Failure to inform prognosis is failure on part of healthcare provider

  • Posted on: October 26, 2018

Healthcare providers are responsible not only to provide treatment and care, but also to inform the patient and relatives / attendants about diagnosis and prognosis. Not doing so is negligence, and this case is an example of the fact.

Surender Kumar was diagnosed with Motor Neuron Disease (MND) and to confirm the same, Neuro Conduction Velocity (NCV) and Electro Myography Test (EMG) were performed. The EMG was abnormal and initial diagnosis of MND was confirmed.

The patient was taken to the neurologist Dr. Aggarwal who provisionally diagnosed Acute Motor Axonam Neuropath (AMAN), which according to him was a variant of Guillane Barre Syndrome (GBS). The neurologist advised physiotherapy which was performed at a hospital, but the patient started gasping intensely and hence, he was shifted to ICU unit of Indraprasth Hospital where he was put on ventilator.

For about four months, the patient received treatment at Indraprasth Hospital after which he was discharged against medical advice. The patient died the same day he was discharged.

After a long and traumatic experience, the patient’s family approached the State Consumer Disputes Redressal Commission, New Delhi, to present the facts of the case and to seek justice.

It was alleged that the ventilator developed mechanical snags frequently and the hospital authorities did little to correct it. It was further alleged that the patient developed Hepatitis which is possible only when an infected needle is used to administer injection. It was also alleged that the neurologist started giving hints about the patient’s inevitable death as he developed various ailments and not because of MND.

The doctor and the hospital could not understand why they were dragged to the court of law. Presenting their side of the story, it was stated that the symptoms patient showed were closely related to both MND and GBS. As healthcare providers, it was our duty to provide treatment and we did so with due diligence. We are not negligence, was their conclusive statement.

The case was complicated and the Commission sought expert opinion which stated that electrophysiological features in cases of MND can also be seen in axonal variety of GBS. They are overlapping – electrophysiological features could be the same in case of MND and axonal variety of GBS. The doctor was misled by the commonality of said features in MND and GBS.

The Commission also observed that the expert opinion didn’t clearly establish the clinical feature that could be helpful in distinguishing between MND and GBS. Hence, on this count, the doctor or the hospital cannot be held negligent.

However, the Commission noted that the patient or his relatives were not made aware of prognosis and there was no explanation given regarding commonality of MND and GBS features, as it stated the following: “The patient’s relatives remained in dark and were under an impression that the disease was fully curable and the treatment was as per standard protocol.”

Hence, Indraprasth Hospital and neurologist Dr. Aggarwal were held negligent and were ordered to compensate ten lakh rupees.

Source: Order pronounced by State Consumer Disputes Redressal Commission, New Delhi on 23rd August, 2018.