Cardiologist, hospital held accountable for ‘cheating and mischief’ in implanting wrong pacemaker

  • Posted on: June 27, 2024

The patient had a history of heart ailments. He consulted the cardiologist at a reputed private hospital; the doctor advised triple chamber pacemaker installation.

For surprising reasons, as you will read in the High Court’s observation below, two surgeries were performed. First on 20th September and the other on 22nd September. The doctor claimed that pacemaker and two leads were implanted during the first surgery. The third lead was attached to the pacemaker during second surgery in order to give ‘ample rest’ to the patient as he had history of heart ailments.

The patient was discharged on the 24th September. However, his condition deteriorated soon thereafter. He was readmitted on 27th September, but unfortunately died within few hours.

Patient’s family was taken aback. They created a scene at the hospital, demanding postmortem. Police had to be called for intervention.

Postmortem was eventually conducted at another hospital. It reported myocardial infraction as cause of death.

The hospital and cardiologist were sued. Patient’s family alleged that:

  1. A cheap double chamber pacemaker costing INR 45,000 was implanted on 20th September, whereas a triple chamber pacemaker costing about INR 4,50,000 was decided to be implanted, and the said amount was deposited with the hospital
  2. The cardiologist performed another surgery on 22nd September to remove the double chamber pacemaker and install the triple chamber pacemaker as patient’s health deteriorated within one day; he connived with the hospital to conceal this ulterior motive
  3. Patient was discharged on 24th September even though his health condition warranted continued medical care

The cardiologist contended that only triple chamber pacemaker was implanted. On 20th September, two leads of the said pacemaker were attached and the third one was attached on 22nd September in order to give patient some rest!

The hospital contended that INR 45,000 was charged not as cost for double chamber pacemaker, but for the services to implant the triple chamber pacemaker.

The High Court was clearly unimpressed by the cardiologist’s and hospital’s defence. Having perused patient’s medical records, test reports and treatment charts, it observed the following:

“The hospital has presented snapshots, claiming that LV and RV leads were grafted on 20th September whereas, RA and pacemaker were implanted on 22nd September. Contrary to this submission, how then the internal progress notes reveal placement of the LV lead on 22nd September?”

“In case the pacemaker was engrafted on 22nd September, it is not explained how the X-ray conducted on 20th September is reflecting the ECPM with wires i.e., installation of the conventional pacemaker.”

“The above record would prima-facie indicate that pacemaker had been installed on 20th September. In case pacemaker was not implanted on 20th September and rather, it was implanted on 22nd September, how then the hospital record reflects that CRT was done on 20th September?”

“The bill issued by hospital further contradicts its stand. In the said bill, the item mentioned is double chamber pacemaker costing INR 45,000, whereas in the same bill, the item shown is Bivent Pacemaker Allure Quadra CRTP with accessories, costing INR 4,47,869.31. In case, double chamber pacemaker was neither ever implanted nor it was ever planned to be implanted, how the bill reflects double chamber pacemaker. In order to justify the inclusion of this item in the bill, the hospital has tried to contend that INR 45,000 is the cost of services for installation of double chamber pacemaker and not the cost of the pacemaker. This stand taken by the hospital is not only self-contradictory but quite contrary to the record.”

“The cardiologist and hospital have placed on the record one CD, which contains 23 hand-picked edited clips with total duration of 98.54 seconds covering patient care at the hospital from 18th September to 22nd September. Otherwise, they were required to get the complete CD of the entire procedure adopted for pacemaker implantation. They had prepared the CD but selectively hand-picked edited clips and the entire CD record has been withheld for the reasons best known to them and again, withholding the best evidence, the inference can be drawn against them.”

“This Court finds that apart from the case of gross medical negligence, it is more a case of cheating having been committed under a conspiracy by the cardiologist and hospital. Despite planning to install a triple chamber pacemaker as per the consent given by patient’s relatives, which costed roughly INR 4.5 lakh, instead planted a cheap double chamber pacemaker costing only INR 45,000, and when the patient developed problems or as the said pacemaker was not fitted properly, then implanted the triple chamber pacemaker. In order to conceal the said mischief, stand is taken that only triple chamber pacemaker was implanted, but in two stages and that in the first stage, only two leads were engrafted and in the second stage, third lead and pacemaker were implanted. The said stand is prima facie found to be incorrect in view of the various documents presented by the hospital itself.”

The hospital and cardiologist were found at the wrong side of law, both were held negligent and ordered to pay heft compensation.

Source : Order pronounced by Punjab & Haryana High Court on 11th March, 2024.