The National Consumer Disputes Redressal Commission (NCDRC) has held a hospital and two doctors in Ludhiana responsible for not taking timely necessary action regarding the deteriorating condition of a woman after her treatment. The Commission has ordered a total compensation of Rs 15 lakh to the hospital and both the doctors.
The matter pertains to the treatment and post-operation care of 36-year-old Kiran Bala. The Commission said that the hospital system should have ensured the consultation of MRI and neuro specialist soon after the woman's condition deteriorated. The Commission considered this to be a lack of promptness on the part of the hospital and the expert team treating it. Also there was some lack of transparency and clarity in the doctors' notes.
This decision was given by the bench of NCDRC Chairman Justice APS Sahi and member Bharat Kumar Pandya on August 4. The complaint was filed by Deepak Bansal and his wife Kiran Bala against Satguru Pratap Singh Apollo Hospitals, Ludhiana and three doctors.
What is the whole matter?
This case started from 17 September 2011. Kiran Bala complained of abnormal discharge of fluid from the nose. After this he was admitted to Ludhiana hospital. After investigation, endoscopic repair was done to treat his problem of CSF rhinorrhoea. CSF rhinorrhoea is a condition in which cerebrospinal fluid (CSF) that surrounds the brain and spinal cord starts leaking out of the nose.
Later, when fluid started leaking again, a lumbar drain was placed in his lower back to aid in treatment. After this, Kiran Bala started feeling increasing pain, numbness and weakness in both the legs.
Problems increased after lumbar drain
The Commission especially looked into the situation in the hours after the lumbar drain was installed. In the recovery note prepared on September 23 at around 5.30 pm, problems in both legs were recorded. According to records, this problem was already present before the procedure. In this record, instructions from Dr. Gaurav to give information to Dr. Deependra were also recorded.
On behalf of the hospital, it was said that Dr. Deependra Singh had arrived to see the patient at around 9 pm. But the Commission found that there was no clear mention of his alleged visit, his advice, any treatment or any investigation in the medical records.
The condition worsened the next day…
On the morning of 24 September, Kiran Bala had numbness and weakness in both her legs. Asked to undergo MRI at around 10 o'clock. The MRI was done around 1 pm and its report was received around 4.30 pm. The MRI report showed signs of spinal thoracic cord myelitis and arachnoid enhancement.
After this, it was recorded in the hospital records that the weakness of his legs increased and the condition reached complete paralysis i.e. paraplegia. Along with this, problems related to bladder and intestines also came to light.
What did NCDRC consider a deficiency?
The Commission looked at the process of placing a lumbar drain and the subsequent care of the patient separately. The Commission found no evidence to prove that the lumbar drain was incorrectly placed or that there was any deviation from the prescribed treatment protocol during the procedure. The commission also found no deficiencies in the first CSF repair surgery.
But the commission said that the patient's complaint of repeated pain and increasing numbness after the procedure should have been taken seriously. After these signs, expert advice and necessary tests should have been done immediately.
The commission also noted that by the morning of September 24, the motor power of the woman's legs was reduced to 1/5. In such a situation, the treating surgeon and anesthetist should have ensured that the resident doctor and nursing staff taking care of the patient at night could recognize signs like loss of sensation and seek specialist advice immediately.
Which doctors were held responsible?
NCDRC held Satguru Pratap Singh Apollo Hospitals, Dr. M. Deependra Singh and Dr. Gaurav Kuthiala responsible. However, the commission also clarified in its decision that it did not find any direct medical negligence in the method of treatment adopted during the procedure or when the treatment was actually given.
According to the commission, responsibility lay in the fact that the hospital did not adequately prepare the patient care team to respond quickly to symptoms such as persistent pain and numbness after the placement of a back drain.
How much compensation was demanded?
The complainants had demanded a compensation of Rs 2 crore in this case. However, the Commission considered this demand excessive. The Commission said that the material on record does not establish sufficient connection between the amount demanded and the financial loss, mental anguish or stress. After this the Commission ordered a lump sum compensation of total Rs 15 lakh.
Who will have to pay how much?
- The hospital will pay 90 percent of the total compensation.
- Dr. Deependra Singh will give 5 percent amount.
- Collector Gaurav Kuthiyala will give 5 percent amount.
- The hospital will also have to pay Rs 25,000 as litigation costs.
6 percent annual interest will also have to be paid on the compensation amount from the date of filing of complaint till payment. The order will have to be followed by October 4. If the amount is not paid by this date, then after October 4, the interest rate on the outstanding amount will increase to 9 percent.