Delhi High Court
Ganga Ram Hospital vs D.P. Bhandari And Ors. on 23 April, 1992
Equivalent citations: 1992(24)DRJ321
JUDGMENT
(1) In the complaint filed by the complainant before the Delhi State Commission and who is respondent herein before us, he had charged the Appellant. Sir Ganga Ram Hospital authorities, and the Senior Consulting Surgeon of the Hospital Dr. T. Singh with failure to provide the patient Shri Rajesh Bhandari proper treatment. The patient eventually died on the 25th May, 1988. The failure to provide proper treatment, according to the Respondent Complainant consisted of (i) delay of 57 hours in taking a scan of his abdomen, (ii) failure to put the patient on the respirator and (iii) failure to admit him in the Icu even though the Doctors considered it essential that the patient should be kept in the ICU.
(2) The State Commission was unanimous in rejecting the allegations (i) above viz. of delay in scanning the abdomen and (ii) not providing the patient with a respirator. The State Commission, however, held that it was essential that the patient should have been transferred to the Icu for treatment and that there was failure on the part of the Hospital Authorities and Respondent No. 2, the consulting surgeon, to produce evidence from the hospital records that no bed was available in the Icu during the period of the stay of the patient in the private ward of the hospital and that the relations of the patient should have been informed immediately that a bed in the Icu could not be made available. On this basis it held the appellants responsible for the failure to shift the patient to Icu when the Doctors so considered it essential and also to inform his relatives that the admission in Icu was not possible due to non-availability of a bed. The majority of the Members of the State Commission held that only the appellant Hospital could be responsible for the above lapses and hence held the hospital liable to payment of compensation of Rs.1 lac Along with costs of Rs. 2000.00 to the complainant. The minority Order of the President of the State Commission held both the Hospital and Dr. T. Singh, Consulting Surgeon, to be responsible and therefore, directed that the complainant should be paid a total compensation of Rs.1 lac of which Rs.80,000.00 is to be contributed by the Hospital Authorities and Rs. 20,000.00 by the Consulting Surgeon, Dr. T. Singh; the costs have also to be shared; Rs. 1600.00 is payable by the Hospital and Rs. 400.00 by the Consulting Surgeon. These Orders of the State Commission were passed on 7.6.1991.
(3) The Appellant Hospital has, in its appeal, challenged the findings of the State Commission and submitted that there has been no lapse, deficiency or negligence on its part and hence it was not liable to pay compensation and costs to the Respondent Complainant.
(4) We have heard the Appellant and the respondents and perused the record. Our findings on these various lapses alleged to have been committed in the treatment of Shri Rajesh Bhandari are briefly set out below.
(5) Before dealing with the specific question of negligence, if any, in this case, we would like to say that, generally speaking, medical professionals are expected to exercise and provide reasonable degree of skill and knowledge and also exercise reasonable degree of care in treating patients.
(6) In the counter to the appeal there is no attack on the professional qualifications, knowledge and expertise of the Doctors who had attended on the patient. There is also no suggestion that they did not correctly diagnoses the patient's diseases or that there was any negligence in treating the patient or in prescribing the proper course of treatment.
(7) The first allegation against the Doctors and the Hospital Authorities is that there was a delay of 36 hours in undertaking scanning of the abdomen of the patient. The State Commission in its Order has not accepted this allegation. The patient was in a serious condition, perhaps in a critical condition, when he was brought to the Hospital and according to them his condition was not sufficiently stable and he was not in a fit state to undergo scanning which would have lasted for about 40 minutes. That he was in a serious condition was already established by the fact that he patient was brought to the appellant hospital (Sir Ganga Ram Hospital) after he was discharged from the Kapoor Hospital on 22nd May, 1988 on the ground that he was suffering from a serious ailment and that therefore, he should be removed to some other hospital having better facilities.
(8) The attending Doctors have also explained that the C.T. Scan was required only for the purpose of confirming that the diagnosis made clinically of Pancreatitis, the extent of disease etc. was correct and to detect the presence of complications if any.
(9) It may be noted that the discharge report of the Kapoor Hospital has not been filed for reasons not known. According to Sir Ganga Ram Hospital's record, at the time of admission in the hospital (Page 80 of the paperbook) "he was diagnosised in the (Kapoor Hospital) as a case of dehydration...." But the Ganga Ram Hospital clinically diagnosised it as a possible case of acute Pancreatitions. This diagnosis was eventually confirmed by the Senior Consulting Surgeon. The State Commission came to the finding"....the disease of the deceased progressed, very rapidly and the same took the fulminate course. All along the treatment of the disease was carefully planned but the operation was not performed on account of the well considered deliberate decision based on the present day accepted medical opinion as well as experience. There was no negligence on the part of the defendant No.2 (Respondent No.2, Senior Consulting Surgeon) or the Hospital.
