While rejecting the complainant's claim of medical negligence, the national consumer disputes redressal commission (NCDRC) directed Delhi-based Max Super Specialty Hospital to pay Rs1 lakh compensation to the patient for administrative lapses.
In an order, Dr SM Kantikar (presiding member) of NCDRC says, "...the findings of directorate general of health services (DGHS) on the administrative lapses of the Hospital can not be ignored. The Hospital is liable to that limited extent of administrative lapses. The Hospital is strictly cautioned and directed to take necessary steps for systemic improvement. The complainant has not produced detailed calculation of alleged excessive changes, therefore in the ends of justice, lump sum amount of Rs1 lakh will be just and reasonable compensation in the instant case."
"In the instant case, I find the standard medical protocol being followed by the three doctors to the best of their skill and with competence at their command. Thus, it is clear that out of '4 Ds', the complainant has proved only the 'duty' of the Hospital and doctors but failed to prove the other ingredients of medical negligence, i.e. dereliction or breach in duty of care and the direct or proximate cause (causa causens)," the bench says.
Medical negligence is discussed in catena of judgements from the Supreme Court and worldwide. In the cases of medical negligence, to bring a successful claim, the victim or victim's family bringing the action must prove the ‘four D's’ against the erring doctor or hospital. The 4 D's of medical negligence stand for 'duty', 'dereliction or deviation', 'direct (proximate) cause' and 'damages'.
In the instant case, Dr Kantikar says, the principle of 'res ipsa loquitur' would not be applicable, considering the medical record. "The complainant has made several allegations on the presumptions. The complaint runs in 48 pages, whereas the brief Written Submissions runs in 37 pages with 39 issues. In my view, mere averments or allegations cannot be taken as a gospel truth. The complainant has not produced cogent evidence to prove his case."
Delhi-based Mohit Jain had filed the complaint alleging medical negligence in his treatment by the Hospital and Dr Sanjeev Kumar, haematologist Dr Rahul Nethani and Dr Mansi Sachdev. In April 2015, he was admitted to Max Super Specialty Hospital and paid Rs16 lakh for his medical treatment.
In his complaint, he alleged that the discharge report was incorrect in facts, vague and misleading. It was sub-standard, which lacks crucial details, and did not give a clear and accurate progression of the patient's condition and treatment. For a long time, he says, he was under the follow-up of a neurologist—Dr Amit Batra, at the Hospital, who put him on anti-epileptic drugs for six months and medication for anxiety regularly, which he was consuming even while filing his complaint with the NCDRC.
In June 2015, he approached the chief minister (CM), deputy CM and health minister of Delhi. He also approached various government authorities like DHS and Delhi Medical Council (DMC). He further alleged that the Hospital and doctors did not cooperate with the government authorities and had not filed medical records.
During the hearing before NCDRC, Max Super Specialty Hospital submitted that the immune thrombocytopenic purpura (TTP) diagnosis was made on 20 April 2015. "The duration of treatment for such patient depends upon the condition of the patient. Initially, five-six sessions of PEX were planned but since the platelet count was gradually increasing, the treatment plan was revised and 12 PEX sessions were carried out as lifesaving measure. Mr Jain was treated with standard protocol. He was discharged in good condition on 4 May 2015. Mr Jain himself acknowledged that he did not suffer repeat episodes."
Further, the Hospital submitted that the DMC observed that the diagnosis seems to have been arrived at in a reasonable period and managed the patient, and the DMC has already held that no case of medical negligence was made out.
Mr Jain submitted the email replies he obtained from three experts in haematology. However, the bench observed that Mr Jain made specific queries and did not send the entire treatment record to the experts. "The possibility of half or incomplete information was given to the experts and/or suppression of material facts cannot be ruled out. The experts have, with good intentions, replied to the emails of the complainant. In my view, such email communications are not construed as expert opinions. The experts were not called by the complainant to file affidavits or to adduce evidence. Thus, the email communications are not sufficient to hold the treating doctors for negligence or deficiency in service."
The main allegation of Mr Jain was a failure to detect the presence of schistocytes in the peripheral blood smear (PBS), which resulted in delayed diagnosis of micro-angiopathic hemolytic anaemia (MAHA) and its treatment. He contended that Dr Sachdev recorded the presence of 25 nRBC on PBS but the presence of schistocytes was totally ignored. "It was gross negligence and case of res ipsa loquitur as not following the standard operating procedures (SOP)."
Dr Kantikar from NCDRC, however, says, "It is evident from the medical record that on 20 April 2015, numerous schistocytes were seen in PBS, however, the presumption of Mr Jain that such numerous schistocytes would not have developed suddenly on 20 April 2015. In my view, Dr Naithani and Dr Sachdev have ordered PBS along with a complete blood count (CBC), from 21st to 25 April 2015 and the same was billed. In the CBC report for each of those dates, the presence of schistocytes was reported. There was no evidence that schistocytes were present in the PBS before 20 April 2015, it was an imagination or presumption of Mr Jain that Dr Kumar, Dr Naithani and Dr Sachdev failed to detect the presence of schistocytes on any date prior to 20 April 2015."
Mr Jain also alleged that when he was diagnosed with a blood problem (haematology), Dr Kumar should have immediately transferred him from medicine to haematology and it was not done in spite of his several verbal and written requests even marked as 'urgent'.
"In my view, Dr Kumar is a specialist in internal medicine, having experience and haematology is an integral part of medicine, thus he can treat the patient of idiopathic thrombocytopenic purpum (ITP). Thus, Dr Kumar was neither prohibited to treat nor it was mandatory for him to shift the instant patient to haematology. Moreover, if necessary, there was always inter-departmental consultation or referral was possible in the Hospital. Thus, Dr Kumar has adopted a reasonable approach for the patient's care," Dr Kantikar from NCDRC says.
Taking cognisance of complaints filed by Mr Jain, the directorate of health also constituted a committee of three officers. Based on factual position in the case, the committee opined that there was double billing, and Mr Jain paid the cost for the number of times for the services not provided but billed.
After carefully analysing the facts and chronology of events in the case, NCDRC observed that Dr Kumar, Dr Naithani and Dr Sachdev are subject specialists with experience. "During the hospitalisation, based on symptoms and signs, the patient was investigated and treated the patient as per the standard of reasonable practice. On 20 April 2015, at the first time the diagnosis of TTP was made from the PBS and treatment with PEX was started. In my view, it was mere assumption of Mr Jain that before 20 April 2015, Dr Sachdev failed to detect schistocytes in PBS. Mr Jain showed recovery after PEX and was discharged on 13 April 2015. As discussed above there was no delay in diagnosis and treatment of TTP."
"It is an admitted fact that, prior to starting PEX, the patient's HIV and hepatitis-B & C viral markers were not done. It was an act of omission from the Hospital and the doctors. However, because of such omission, Mr Jain did not suffer any injury or loss; but in fact, the PEX Therapy was beneficial. Therefore, the Hospital and doctors are not liable (for) this act of omission," Dr Kantikar from NCDRC says.
Based on the findings of the medical council of India (MCI), DHS and various medical literatures on TTP and following the precedents of the Supreme Court, NCDRC says medical negligence is not conclusively attributable to the Hospital and the doctors. The bench, however, accepted the findings of the DGHS and asked Max Super Specialty Hospital to pay Rs1 lakh to Mr Jain as compensation within four weeks.
(Consumer Case No785 of 2017 Date: 23 March 2023)
