The NCDRC directed Suretech Hospital and Research Page 2 of 42 Centre Private Limited, a Hospital in Nagpur, Dr. Nirmal Jaiswal, Chief Consultant and Intensive Care Unit In-charge, at Suretech Hospital, Dr. The Civil Appeal (Diary No.21513 of 2018) has been filed by Suretech Hospital, Dr. Sunita filed Civil Appeal 4847 of 2018 seeking enhancement of compensation ordered for medical Page 3 of 42 negligence during her treatment. Sunita was taken to Gondia hospital within 15 minutes of meeting with a serious car accident near Gondia, resulting in multiple injuries. On 06.05.2004 at around 12:30 AM, the complainant/patient was shifted from Gondia Hospital to the ICU in Suretech Hospital, Nagpur under Dr. Sunita was put on a ventilator through her Tracheostomy Tube (hereinafter, ‘ TT ’), which was weaned off on 08.05.2004.
Madhusudan Shendre, removed the ‘ TT’ and forcefully performed ‘Nasotracheal Intubation’ (hereinafter ‘NI’ ) i.e., inserting an Endotracheal tube through the nose to facilitate breathing. The liquid feed started passing into her respiratory tract, and got collected in her lungs leading to Frank pus and severe infection, ultimately causing ‘Severe Septicemia’. Pradhan reinserted the ‘TT’ without a cuff through the pre-existing tracheostomy wound to aid respiration.
Sunita flew back to Nagpur, and got herself admitted to Shanti Prabha Nursing Home. Sunita was discharged from Shanti Prabha Nursing Home, Nagpur. The scan indicated a 3.5 cm subglottic stenosis. Bhargava, ENT specialists, who conducted Flexible Fiberoptic Bronchoscopy to observe signs of injuries in the subglottic region. A 3.5 cm long subglottic stenotic segment was excised in the surgery. Sunita filed Consumer Case No 48 of 2005 under Sections 12 and 21 of Act, 1986 before the NCDRC on 16.05.2005 alleging medical negligence in her treatment at Suretech Hospital, resulting in permanent damage to her respiratory tract and permanent voice-loss, altering her life forever. As per the complainant, the unnecessitated and Page 9 of 42 forcefully-conducted ‘NI’ procedure was the only reason she suffered from voice-loss and permanent deformity in her respiratory tract. Sunita’s Bronchoscopy or ‘NI’ on 13.05.2004. Rajesh Swarnakar as the pulmonologist and bronchoscopist at Suretech Hospital, conducted the aforesaid Bronchoscopy and ‘NI’ procedure. Further, the test cannot be conducted without the patient’s cooperation, as they are instructed to swallow the Barium solution. After the test, as a part of the routine procedure, appropriate steps were taken to remove the Barium Swallow Solution that was aspirated by the patient, using a suction machine.
The patient was hospitalized in a semi-comatose state, and then immediately put on a ventilator by Dr. Sunita’s complete blood count report WBC – 16700 on 06.05.2004 indicated neutrophilia-84% i.e., showing signs of infection at the time of her admission to Suretech Hospital. Sunita could have also come to effect between 04.06.2004 to 03.07.2004 when she was being treated in her own house under Dr. Jaiswal’s instructions, he attempted ‘TT’ decannulation (i.e., Removing ‘ TT’ ) on 11.05.2004 since ‘ TT’ removal had become necessary. Shendre removed the ‘TT’ and covered Mrs. The ‘ NT’ stent was expected to serve the purpose of holding the anterior flap and supporting the weakened anterior tracheal wall, preventing a collapse in the lumen, which was causing a problem in decannulation of the ‘ TT’.
Thus, ‘NI’ was performed without any basis or justification, especially as a short- term measure, even though the patient was responding well to her existing treatment. The NCDRC further observed that the expert medical committee report formulated by RML Hospital was silent about the baseless and forced ‘NI’ procedure that was carried out, even though Page 15 of 42 the Bronchoscopy report indicated that the patient had a normal airway. Page 16 of 42 Sunita’s case, intervention was done even when her platelet levels dropped down to 26,000.
The NCDRC held that the negligence charge with respect to vision loss and the hospital ignoring Mrs. The NCDRC concluded that just based on a single act of negligence, wherein, unjustifiably, ‘NI’ was forcefully performed, replacing the existing ‘ TT’, it is not possible to conclude that subsequent resultant medical complications, including permanent respiratory tract deformity and voice-loss suffered by Mrs. Reasoning, that as only a single act of negligence is proved, that too not attributable to all subsequent medical complications, it is only fair to announce compensation against the medical expenses incurred at Suretech Hospital. The patient claims that though the NCDRC was correct in attributing medical negligence with respect to the unjustified forced ‘NI’ procedure, replacing the existing ‘TT’, the NCDRC erred in holding that there is no direct link attributable to the said act of negligence leading to subsequent prolonged medical complications, permanent respiratory damage, and voice-loss. Sunita claims that the sole Page 19 of 42 reason why she lost her voice and suffered from tracheal stenosis, is the forced ‘ NI’. It is further claimed that as per medical science, 95% subglottic stenosis cases are acquired, and out of those about 90% cases result from traumatic ‘NI’. 25,00,000/- was claimed for the mental stress and agony caused to her husband. 20,00,000/- was claimed collectively for the suffering undergone by the patient’s children due to her disability. Also, assailing the same impugned decision by the NCDRC, Suretech Hospital, Dr. It is further contended that the NCDRC did not find any causal connection between the ‘NI’ procedure conducted on 13.05.2004, after removing the ‘TT’ and the alleged tracheal injuries and the subsequent medical complications.
Sunita treatment, as also observed by the medical expert board. As per the medical board, as there was no negligence, and satisfactory treatment was given, Dr. Arti Wanare, Ophthalmologists at Suretech Hospital conducted Mrs. It is further contended that even though the medical bill raised at Suretech Hospital was Rs. 6,11,638/- as medical expenses against the treatment undergone at Suretech hospital. A reasonably plausible cause of the stridor would either be injuries suffered in the road accident or the emergency ‘TT’ procedure conducted at Gondia Hospital. Sunita’s complaints about blurred vision, negligence Page 24 of 42 leading to thrombocytopenia i.e., platelet levels falling significantly to dangerously low levels, and negligence with respect to the ‘ Barium Swallow Test’ causing breathlessness in Mrs.
Additionally, although decisive care intervention ordinarily begins when platelet levels drop below 20,000, an interference was done when the platelet levels fell below 26,000 in the case of Mrs. In sum and substance, the main contention arising in the aforesaid Civil Appeals that needs to be addressed is whether the act of conducting the ‘NI’ procedure on Mrs. Negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued.
So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed.
