Doctors liable for poor care of patients

HERE is a case of medical negligence that reflects, more than anything else, the poor infrastructure in many government hospitals around the country, thereby putting at great risk, the lives of those who go there for treatment. The order of the consumer court in this case, holding the state government vicariously liable for the death of a patient, should send out a clear signal to state administrations around the country that courts will take a serious view of such administrative incompetence.

In this case, the victim was a young mother who was admitted to the government hospital in Pauri Garhwal, Uttaranchal, with pregnancy-related complications. The hospital was apparently not equipped to deal with the medical condition, described as "placenta previa with bladder invasion, a potentially life-threatening condition," but the doctors there did not inform the patient or her husband of the nature of the complications. Nor did they advise them to go to a nearby well-equipped hospital.

Since there was no anaesthetist at the hospital, an ophthalmologist doubled up as an anaesthetist and the gynaecologist performed an emergency surgery and saved the child. However, despite the fact that the mother was bleeding profusely and urgently needed blood transfusion, they did not care to give her blood. Since the hospital had no provision for keeping post-surgery patients, she had to be moved to the female hospital. The doctors did that by forcing the patient to walk the distance. Given this kind of post-surgery care, it was no wonder that the mother died soon after.

In fact, a magisterial inquiry, conducted into the incident, also highlighted the absence of adequate infrastructure and staff at the hospital. It said there was no blood bank facility, nor any provision for keeping patients needing post-operative care. Inadequate and qualified staff was also a major lacuna.

In his complaint before the state consumer disputes redressal commission, the husband of the patient, Vinod Prasad Nautiyal, argued that absence of adequate facilities at the hospital coupled with the callous negligence of the doctors led to the untimely and unfortunate death of his wife. In fact, the doctors attending on her should have warned him of the complications involved and advised that she be taken to a better equipped hospital. They did not do so. Even post-surgery, they did not give his wife blood transfusion when she needed it, nor oxygen.  

Government hospitals around the country should have the basic facilities required for patient care
Government hospitals around the country should have the basic facilities required for patient care

The opposite parties the doctors and the state government on the other hand argued that they did everything they could to save the child and the mother, when the latter was brought in a critical condition, and even though the surgery was performed in the absence of a qualified anaesthetist, there were no complications associated with it. 

Dismissing these arguments, the state commission held the doctors and the state government jointly liable for the death of the patient and awarded a compensation of Rs 2.5 lakh. Both the parties filed appeals before the national consumer disputes redressal commission.

The national commission, in response, dismissed the appeal of the hospital and the state government and enhanced the compensation awarded by the state commission by a lakh of rupees. While doing so, it pointed that reasonable care, expected under the circumstances, was not taken by the doctors. Referring to the argument of the hospital that the patient had a history of complicated pregnancies, the commission pointed out that given that background, there was need for greater care. Yet, the operation was performed with no arrangement for a qualified anesthetist.

 Similarly, despite the fact that the patient had complained of bleeding, the operation was performed without any arrangement for blood. Describing this as "gross negligence," the national commission observed: "We agree with the state commission that no expert opinion is required to establish that they constitute acts of professional negligence."

Even though this case goes back to 1993, even today, many government hospitals around the country do not have basic facilities required for patient care. This order of the court holding the state government to be vicariously liable should force governments to pay more attention to this aspect of healthcare. 

Similarly, in many cases in the past, the courts have held that poor post-operative care constitutes negligence and doctors and hospitals that are guilty of such negligence will be held liable. This order reinforces this further (Vinod Prasad Nautiyal vs  Smt Savitri Uniyal and others (FA No 79 of 2005, decided on  May 20, 2011).