St. Stephan Hospital vs Siya Ram Sagar

THIS First Appeal has been filed by St. Stephan Hospital (hereinafter referred to as the ''Appellant '') being aggrieved by the order of the State Consumer Disputes Redressal Commission, Delhi (hereinafter referred to as the ''State Commission '') which had accepted the complaint of Siya Ram Sagar and others, Respondents herein and original complainants before the State Commission alleging medical negligence against the Appellant. Facts:

IN their complaint before the State Commission, Respondents had contended that Smt. Sharda (hereinafter referred to as the ''patient '') who was wife of Respondent No. l and mother of Respondent Nos. 2 and 3, and was a patient of chronic rheumatoid arthritis had developed abdominal pain and other complications in the morning of 14.10.1997 and was admitted in Appellant/Hospital for treatment. Smt. Sharda was initially admitted in the ICU but after some time she was shifted to the ward and Respondents were informed that she was out of danger. However, her condition worsened in the night but the doctors in the Appellant/Hospital examined her only the next morning and after conducting certain tests informed the Respondents that a surgery was required and since the patient was highly anaemic, blood transfusion would also be necessary. Respondents were, therefore, advised to contact the blood bank where they were informed that blood for the patient could only be supplied if Respondents arranged for donation of blood in return by three healthy donors. Respondents accordingly identified three persons with sound health as donors who donated the required units of blood. However, thereafter instead of conducting the surgery, Respondents were asked to shift the patient to Tirath Ram Shah Hospital for the surgery since the Appellant/Hospital did not have the required facilities for the same. Respondents were assured that the blood required would be sent by the Appellant/Hospital to Tirath Ram Shah Hospital. The patient was accordingly shifted to Tirath Ram Shah Hospital but despite repeated requests blood was not sent to that hospital and instead Respondents were informed by the Appellant/Hospital that blood cannot be sent outside the Appellant/Hospital. Since, doctors at Tirath Ram Shah Hospital did not want to risk any surgery without adequate arrangements for blood transfusion, her treatment was delayed and a short while later, the patient expired at a relatively young age of about 45 years. Being aggrieved and since Rs. 50,000 had been paid as fees to the hospital for patient ''s treatment, Respondents filed a complaint before the State Commission requesting that the Appellant/Hospital be directed to pay Respondents compensation of Rs. 15 lakh for medical negligence and deficiency in service which resulted in the pre-mature death of the patient and thus depriving Respondents the company and care of their wife and mother respectively, along with interest @ 24% per annum as also any other relief including litigation costs as deemed appropriate. Appellants on being served filed a rejoinder in which the allegations of medical negligence and deficiency in service were denied and it was stated that the cause of the death of the patient was chronic renal failure and not due to non-availability of blood or any other negligence as contended by Respondents. It was specifically stated that the patient had come in a very poor health condition since apart from suffering from rheumatoid arthritis for 20 years, she had bed sores, abdominal pain and low urine output. She was also dehydrated with low blood pressure. She was, therefore, admitted in the private ward and pathological investigations revealed that she was very anemic, her hemoglobin being

3 GM with mild renal impairment. She was, therefore, advised blood transfusion. Next day, repeated renal functions tests indicated that there was marked deterioration and any surgical intervention was therefore, ruled out. Thereafter, patient suffered total renal failure and there being no dialysis facilities at Appellant/Hospital, she was referred to Pushpawati Singhania Institute of Research for dialysis. However, Respondents instead took her to Tirath Ram Shah Hospital where she died. Thus, the cause of patient ''s death was because of chronic renal failure and not due to the reasons cited by Respondents. 4. The State Commission after hearing both the parties allowed the complaint by observing as follows: "Admittedly, the OPs have not controverted the fact that the clinical tests showed that the condition of the patient as critical. It is not understandable then why the patient was kept in private ward instead of ICU. Clinical tests showed low haemoglobin and were indicative of Chronic Renal Failure which required transfusion as well as service of Nephrologists on that very day itself. When there was such an urgent need to transfuse blood it was not understandable why blood was not transfused in spite of the blood having been arranged by the patient ''s family members by donation of blood by three youths. The donation cards prove the fact that the O.P.1 hospital asked for arrangement of blood for transfusion. In spite of that blood donated was not transfused. The patient was kept in the hospital for such a long time without administering proper and effective medication and by the time the patient was shifted to Tirath Ram Shah Hospital-OP 3, the condition of the patient had deteriorated to a point of no return. Had the clinical and other tests like creatinine been indicative of chronic renal failure there was no question of arranging blood by three youths for transfusion and after obtaining blood lot of time was wasted and when the condition deteriorated, the O.P-1 hospital advised the complainant to take the deceased to another hospital where there was dialysis facility. No record of Nephrologist has been produced to show that the O.P. hospital availed the services of a Nephrologist and obtained the opinion that there had been chronic renal failure on that day itself. It is also not understandable as to why the patient was referred to Pushpawati Singhania Institute, if not to Tirath Ram Shah Hospital after a lapse of ten twelve hours and that too with a promise to supply blood to the patient ''s attendants because of the internal arrangement of the hospital with regard to donors card. Even when the patient was shifted to Tirath Ram Shah Hospital the blood promised was not given to the attendants of the deceased. Instead they asked them to arrange fresh blood from some other agency.... "

