District Consumer Commission holds hospital and neurologist responsible for delaying mechanical thrombectomy; parents awarded ₹1 crore compensation and ₹50,000 litigation costs
The District Consumer Disputes Redressal Commission (DCDRC), Hyderabad, has held a Nallagandla-based private hospital and its consultant neurologist guilty of medical negligence in the death of a brain-stroke patient. The Commission directed the hospital and doctor to jointly pay ₹1 crore in compensation to the patient’s parents.
The bench comprising President B Uma Venkata Subba Lakshmi and members C Lakshmi Prasanna and B Raji Reddy also directed the hospital and neurologist to pay ₹50,000 towards litigation costs.
The case dates back to 17 August 2020, when the patient suffered a massive brain stroke and was found unconscious in his hostel room. He was immediately taken to the University Health Centre, which referred him to the treating hospital.
An MRI conducted on the same day reportedly revealed a massive hyperacute infarct in the right middle cerebral artery (MCA) territory, with complete occlusion of the right MCA and its branches.
The patient’s attendants alleged that he was placed in an isolation ward without being properly informed about the treatment plan or prognosis. They further alleged that despite requests from the patient’s friends to begin treatment immediately and assurances that hospital expenses would be arranged, treatment, including mechanical thrombectomy, was delayed while consent was awaited and later while waiting for the RT-PCR test result.
After the patient tested positive for COVID-19, he was transferred to a COVID-designated hospital. He died on 21 August 2020.
Hospital Claimed Therapeutic Window Had Passed
The hospital and neurologist denied negligence and argued that by the time the patient reached the hospital, the therapeutic window for thrombolysis had already passed.
They stated that the patient had been brought beyond the therapeutic window, making thrombolysis contraindicated. They further claimed that mechanical thrombectomy could not be performed because of the lack of timely consent and uncertainty regarding the exact time of stroke onset.
The hospital also submitted that, after reviewing the MRI, the treating neurophysician and interventional neurologist had recommended mechanical thrombectomy on 17 August itself. However, according to the hospital, the patient’s friends wanted to consult his family before providing consent.
The hospital maintained that the accompanying friends were not authorised to take medical decisions on the patient’s behalf. Therefore, conservative treatment was provided while his neurological condition was monitored.
Commission Questions Delay in Emergency Treatment
After examining the medical records and arguments presented by both sides, the Commission questioned why the treating doctors, including the neurologist, delayed the procedure while waiting for consent from the patient’s family, who were physically absent and unreachable.
The Commission noted that the hospital itself had maintained that mechanical thrombectomy could be performed within six to 24 hours of stroke onset.
The Commission further observed that the hospital’s later claim that the patient was not clinically suitable for mechanical thrombectomy was not supported by the doctor’s notes or case sheets.
The Commission concluded that even if the patient’s friends could not provide the exact time of symptom onset, the six-to-24-hour window for thrombectomy remained relevant. It held that the medical team failed to conduct the procedure within 24 hours of the patient’s admission.
Emergency Situation Could Permit Treatment Without Explicit Consent
The Commission also referred to the emergency exception to the informed-consent requirement. It observed that while informed consent is an important rule, exceptions exist in emergency situations where a patient is unconscious or incapacitated and immediate intervention is required.
According to the Commission, the doctors should have proceeded with treatment under implied or presumed emergency consent to prevent catastrophic neurological impairment and irreversible harm.
The Commission ultimately held the treating hospital and neurologist negligent and deficient in providing necessary treatment to the patient.
It further observed that doctors have a professional obligation to provide immediate emergency care without allowing procedural, administrative or consent-related hurdles to delay life-saving treatment.
COVID Protocol Could Not Justify Delay in Stroke Treatment
The hospital also defended the patient’s transfer to another facility by citing COVID-19 protocols that were in force during the pandemic.
The patient’s Rapid Antigen Test on 17 August was negative and his HCRT chest screening was reported as normal. However, his RT-PCR test subsequently returned positive on 19 August.
The hospital argued that it was a non-COVID facility and that government instructions required COVID-positive patients to be referred to designated hospitals. It maintained that the patient was not abandoned and that he continued to receive monitoring and treatment before arrangements were made for his transfer.
The Commission, however, held that COVID protocols could not justify delaying necessary emergency stroke treatment. It observed that official advisories issued by the Union Ministry of Health and the Indian Council of Medical Research required hospitals to provide emergency care without waiting for COVID test results.
The Commission held that the hospital delayed necessary treatment and discharged the patient in a haemodynamically unstable condition on 19 August 2020.
It further observed that the hospital should have conducted thrombectomy while awaiting the RT-PCR report and stabilised the patient before transferring him to another hospital.
Patient’s Condition Worsened Before Transfer
According to the records, while discharge formalities were underway, the patient’s condition deteriorated. He developed seizures and his Glasgow Coma Scale dropped.
The medical team subsequently intubated him and connected him to a mechanical ventilator because of the risk of aspiration and further deterioration. He was then transferred to the second hospital.
Records from the second hospital showed that a CT scan revealed a large subacute infarct involving the entire right MCA territory, along with significant mass effect, brain herniation and brainstem compression.
The patient arrived at the second hospital in a highly critical condition, with dilated and non-reactive pupils. He was immediately shifted to the intensive care unit after consultation with a neurosurgeon.
The records stated that he suffered cardiac arrest during the late afternoon of 21 August. Cardiopulmonary resuscitation was initiated and spontaneous circulation returned, following which he was supported with inotropes and vasopressors. However, both pupils remained dilated and fixed and there was no response to stimuli.
The patient ultimately died on 21 August 2020 at 4:11 pm.
Commission Awards ₹1 Crore Compensation to Parents
While determining compensation, the Commission considered the patient’s age, education and family circumstances.
It observed that his death deprived his parents of their primary source of future financial dependency, security and care. The Commission also recognised the emotional trauma and mental agony suffered by the parents following the death of their young son.
Accordingly, the Commission awarded ₹1 crore to the parents towards loss of dependency, future prospects, filial consortium and mental agony.
The hospital and neurologist were also directed to pay ₹50,000 towards litigation costs.
The Commission ordered that the amount be paid within 45 days. In case of failure to comply, the amount would carry interest at the rate of 9% per annum from the date of receipt of the order until payment.
Complaint Dismissed Against COVID Testing Laboratory
The original complaint also named the second treating hospital, its doctor and the laboratory that conducted the RT-PCR test.
The patient’s parents had alleged that the laboratory issued a false RT-PCR report because a subsequent test at the second hospital was negative. The laboratory denied the allegation and stated that it was a NABL-accredited facility and had followed applicable COVID-19 testing standards.
The laboratory submitted that its role was limited to processing samples collected and sent by the hospital. It also questioned the reliability of the subsequent negative test, pointing to a record that allegedly showed an unusually short six-minute interval between sample collection and reporting.
The Commission rejected the allegations against the laboratory, observing that there was no cogent evidence supporting the claim that the RT-PCR report dated 19 August 2020 was false.
It also noted that the laboratory had produced quality-control records and documentation relating to concordance in the World Health Organization’s external quality assessment programme. The Commission observed that these documents remained unchallenged and unrebutted by the complainant.
The complaint against the second hospital, its doctor and the laboratory was consequently dismissed.