hypertension, coronary artery disease and a previous stroke. The hospital maintained that thrombolysis was not administered due to medical contraindications and that treatment was provided by a multidisciplinary team in accordance with accepted medical standards. It further argued that the patient's subsequent complications and death were attributable to his underlying illnesses and relied on the Andhra Pradesh Medical Council's finding that no negligence had been established against the treating doctors.

Commission's Observations

The Commission found serious deficiencies in the hospital's treatment records and noted that Apollo Hospitals failed to produce complete emergency records from its Secunderabad branch, where the patient was first taken. It observed that no documentary evidence had been produced to show what treatment was administered during the crucial period immediately after the onset of stroke symptoms and held that the hospital had withheld the "best available evidence." The Commission further noted that crucial documents, including original treatment records and master charts, were not placed before it, while the records produced contained inconsistencies, overwriting and discrepancies regarding dates and timings.

Referring to the medical evidence, the Commission noted that the patient developed stroke symptoms at around 1:30 PM, but the first medication was administered only at 7:13 PM. Emphasising that timely intervention is crucial in acute ischemic stroke cases, it held that the hospital had failed to provide treatment during the critical "golden hour" period, resulting in deterioration of the patient's condition.

The Bench rejected Apollo Hospitals' contention that thrombolysis could not be administered because of the patient's comorbidities, observing that such justification did not find place in the contemporaneous medical records. It further remarked that the hospital's maintenance of medical records was wholly unsatisfactory and not expected from an institution claiming international accreditation standards. Accordingly, the Commission concluded that the delay in treatment constituted medical negligence.

Decision

Holding Opposite Party No.1 (Apollo Hospital) vicariously liable for the acts and omissions of the other opposite parties, the Commission partly allowed the complaint with costs of ₹25,000. It directed the hospital to pay ₹40,11,876 towards medical negligence, ₹1,00,000 towards loss of estate, ₹50,000 to the first complainant (wife) and ₹25,000 each to complainants 2 and 3 towards loss of consortium and paternal affection, and ₹1,00,000 as compensation for shabby maintenance of medical records.

The Commission directed that the amounts be paid within 30 days from the date of receipt of the order. In the event of default, the amounts awarded towards medical negligence, loss of estate and compensation for shabby maintenance of records would carry interest at 9% per annum from the date of default until realization.

The Commission further directed that, out of the compensation awarded towards medical negligence, loss of estate, compensation for shabby maintenance of records and costs, 50% shall be payable to the first complainant and 25% each to complainants 2 and 3. The complaint was accordingly partly allowed.

Case Title: Chandrakala & Ors. v. Apollo Hospital Enterprises Ltd. & Ors.

Case No.: C.C. No. 116 of 2015

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