A rather regrettable medical situation arose in Mallya Hospital, one of Bangalore’s premier hospitals, two years ago. A patient’s life was placed at great peril and she is lucky to be alive today. At the culmination of a case fought and appealed at a consumer forum, the hospital paid the patient Rs.265,588 a few days back.
Here’s what happened:
Early June 2006
M G Radha, aged about 58, a housewife and resident of Vidyaranyapura began experiencing bouts of back pain. The pains persisted for about 15 days, and Radha and her family decided to get the condition investigated at Mallya Hospital.
21 June 2006
She was admitted to Mallya Hospital where she was diagnosed that a stone from the gall bladder had slipped and lodged itself in the bile duct, and two more stones were present in the gall bladder. This was ascribed as the reason for the pain. Dr K C Janardhan, a gastrointestinal specialist and a general and surgical oncologist, prescribed two surgeries: (i) Endoscopic removal (ERCP) of the stone lodged in the bile duct and (ii) Cholecystectomy for removing the two stones present in the gall bladder.
On the same day, Dr Srinivas, a gastroenterologist, performed the ERCP. It is a known fact that when this procedure is performed, the patient always stands a slim chance of developing acute pancreatitis as an offshoot of the procedure. In fact, it is the most serious complication that can result from the ERCP procedure (refer: www.uptodate.com).
22 June 2006
Dr Janardhan then performed a cholecystectomy surgery on Radha. While a gap of 3 to 4 days between these two surgeries is considered ideal, the surgeons at Mallya Hospital carried out this second procedure immediately on the following day.
24 to 27 June 2006
Radha’s health began to deteriorate – hospital records say she was experiencing breathlessness, sweating, low back pain, and sluggish bowel. Radha was sent to the Intensive Care Unit (ICU) for further observation. Radha’s condition continued to deteriorate even in the ICU, where the same medicines that were given to her in the ward were administered. Acute pancreatitis could have been suspected.
29 June 2006
Though her condition remained much the same, she was shifted back into the ward. The doctor in charge of the transfer-out (of ICU) made a noting in her transfer sheet saying "inflammatory changes in the pancreas tail noted".
The worst had happened; Radha had contracted acute pancreatitis because of the endoscopy, as indicated by the note on the transfer sheet.
29 June to 7 July 2006
During these days, Radha was housed in a ward. The treatment continued to be the same. She complained continuously of abdominal pain, back pain, breathlessness and weakness. The orthopedic surgeon then suggested her pain might be due to a problem in the disc and hinted she might have to undergo another operation – but the family refused his suggestion, and rightly so.
On 4 July, Radha’s legs became swollen. The next day, an ultrasound detected 300 ml of fluid in her left lung and 50 ml in the right. Hospital records of 6 July claim the pain had subsided. On the 7th, she was discharged despite not being able to walk, her abdomen swollen and most of the other conditions stated above. The hospital records stated her condition (at the time of discharge) as "Afebrile. The diagnosis of choledocholithiasis, cholelithiasis, hypertension and pneumonitis."
There was no mention of acute pancreatitis, nor was she treated for the same. She was advised to consult the doctors at the hospital after 15 days at the time of discharge.
For Radha, the discharge was like going on a sightseeing pleasure trip in an ambulance.
8 to 12 July 2006
Radha had left Mallya Hospital for home, but the pain didn’t leave her. Anguished and desperate at her condition, her family frantically called up Mallya Hospital to be told by Dr Janardhan to bring her there. But too much water had flown under the bridge – Radha’s family had lost faith in Mallya Hospital and they called in the family physician. For the next 4 days, there was no change in her condition. In fact, it worsened, and on 12 July, she was admitted to Bangalore Hospital.
13 to 27 July 2006
Tests revealed that Radha was suffering from Necrosis of Pancreas – she was on her deathbed and had to be immediately operated upon. For 11 days Radha battled for her life, and eventually emerged victorious – her family took her home on 27 July 2006.
Under the circumstances, it was remarkable that Radha recovered, for she was extremely weak, and had almost lost her will to live. She had a huge scar on her abdomen, a major part of her infected pancreas had to be surgically removed by the doctors at Bangalore Hospital. She had lost her hair and her body was now vulnerable to many life-threatening medical conditions.
October 2006 – June 2007
Radha’s family decided to seek justice for the pain and trauma caused to them due to Mallya Hospital’s negligence. They had spent a massive sum of about Rs.4,50,000 on the treatment too. Radha sent a legal notice to Mallya Hospital in October 2006, demanding compensation, but the replies were evasive.
Realising that the case was going nowhere after a while, they filed an official suit against Mallya Hospital at the Bangalore District Consumer Forum. Radha demanded about Rs.9,00,000 as compensation: Rs.5,00,000 as damages and the rest as hospital costs and out-of-pocket expenses.
The Consumer Forum found Mallya Hospital guilty of negligence and they ordered them to pay Rs.2,15,588 (the sum Radha had been billed for at Bangalore Hospital), plus Rs 50,000 being other costs incurred by the family.
Mallya Hospital decided to fight the order.
July 2007 to May 2008
Mallya Hospital filed an appeal in KSCDRC (Karnataka State Consumer Disputes Redressal Commission) after receiving the order. Their contention was that Radha was recovering well after the two surgeries; the hospital had considered the possibility of acute pancreatitis; and at the time of her discharge the patient was fit to be discharged. They also argued that her condition had worsened because she had seen a family physician after her discharge and not because of negligence from their end.
KSCDRC, however, went into minute details of the case and found Mallya Hospital guilty of negligence.
In its order on 31 May 2008, KSCDRC ruled that Mallya Hospital failed to detect that Radha was affected by acute pancreatitis, a complication that arose from the surgeries carried out by the surgeons at the hospital. The order also damns the hospital for treating Radha based on symptoms rather than investigating the source of her problems. The order also mentions other lapses by the hospital.
Accordingly, KSCDRC upheld the earlier order, dismissed Mallya Hospital’s appeal and ordered it to pay up Rs.265,588, the amount incurred by Radha at the hospital plus damages, within 30 June 2008.
Mallya Hospital has paid the sum, but has not apologised.
This may sound like a one-off case, but its implications are frightening. If reputed institutions cannot be trusted with the basic procedures of diagnosis, treatment and a display of empathy, how can the ubiquitous neighbourhood nursing homes and government hospitals be expected to do so? Or are we, as patients, guilty of erroneously concluding that bigger is better?
Hospitals and doctors must be more accountable and responsible for the patients who pass their portals, the Hippocrates oath notwithstanding. The silver lining in this sordid saga is that all is not lost yet. Thanks to the consumer courts, there is still hope for a mere citizen to demand justice and get it, albeit delayed and not entirely satisfactory.
In the meantime, Radha leads an apparently normal life, and stares at an uncertain future. Her carpet-bombing at Mallya Hospital has left her shocked. Fortunately, her digestive system is in order even though her pancreas was operated upon, the two-cm long pancreas’ tail is still intact.
We can only wish her good luck. ⊕