The State Commission in view of the above facts concluded that the inordinate delay in not transfusing the blood in the first instance and also delay in referring the patient to a well-equipped hospital for dialysis amounted to both medical and administrative negligence and directed that a lump sum compensation of Rs. 50,000 as also Rs. 10,000 would meet the ends of justice.

BEING aggrieved by this order, the present First Appeal has been filed. Counsel for Appellant was present. None appeared on behalf of Respondents. However, since service was complete, it was decided to proceed with the caseex parte. Counsel for Appellant stated that the State Commission erred in concluding that there was medical negligence on Appellant ''s part. In fact, due care was taken to treat the patient right from the time of her admission to the Appellant/Hospital, particularly, in view of her multiple health problems which included chronic arthritis, bed sores, abdominal pain and low urine output. However, since at the time of her admission, there was only mild renal impairment, she was kept in a ward for diagnosis and treatment and not in the ICU. In fact, the renal failure occurred only the next day and she was immediately advised to undergo dialysis in another institution which had the required facilities. It was further explained that the patient being highly anaemic, blood transfusion was necessary but as per the policy guidelines of NCT Government of Delhi, it was not possible for the blood to be sent by Appellant/Hospital to another hospital.

WE have heard learned Counsel for the Appellant and have carefully gone through the evidence on record. From a perusal of the case-history pertaining to the patient recorded at the time of her admission on 14.10.1997, it is evident that apart from severe rheumatoid arthritis because of which she was bed ridden, she was suffering from severe dehydration and anaemia. The case history also specifically records that she was suffering from renal failure. Thus, the contention of the Appellant/Hospital that the patient was suffering from only mild urinary impairment and that renal failure occurred next day is not factually correct. We note that despite this critical condition, the patient was not kept in the ICU but was kept in the private ward. Had she been kept in the ICU, undoubtedly she would have been duly attended to when her condition worsened during the night instead of the treatment being postponed to the next day. Apart from this, once the patient was detected with renal failure, instead of admitting heron 14.10.1997, Appellant/Hospital should have immediately referred her for dialysis instead doing so only later on the next day. We also note that a Nephrologist was present in the hospital but it is not clear whether the Nephrologist attended to the patient. We further note that since the patient had a haemoglobin count of only 4.3 which is dangerously low and blood transfusion was an immediate necessity and although blood was arranged, she was not given the necessary transfusion nor was the blood/donor card sent to the Tirath Ram Shah Hospital which could have facilitated immediate blood transfusion there. Appellant ''s contention that this is against the policy of the NCT Government of Delhi is not factually correct because a perusal of the relevant circular of the NCT Government of Delhi only states that during a meeting with representatives of the blood banks under the Chairmanship of Secretary (Health & Medical), Govt. of Delhi, it was decided that the Donor Card should be redesigned in such a way that it can be honoured by all blood banks; it did not prohibit transfusion of blood or transfer of the donor card.

WHAT constitutes medical negligence is now well-established through a catena of judgments of this Commission as also the Hon ''ble Supreme Court and essentially, the yardsticks against which medical negligence is judgedinter alia include whether the doctor in question possessed the medical skills expected of an ordinary skilled practitioner in the field at that point of time and whether the doctor adopted the practice (of clinical observation diagnosis -including diagnostic tests and treatment) in the case that would be adopted by such a doctor of ordinary skill. In the instant case, it is clear that the doctors at the Appellant/hospital were deficient in the treatment of the patient who was diagnosed with acute anaemia requiring immediate blood transfusion as also total renal failure which also required immediate dialysis. Necessary steps to deal with this critical medical situation was unduly delayed including referral to another hospital. Keeping in view these facts, we agree with the State Commission that there was both medical and administrative negligence in this case. The State Commission taking into consideration all facts including the already existing poor medical condition of the patient had awarded Rs. 50,000 as compensation along with litigation cost of Rs. 10,000 to meet the ends of justice. We see no reason to interfere with the above order of the State Commission and uphold the same in toto. The First Appeal is accordingly dismissed. First Appeal dismissed.