Upholding an order issued by the Rajasthan state consumer disputes redressal commission, the national consumer disputes redressal commission (NCDRC) directed Jaipur-based Narayana Hridayalaya Ltd (Narayana Multispecialty Hospital), Dr Ankit Mathur and cardiac consultant Dr Anshu Kabra to pay Rs50 lakh compensation with 9% interest to a patient. In a somewhat shocking case, Jaipur-based Raghuveer Singh, who had sought medical attention for tooth extraction, ended up undergoing a total of 14 successive surgeries, administering of 42 units of blood, rupture to his heart, blood into his lungs, gangrene in the leg where the catheter was inserted, amputation of his leg up to the knee and further amputation up to the hip.
In an order last week, the NCDRC bench of Subhash Chandra (presiding member) and air vice-marshal (AVM) J Rajendra (retd) (member) says, "Even when the patient was in critical distress, Narayana Multispecialty Hospital, Dr Mathur and Dr Kabra continued with experimental procedures, instead of promptly ensuring more seeking specialised medical attention. It jeopardised his safety. Therefore, medical negligence is conspicuous even to the naked eye...Considering the facts and circumstances of the case, the compensation awarded by the state commission to the complainant is just and fair."
NCDRC also observed that in this case, Dr Mathur and Dr Kabra were found wanting on all the counts as discussed in the Supreme Court judgement in the case of Dr Laxman Balakrishna Joshi vs Dr Trimbak Bapu Godbole. "It was not even a bona fide mistake, but a therapeutic misadventure," the bench says.
On 23 March 2017, Mr Singh went to Soni Hospital for a tooth extraction. However, during the procedure, he experienced excruciating pain, leading to his admission to the hospital. After examination, the doctors recommended an angiography due to his low blood pressure and seizures. Due to urgency, his family was contacted for consent. Angiography revealed 60%, 70%, and 100% blockages in his arteries and the doctors advised stent placement. Since he came in initially seeking treatment for tooth pain, he was unable to undergo the stent procedure immediately.
Upon medical examination at Narayana Hridayalaya on 2 April 2017, Mr Singh was advised to undergo stent placement by Dr Kabra, who assured him of the Hospital's expertise in the procedure. On 3 April 2017, Mr Singh was taken to the operation theatre (OT) by the Hospital and Dr Kabra. After concluding the procedure, he regained consciousness at 4pm and complained of chest pain. This concern was communicated to Dr Kabra by his family members. In response, the doctor reassured them that pain after stent placement was normal and it would subside and Dr Kabra left the place.
As his chest pain persisted and intensified further, his family members reported to Dr Rahul, who examined him and summoned senior doctors for evaluation. Overhearing the doctors' conversation, it became apparent that Mr Singh had sustained a rupture in his heart, resulting in bleeding and blood accumulation. As it was critical, he was taken back to the OT to examine the source of pain. An incision was made in his chest to remove accumulated blood due to bleeding. However, there was continuous bleeding and attempts to stop it were unsuccessful. The doctors administered an injection for blood-thickening. After about 90 minutes, he was transferred to the intensive care unit (ICU), and the family was informed that the operation was successful.
However, at about 6pm on the same day, Mr Singh informed the medical staff that he had no sensation in his right leg. They explained to him that it was due to the placement of the stent and that the sensation would return in a while. However, an hour later, at 7pm, he again informed Dr Kabra that he could not feel his feet and requested an examination.
Dr Kabra examined Mr Singh and identified blackening where the stent was inserted. Mr Singh was administered a potent medicine to dilute the blood. However, bleeding resumed from the site of the heart puncture as well as his feet.
At 9pm, his family alerted Dr Kabra about his condition and chest pain. The doctor examined him and conveyed that Mr Singh had developed gangrene. Dr Mathur was present for a different procedure and was called in. While the severity of the situation demanded specialist consultation, this was not done. At 10pm, the family of Mr Singh was informed that he was in a critical condition, with both his right leg and heart bleeding. An urgent operation was deemed necessary to save his life.
