Putting a brain-dead patient on ventilator, costed Rs.5 lakhs to the Doctor and Hospital.

A case emphasising importance of Informed Consent and proper documentation. *Men may lie, but documents won't*..

Case Details :

Shashikant Sharma & anr. V/s.Dr. Manohar Lal Sindhwani  and Batra Hospital & Medical Research Centre, New Delhi & ors.

Complaint No. 178/2006, decided on 08/06/2018, by Hon. State Commission, Delhi. 

Judgement Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=8%2F0%2FCC-178%2F2006&dtofhearing=2018-06-08

Facts in Short :

1. The Complainants, bereaved parents of the deceased Master Prashant Mudgal who was aged about 14, filed the present Complaint against the Opponents for Claiming Rs.75 lakhs compensation for causing death of thier 14 years son.

2. The case is of 2006. On 19/04/2006, when the deceased-patient went to Dr. sindhwani, he was suffering from enteric fever/ typhoid of high grade/ pneumonia and he was advised to get admitted in the said Hospital. The patient on his own went upstairs. However after 2-3 days, it was diagnosed as a case of jaundice alongwith enteric fever. His developed aggressiveness was also associated with Jaundice.

3. On 24/04/2008, the patient had to be shifted on Ventilator and there were lot of grievances about patient putting on Ventilator. 

a) It was alleged that at the outset there was no consent taken for putting the child on ventilator. 

b)The Tube of the ventilator was wrongly inserted into the food pipe and the child was not properly attended by the Sr. Doctors. The cholroquin was wrongly administered as it could only be given in extreme circumstances after definitive diagnosis of malaria.

c) There was no CT Scan conducted before putting the child on ventilator. 

d) The Child was declared as brian dead by the opponent No.1 Doctor, who was not the empanelled Doctor having authority to declare, on the contrary the Opponent no.1 was not even the practising Doctor, but just a Blood Bank Incharge in Jammu.. All the reports were alright till 24/04/2008.

e) The patient who was brain dead on 26/04/2008, was declared so on 28/05/2008, which criminally increased the Hospital bill and when there were 

On these banground the case was filed for claiming Rs. 75 Lakhs.

4. Defense of Doctors. :

a. The Doctors vehemently opposed the Compliant and refuted all the allegations. 

b.) The child had taken treatment at home without any investigations.on 24.04.2006, the condition of the patient worsened further.  Patient became more agitated and restless.  After discussion with the relatives it was decided to put the patient on ventilator.  He was shifted to MICU-I where patient was intubated and ventilated at 11.00 am.  

c)Intubation was smooth and patient’s vitals were stable, saturation well maintained.  At 1.00 pm, arterial blood gas was done which was normal.  At 1.15 pm, patient had cardiac arrest. Immediate CPR & resuscitative measures were executed and patient revived. 

d) Since the patient was not responding to drug treatment of stage-I hepatic encephalopathy, father was advised to give consent for electively hyperventilate and paralyze by incubating so that raised intra-cranial tension could be brought down.

e)With the intervention of senior consultant and Physician Dr. Arun Dewan, relatives of the patient agreed for elective intubation which was carried out by a team of critical care specialist Dr. Jha

Expert Opinion from AIIMS was also sought, which agreed to the treatment being given.

f)The rapid down hill course of the patient on 24/04/2008  was because of all bad prognostic features of fulminent  hepatic failure

Held :

1. The Commission sought the expert opinion from Dr. Ram Manohar Lohia Hopital, New Delhi, which after going through all the records opined that the patient was appropriately managed.

2. The contentions of the Complainant  regarding   adverse effect  of cholroquin when given to a patient suffering from hepatitis, were turned down for want of any medical evidence/opinion.

3. However the Commission agreed to the contentions of the Complainant that the opponents were not at all justified in sustaining artificially the patient on ventilator from 26.04.2006 till 28.05.2006 when the patient was declared brain dead.    

4.After perusing the record the Commission observed lastly that the record shows that the Doctors never informed the relatives of the patient that the patient was ‘brain dead’ on 26.04.2006.  They were never explained the role of ventilator in the case of a patient who is ‘brain dead’, when  the patient was found ‘brain dead’ by several doctors including the neurologists on several occasions.  Relatives of the patient did not consent to putting the patient on ventilator.  It was on the intervention of a senior doctor named Dr. Jha when the patient was put on ventilator.  Even at this juncture, no ‘consent’ or ‘informed consent’ was taken in writing from the relatives.

5. The Commission held the Opponents are deficient in service and further directed them to pay a sum of Rs.5 lakhs plus interest @7% interest p.a. till its actual realisation to the Complainant. 

The Case is very important. It's the common allegations which are being made at Doctors and Hospitals that by the patients that "we don't know what happens inside ICU/CCU and we don't either understand what happens inside, we have trust in Doctors." This case will put up questions on the integrity of the other Doctors too.. Certainly its wrong to measure all the Doctors in one scale It is said that men can lie but not the documents and exactly this happened in the case in hand, thus a lesson to be learnt by the Doctors.

thanks and regards

Adv. Rohit Erande

Pune.  ©