Stent used or not – that’s at heart of the matter

  • Posted on: July 20, 2023

The patient had a history of heart ailments, and was also diabetic. He was admitted to the hospital with complaints of chest pain. Coronary angiography (CAG) was performed which confirmed stenosis in left artery.  

A serious complication occurred while the doctor was performing per cutaneous coronary angioplasty (PTCA) – the coronary artery was perforated. Despite measures to seal the perforation, the patient could not be saved. He died after few hours.

His family sued the doctor and hospital, alleging that:

  1. Cardiac anaesthesia was not given as cardiac anaesthetist was not available
  2. Coronary perforation was anticipated, but the doctor could not seal it off as he was not competent to perform the procedure
  3. Graft stent was billed even thought it was not used

The doctor and hospital were not taken aback by the barrage of allegations. It was stated that the patient’s family was explained in detail about the risks and benefits of the procedure, and an informed consent was obtained for the high-risk surgery. It was further stated that a CD of PTCA procedure was handed over to the family – the complication and steps taken to manage it was clearly recorded in it.

The Commission too went through the CD and medical records, observing the following:

PTCA was performed after informed consent. In case of PTCA procedure cardiac anaesthetist is not required; as per practice guidelines, it is an accepted practice that the procedure is performed under local anaesthesia and mild sedation. The doctor during PTCA procedure opened graft master stent measuring 3 mm x 16 mm to be used to seal the perforation which did not track and it may not be seen in post-mortem. Therefore, the allegation of complainant about not using the Graft Stent and it was not seen in post-mortem is not sustainable. It should be borne in mind that in cath lab, the stock of stents of various sizes of various manufacturer companies are kept on consignment basis and billed only after the use. Moreover, stents are being supplied by different vendors, which bear different dates on the bills.

We further note that after the complication of perforation, complete resuscitative efforts were made by the doctor and his team, but patient’s condition deteriorated rapidly and she could not be saved. The doctors tried to explain cause of death to the relatives, but they were not in a receptive mood and due to hostile attitude, the doctor himself informed the police station to register the death as medico legal case.

The Commission dismissed family’s complaint against doctor and hospital, laying their unwarranted aggression to rest.

Source : Order pronounced by National Consumer Disputes Redressal Commission on 7th February, 2023.