Hospital has every right to insist on fee payment, but there is also a prime duty to care for emergency patients: National Consumer Forum

The National Consumer Disputes Redressal Commission (NCDRC) recently awarded the wife of a patient who died in the Christian Medical College (CMC), Vellore compensation for medical negligence..Complications had arisen after the doctors administered a blood thinner on the patient. The patient's demise followed internal bleeding and a stroke. The patient had died after the hospital delayed treatment and the conduct of CT scan citing Rs 1,850 in unpaid dues. .A Bench of members of Dr SM Kantikar and Dinesh Singh awarded the compensation to the deceased patient's wife finding that,."... deficiency / negligence is conclusively established. In our considered view, in the facts and specificities of the instant case, compensation of Rs. 25 lakh with interest at the rate of 8% per annum from the date of the death of the patient appears just and equitable ..."NCDRC.The patient, a man aged about 58 years, is stated to have had a history of pain in his left arm after engaging in strenuous activity. He was also a patient of diabetes and hypertension. .In 2009, the patient visited the hospital's outpatient department complaining of pain in his left arm on exertion. Diagnosed with Coronary Artery Disease, he was admitted to the Hospital and advised an Angioplasty. On further examination, the patient was recommended a Coronary Arterial By-pass Graft (CABG) surgery to avoid multiple stenting..During this time, the patient was informed that his surgery would be impossible for the following two weeks given the number of other patients awaiting surgery. In the meantime, the hospital began administering the patient doses of Heparin to the patient, without explaining the reasons for this treatment or obtaining his consent. Further, his chances of bleeding because of the administration of the medicine was not examined.. A couple of days later, the patient is stated to have repeatedly complained to the hospital authorities of bleeding and disorientation, which was ignored. It is stated that they continued administering the drug which was the cause of the bleeding (Heparin), only to be informed later that he had suffered a stroke and there was an immediate need for a Computed Tomography scan of his brain ('CT scan')..Citing unpaid dues, the CT scan sought was denied for over 3 hours. These 'dues' were demanded despite the complainants' prior deposit of Rs 1,50,000..The delay in treatment and the improper administration of Heparin led to anticoagulation, a resultant brain hemorrhage, a stroke, and ultimately his demise, it was averred by the patient's family..The hospital argued that the complaint was based on a suppression of facts that could not be adequately adjudicated in a Consumer Redressal Forum. They disputed the day of his admission into the hospital and claimed that consent was not normally required before administering heparin. They also contended that he opted for a CABG over an angioplasty..It was further contended that the blood thinners the patient had been taking prior to his treatment at the hospital may have caused internal bleeding..The patient's wife (the complainant) through her counsel refuted the hospital's claims..The National Consumer Commission found that the administration of heparin was not improper according to established medical practice, but held the hospital negligent for the inordinate delay in treatment after the patient suffered a stroke. Additionally, the heparin administration was not stopped despite the stroke the patient suffered, nor was an antidote used, it was noted..Discussing the delay in obtaining a CT scan because of the hospital's insistence on payments, the Commission pointed out:."Although the patient was in most urgent need of the diagnostic CT scan but it was delayed for getting a receipt of Rs. 1850/- towards CT scan charges. The hospital was aware that the complainants had already deposited 150000/- in advance. … It seems at that relevant time the rigid protocols prevailed over the medical ethics, which amounts to failure of duty of care.".The Commission went on to emphasise, ."Hospital has every right to insist (on) the payment but it was also a prime duty to care (for) the emergency patient."NCDRC.Further, reliance was also placed on the NCDRC's ruling in Pravat Kumar Mukherjee vs. Ruby General Hospital and Ors, II which had dealt with the question “Can doctors insist and wait for money (fees) when death is knocking the doors of the patient?” ."Obvious answer is recovery of fee can wait - but not the death nor the treatment for trying to save the life", the Bench noted in this case. .The Commission ultimately accepted the complainant's arguments applying the "but for" test applied to medical negligence cases. Finding that 'but-for' the hospital's negligence the patient would have survived, the Commission ruled that the doctors did not comply with accepted standards of care..Hence, deficiency and medical negligence was conclusively demonstrated, the Commission ruled..Accordingly, an amount of "Rs. 25 lakh with interest @ 8% per annum from the date of the death of the patient till its realization" was granted to the patient's wife to compensate for the doctors' negligence..Read the Order here: