Book reviewed by Dr. VP Singh (MD,LLB)

http://www.anilaggrawal.com/ij/vol_014_no_002/reviews/tb/page001.html

Major surgery done without ensuring availability of Life-saving equipment (ventilator) to manage complications – Medical negligence

M. Rajavadivelu v. Janamma Hospital

Date of Judgment 4.3.2013 by National Consumer Disputes Redressal Commission, New Delhi.

Facts: In his complaint to the State Commission, Appellant had contended that his late wife Mrs. Vijayalakshmi had been admitted to Respondent No.1/ Hospital on 2-1-1998 for undergoing Hysterectomy, which was done on 3-1-1998 by Respondent No.2 under general anaesthesia administered by Respondent No.3. It was informed that surgery was successful and the patient would recover within one hour.

However, at 9.45 a.m. Appellant was told by the Respondents that the Patient had developed breathing problems and would need to be shifted to the nearby Chennai Kaliappa Hosp. for ventilator support. Ambulance was sent from that Hospital. Shifting the Patient to ambulance took about 10 minutes, no doctor accompanied the Patient in the ambulance and only a nurse was present. During the transit period in ambulance Patient was again deprived of oxygen since the oxygen was not pumped to the Patient through an ambu bag. This delay proved to be fatal.

In the admission sheet of Chennai Kaliappa Hospital it was found - Patient was not conscious and the pulse rate and heart sounds were not heard. She was shifted to ICCU and connected to the ventilator with a diagnosis of Hypoxic Encephalopathy due to lack of oxygen to the brain. Tracheotomy was done on 4-1-1998. Patient shifted to Ramachandran Medical College Hosp However, Patient passed away on 3-4-1998.

It was contended that Patient expired due to medical negligence and deficiency in service. After the surgery was over when there was breathing problem, life-saving equipments like a ventilator were not available in the Respondent No.1/Hospital. If Patient had been put on a ventilator and sufficient oxygen to the brain had been ensured she would not have suffered Hypoxic Encephalopathy, which caused her death. Time taken to shift the Patient to the Chennai Kaliappa Hospital took about an hour, which proved fatal.

Order of State Commission: “There is nothing on record to show that the opposite parties had committed anything wrong in the performance of the surgery and administration of anesthesia. Opposite party-3 deposed that the patient regained consciousness after surgery and that there was no Hypoxia during surgery and there was no reintubation after surgery. Oxygen cylinder was available in the ambulance which carried the patient to Chennai Kaliappa Hospital. A well trained nurse accompanied the patient. No medical code expects that the patient must be accompanied by the surgeon and anaesthetist when she is being shifted to another hospital.

The first charge relating to negligence falls to the ground.

As regards the allegation regarding the non-pre- assessment tests before administering anaesthesia, the witness examined by the complainant viz., P.W.II expert has clearly admitted that he had no occasion to peruse the discharge summary as well as pre-assessment chart.          

There are no allegations with regard to the administration of the anaesthesia by the complainants. It is not the case of the complainants that the death occurred due to administration of anaesthesia. The patient died only after a period of three months. The expert P.W.II has not been able to give the cause for the death. His evidence is an interested one.

The opposite party-3 is a Senior Anesthetist and having rich experience for several decades. There is no legal evidence to prove the negligence on the part of the opposite parties.”

National Commission Held: It is admitted by the Respondents that soon after the surgery the Patient developed breathing problems, that there was no ventilator facility in the Respondent No.1/Hospital, which necessitated Patient being shifted to a nearby Hospital.

Had a ventilator been available and the required oxygen administered to the Patient by Respondents, she would not have suffered from Hypoxic Encephalopathy which led to her death some weeks later.

It is medically well established that Hypoxic Encephalopathy occurs when the brain does not receive enough supply of oxygen which can be fatal because as little as within 5 minutes of oxygen deprivation, brain cells can begin dying. In the instant case, Respondents have themselves admitted that they took 10 to 15 minutes to transfer the Patient to the ambulance and thereafter some more time to the Hospital, which was undoubtedly fatal in this case.

The Respondents should not have conducted a major surgery like Hysterectomy under general anaesthesia without ensuring that such life saving facilities were available in their Hospital. Further, they should have ensured that oxygen through ambu bag was available in the ambulance because a Patient with breathing problems cannot breathe the required oxygen through the oxygen tube/catheter attached to the oxygen cylinder.

Medical negligence and deficiency in service is established. Respondents are jointly and severally directed to pay the Appellant 3 lakhs within a period of 3 months, failing which it will carry interest @ 9% per annum for the period of default. 

Patient given first aid / treatment but not hospitalized – No need to maintain medical records

Shri Mahesh Prasad Aggarwal v/s M/s. Kamayani Patients Care India Ltd

The National Consumer Commission held that a doctor / hospital treating a patient or giving first aid does not have to maintain medical records of that patient if the patient is not hospitalized. 

The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 lays down that “Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment”.

Thus Hospitals or nursing homes are bound to prepare, preserve and provide medical records of only those patients who are hospitalized and none else.

In Shri Mahesh Prasad Aggarwal v/s M/s. Kamayani Patients Care India Ltd., the patient was on his way to Agra when his vehicle overturned. He was rushed to a nearby hospital where he was examined by doctors, CT scan and x-ray were done, and his hand was plastered. In the meantime the patient’s father and younger brother, a doctor having his own nursing home in Agra, arrived and the patient was taken away to his home. The family then decided to shift the patient to Delhi, but he died in the ambulance in transit.Patient’s family alleged negligence in treating and also in failure to give proper documents at discharge.

Hospital stated that the statutory provisions regarding maintaining medical records or giving documents at discharge were applicable only for indoor patients. In this case the patient was merely given first aid. It was further pointed that the patient was advised hospitalization but his family took him away.

National Consumer Commission held that the patient was never admitted in the hospital and hence the relevant regulations did not apply. The Commission held that there was nothing wrong if the hospital did not maintain record of the patient who was given first aid but never hospitalized.