(10) The State Commission has also rejected the second allegation that the patient was not put on the artificial respirator keeping in view that he was gasping for breath. According to the finding of the State Commission which has remained unchallenged, the patient was being given cent per cent oxygen and therefore, the Doctors did not find it necessary to use a respirator in this case. According to the finding of the State Commission "no evidence has been brought on the record by the complainants that the statement of Dr. T. Singh (Senior Consulting Surgeon) is incorrect and that providing cent per cent oxygen to the patient was not sufficient." Therefore, they did not find any merit in the contention of the Respondent complainant and rejected the charge.
(11) Here it would be relevant to reproduce the finding of the State Commission about the treatment of the patient. "THE facts of the case have already been given in detail. The disease in this case had taken a fulminate course. The course adopted by Dr. Singh for treatment of the disease is fully supported by the wellknown treatises, quotations from which have been reproduced above. He is a highly qualified person and is an eminent surgeon. In the circumstances, he cannot be held guilty of any negligence".
(12) The third and most important charge against the Hospital and the Senior Consulting Surgeon was that there was failure on their part to secure admission of the patient in the Icu even though, the Doctor attending on the patient were unanimous and repeatedly advised his admission in the ICU. According to the appellant Hospital, the patient could not be shifted to Icu in the absence of a bed. The Appellant Hospital has explained that the Icu is primarily meant for patients suffering from cardiac and respiratory problems and for admission of persons undergoing surgery in the hospital to whom advance booking is made. Secondly "Admitted cases in the hospital needing intensive care have priority over new admissions. These cases are transferred in Icu subject to the availability of beds.
(13) According to the Senior Consulting Surgeon admission to the Icu is the responsibility of the Hospital administration and not of the consultant who merely advised. The Doctors have also submitted that non-admission of the patient to the Icu made no difference in the treatment provided to the patient. According to them admission to the Icu, in such a case, is essentially intended to relieve the Doctors of the responsibility for motoring such patients continuously and by admission to the Icu this is transferred to the nursing staff. They have pointed out that in this case the paramedical staff paid 140 visits to the patient and the Doctors made 25 visits to him during the total period of 57 hours the patient remained-admitted in the hospital before his death. In other words, according to the Doctors, there was no short-coming in the degree of care provided to the patient. These facts have been cited to establish that mere admission to the Icu would not have meant a more intensive care and treatment other than what was actually given to the patient.
(14) The State Commission, however, came to the conclusion that "the deteriorating condition of the patient required close monitoring and that was possible in the Icu and not in the room (Private Ward)." It held that the plea of the appellant hospital and the Senior Consulting Surgeon that it did not make any difference whether the patient was treated in the private ward or in the Icu is not correct and that it is an after thought.
(15) According to the State Commission, in the Icu there are more facilities for monitoring the disease. It observed that it is not established that the facility of the doctors and nurses was provided to the patient in the same way as it would have been available to him in the ICU. It has also not been proved that the instruments available in the Icu were provided to the patient in the room...". Thr patient was in a very bad state of health and it was not possible for the relatives to ensure that the Doctors and the nurses continuously or regularly monitored the patient as is done through instruments and nursing staff in the ICU. According to the finding of the State Commission it was essential that the patient should have been transferred to Icu for treatment of his disease. The State Commission has held that the contention of the Appellant that no bed was available in the Icu during the 57 hours of stay of the patient in the hospital is difficult to believe in the absence of records of bed availability.
(16) It has further held that it was the duty of the Doctors in charge to find out whether any bed could or could not be made available in the Icu shortly after the admission of the patient in the hospital and if it was not possible to provide such a bed, it was the duty of the Doctors in charge in the hospital to have informed the attendants of the patient accordingly. Further, that it was the duty of the Doctor or Senior Consulting Surgeon in the team to find out the person in charge of the Icu as to when the bed would be available. They should have informed the complainants that they were unable to provide accommodation to the patient in the Icu so that his attendants could decide whether to keep him in the hospital or to transfer him to some other hospital. Consiquently, the State Commission has held that there was negligence on the part of the hospital and the attending Doctors as they failed to inform the complainant that it wasn't possible for them to allot a bed in the Icu within a short period after his admission.
