Awareness about patients’ rights is growing in India. This trend is clearly discernible in the recent spurt in litigation concerning the liability of medical professionals and the medical establishment. The Supreme Court judgment in the Anuradha Saha medical negligence case is a landmark in the annals of medical jurisprudence. The court not only adjudicated on how to determine negligence on the part of doctors in the event of a patient’s death, but also imposed greater responsibility on them.
The judgment also reinforced the patient’s right to know the line of treatment followed by the doctors and the risks involved in the treatment. The compensation awarded was the highest in a case of medical negligence in India to date.
An extraordinary case
Mrs Saha, aged 36 years, fell victim to toxic epidermal necrolysis (TEN), when she and her husband, Dr Kunal Saha, were in India on a holiday in 1998. On 11 May 1998 she was admitted to Advanced Medicare & Research Institute hospital (AMRI) in Kolkata, where her condition deteriorated. She was later transferred by air ambulance to Breach Candy Hospital in Mumbai, where she died on 28 May 1998.
TEN is an exfoliative dermatological disorder of unknown cause where the patient looses epidermis in a sheet-like fashion, leaving extensive areas of denuded dermis that must be treated like a large, superficial burn wound. The incidence of TEN has been reported at 1 to 1.3 per million population per year and accounts for 1% of drug reactions that require hospitalization, with a mortality rate of 25% to 70%.
Mrs Saha’s husband, himself a doctor, felt that doctors treating his wife were grossly negligent in her treatment and that this caused her death. He accordingly issued legal notice to as many as 26 doctors who treated Mrs Saha between April and the date of her death, alleging negligence and deficiency in service on their part and claiming compensation from them.
On 9 March 1999 Dr Saha filed a complaint before the National Consumer Disputes Redressal Commission (NCDRC), claiming total compensation of ₹770.7 million (US$12.5 million). Later he also filed another complaint against Breach Candy Hospital, its doctors and functionaries claiming further compensation of ₹253 million. These are some of the facts which make the case extraordinary.
Outline of treatment
Mrs Saha was treated at AMRI hospital, with excessive doses of glucocorticosteroids and in particular Depo-Medrol. Depo-Medrol is a long-acting steroid recommended for treatment of conditions such as asthma and arthritis and not for an acute disease like TEN.
The treatment of TEN includes withdrawal of any suspect drug, avoidance of skin trauma, insertion of a peripheral venous line, plasmapheresis and administration of macromolecular solution, in a burns unit or intensive care unit under strict aseptic conditions.
At AMRI, no symptomatic therapy was administered and no emergency care was provided to Mrs Saha. The dermatologist who examined her recommended treatment with steroids and application of ointments. However he did not prescribe any medicine for preventing secondary infection or steps to be taken to maintain electrolyte balance.
There was no improvement in Mrs Saha’s condition at AMRI, and she was shifted to Breach Candy Hospital in a serious condition. There her condition further deteriorated. Plasmapheresis, which would be the standard treatment under such conditions, was not done and she died in the hospital.
The above facts point to gross medical negligence by the doctors at AMRI and at Breach Candy Hospital.
Supreme Court order
After hearing the case, the Supreme Court remanded it back to the NCDRC for determining the quantum of compensation to be paid by AMRI and three Kolkata doctors. The 15-year-long battle over Mrs Saha’s death due to medical negligence ended on 24 October 2013 when the court enhanced the compensation awarded by the NCDRC from ₹13.5 million to ₹60.8 million with interest of 6% per annum from the date of the complaint to the date of the payment to the claimant.
The court reinforced the patient’s right to know and made it clear that doctors must tell patients about the risks involved in any line of treatment they are following and the adverse effects of any medicine. If some reaction is anticipated, the patient must be informed. The court warned that whether a doctor kept a patient informed about the pros and cons of a line of treatment will be considered in every future case of medical negligence.
The Supreme Court’s order in this landmark case gives some hope that the victims of medical negligence will not be completely at the mercy of doctors and the medical establishment. The judgment will also make doctors more accountable to their patients.
Dr Rachna Bharadwaj is an associate at Krishna & Saurastri Associates and an advocate registered with the Bar Council of India.
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