At midnight, he underwent two operations conducted by Dr Mathur, which continued until 4am. At 7am, they informed the family that his heart was functioning normally, blood was circulating up to his knee, and a balloon-assisted procedure was used during leg surgery to stabilise his condition.
However, subsequent examination by Dr Pradeep Goyal revealed impaired blood flow below the knee. This was informed to Dr Mathur, prompting immediate action. Another operation was performed on him and Dr Mathur informed the family that blood flow remained restricted below the knee. Later, as Mr Singh's leg was significantly swollen, incisions were made on both sides of the leg to prevent it from bursting.
On 5 April 2017, due to a festering infection posing a risk of kidney failure, it was recommended that Mr Singh's leg be amputated below the knee. On 6 April 2017, the amputation procedure was carried out. The next day, Dr Kabra alerted the family to an increase in Mr Singh's creatinine levels and the need for dialysis. Dialysis commenced at 7pm for five hours.
On 13 April 2017, it was decided that blood accumulated in the lungs and necrotic muscle tissue in the leg needed to be removed. Another operation was done by Dr Mathur to amputate Mr Singh's right leg from the hip joint.
On 17 April 2017, Dr Mathur once again informed the family of blood accumulation in his chest, necessitating another surgery. It was done by Dr Mathur and Dr CP Srivastava. These extensive medical interventions, totalling 14 successive surgeries, resulted in a profound deterioration in Mr Singh's overall physical condition.
"A self-reliant person now requires to be assisted in daily tasks. His right eye vision significantly reduced, which may deteriorate further. The repeated injections have left his body significantly debilitated," Mr Singh says in his complaint before the state commission.
In their written submission, Narayana Hridayalaya and both the doctors denied any negligence in the treatment and contended that certain important facts such as bleeding and a drop in blood pressure, were not disclosed by Mr Singh before or during the treatment. They asserted that he arrived at the Hospital with only the angiography CD, and the entire sequence of events was not disclosed. They also emphasised that they cannot provide specific comments on undisclosed events.
While allowing the complaint, the state commission directed Narayana Hridayalaya to pay Rs30 lakh and Dr Mathur and Dr Kabra, Rs10 lakh each to Mr Singh with an interest at the rate of 9%pa (per annum) from the date of filing of the complaint, i.e., 18 December 2017 to the date of payment.
Aggrieved by the order of the state commission, both parties filed cross-appeals before NCDRC.
During the hearing, the bench noted that the contention pertaining to the stand of the state commission with respect to the option of open-heart surgery was an observation, based on the version of the doctors themselves that, in the given condition of the blockages of Mr Singh, open heart surgery was more appropriate and that it was Mr Singh who had sought angioplasty as against open-heart surgery.
As regards consent, NCDRC says that after Mr Singh was taken in for an angioplasty, all along, he was in a very critical state with imminent threat to his life. "Thus, the consent that was obtained was without scope for any informed deliberations and making a decision. It was rather without option to him or his relatives. As regards the allegation of medical negligence, evidently, the critical pre-operative checks to determine his suitability to undergo the surgery were not carried out. This failure was discovered after the completion of angiography when continuous bleeding was noticed from the leg where the catheter was inserted. Only then it was discovered that he was suffering from peripheral vascular disease (PVD), and further complications emerged as a sequel."
"In addition to the insertion of the catheter from the leg to the patient suffering PVD, the negligence is also conspicuous as this procedure further resulted in rupturing his heart, profuse bleeding, accumulation of blood in lungs, loss of sensation to his leg and infection. Ultimately, this led to gangrene, 14 surgeries and amputation of his right leg first to the knee and thereafter up to the hip," the bench of Mr Chandra and AVM (retd) Mr Rajendra noted.
While dismissing both the appeals, NCDRC says, the compensation awarded to Mr Singh by the state commission is just and fair and, therefore, is affirmed.
(First Appeal Nos1778/1827 of 2019 Date: 17 November 2023)