Hospitals must ensure nursing care
Pushpa Girimaji

Critical patient care includes not just administration of medicine but also nursing, and failure on any one or both counts constitutes negligence. This, in short, is the message that comes from a recent order of the highest court in the country. The order, directing a hospital to pay compensation for denying nursing care to a terminally ill patient, in a way re-defines medical negligence under the Consumer Protection Act. It also highlights the importance of nursing in patient care.

The order, involving an Army hospital, also makes it clear that the armed forces cannot get away with medical negligence on the ground that the service provided by armed forces hospitals to its personnel is free and, therefore, outside the purview of the CPA. Referring to the decision of the Supreme Court in the case of Laxman Thamappa Kotgiri vs GM, Central Railways, and also Indian Medical Association vs VP Santha, the national consumer disputes redressal commission made it clear that where medical service was rendered as part of the terms and conditions of service, it would not amount to free service and would, therefore, come under the jurisdiction of the courts.

The commission's order has its origin in the complaint filed by Wg Cdr KK Chaudhary (retd) against the Base Hospital (Army), Delhi cantonment, alleging deficiency in providing para-medical services to his ailing wife. His wife was admitted to the hospital on November 30, 2003, and discharged on December 5. During this time, various tests confirmed that she was suffering from cirrhosis of the liver. She was re-admitted on the night of December 5 and breathed her last on December 8.

In his complaint, Wg Cdr Chaudhary alleged that even though his wife was completely bed-ridden and was in no position to take care of herself, or even take the medicine on her own, she was not provided with adequate para-medical staff during her stay at the hospital from December 5 till her death. Seeing her condition and the absence of para-medical staff to attend on her, he had taken special permission from the duty medical officer to allow his daughter to stay with her and take care of her. But on that fateful night, the gastroenterologist treating her did not allow it. So much so, that even when his wife breathed her last, no nurse or ayah was present.

Even though she died in the night, he was not even informed of her death, and he learnt about it only when he went to visit her in the morning. The district consumer disputes redressal forum, which first heard the case, initially agreed with the contention of the hospital that the complainant was not a client as defined in the CPA, and dismissed it. In response to his appeal, the state consumer disputes redressal commission examined the issue and held that the complainant was indeed a client, and remanded the case back to the forum for redress.

This time the forum heard the case in detail and concluded that the wife of the complainant was suffering from terminal cancer, and there was no chance of full recovery. There was also no evidence to prove that her death was caused by medical negligence. However, it was obvious that she needed constant nursing care, which was denied to her. There was apparently paucity of nursing staff and, at times, not even a single nurse was available to attend to serious patients like the complainant's wife in the hospital. In such a situation, the hospital should have at least allowed the patient's daughter to stay with her and take care of her. As a result, there was no one to attend to the patient when she breathed her last.

On the ground that she did not receive the much-needed para-medical help, particularly given her condition, the district forum awarded Rs 50,000 as compensation to the complainant. When the state commission, too, upheld this view, the hospital filed a revision petition before the national commission. The commission, after a detailed hearing, observed that there may be no evidence suggesting that the death of the complainant's wife was direct or proximate cause of medical negligence, but it had been shown that she did not receive para-medical help, which she badly needed.

The commission, therefore, held that there was no reason to take a different view than what the courts at the state and the district level had held. However, it opined that the compensation awarded was on the higher side and reduced it to Rs 25,000 (Commandant, Base Hospital (Army), Delhi Cantonment and others vs Wg Cdr KK Chaudhary(retd), revision petition No 3247 of 2008, decided on February 2, 2009).