Lapses committed by Ophthalmology, ENT, Medicine & Cardiology Depts. made PGIMER to vicariously pay Rs.6.60 lakhs

The Patient with bad cardiac parameters was not admitted in ICU/CCU, but was referred from one OPD to another. It was held to be lapses committed by various Depts. of PGIMER and thus held to be "Institutional Negligence"  of the Hospital. 

Case Details :

PGIMER & anr. V/s. Jasmine & ors.

F.A. no.45/2012, 

Before Hon. Members : 

Dr. B.C. Gupta (Presiding.Member.) and Dr. S.M.Kantikar

Judment Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F45%2F2012&dtofhearing=2018-02-23

Facts in brief :

1. Ms. Pritpal Kaur, (since deceased) the patient, 55, suffering from eye problem was admitted in Advanced Eye Care Dept of PGIMER. She also had other health problems like fever, difficulty in breathing with pain in abdomen, backache and diarrhea.She was kept overnight. it was further alleged that even  though the patient was a known case of Restrictive Cardiomyopathy having diastolic heart failure, raised JVP with tender hepatomegaly, she was given discharged on very next day morning without referring to Cardiac emergency.

2. After 30 minutes of discharge, the patient was taken to Cardiac OPD. It was alleged that even though the patient had very low BP, the Sr. Resident Doctor, without consulting Sr. Cardiologists, only  prescribed ORS and Ciplox TZ tablets. .Next day the patient was again brought to Advanced eye care Dept, where the then Doctor referred her to ENT OPD. it was alleged that again in spite of her low BP and other bad parameters , the Doctor did not advice her to get admitted in ICU. After 2 -3 days again the patient was brought to PGIMER, but in more deteriorated condition , where she was treated by Jr. Residents and fro 24 hrs, no Cardiac assistance was made available to her.In the afternoon she was put on Ambubag and trichotomy was done. However despite of repeated requests, she was not shifted to ICU/CCU and ultimately the patient died. Hence her husband filed a consumer case against the Hospital and Doctors in State Commission. independent expert opinion was also sought for. During the pendency of the petition, the husband also died and therefore thier daughters were brought on record. The state Commision allowed the complaint and awarded Rs.6,60,000/- as compensation + Rs.10,000/- as costs to be recovered from the Hospital and Doctors. Hence the Appeal was filed.

Defense of the Hospital and Doctors :

1. They refuted all the allegations made in the Compliant. It was contended that all the Depts. did thier job well and prescribed proper medication considering the health parameters of the deceased. However in spite of all the medication, the patient's health deteriorated and ultimately due to renal failure, the ;patient succumbed to death.

2. It was also contended that the State commission gave its verdict on surmises and conjectures, ignoring the expert opinion given by Government Medical College. It was contended that every case does not require ICU/CCU admission.During hospitalization, many Senior and Junior residents were monitoring the patient.   The patient was given treatment in accordance with the standard guidelines of “Surviving Sepsis Campaign”. 

3. The complainants on thier own sought the expert opinion of one private Cardiologist, Dr. Anil Grover and it was not an authentic opinion to be relied upon. 

Held :

1. The National Commission dismissed the Appeal and upheld the decision of State commission. It is an admitted fact that the patient was suffering from Restrictive Cardiomyopathy since 1999 and same was mentioned in the medical record. 

2. The commission opined that the patient should not have been discharged who had  BP  70/50 mm of Hg and she was in Diastolic Failure, with raised JVP and tender hepatomegaly and rather should have been referred to Cardiac emergency. When on next day the patient was again brought to Cardiac OPD, in bad state, the then Sr. Resident without consulting Sr. Cardiologist simply advised her ORX and Ciplox TZ and sent her home.

3. On next day she came to Optahl. OPD from there she was referred to ENT  as there was Orbital Cellulite secondary to sinus infection. However no where her Low BP was considered and she was discharged from medical emergency. On next day also when she was brought in advanced stage, she was not given the proper cardiac treatment by Sr. Doctors and she was not shifted to ICU/CCU. Thus these lapses committed by various Depts. of PGIMER was considered as "Institutional Negligence"  of the Hospital.

4. The Commission relied upon the private expert opinion of the Cardiologist Dr. Anil Grover, who opined that there is lot of difference in examining the patient in emergency OPD/Ward and in Cardiology OPD.   Also, the examination of patient by Consultant or Junior or Senior Resident (SR) has lot of difference. The patient should have been seen by the Cardiologist.  He also opined that one does not send the patient to home, who was perceived to be “sick, septicemic” and has systolic BP of 80 mmHg with raised JVP. This important aspect was not considered by experts of GMC, Chandigarh. 

5. Thus the Doctors failed in their duty to provide reasonable care and treatment to the deceased wife of the complainant. However the National Commission held the PGIMER vicariously liable and fruther gave it the liberty to initiate internal disciplinary action and also gave it liberty to collect the compensation amount from Doctors.  

Important judgment indeed for all the Doctors. It underlines various important aspects to be kept in mind in day to day practice. Role of Jr. and Sr. residents is to be overviewd.  Its better for them to consult their Senior in such cases and to document the same.  Moreover, if the patient is with such bad parameters, shift him/her to ICU. Prevention is better than cure. Else take the expressed informed consent. 

Thanks and Regds

Adv. Rohit Erande.

Pune.©