(17) Having come to this finding, the State Commission assessed the implications of this lapse. The State Commisson observes. "In case he had been admitted to Icu, it was possible that his end would not have come so early. However, it cannot be forgotten that the pancreatIT is is a deadly disease and the stage at which the disease had reached it might have not been possible to prolong the life of Rajesh for a long time. Even if the duration of his life could be extended for a short time that could have given great relief to the complainant and other relations. It cannot be doubted that the complainants have suffered great mental distress and agony on the death of Rajesh. Consequently, I grant exemplary damages to the complainant, which I assess at Rs. 1 lac."
(18) It is evident even from the observation of the State Commission that the patient was suffering from serious incurable disease which had reached the terminal stage. There was little hope of his recovery and survival. At best, his life could be prolonged for a short time with the help of the life support systems.
(19) From the materials available on record including the original of the register maintained in the Intensive Care Unit of the hospital which was produced before us it is found that going by priority of registration, no vacant bed in the Icu could be made available to the patient at any time prior to the expiry of the patient i.e. between 0015 Hrs on 23.5.89 till the time of expiry of the patient at 0905 Hrs on 25.5.89. The register shows that on the recommendation made by Dr. T. Singh, an entry had been made therein that a bed should be allotted to the patient, Mr. Bhandari as soon as possible. However, before the patient's turn came for getting the bed in the Icu the patient passed away. It is seen from the records that only three beds fell vacant in the Icu during the relevant period and that those beds were allotted to three others who had been admitted into the hospital earlier than the deceased and in respect of whom requisitions for allotment of beds in Intensive Care Unit had been made earlier than that of the deceased.
(20) The evidence in the case shows that on finding that no bed was available in the Icu for the patient being transferred there, arrangements were made in the ward itself for continuous administration of oxygen to the patient and for constant monitoring of his condition. The State Commission has categorically negatived the argument advanced on behalf of the complainant that there was negligence on the part of the hospital and its doctors in not providing the patient with respirator. After referring to the reply, filed by Dr. Singh to the interrogatory served on him the State Commission has observed "NO evidence has been brought on record by the complainant that the statement of Dr. Singh to the interrogatory served on him that the team of doctors, specially Consultants, anaesthetist. Dr. Subhash Gupta and Senior Consultant Physician Dr. P.S.Gupta did not recommend use of respirator and that the judgment of 5 doctors at 5 p.m. on 24th May, 1989 for non-use of respirator was unanimous."
(21) The State Commission has further stated thus: "No evidence has been brought on the record by the complainants that the statement of Dr. Singh is incorrect and that providing cent per cent oxygen to the patient was nor sufficient."
(22) From the evidence placed on record it is seen that during the period the patient was treated in his room in the private ward, the doctors performed all the functions necessary for watching the deteriorating condition of the patient and providing the requisite medical treatment called for under those conditions. The case sheet which are on record show that as many as 140 visits were made by the paramedical staff and 25 visits by the doctors to the patient's room during 57 hours, the period when his condition required to be kept under constant watch and there was regular monitoring of his pulse, urine, blood pressure, respiratory functions etc. Taking into account all the facts and circumstances disclosed by the materials available on record, we find ourselves unable to uphold the finding recorded by the State Commission that there was negligence on the part of the hospital in not transferring the patient to the ICU.
(23) The State Commission has also expressed its view that in case no bed was available in an Icu for being provided to the patient, the hospital ought to have informed the relatives of the patients about it and advised them to remove the patient to any other nearby hospital where Icu facilities could be provided to him and failure to do so constituted 'deficiency'. While dealing with the question whether the hospital could be said to be negligent in not having subjected the patient to scanning immediately after clinical diagnoses of his condition, the State Commission has itself recorded a clear finding that the condition of the patient was such on 23rd May, that it would have been risky and hazardous to subject him to the strain of being taken to the scanning centre for undergoing scanning. When such was the situation, it would not have been proper for the doctors to suggest to the relatives of the patient that he may be removed to some other hospital for being admitted to an ICU. Such a course of action would not have been in the interest of the safety and comfort of the patient and all that it would have helped to achieve was to enable the hospital to avoid a terminally ill patient breathing his last while being under its care.
(24) In the circumstances we do not consider that it is just or reasonable to attribute any negligence or deficiency to the appellant hospital merely on account of their omission to inform the relatives of the patient that they may, if they so choose, remove the patient to some other hospital in view of the non-availability of any vacant bed in their Intensive Care Unit.
(25) In the result, we are constrained to allow this appeal, set aside the order of the State Commission and dismiss the complaint petition. We make no order as to costs.