Imagine going to a hospital for a simple medical procedure and waking up to find yourself a prisoner in your own body. This is the devastating reality for a woman in Chennai, India, who was left in a vegetative state after treatment at a private medical college.
A consumer court in Chennai has ruled in favor of the patient's family, imposing a significant fine of ₹51,14,431 lakh (around $67,000 USD) as compensation and a staggering ₹75,000 (around $1,000 USD) as a monthly plan for the kin.
While the financial penalty offers some solace, the bigger question remains: what went wrong?
The ordeal began in 2021 when the patient's family sought treatment for a urinary tract infection (UTI) at the private medical college. The family alleged that despite informing the hospital about the patient's allergies, she was administered an injection of a specific antibiotic named ceftriaxone, which triggered a sudden life-threatening reaction named anaphylactic shock.
A UTI is an infection of any part on urinary tract that occurs due to entry of bacteria in the urinary tract. The most frequent culprit is a bacterium named Escherichia coli (E. coli). Standard treatment for UTIs involves antibiotics like amoxicillin, nitrofurantoin, ciprofloxacin, and ampicillin.
The family's counsel contended that the hospital administered the antibiotic Ceftriaxone without conducting any necessary medical tests to test for allergy to the drug (despite being informed by the family that the patient was allergic to the said drug) or addressing the infection with the usually prescribed antibiotics (standard treatment for UTI).
The family further alleged that the hospital withheld complete medical records and a detailed bill breakdown despite repeated requests. They were only provided with a single-page discharge summary, riddled with discrepancies. This lack of transparency fueled suspicion and suggested a potential attempt to conceal crucial information.
The hospital's legal counsel maintained that the hospital’s medical team followed accepted medical protocols. They claimed that the patient was appropriately tested for allergy to the said medicine by injecting a small amount of the test dose of ceftriaxone. According to the opposite party’s counsel, the medical team proceeded with the treatment only after ensuring that the patient exhibited no symptoms of allergy to the medicine and that her vitals ( like pulse rate, heartbeat, and blood pressure) were also normal after the test dose administration. They also denied withholding medical reports and asserted that all necessary documents were provided upon discharge.
The case reached the consumer court, where the judge acknowledged references to established legal precedents set by the Supreme Court in similar medical negligence cases such as the cases of Dr Laxman Balakrishnan Joshi versus Dr trimbak bapu godbole, Jacob Mathew versus State of Punjab, Martin f D'Souza versus Mohammed Ashfaq etc and noted that in medical practice there could be genuine differences in opinion and treatment approaches. However, while adopting treatment procedures the medical professionals should ensure that the procedures are not unreasonable..
The court emphasized that medical professionals have a responsibility to ensure their treatment plans are reasonable, considering the potential risks associated with a treatment procedure and the context of the patient's condition. This focus on reasonableness aims to prevent “defensive medicine”, a practice where doctors prioritize avoiding negligence claims over providing the most appropriate treatment for the patient.
This also means Unreasonableness in professional conduct is proven in a specific case, based on the circumstances of the case and evidence, the medical professional cannot escape associated liability.
Scrutinizing relevant documents presented by both parties, the court observed several inconsistencies in the claims cited by the opposite party. Some of the gross discrepancies observed by the commission and court were:
Only a single-page, handwritten discharge summary was provided initially that also after several requests from the aggrieved)
Detailed Summary and complete medical records were issued only after the Tamil Nadu Medical Council issued directives to the hospital.
The discharge summary was handwritten (against the digital summaries being the usual practice at the hospital) depicting they were fabricated esp. for the case.
There were significant differences in the content and format of summaries provided initially to the patient and later on the directions of Tamil Nadu Medical Council again depicting that the handwritten summary was most probably fabricated one.
25 vials prescribed with no reason to explain why they were prescribed and to whom they were administered, such an act of a hospital amounts to unfair trade practices as defined in section 2 (47) of the Consumer Protection Act 2019.
Additionally, discrepancies in the content, dates of tests, time of administration of medicines, etc. of the submitted documents, raised concerns about potential manipulation to fabricate evidence.
These inconsistencies supported the family's claims regarding withheld information and potentially fabricated medical records, suggesting a deliberate attempt to cover up the negligent acts of their medical team by the hospital.
The honorable court also observed that the act of administering ceftriaxone as a final choice of drug in E.coli. caused UTI, by the team of doctors at the hospital, was suitably below the conduct of a competent practitioner in his field and was the primary reason that the patient suffered anaphylactic shock which further led to her indefinite vegetative state. Such act constituted Medical-Negligence and Deficiency of Service as defined in section 2(11) of the Consumer Protection Act, 2019
“The consumer court ultimately sided with the family, holding the hospital accountable for Medical-Negligence and deficiencies in service”.
The Consumer Court imposed a huge fine, directing the Tagore Medical College and Hospital, Chennai to pay Rs. 89,431 as a refund of the amount paid by the complainant towards the medical expenses to the hospital, damages amounting to Rs.50 lakh as compensation for monetary loss & the mental agony suffered by the complainant, and Rs.25000 to be paid as a cost of proceedings to the complainant.
The District Consumer Disputes Redressal Commission also directed the hospital to pay the complainant a sum of rupees 75000 per month for the patient’s lifetime, towards her recurring medical maintenance charges.
This landmark verdict highlights several crucial points:
The Importance of Transparency: The court's emphasis on detailed medical records and the need for transparency reflects the growing need for open communication and patient empowerment in the healthcare system.
Accountability for Unreasonable Practices: The court's decision highlighted the importance of holding medical professionals accountable for demonstrably unreasonable treatment plans that deviate from accepted medical practices.
Mental Agony as one of the serious consequence of medical negligence: The court acknowledged the devastating impact on the family, awarding compensation for mental agony, medical expenses, and ongoing medical maintenance costs for the patient's indefinite vegetative state.
While the financial compensation may offer some solace, the true cost lies in the lives tragically altered by this event, wherein a father lost his companion, a woman lost her right to live a productive life with dignity, and a family that lost their mother and trust in the healthcare system. The hospital faces a hefty fine, but can this verdict truly bring justice to the woman and her family?
“Urinary Tract Infection (UTI) - Symptoms and Causes.” 2024. Mayo Clinic. Accessed July 9. https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447.
“Ceftriaxone: Indications, Side Effects, Warnings.” 2024. Drugs.Com. Accessed July 9. https://www.drugs.com/cdi/ceftriaxone.html.
Anaphylaxis-Anaphylaxis - Symptoms & Causes.” 2024. Mayo Clinic. Accessed July 9. https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.
Katz, Eric D. 2019. “Defensive Medicine: A Case and Review of Its Status and Possible Solutions.” Clinical Practice and Cases in Emergency Medicine 3 (4): 329–32. doi:10.5811/cpcem.2019.9.43975.
Defensive Medicine: A Case and Review of Its Status and Possible Solutions - PMC (nih.gov)
“Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment.” 2024. Cleveland Clinic. Accessed July 9. https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state.
Rehash/Dr.Aditi Bakshi/MSM
